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Biomedical subjects

Anne M Weber

Publications and source records attributed to Anne M Weber.

31 records · Page 2Linked to original sources
PubMed2004

Episiotomy use among residents and faculty compared with private practitioners.

OBJECTIVE: To describe trends in episiotomy use among residents, faculty, and private practitioners at an academic institution. METHODS: We reviewed data from the Magee Obstetric Medical and Infant database, containing details of every delivery at Magee-Womens Hospital since 1995. The study population was women who had spontaneous or operative vaginal delivery of a singleton, liveborn, vertex-presenting infant, at 37 weeks or more, from 1995 to 2000 (completed data set years). The first delivery recorded for a patient in the database was analyzed. Residents and faculty were described as "academic" practitioners. Data were analyzed with the Fisher exact test, chi2 test for linear trend, and logistic regression models. RESULTS: There were 27702 women with 15190 episiotomies, for an episiotomy rate of 54.8%. The rate of episiotomies decreased from 59.7% to 45.0% during the study period (P <.001). Independent risk factors for episiotomy included age 30 years or more, white race, higher educational status, married, nulliparity, and history of cesarean delivery. The strongest predictor of episiotomy use was practitioner type, with women attending private physicians having an adjusted 7-fold increased risk of episiotomy (odds ratio 7.1; 95% confidence interval 6.5, 7.7). Patient characteristics related to practitioner type included age, race, educational status, marital status, nulliparity, and mode of delivery (P <.001). CONCLUSION: High rates of episiotomy use were found among private practitioners, despite current evidence-based literature that supports restricted use of episiotomy.

Adult↗
PubMed2004

Maternal morbidity associated with vaginal versus cesarean delivery.

OBJECTIVE: To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies. METHODS: The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery without trial of labor, and repeat cesarean delivery with trial of labor. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) for morbidity by delivery mode adjusted for demographic characteristics and comorbidities. Spontaneous vaginal delivery was used as the referent group (odds ratio = 1). RESULTS: Of 32,834 subjects, 27,178 had vaginal delivery (operative = 4,908; spontaneous = 22,270) and 5,656 had cesarean delivery. Third- or fourth-degree lacerations occurred in 1,733 (7.8%) women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95% CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95% CI 5.9, 17.9) than after spontaneous vaginal delivery. The risk of transfusion was highest in women delivered by primary cesarean after labor, 4.2 times higher (95% CI 1.8, 10.1) than spontaneous vaginal delivery. The risk of pneumonia was 9.3 times higher (95% CI 3.4, 25.6) after repeat cesarean delivery with labor. Deep venous thromboses occurred in 15 (0.1%) after spontaneous vaginal delivery, 2 (0.04%) after operative vaginal delivery, and 12 (0.2%) after cesarean delivery. CONCLUSION: Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased risks of endometritis, the need for transfusion, and pneumonia; however, these rates are lower than reported previously.

Adult↗
PubMed2004

Abdominal sacrocolpopexy: a comprehensive review.

OBJECTIVE: To summarize published data about abdominal sacrocolpopexy and to highlight areas about which data are lacking. DATA SOURCES: We conducted a literature search on MEDLINE using Ovid and PubMed, from January,1966 to January, 2004, using search terms "sacropexy," "sacrocolpopexy," "sacral colpopexy," "colpopexy," "sacropexy," "colposacropexy," "abdominal sacrocolpopexy" "pelvic organ prolapse and surgery," and "vaginal vault prolapse or surgery" and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search. METHODS OF STUDY SELECTION: We examined all studies identified in our search that provided any outcome data on sacrocolpopexy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. TABULATION, INTEGRATION, AND RESULTS: Follow-up duration for most studies ranged from 6 months to 3 years. The success rate, when defined as lack of apical prolapse postoperatively, ranged from 78-100% and when defined as no postoperative prolapse, from 58-100%. The median reoperation rates for pelvic organ prolapse and for stress urinary incontinence in the studies that reported these outcomes were 4.4% (range 0-18.2%) and 4.9% (range 1.2% to 30.9%), respectively. The overall rate of mesh erosion was 3.4% (70 of 2,178). Some reports found more mesh erosions when concomitant total hysterectomy was done, whereas other reports did not. There were no data to either support or refute the contentions that concomitant culdoplasty or paravaginal repair decreased the risk of failure. Most authors recommended burying the graft under the peritoneum to attempt to decrease the risk of bowel obstruction; despite this, the median rate (when reported) of small bowel obstruction requiring surgery was 1.1% (range 0.6% to 8.6%). Few studies rigorously assessed pelvic symptoms, bowel function, or sexual function. CONCLUSION: Sacrocolpopexy is a reliable procedure that effectively and consistently resolves vaginal vault prolapse. Patients should be counseled about the low, but present risk, of reoperation for prolapse, stress incontinence, and complications. Prospective trials are needed to understand the effect of sacrocolpopexy on functional outcomes.

