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ABSTRACT: To investigate whether improvements in sonographic technology would allow detection of embryonic demise at a crown-rump length (CRL) < 5 mm.
A prospectively collected, computerized ultrasound database was queried for singleton gestations with CRL < or = 5 mm from January 2000 to February 2003. Embryonic viability was determined by repeat ultrasound examination after 6 weeks'gestation confirming cardiac activity or by documentation of an ongoing pregnancy. Viability rates in the presence or absence of cardiac activity were calculated for CRL of 2.0-2.9, 3.0-3.4, 3.5-3.9, 4.0-4.4, 4.5-4.9 and 5.0 mm. Sensitivity, specificity, positive predictive value and negative predictive value for embryonic demise were calculated, with a subanalysis based on the presence of vaginal bleeding.
Outcome was available for 179 of 195 gestations meeting inclusion criteria. The absence of cardiac activity at CRL > or = 3.5 mm had 100% positive predictive value and specificity. The presence of vaginal bleeding did not affect this cutoff.
Improved sonographic technology permits diagnosis of embryonic demise at a CRL > or = 3.5 mm under ideal conditions. Vaginal bleeding increases the likelihood of demise, but does not alter test performance. Further investigation is warranted, as our data suggest a limit closer to 3 mm.
The Journal of reproductive medicine 06/2007; 52(5):375-8. · 0.87 Impact Factor
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ABSTRACT: To determine the prevalence of 2 musculoskeletal pain disorders among women presenting to a referral chronic pelvic pain clinic.
This was a retrospective, cross-sectional study of 987 women (aged 14-79) presenting for evaluation from 1993 to 2000 at a university-based gynecologic chronic pelvic pain clinic.
At the initial visit, all women completed standardized interviews and underwent a pelvic examination. Single-digit palpation of the levator ani and piriformis muscles was performed intravaginally. Among these women, 212 of 955 (22%) had tenderness of the levator ani muscles, while 128 of 943 (14%) had tenderness of the piriformis muscle (pain score > 3 of 10 on a visual analogue scale). Both levator ani tenderness and piriformis tenderness were associated with a higher total number of pain sites, previous surgery for pelvic pain, Beck Depression Inventory score, McGill Pain Inventory score and pain worsened with bowel movements (p < 0.05).
Piriformis and levator ani pain are present in a significant proportion of female chronic pelvic pain patients. Further research into the natural course, diagnosis and treatment of pelvic musculoskeletal pain is needed to determine its true contribution to chronic pain.
The Journal of reproductive medicine 03/2006; 51(3):185-9. · 0.87 Impact Factor
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ABSTRACT: We sought to assess the effectiveness of a problem-oriented approach to teaching residents accurate coding and documentation of ambulatory gynecology visits.
This was a pilot before-and-after study. Nine resident volunteers underwent 4 individual instructional sessions on coding and documentation with a trained faculty member over 6 weeks. Outcomes were assessed by comparing the appropriateness of procedure and diagnostic codes billed in participant continuity clinic prior to and in the 6 to 9 months following the intervention.
Following the intervention, participants demonstrated an increase in the accuracy of coding the correct category of the evaluation and management service, an increase in the appropriate use of modifiers, and a decline in undercoding errors.
Problem-oriented interactive learning appears to be an effective method of teaching residents proper coding and documentation.
American journal of obstetrics and gynecology 12/2005; 193(5):1790-3. · 3.28 Impact Factor
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ABSTRACT: Chronic pelvic pain is a common clinical problem with many causes. In addition to gynecologic causes, it is important to evaluate other potential etiologies, including the pelvic musculoskeletal system. There have been few published studies on musculoskeletal causes of pelvic pain and its treatment. The objective of this study was to evaluate treatment of pelvic musculoskeletal pain among women with chronic pelvic pain. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Additional articles were sought by discussion with a clinician specializing in this field and review of relevant textbook bibliographies. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain outcome measure. Each report must have described at least four patients. For each selected article, two investigators separately summarized pertinent data on study characteristics, patient profiles, intervention characteristics, and treatment outcomes. Discrepancies were resolved by discussion. Twenty-nine treatment studies met entry criteria. The existing literature largely consists of retrospective, uncontrolled observational studies. The two studies that feature control groups lack sufficient size and scope to allow generalizability. Properly designed and executed randomized, controlled trials are urgently needed to determine the true effectiveness of treatments for pelvic musculoskeletal pain. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the current data on musculoskeletal causes of chronic pelvic pain, to outline the various techniques used to treat musculoskeletal causes of chronic pelvic pain, and to recall the lack of evidence based data on the subject and need for randomized controlled trials.
