Acoustic streaming cannot discriminate reliably between endometriomas and other types of adnexal lesion: a multicenter study of 633 adnexal masses.

OBJECTIVE: To determine the ability of acoustic streaming to discriminate between endometriomas and other adnexal masses. METHODS: We used data from 1938 patients with an adnexal mass included in Phase 2 of the International Ovarian Tumor Analysis (IOTA) study. All patients had been examined by transvaginal gray-scale and Doppler ultrasound following a standardized research protocol. Assessment of acoustic streaming was voluntary and was carried out only in lesions containing echogenic cyst fluid. Acoustic streaming was defined as movement of particles inside the cyst fluid during gray-scale and/or color Doppler examination provided that the probe had been held still for two seconds to ensure that the movement of the particles was not caused by movement of the probe or the patient. Only centers where acoustic streaming had been evaluated in > 90% of cases were included. Sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV and NPV) of acoustic streaming with regard to endometrioma were calculated. RESULTS: 460 (24%) masses were excluded because they were examined in centers where

Women's perception of self-worth and access to health care.

OBJECTIVE: : Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status. METHOD: : A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior. RESULT: : Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity. CONCLUSION: : To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a 'cross-sectoral approach', involving both gender and development issues.

Conflict-induced displacement and involuntary resettlement in Colombia: putting Cernea's IRLR model to the test.

This paper tests Cernea's (1997) impoverishment risks and livelihood reconstruction (IRLR) model in cases of conflict-induced displacement (CID). In applying the model to a situation involving internal conflict, the article illustrates the particular problems encountered by internally displaced people (IDPs) and policymakers charged to respond to them. The article searches for local interpretations of CID and resettlement through a comparative profile of two IDP settlements in Colombia: one urban, the other rural. It concludes that the IRLR model, when contextualised, provides a useful tool to identify and categorise risks of impoverishment and resettlement priorities. At the same time, however, the article demonstrates that the model insufficiently captures the root causes or causality of CID.

What women say about antenatal care in St Petersburg, Russian Federation.

A capacity building program for professionals in maternal and child health care in St Petersburg, Russian Federation, commenced in 1994. The program was designed to provide 12 workshops in evidence-based antenatal and intrapartum care, as well as appropriate preparation of parents for pregnancy, birth and parenthood, for health care professionals in the city. As part of this program women's observations on the quality of their maternity care services during their transition to parenthood were explored. These reports reflect maternity care practices in the former Soviet Union.

Women's experiences of birth in St. Petersburg, Russian Federation, following a maternal and child health intervention program.

BACKGROUND: An educational program for professionals in maternal and child health care in St. Petersburg, Russian Federation, was conducted between 1994 and 1997. METHODS: The program was designed to provide 12 workshops in evidence-based antenatal and intrapartum care, and appropriate preparation of parents for pregnancy, birth, and parenthood for health care professionals in the city. RESULTS: Observations on the quality of maternity care service provided for women at the start and after the completion of the intervention program are reported. Significant changes occurred in maternity care practices during the period in which training programs were offered in St. Petersburg. In particular, more family centered care services were introduced, and breastfeeding practices improved. Significant reductions in maternal and perinatal mortality occurred. CONCLUSIONS: Most maternity hospitals showed a reduction in the use of interventions in delivery over the period of study, although one or two showed tendencies to follow in their Western counterparts' footsteps, including the emergence of a high cesarean delivery rate. This is not yet a cause for concern, but is worth future monitoring by local authorities.

Contraceptive knowledge, attitudes and use among women attending health clinics in St. Petersburg, Russian Federation.

PIP: This study describes women's knowledge, attitudes, and use of contraception in Russia. Data were obtained from a sample of 917 women attending 44 women's consulting centers in St. Petersburg during January 15-30, 1995. Findings indicate that 68% were married; 21% were single. 56.1% worked full-time, 7.2% worked part-time, and 9.4% were students. 50.9% reported having received sex education, of whom 73.8% learned about birth control methods and 70.7% learned about abortion. Over 90% of the entire sample knew about condoms, IUDs, and oral contraceptives. About 60-70% knew about rhythm, withdrawal, and female sterilization. 49-56% were aware of vaginal suppositories and vasectomy. Under 23% were aware of the diaphragm, sponge, jelly, and foam. People talked about family planning with doctors and partners. 58.7% preferred joint responsibility for family planning. 909 women responded to the question about the current method being used: 41% reported using condoms; 33.8%, IUDs; 32.8%, pills; 23.7%, the rhythm method; and 17.2%, withdrawal. Many women used multiple methods, but the questions did not clearly distinguish single from concurrent multiple method use or switching between a few methods. 20.6% report nonuse. 115 of 187 were pregnant or desiring a pregnancy. Nonusers were concerned about side effects. Method choice was based on effectiveness and ease of use. Few were dissatisfied with their method choice. About 75% reported method switching over time. Most of the 452 oral contraceptive users knew 2-3 side effects. 25.1% of the 319 condom users were usual users.^ieng

Serum human chorionic gonadotrophin levels in early pregnancy.

