Postpartum surveillance of urinary retention by ultrasonography: the effect of epidural analgesia.

Our objective was to investigate by ultrasonography whether the risk for postpartum urinary retention is increased following administration of epidural analgesia during labor and delivery. In a prospective study, 106 healthy women who had undergone vaginal delivery were evaluated. Sixty-eight of the women had received epidural analgesia during labor and delivery. All subjects had an ultrasound examination at a mean of 42 h after delivery, and residual urine volume was estimated immediately after voiding. Correlations among obstetric parameters, epidural analgesia and residual urine volumes were evaluated. The mean accuracy rate of ultrasonography for estimation of bladder volumes was +/- 10.2%. No cases of clinically evident urinary retention were diagnosed in the total puerperal population. There were no significant differences between the groups in the average amounts of residual urine as measured by ultrasonography. With modern obstetric practice, epidural analgesia for labor is not associated with an increased risk for postpartum urinary retention. The non-invasive nature of ultrasound renders it especially attractive and useful for measuring residual urine volume in postpartum patients. The safety, simplicity and relative comfort of this method over-ride the slightly imperfect calculations that it currently yields, and makes it preferable to catheterization or cystometry for evaluation of residual urine volume.

Are Israeli women in a low risk group for developing squamous cell carcinoma of the uterine cervix?

OBJECTIVE: Invasive cervical squamous cell carcinoma is not a common disease among Jewish women. In the present study an attempt was made to find what is the distribution of the known risk factors in this population. METHODS: Three hundred and ninety-one patients with various cervical cytological abnormalities comprised the study group. They were compared to 350 Israeli women with negative cytology. The risk factors were extracted from an anonymous questionnaire. The results were statistically analyzed and compared to the equivalent figures published in the literature pertaining to non-Jewish women. RESULTS: The prevalence of abnormal cytology among the Israeli women was almost the same as that of the non-Jewish group: 24/1000 and 26/1000, respectively. Significant statistical differences were found between the following risk factors: number of sexual partners, age at first intercourse, age at first pregnancy. Women in the study group were younger when they became sexually active and at first pregnancy, they had a larger number of sexual partners, fewer of them were married and fewer of them were observant of Jewish ritual practices. In addition, they had achieved higher academic levels than the women in the control group. CONCLUSIONS: It was found that the distribution of the known risk factors among the study group was practically the same as those in the non-Jewish population. Moreover, it was found that there was an increase of 29.2% (from 17/1000 to 24/1000) in the prevalence of cervical premalignant lesions among the Israeli women. We believe that this population can no longer be considered as being at low risk for this disease.

Prevalence of human papillomavirus infection and HPV DNA among male partners of Israeli women with genital premalignant and human papillomavirus lesions.

The role of the males who are sexual partners of females with genital human papillomavirus (HPV) infection and premalignant lesions is explored in the present study. Within a period of 3 years, 391 females with genital premalignant and HPV-associated lesions were examined and treated at the Cervical Pathology Unit of the Tel Aviv Medical Center. The male partners of all the women were asked to attend this unit, and 322 of them responded. All participants underwent colposcopic examination of the anogenital area followed by colposcopically guided biopsies from the most representative lesions, when present, part of which included in situ hybridization (ISH) of HPV DNA sequences 6/11 and 16/18. The histological prevalence of HPV among the male partners was 86.6% (185 of 213 biopsies). Of the 48 couples who had ISH evaluations, the ISH could not identify any copy of HPV DNA in 58.3% of the males (28 cases) and 41.6% of the females (20 cases). Among the males, HPV 6/11 and 16/18 were found in 17 (35.4%) and 3 cases (6.2%), respectively, and among the females there were 23 (48.0%) and 5 cases (10.4%), respectively. Correlation of HPV DNA sequences 6/11 and 16/18 between the couples was found in six (12.5%) and in one (2.0%), respectively. These data do not support a direct contamination by the current male partner. The question of treating the male partner of a woman with genital HPV and premalignant lesions remains to be evaluated.

Flow velocity waveforms of the uterine artery in pregnancy: transvaginal versus transabdominal approach.

Our objective was to compare recordings of flow velocity waveforms from the uterine artery via the transvaginal and transabdominal approach in normal human pregnancies. In a cross-sectional study from 16 to 40 weeks' gestation, 88 healthy pregnant women underwent a continuous-wave Doppler examination of their uterine arteries by both the transvaginal and the transabdominal approach. Measurements were recorded for both uterine arteries and averaged. Values recorded transabdominally were significantly lower than those obtained transvaginally in all patients < or = 27 weeks' gestation. From 28 weeks to term, transabdominal values remained lower, but the difference was smaller and insignificant, and noted only as a trend. Transvaginal velocimetry of the uterine artery produces significantly higher systolic:diastolic ratios than that of transabdominal recordings until 27 weeks' gestation. Thereafter, trophoblastic invasion of the uteroplacental circulation is maximal, and the difference between the values are minimal and insignificant. However, a pattern of lower resistance in the transabdominal approach remains consistent until term.

Vaginal versus cesarean section oriented approaches in the management of breech delivery.

In a 5-year retrospective study, 543 singleton breech presented infants weighing more than 1000 g were reviewed in two obstetric departments. Department "A" actively conducted the labor with lower cesarean section rate (26%). Department "B" attempted a trial of labor with less invasive procedures and performed more cesarean sections (38% P less than 0.05 S). The management of labor, fetal and maternal outcome were compared between the two departments. Both vaginal and abdominal routes of delivery in fetuses weighing more than 1500 g resulted in the same fetal and maternal outcome. For fetuses weighing 1000-1500 g cesarean section is probably the recommended delivery route.