Female↗
PubMed2004

Pelvic symptoms in women with pelvic organ prolapse.

OBJECTIVE: To assess symptoms of bladder, bowel, and sexual function in women with pelvic organ prolapse and to compare symptoms by different degrees of prolapse. METHODS: This retrospective study used data from 352 women with prolapse or urinary incontinence. The pelvic organ prolapse quantification measurements, as well as responses to 3 self-administered questionnaires assessing urinary, bowel, and sexual function were used. For each individual, pelvic organ prolapse quantification measures of prolapse were obtained in centimeters in relation to the hymen for 3 compartments: anterior vagina, vaginal apex or cervix, and posterior vagina. Data were analyzed by comparing the frequency of symptoms to centimeter measures of the most advanced prolapse (regardless of site) and the other compartments of prolapse. RESULTS: Of the 330 patients available for analysis, 2.4% had stage I, 46.1% had stage II, 48.2% had stage III, and 3.3% had stage IV prolapse. The average age was 58.8 years (+/- 12.1), with a median parity of 3. Forty-eight percent were postmenopausal and taking estrogen, 27% were postmenopausal and not taking estrogen, and 25% were premenopausal. Patients who had stress incontinence symptoms had less advanced prolapse (median 5 cm less prolapse in the apical compartment) than patients without stress incontinence. Women who required manual assistance to urinate had more advanced prolapse (median 3.5 cm more prolapse in the most advanced compartment) than those who did not. Patients with urinary urgency and urge incontinence also had less advanced prolapse, although the differences were smaller than for stress incontinence (median 3 cm difference or less). There were no clinically significant differences in any compartment for symptoms related to sexual or bowel function. CONCLUSION: Women with more advanced prolapse were less likely to have stress incontinence and more likely to manually reduce prolapse to void; however, prolapse severity was not associated with sexual or bowel symptoms. LEVEL OF EVIDENCE: II-2.

Coitus↗
PubMed2003

Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB): design and methods.

The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) was a multicenter, randomized clinical trial that assessed the efficacy and effectiveness of hysterectomy versus endometrial ablation (EA) for dysfunctional uterine bleeding (DUB) in women for whom medical management has not provided relief. Resource centers included a coordinating center, a chair's office, the American College of Obstetricians and Gynecologists, the Agency for Healthcare Research and Quality Project Office and 33 clinical centers in the United States and Canada. STOP-DUB enrolled: (1) eligible patients for whom medical treatment had not been successful and who were randomized to either hysterectomy or EA and (2) an observational cohort of patients who were "provisionally ineligible" or who were eligible but did not wish to be randomized. Enrollment began in October 1997 and ended in June 2001. The primary outcome addressed by the randomized trial was the impact of surgery on bleeding, pain, fatigue, and the major problem (symptom) that led the woman to seek treatment for her condition, measured 1 year following surgery. Additional outcomes included the impact of surgery at time points after 1 year; changes in quality of life, activity limitation, sexual functioning, and urinary incontinence; surgical complications; additional surgery; and resource utilization. The costs and the relative cost-effectiveness of the two surgeries were calculated. The main scientific objective for the observational study was to examine changes over time in terms of treatment selected, DUB-related symptoms, and quality of life.

Female↗
PubMed2003

Procedures for pelvic organ prolapse in the United States, 1979-1997.

OBJECTIVE: The objective of our study was to describe national rates of surgery for pelvic organ prolapse. STUDY DESIGN: We used the National Hospital Discharge Survey, a federal database that samples inpatient hospitals in the United States. Data from 1979 to 1997 were analyzed for diagnoses and procedures coded with the ICD-9-CM classification system. Age-adjusted rates were calculated by using the 1990 census population and compared for change over time by using the Score test for linear trend. RESULTS: Approximately 200,000 women undergo inpatient procedures for prolapse in the United States each year, ranging from 165,000 in 1988 to 226,000 in 1979. There was a significant decrease in the overall age-adjusted rate of procedures performed over the study period, from 2.2 to 1.5 procedures per 1000 women (P =.01). The rate of prolapse procedures for women younger than 50 years decreased by more than half (1.9 to 0.8 per 1000 women, P <.001), whereas the rate remained stable in women who were aged 50 years and older (2.7 to 3.3 per 1000 women, P =.5). CONCLUSION: Prolapse procedures are performed very frequently in the United States, although the rate has decreased slightly over time.

Adult↗
PubMed2003

Procedures for urinary incontinence in the United States, 1979-1997.

