ABSTRACT
OBJECTIVE: The purpose of this study was to determine the most accurate method in estimating the preoperative uterine weight of enlarged nongravid uteri. STUDY DESIGN: We performed a retrospective review of 1238 patients who were premenopausal and underwent hysterectomy for benign indications between January 1993 and July 1999. Eight hundred and sixty-four patients were selected to include only those that had both a reported bimanual assessment of preoperative uterine size and an ultrasonography report with all 3 estimated uterine dimensions. Reported uterine sizes on bimanual examination were converted to clinical weight (CWT). Two different calculations were used to estimate uterine weight from ultrasound measurements (UWT 1 and 2). Actual uterine weights (AWT) in pathology reports were then compared with the findings of bimanual assessment and the calculated weights to determine which method is the best predictor of AWT. Simple linear regression analysis was used to measure and compare how closely the estimated weights predicted the actual weight. Predictive residuals sum of squares (PRESS) was then used to determine the best predictor of actual weight. RESULTS: After exploring the data using linear modeling, all 3 estimated weights were significantly correlated to the actual weight when compared, but PRESS scores showed that the clinical weight estimate was superior by far compared with the other 2. CONCLUSION: In this study, bimanual assessment was shown to be the most accurate method of preoperative uterine weight estimation. Ultrasound examination may not be routinely needed when deciding the route of hysterectomy based on estimated weight.
Subject(s)
Uterine Diseases/pathology , Uterine Diseases/surgery , Uterus/pathology , Adult , Female , Humans , Hysterectomy , Leiomyoma/surgery , Linear Models , Organ Size , Retrospective Studies , Ultrasonography , Uterine Diseases/diagnostic imaging , Uterine Hemorrhage/surgery , Uterine Neoplasms/surgery , Uterus/diagnostic imagingABSTRACT
OBJECTIVE: To compare small-for-gestational-age (SGA) twins to appropriate-for-gestational-age (AGA) twins regarding preterm delivery (PTD). STUDY DESIGN: Retrospective review of maternal and neonatal records of live, nonanomalous twins > or = 25 weeks' gestation delivered in 1984-2000 in a tertiary care center. Pregnancies (N = 679) were divided into AGA/ AGA (n = 347), SGA-AGA (n = 191) and SGA/SGA (n = 141) groups using singleton growth curves. The PTD rate was compared and logistic regression analysis was done to study factors that influenced PTD at < or = 34 weeks. p < 0.05 was considered significant. RESULTS: The PTD rate at < or = 34 weeks was AGA/AGA (38.6%), SGA-AGA (14.7%) and SGA/SGA (1.4%) (p < 0.001). On multiple logistic regression analysis, discordance significantly increased PTD (OR = 5.05, 2.47-10.31, p = 0.001), while smallness for gestational age significantly decreased PTD (OR = 0.095, 0.05-0.17, p < 0.001). The PTD rate increased directly with the increase in the relative overall weight of the twins. CONCLUSION: The PTD rate is higher in AGA twins as compared to SGA twins. The PTD rate is directly related to the overall weight of the twins.
Subject(s)
Birth Weight/physiology , Infant, Newborn/growth & development , Infant, Premature , Infant, Small for Gestational Age , Premature Birth/physiopathology , Twins , Female , Fetal Growth Retardation/etiology , Fetal Growth Retardation/physiopathology , Gestational Age , Humans , Infant, Premature/growth & development , Infant, Small for Gestational Age/growth & development , Logistic Models , Pregnancy , Premature Birth/etiology , Retrospective StudiesABSTRACT
OBJECTIVE: The purpose of this study was to compare maternal and neonatal complications in spontaneous versus in vitro fertilization twins. STUDY DESIGN: Twin gestations that were delivered from 1995 to 2000 were reviewed. Cases consisted of 56 in vitro fertilization twins, each of which was matched to two control mothers by age and parity. They were compared regarding various maternal and neonatal complications. RESULTS: In vitro fertilization twins were more likely to have preterm labor compared with control twins, with no difference in the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, placenta previa, or preterm premature rupture of membranes between the two groups. The cesarean delivery rate was significantly higher in cases of twins who were conceived by in vitro fertilization (76.8% vs 58.0%, P=.026), despite a similar rate of elective cesarean delivery and the incidence of nonvertex twin A in both groups. The preterm delivery rate was significantly higher (67.9% vs 41.1%, P=.002) and the gestational age was significantly lower (35+/-3 weeks vs 36+/-3 weeks, P=.043) in cases compared with control subjects. Both twins were, on the average, 230 g lighter in the in vitro fertilization group compared with the control group. However, intrauterine growth restriction was more frequent in the control group (36.6% vs 25%, P=.044). There was a significantly higher incidence of admission to the neonatal intensive care unit, respiratory distress syndrome, a need for mechanical ventilation, and pneumothorax in cases compared with control subjects. CONCLUSION: When compared with spontaneous twins, in vitro fertilization twins are more likely to be delivered by cesarean delivery and to have a higher incidence of preterm birth and prematurity-related respiratory complications with a longer nursery stay.