Obstetrical and Gynecological Survey 07/2005; 60(7):474-83. · 2.51 Impact Factor
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ABSTRACT: Chronic pelvic pain in women has multifactorial etiology, but pelvic musculoskeletal dysfunction is not routinely evaluated as a cause by gynecologists. Whether diagnostic tests can reliably identify women with such conditions is unclear. The objective of this study was to determine the level of support in the literature for diagnostic tests of pelvic musculoskeletal problems. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain diagnostic test. Relevant bibliographies were also searched, and outside consultation with a pain researcher was sought to identify additional needed studies. For each selected article, 2 investigators separately summarized relevant data on study characteristics, patient profiles, and test efficacy. Discrepancies were resolved by discussion. Six diagnostic studies were identified that met entry criteria. No gold standard diagnostic tests exist for pelvic musculoskeletal problems, and the methodologic quality of available studies is low. Studies defining such clinically useful tests are needed to further refine a rational approach to chronic pelvic pain management. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the paucity of evidence-based literature and valid consensus of diagnostic criteria and modalities in defining the musculoskeletal causes of chronic pelvic pain in women, to recall that there is no gold standard diagnostic test for pelvic musculoskeletal problems, and to recall that the statistical evaluation of the methods described were wanting.
Obstetrical and Gynecological Survey 07/2005; 60(6):379-85. · 2.51 Impact Factor
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ABSTRACT: Although the pregnancy rate in adolescents has declined steadily in the past 10 years, it remains a major public health problem with lasting repercussions for the teenage mothers, their infants and families, and society as a whole. Successful strategies to prevent adolescent pregnancy include community programs to improve social development, responsible sexual behavior education, and improved contraceptive counseling and delivery. Many of these strategies are implemented at the family and community level. The family physician plays a key role by engaging adolescent patients in confidential, open, and nonthreatening discussions of reproductive health, responsible sexual behavior (including condom use to prevent sexually transmitted diseases), and contraceptive use (including the use of emergency contraception). This dialogue should begin before initial sexual activity and continue throughout the adolescent years.
American family physician 11/2004; 70(8):1517-24. · 1.70 Impact Factor
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ABSTRACT: Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic pain. In the evaluation of chronic pelvic pain, laparoscopic techniques vary from conservative procedures, such as pain mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic pain.
Obstetrics and Gynecology Clinics of North America 10/2004; 31(3):619-30, x. · 1.70 Impact Factor
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ABSTRACT: The study was undertaken to determine whether respiratory distress syndrome (RDS) is associated with an increased risk of nonpulmonary morbidity in neonates born between 34 to 36 weeks' gestation.
We performed a matched case-control study of 75 infants with (cases) and 75 without (controls) RDS, delivered between 34 and 36 weeks' gestation. Infants with RDS and no other causes for respiratory failure (anomalies, hydrops, asphyxia) were included. Controls were matched for gestational age at birth, year of care, gender, plurality, and race. Inpatient records were reviewed for the incidence of nonpulmonary morbidities before discharge. McNemar test and conditional logistic regression were used to evaluate differences between cases and controls.
Our study cohort was 69% male, 48% white, 33% African American, and 19% Hispanic. Cases had longer hospital (11 vs 7days) and neonatal intensive care unit stays (10 vs 7 days), and more frequent apnea-bradycardia (30% vs 5%), pneumonia (12% vs 1%), and suspected sepsis diagnoses (27% vs 3%), P <or=.008 for each. Antibiotic use (96% vs 45%), transfusion (20% vs 0%), phototherapy (57% vs 29%), and hyperalimentation (57% vs 4%) were more common in the RDS group, P <or=.002 for each. Other major morbidities (intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia) were uncommon in cases and controls. Similar results were obtained when controlling for mode of delivery and antenatal steroid use.
RDS at 34 to 36 weeks is associated with increased morbidity and neonatal interventions. In the absence of RDS, major morbidity is uncommon.
American Journal of Obstetrics and Gynecology 11/2003; 189(4):1053-7. · 3.47 Impact Factor
