Longitudinal assessment of lung area measurements by two-dimensional ultrasound in fetuses with isolated left-sided congenital diaphragmatic hernia.

OBJECTIVE: To evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two-dimensional (2D) ultrasound. METHODS: Fetal right lung measurements obtained by 2D ultrasound between 19 and 37 weeks' gestation were evaluated longitudinally in 66 healthy fetuses and 52 fetuses with isolated left-sided CDH. Right lung areas were determined by the 'tracing' and 'longest-diameters' methods and, subsequently, lung area-to-head circumference ratios (LHRs) were calculated. Functions fitted to these size parameters with respect to gestational age were evaluated for three sets of group-wise comparisons: (1) healthy vs CDH fetuses; (2) different degrees of severity of CDH; and (3) CDH fetuses that survived vs those that died by 6 months postpartum. RESULTS: There was a significantly slower increase in right lung areas and LHRs with advancing gestational age in CDH fetuses than in healthy individuals (P < 0.05). Compared to those with milder forms of CDH, lung areas and LHRs of fetuses with more severe forms displayed a smaller increase (P < 0.05) and LHRs of fetuses with severe CDH did not increase during pregnancy (P > 0.05). Individuals who died postpartum did not show any increase in LHR (P > 0.05) throughout gestation. CONCLUSIONS: The right lung area and LHR, calculated using either the longest-diameters or tracing method, display reduced growth rates during gestation in cases of isolated left-sided CDH as compared with healthy fetuses. The growth curve characteristics of fetal lung areas and LHRs may be useful for predicting neonatal mortality.

Previous cesarean section. A contraindication to vaginal hysterectomy?

OBJECTIVE: To compare surgical outcomes of vaginal hysterectomy between women who have had one or more cesarean deliveries and those who have not. STUDY DESIGN: A retrospective, chart review study was performed on women undergoing vaginal hysterectomy during a four-year period. Of 275 women who met the study criteria, 104 had a history of previous cesarean deliveries, and 171 did not. The groups were compared for indications for surgery, operative time, length of hospitalization and surgical complications. RESULTS: Previous cesarean delivery did not affect hemoglobin loss, hospital stay or operative time among women undergoing vaginal hysterectomy. The complication rate (either operative or postoperative) was 12.3% among women without a history of cesarean section, 6.8% among those with one, 3.7% among those with two and 11.1% among those with three or more (chi 2 = 2.8, P = .4). The odds for surgical complications were not significantly different between women with one or more prior cesarean deliveries as compared to those without after adjustment for possible confounders. CONCLUSION: Surgical complications with vaginal hysterectomy do not appear to be higher among women with a prior cesarean section as compared to those without a history of such operation.

Validity of self-assessment of pubertal maturation in African American and European American adolescents.

PURPOSE: To evaluate interobserver reliability of physician assessments of pubertal maturation and to evaluate the validity of self-assessment compared to physician assessments of pubertal maturation by girls in a multiethnic sample. METHODS: The study design is descriptive. A total of 107 8-17-year-old healthy volunteers from settings with large minority populations in the Houston metropolitan area were recruited for a study on adolescents' energy needs. The two outcome measures were interobserver reliability between two physicians' assessments of breast and pubic hair, and the self-assessment of breast and pubic hair maturation compared to physicians' assessments. RESULTS: The kappa coefficient for physician interobserver agreement for breast maturation was 0.5. The kappa coefficient for physician interobserver agreement for assessment of pubic hair was 0.79. The kappa coefficient for the validity of self-assessment of breast development was 0.34, and that for self-assessment of pubic hair was 0.37. CONCLUSION: Interobserver agreement for physician assessment of breast maturation was low and self-assessment of breast maturation was not reliable in this group of adolescent girls. However, whereas physician interobserver agreement for pubic hair was good, self-assessment of pubic hair maturation was not reliable in this group of adolescent girls.

Characteristics of injectable contraceptive users in a low-income population in Texas.

Among 600 women at 17 family planning clinics in Texas who expressed interest in using the hormonal injectable depot medroxyprogesterone acetate (DMPA), 536 (89%) actually received the injectable. Thirty percent of the DMPA recipients were younger than 21 and 77% were not married. The average numbers of pregnancies and births were 1.9 and 1.2 per woman; one-third of the women had had at least one abortion. The majority of women receiving DMPA (66%) were using it to space births. Their main sources of information about the method were friends (42%) and health care providers (37%), and the most commonly reported reason for its use was dissatisfaction with previous contraceptive methods.

PIP: The purpose of this prospective study was to add to the little data that exists concerning the characteristics and attitudes of depot medroxyprogesterone acetate (DMPA) users. Among 600 women at 17 family planning clinics in Texas who expressed interest in using the hormonal injectable DMPA, 536 (89%) actually received the injectable. DMPA users were significantly more likely than other women to be 20-24 years old, whereas a smaller percentage were 30 or older (p 0.001). 30% of the DMPA recipients were younger than 21; 50% were Black; and the rest were either White (25%) or Hispanic (24%). 77% of women adopting DMPA were not married. In contrast, most of the other patients who received contraceptive care at these clinics were married (64%; p 0.001). The average education of the DMPA acceptors was 11.9 years: Hispanic women had significantly less education (10.6 years) than did either Blacks or Whites (p or= 0.001). The average numbers of pregnancies and births were 1.9 and 1.2 per woman; 1/3 of the women had had at least 1 abortion. 34% of the women indicated they had no desire for more children. The majority of women receiving DMPA (66%) were using it to space births. Their main sources of information about the method were friends (42%) and health care providers (37%). 58% of the women reported dissatisfaction with previous contraceptive methods as the reason for its use, while 42% chose it because they were curious about it. 17% of the women were concerned about the method's effect on future pregnancies and 10% about the women's ability to conceive. In addition, a possible hormonal effect and the newness of the method were each cited by about 15% of DMPA users. The most frequently cited reasons for not receiving the injection involved the fear of bleeding (21%), acne or skin problems (21%), abdominal pain (19%), and weight gain (14%). One potential limitation of these findings is that the attitudes of women of lower socioeconomic status about DMPA may differ from their more affluent counterparts.