ABSTRACT
OBJECTIVE: We compared fluid-based cytologies (FBC) with conventional Papanicolaou (Pap) tests (CT) to determine if either is superior. STUDY DESIGN: This was a systematic review of original research reports evaluating both CT and FBC with respect to specimen adequacy, comparison with a reference standard, or both. Two reviewers independently reviewed the titles, abstracts, and full articles to determine inclusion status, with differences resolved by consensus with a third author. Risk differences (RD) between occurrence rates for FBC and CT were used for the specimen adequacy data. Sensitivity and specificity were pooled independently and weighted by the inverse of the variance using a random effects model. DATA SOURCES: Studies published between 1985 and November 1999 were identified from MEDLINE, Best Evidence, EMBASE, Biological Abstracts/RRM, and The Cochrane Library. OUTCOMES MEASURED: Sensitivity, specificity, area under the receiver operating characteristic curve (AuROC), and the proportion of satisfactory, unsatisfactory, and "satisfactory but limited by" test results were measured. RESULTS: There was no significant difference in AuROC (P = .37). FBC specimens were more likely to be satisfactory (RD=0.06; 95% confidence interval [CI], 0.03-0.09) or to have absent endocervical cells (RD=0.06; 95% CI, 0.02-0.10) but had 10% fewer "satisfactory but limited by - other" reports (RD = -0.10; 95% CI, -0.14 to -0.06). There was no difference in unsatisfactory Pap test results. CONCLUSIONS: For most women there is no reason to replace CT with FBC. For women at high risk of cervical cancer or who are screened infrequently, the possible increase in FBC sensitivity may outweigh the potential harms from additional false positives.
Subject(s)
Histological Techniques/methods , Papanicolaou Test , Uterine Cervical Neoplasms/pathology , Vaginal Smears/methods , Confidence Intervals , Evidence-Based Medicine , Female , Humans , Mass Screening/methods , Probability , Sensitivity and Specificity , Uterine Cervical Neoplasms/diagnosisABSTRACT
Contraception and preconception counseling are vital issues in women's health. This article reviews recent literature in both fields with an emphasis on clinical outcomes research. Satisfaction (which affects compliance), morbidity and mortality, and side effects of contraceptives are reviewed. Current literature on preconception counseling is discussed.
Subject(s)
Contraception/methods , Preconception Care/methods , Adolescent , Adult , Contraceptives, Oral/adverse effects , Counseling , Female , Genetic Counseling , Humans , Patient Acceptance of Health Care , Prenatal Care , Sexually Transmitted Diseases/prevention & controlABSTRACT
Postdate pregnancy (more than 42 weeks' gestation) accounts for about 10 percent of obstetric deliveries. Maternal and fetal assessment in anticipation of postdate pregnancy must begin early in the pregnancy. Gestational age must be accurately determined through judicious use of historical, physical and laboratory data. Familiarity with the physiologic changes associated with pregnancy, both near and after term, can help in predicting the possibility of neonatal morbidity from fetal macrosomia or dysmaturity, placental insufficiency and meconium-stained amniotic fluid. Management of the postdate pregnancy includes antenatal testing to measure fetal well-being. If testing indicates fetal distress or absent amniotic fluid, immediate delivery should be initiated. Cervical ripening should be considered if the Bishop score indicates an unfavorable chance of successful induction and if there is no need for immediate delivery. When labor commences after 42 weeks' gestation, continuous fetal monitoring is essential.
