Measures of sexual behavior and the risk of pelvic inflammatory disease

Article Abstract:

Pelvic inflammatory disease (PID), a bacterial infection of the uterus, fallopian tubes, and nearby ligaments, is most frequently caused by Neisseria gonorrhoeae or Chlamydia trachomatis (two organisms that are transmitted sexually). The relationship between sexual behavior and the risk of PID was investigated by interviewing 18- to 44-year-old women with and without the disease regarding their reproductive and medical histories, contraceptive methods, and recent sexual behavior, including frequency of sexual intercourse and number of recent sex partners. The interviews were conducted with 712 women who were hospitalized for their first episode of PID (which can recur) and 2,719 control women who were hospitalized for nongynecological medical problems and had no history of PID. The survey suggested that younger women, black women and women with fewer years of education had an increased risk of PID. The risk of hospitalization for PID was increased three-fold for women who reported having four or more sex partners compared with those who had only one recent partner. Frequent intercourse (more than six times per week) also increased the risk for PID three-fold, even in married women with one sex partner. If the patient had a history of gonorrhea, then the risk for PID was increased. The authors suggest that sexual behavior which is known to increase a woman's risk of contracting a sexually transmitted disease will probably increase her risk of developing pelvic inflammatory disease. In addition, frequent intercourse between monogamous partners, which does not raise the risk of acquiring a sexually transmitted disease, appears to increase risk of PID. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexually transmitted diseases, Reports, Risk factors, Physiological aspects, Sexual behavior surveys, Pelvic inflammatory disease

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Routine prothrombin time determination before elective gynecologic operations

Article Abstract:

Prothrombin is a protein that is made in the liver and is required for normal blood clot formation. It causes blood to clot by activating an enzyme called thrombin, which converts a soluble blood protein, fibrinogen, into an insoluble fiber, fibrin. The prothrombin time (PT) is a blood coagulation (clotting) test used to diagnose bleeding disorders. Many hospitals require a PT test to be performed on all patients about to undergo surgery. However, medical textbooks recommend using PT tests only if the patient has a medical history or physical examination that indicates that he or she may have a blood disorder. Several studies have tried to evaluate the usefulness of the PT test in patients having surgery. In one study involving 480 patients, 97 percent had a normal PT test and only 1 patient may have benefitted from having the test performed. In another study, 60 percent of the PT tests that were performed were not necessary and under 1 percent of the tests identified blood abnormalities. This article describes the results of a study designed to evaluate the usefulness of PT testing prior to elective gynecological surgery. During a six-month period, 1,546 women attending the Women's Hospital in Los Angeles underwent PT testing prior to gynecological surgery. Ninety-eight percent of the women had normal results. Twenty out of 25 women who had abnormal test results did not benefit from having the test performed, and only five patients had a medical history or physical examination that suggested a PT test should be performed. It is concluded that PT tests before gynecological surgery do not improve patient care and should not be used routinely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Medical examination, Blood clotting disorders, Blood coagulation disorders, Preoperative care, Patients, Blood coagulation tests, Prothrombin time

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Surgical management of leiomyomata during pregnancy

Article Abstract:

Leiomyomas (fibroids) are noncancerous solid tumors found on the walls of the uterus. They are the most common type of tumor found during pregnancy, occurring in 0.3 to 2.6 deliveries per 100. The true incidence of these tumors is unknown, since patients without symptoms are not evaluated. Although most patients with leiomyomas during pregnancy do not experience complications, a small percentage of patients may require surgery. Severe pain, the most common symptom of leiomyomas, is caused by degeneration of tissue as the pregnancy progresses. It is thought that the tissue degenerates as the vessels supplying the tumors become twisted, decreasing the tumor's nutrient supply. There were 106 leiomyomas out of 123,492 deliveries, 14 of which required surgery (1.1 per 10,000 births). Of the patients requiring surgery, five had exploratory abdominal surgery only, six had only the tumors removed and three had the entire uterus removed (one because of pain and two because the patients requested abortions or sterilization). One patient with a leiomyoma on the cervix (the neck of the uterus) developed an infection and lost the fetus after surgery. Of the 13 women having the tumors removed at the time of cesarean section delivery, one had excessive bleeding. Conservative surgical management is indicated when the pain persists or the diagnosis is uncertain. The removal of tumors with stalks up to five centimeters long is safe in selected patients with leiomyomas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Surgery, Pregnant women, Pregnancy, Complications of, Pregnancy complications

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