OBJECTIVE: The objective of our study was to describe the national rates of surgery for urinary incontinence in women. STUDY DESIGN: We used the National Hospital Discharge Survey, a federal database that samples inpatient hospitals in the United States. Data from 1979 to 1997 were analyzed for diagnoses and procedures coded by using the International Classification of Diseases, 9th revision, Clinical Modification, classification system. Age-adjusted rates were calculated by using the 1990 census population and compared for change over time with the score test for linear trend. RESULTS: The number of women undergoing inpatient surgery for urinary incontinence has varied from 33000 in 1979 to 85000 in 1993. The rate of surgeries for incontinence has almost doubled, from 0.32 procedures per 1000 women per year in 1979 to 0.60 procedures per 1000 women per year in 1997 (P =.02). The number of suprapubic slings performed increased over time. Approximately 2100 slings were performed per year until 1996, when 7348 were performed, followed by 10,192 in 1997 (rate increase from 12 to 75.2 per 1000000 women per year, P =.03). Women undergoing incontinence procedures were 79% white, 3% African American, and the remaining 18% other (including unknown). Thirty-seven percent of cases were performed in the South, 25% in the Midwest and West, and 12% in the Northeast. From 1979 to 1997, the mean age of women at the time of surgery increased from 50.5 +/- 12.1 years to 56.6 +/- 13.3 years; mean length of hospital stay decreased from 9.9 +/- 4.5 days to 2.7 +/- 1.4 days (P <.001). CONCLUSION: The rate of surgery for urinary incontinence in women has nearly doubled from 1979 to 1997.

Female↗
PubMed2002

Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system?

OBJECTIVE: To estimate the relationship between Q-tip measurement of urethral hypermobility and visual assessment of the urethrovesical junction as assessed by points Aa and Ba of the pelvic organ prolapse quantification (POP-Q) system. METHODS: A total of 274 patients with pelvic organ prolapse or urinary incontinence had preoperative Q-tip test straining angles and POP-Q staging measurements. By the Q-tip test, urethral hypermobility was defined as a straining angle of 30 degrees or greater relative to the horizontal. As defined in the POP-Q system, point Aa is located in the midline of the anterior vaginal wall 3 cm from the external urethral meatus and represents the urethrovesical junction. Point Ba represents the most dependent position of the anterior vaginal wall. The correlation between point Aa of the POP-Q system and the Q-tip test was assessed using the Spearman correlation coefficient. Similar assessments were made for point Ba. RESULTS: Mean age of the 274 subjects was 58.5 +/- 11.8 years; mean parity was 3.1 +/- 1.6. A total of 104 patients reported prior surgery for prolapse or incontinence. Mean Q-tip straining angle was 61 +/- 20 degrees; 258 (94%) had urethral hypermobility. Values of point Aa ranged from -3 cm to +3 cm, with median 0 cm. The correlation coefficient between the Q-tip straining angle and point Aa was r = 0.47 (P <.001). Urethral hypermobility was observed in 95% of patients with stage II prolapse at point Aa and in 100% of patients with stages III and IV prolapse at point Aa. The correlation coefficient between the Q-tip straining angle and point Ba was r = 0.32 (P <.001). CONCLUSION: Although the correlation between the Q-tip straining angle and point Aa of the POP-Q was moderately strong, one value cannot be predicted from the other. The Q-tip test may be unnecessary in patients with stages II, III, and IV prolapse at point Aa as virtually all such patients demonstrate urethral hypermobility.

Female↗
PubMed2002

Episiotomy use in the United States, 1979-1997.

OBJECTIVE: To describe episiotomy usage at vaginal delivery in the United States from 1979-1997. METHODS: We used the National Hospital Discharge Survey, a federal database of a national sample of inpatient hospitals. Data from 1979 to 1997 were analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diagnoses and procedures. Rates per 1000 women were calculated using the 1990 census population for women aged 15-44 years. We calculated the number of episiotomies per 100 vaginal deliveries. Rates and percentages were compared using the score test for linear trend. RESULTS: The number of episiotomies ranged from a high of 2,015,000 in 1981 to a low of 1,128,000 in 1997. The age-adjusted annual rate for episiotomy with vaginal deliveries varied from 32.7 in 1979 to 18.7 in 1997 per 1000 women aged 15-44 years. The percentage of episiotomy with vaginal deliveries ranged from 65.3% in 1979 to 38.6% in 1997 (P <.001). Episiotomy with operative deliveries decreased over time (87.0% to 70.8%, P <.001), as did episiotomy with spontaneous deliveries (60.1% to 32.8%, P <.001). Women undergoing episiotomy were slightly younger (mean +/- standard deviation, 25.7 +/- 5.5 years) than women without episiotomy (26.2 +/- 5.7 years, P <.001). Black women (39%) were less likely to receive episiotomy than white women (60%, P <.001). More women with private insurance (62%) had episiotomy performed than women with government insurance (43%, P <.001). CONCLUSION: Although episiotomy use has decreased over time, the most recent rate of 39 per 100 vaginal deliveries remains higher than evidence-based recommendations for optimal patient care.

Adolescent↗