Detection of cervical dysplasia by acetic acid application to the cervix

To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening. During a 2 years period, 42 patients attending the Fertility Clinic for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious aceto-white lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively. Forty two women were referred for colposcopy because of abnormal aceto-white areas on the cervix. Six patients [15%] had cervical intra-epithelial neoplasia [CIN], four CIN I, two CIN II, 11 [26%] had koilocytosis, and 8 [19%] has benign histologic findings. In total, 25 patients had suspicious lesions at colposcopy for which biopsies were performed, and 17 [40%] had normal colposcopic examinations. Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. Also, acetic acid visualization of the cervix may be useful in settings where cervical screening opportunities are limited, such as third world countries and other underserved areas. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy

Reevaluation of low dose aspirin in prevention of preeclampsia in healthy nulliparous

Although low-dose aspirin has been reported to reduce the incidence of preeclampsia among women at high risk for this complication, its efficacy and safety in healthy, nulliparous pregnant women are not known. 62 normotensive nulliparous women who were 13 to 26 weeks pregnant were studied to determine whether treatment with aspirin reduced the incidence of preeclampsia. Of this group, 31 women received 60 mg of aspirin per day and 31 received placebo for the remainder of their pregnancies. The effect of aspirin on maternal and neonatal morbidity was also evaluated. Of the original group of 62 women, 58 [95%] were followed throughout pregnancy and the immediate pureperium. The incidence of preeclampsia was lower in the aspirin group [1 of 28 women [4.6%]] than in the placebo group [2 of 30 women [6.3%]] [relative risk, 0.7, 95% confidence interval, 0.6 to 1.0, P = 0.05], whereas the incidence of gestational hypertension was 6.7 and 5.9%, respectively. There were no significant differences in the infants' birth weight or in the incidence of fetal growth retardation, postpartum hemorrhage, or neonatal bleeding problems between the two groups

Oxytocin infusion regimens for induction of labor at term in primigravidas

To compare induction of labor by intravenous oxytocin in regimens increasing incrementally at 15 and 30-minute intervals. In a randomized controlled trial, 62 primingravidas requiring induction of labor by oxytocin infusion were randomly allocated to incremental increases at 30-minute intervals [31 patients] or 15-minute intervals [31 patients]. The main outcomes assessed were mode of delivery, complications of labor and delivery [precipitate labor, hyperstimulation postpartum hemorrhage, perineal tears, puerperal pyrexia, and number of days in the hospital]. The 30-minute incremental regimen resulted in less precipitate labor, uterine hyperstimulation, and reduced length of stay in the hospital [difference in medians 3 days]. The induction delivery interval was longer with 30 minutes [median 8 hours] than with 15 minutes [median 5 hours] [difference in median 2 hours 95% confidence intervals in median 0-3 hours]. With the 30-minute interval, there was a reduction in the occurrence of postpartum hemorrhage, perineal tears, and puerperal pyrexia, but these differences did not reach statistical. For the indiction of labor in primigravidas, 30 minute incremental increases in the infusion rate of oxytocin were superior to a 15-minute incremental protocol in reducing the incidence of hyperstimulation and precipitous labor

Perinatal outcome in subclinical hypothroid pregnancies

To relate hypothyroidism to perinatal outcome, a 23 hypothyroid patients with no other medical illnesses was divided into two groups according to the initial thyroid function tests. The purpose of the study was to report the pregnancy outcomes of gestational hypertension, low birth weight, fetal death, congenital anomalies, maternal anemia, and postpartum hemorrhage. Gestational hypertension, namely, eclampsia, preeclampsia, and pregnancy induced hypertension was significantly more common in subclinical hypothyroid patients than in the general population with rates of 22, 15 and 7.6%, respectively. In addition, 25% of the subclinical hypothyroid subjects who remained hypothyroid at delivery developed gestational hypertension. Low birth weight in subclinical hypothyroid patients was secondary to premature delivery for gestational hypertension. Except for one stillbirth and one case of clubfeet, hypothyroidism was not associated with adverse fetal and neonatal outcomes. Normalization of thyroid function tests may prevent gestational hypertension and its attendant complications in hypothyroid patients