Serum hCG reference intervals for various gestational periods in normal pregnancies were determined using three commercial assays--two standardized against the WHO 2nd IS (Amersham Amerlex-M beta HCG RIA (AMX) and Abbott beta-HCG 15/15 (ABB] and one standardized against the WHO 1 IRP (Hybritech Tandem -E HCG (HYB]. Serial samples from patients with accurately determined gestational periods were analyzed. We correlated these assays to determine the validity of the common practice of interchanging values between assays using the same WHO standard and of converting 1st IRP values to 2nd IS values by a fixed factor. The slope of correlation between the two 2nd IS assays (AMX, ABB) was 1.43, r = 0.960; whereas between the 1 IRP assay (HYB) and the two 2nd IS assays the slopes were 1.67, r = 0.963 and 1.22, r = 0.971 for AMX and ABB, respectively. In a prospective study of 52 patients with normal pregnancies, serum beta-hCG values in 46% of samples taken at 28-35 days gestation fell below the lower limit of the reference curves supplied with the AMX kit. Ninety-two percent of samples were within the newly established intervals. These results indicate that supplier's reference limits may not be accurate; in addition, a common factor should not be used to convert values from one commercial kit to another.

Who Will Deliver Canada's Babies in the 1990s?

Family physicians and obstetricians are rapidly discontinuing obstetric practice. Infringement on lifestyle and threat of litigation are the two most important reasons for both family physicians' and obstetricians' withdrawing from obstetric practice. Only 4% of each medical school graduating class will enter practice as fully trained obstetricians. The most likely way to avoid future gaps in obstetric care is to attract more students and family medicine trainees to obstetrics. Strategies to stimulate undergraduate interest in low-risk obstetrics, to attract family medicine residents to pre-natal and intrapartum care, and to retain more of the family physicians and obstetricians now involved in delivering babies urgently require attention.

Difficulties encountered in a randomization trial of CVS versus amniocentesis for prenatal diagnosis.

In April 1985, having completed a study of the short-term complications of chorionic villus sampling (CVS), we began a randomized comparison of CVS versus amniocentesis. Our study continued over a 15-month period, and during that time we had difficulty recruiting patients, with only 10.6% of 1254 women referred for prenatal diagnosis fully participating in this study. However, 30.2% of those eligible by dates and indication chose to enter the study. CVS was available in our province only through this study, and the two most common reasons for such a low rate of recruitment were reporting too late in pregnancy and the concern about the potential risks of CVS. Patients continued to seek counselling too late for CVS despite direct and continuous contact with regional physicians. Our patients' concern about risk might well vary with the attitude of their physicians towards CVS, and with the information provided at the time of pre-test counselling. The small number of patients actually enrolled did not permit any meaningful comparison of amniocentesis to CVS. However, our experience with pregnancies lost post-CVS suggests that a pregnancy with an apparent low implantation at the time of sampling may be at a higher risk of loss.

Assessment of the early risks of chorionic villus sampling.

A study was carried out to develop proficiency in performing chorionic villus sampling (CVS) and to determine whether the risk for miscarriage was so high as to preclude a randomized clinical trial comparing CVS with amniocentesis. A total of 202 women who had decided to have induced abortions volunteered to either undergo CVS (101 women) or be a control (101). There were no differences between the two groups in factors that may affect the rate of miscarriage. CVS was performed an average of 9.8 days before abortion. The rate of fetal loss was significantly higher in the CVS group (p = 0.009). An analysis of the results as a function of the physician's experience over time showed that there were distinct learning phases. It may take longer than is generally recognized to acquire the expertise necessary to perform CVS with the lowest risk possible. Caution should be exercised before diagnostic CVS is offered to women who plan to continue their pregnancies.

Assessment of intrauterine growth retardation by diagnostic ultrasound.

In the first 1,000 cases referred to the Department of Diagnostic Ultrasound for Obstetrics and Gynaecology, 200 patients with singleton pregnancies were examined by this modality for possible intrauterine growth retardation (IUGR). Inclusion in this study was based on one or more of the following criteria: past history of IUGR, present clinical impression of IUGR, present high risk of developing IUGR, and unsuspected IUGR evidenced by diagnostic ultrasound. In 34 per cent of cases, serial examinations indicated that the date of confinement had to be recalculated. Ultrasound was in agreement with delivery results in 82 per cent of cases. Sixteen per cent of cases in this study resulted in growth-retarded infants. Ultrasound correctly diagnosed 70 per cent of these.