- Email: [email protected]
Predicting cerebral Palsy
most rapid method for stopping the labor and thus allowed a more rapid discharge. Further confirmation and, when greater numbers are available, evaluation of subgroups by gestational age are needed. To group 2O-week pregnancies with >3O-week pregnancies seems to be too encompassing.
PredictingCerebral Palsy
Obet
Gy-
. . . Commentary: Many investigators have addressed the issue of cerebral paIsy. As in this study, no researchers have been able to define a specific causative factor. Although the rate of cesarean delivery was higher in infants with cerebral palsy, the complication rate of pregnancies showed no difference. The predictive value of the Apgar score was limited. Thus, we have obtained more information but no more knowledge about the cause of this condition. In another article reviewed in this issue, the finding of meconiutn in the amniotic fluid of preterm infants is viewed as a risk factor. However, this is a related finding and not a causative factor. Continuing research is needed. Many studies now indicate that the cause of cerebraJ palsy, whatever it is, precedes labor, delivery, and the management provided by the obstetrician. fllWJ85686~98lKHlli.9
l
MD
Editor
61.
Crosignani PG, Vercellini J?,Apolone G, De Giorgi 0, Cortesi I, Meschia M. Endometrial resection versus vaginal hysxerectomy for menorrhagia: Long-term clinical and quality-of-life outcomes. Am J Obstet Gynecol
Synopsis: These investigators have reported on the findings in the Danish Cerebral Palsy Register for all children born between 1982 and 1986. There were 175 preterm singleton infants born who were diagnosed with cerebral palsy. They were compared with 687 matched controls. The authors could find no complication that was associated with cerebral paIsy. The rate of cesarean delivery was higher among infants with cerebral palsy (67% versus 56%). The rate of Apgar scores <7 was higher in cases at 1 minute, but at 5 minutes there was no difference.
6 . ACOG CLINICALREVIEW
W. Hale,
Menorrhagia Treatments Explored
Topp M, Langhoff-Roes J, Uldall P. Preterm birth and cerebral palsy: Predictive value of pregnancy complicaGons, mode of delivery, and Apgar scores. Acta necol &-and 1997;76:843-8.
Ralph
tients. A small number of patients who undergo ablation will subsequently need a hysterectomy. This finding is similar to that of another article reviewed in ACOG CIinicaL Review (Likelihood of the need for hysterectomy after endometrial ablation. ACOG Clin Rev 1997;2[4]:
1997;177:95-1131.
Synopsis: This study comprised 77 women who were evaluated 2 years afier undergoing treatment for menorrhagia and were 550 years of age. Vaginal hysterectomy was performed on 39 women, and 38 had endometrial resection. Using a general health survey questionnaire, an anxiety depression tool, and a sexual rating scale, the authors reviewed each group. Of those who underwent endometrial resection, 33 (86.8%) were very satisfied or satisfied, compared with 37 (94.8%) of those who underwent vaginal hysterectomy. In the endometrial resection group, four patients underwent a subsequent hysterectomy. In this group, eight patients reported amenorrhea, four reported monthly spotting, ten reported hypomenorrhea, and 12 reported normal periods.
. . . Commentaryz For the last 10 years, there has been a growing debate about the appropriate treatment for menorrhagia that fails to respond to conservative therapy. Until the rapid rise in the use of the hysteroscope, the almost universal opinion was that hysterectomy was the treatment of choice. Since the use of the hysteroscope has made endometrial ablation an ahernative, the decision has become more complex. These authors have compared both forms of therapy in a relatively small number of cases. Their conclusion is that both methods result in a high percentage of satisfied pa-
May/June 1998
A major finding in these reports and others is the importance of patient choice. For some patients, preserving the uterus is important, and these patients are candidates for ablation. Others prefer to have a hysterectomy. ACOG Patient Education Pamphlet APO08 on understanding hysterectomy can help explain this operative procedure to patients. Informed consent is important, not only for legal reasons, but also because it allows the patient to participate in treatment decisions. Surveys have shown that patients usually are much more satisfied if they have been made an integral part of the decisionmaking process.
High-Impact Sports Do Not DamagePelvic Structure Nygaard IE. Doa prolonged high-impact activity contribute to later urinary incominence? A retrospective cohort study of female Olympians. Obstet Gynecol l997;90: 718-22.
Synopsis: In a retrospective cohort study, US female Olympians who competed in gymnastics, swimming, and track and field between 1960 and 1976 were asked to complete a questionnaire. One hundred four women responded (51.2Oh).The purpose was to determine the prevalence of symptoms of stress and urge incontinence. Athletes who participated in highimpact sports (gymnastics, track and field) were compared with athletes who participated in a low-impact sport (swimming). Athletes of high-impact sports were more likely to report incontinence while competing than were swimmers (35.8% versus 4.5O’o). Swimmers were more likely to be parous than were competitors of highimpact sports (83.3% versus 60.7%). There was no difference in the prevalence of stress incontinence between the groups. The author concludes that high-impact sports did not predispose Ql998 by the Amerwn Collegeof Obstetrwans and Gynecolog;sts Publishedby Ekewr ScienceINK 1085~f%62/9.86550
PredictingCerebral Palsy
Obet
Gy-
. . . Commentary: Many investigators have addressed the issue of cerebral paIsy. As in this study, no researchers have been able to define a specific causative factor. Although the rate of cesarean delivery was higher in infants with cerebral palsy, the complication rate of pregnancies showed no difference. The predictive value of the Apgar score was limited. Thus, we have obtained more information but no more knowledge about the cause of this condition. In another article reviewed in this issue, the finding of meconiutn in the amniotic fluid of preterm infants is viewed as a risk factor. However, this is a related finding and not a causative factor. Continuing research is needed. Many studies now indicate that the cause of cerebraJ palsy, whatever it is, precedes labor, delivery, and the management provided by the obstetrician. fllWJ85686~98lKHlli.9
l
MD
Editor
61.
Crosignani PG, Vercellini J?,Apolone G, De Giorgi 0, Cortesi I, Meschia M. Endometrial resection versus vaginal hysxerectomy for menorrhagia: Long-term clinical and quality-of-life outcomes. Am J Obstet Gynecol
Synopsis: These investigators have reported on the findings in the Danish Cerebral Palsy Register for all children born between 1982 and 1986. There were 175 preterm singleton infants born who were diagnosed with cerebral palsy. They were compared with 687 matched controls. The authors could find no complication that was associated with cerebral paIsy. The rate of cesarean delivery was higher among infants with cerebral palsy (67% versus 56%). The rate of Apgar scores <7 was higher in cases at 1 minute, but at 5 minutes there was no difference.
6 . ACOG CLINICALREVIEW
W. Hale,
Menorrhagia Treatments Explored
Topp M, Langhoff-Roes J, Uldall P. Preterm birth and cerebral palsy: Predictive value of pregnancy complicaGons, mode of delivery, and Apgar scores. Acta necol &-and 1997;76:843-8.
Ralph
tients. A small number of patients who undergo ablation will subsequently need a hysterectomy. This finding is similar to that of another article reviewed in ACOG CIinicaL Review (Likelihood of the need for hysterectomy after endometrial ablation. ACOG Clin Rev 1997;2[4]:
1997;177:95-1131.
Synopsis: This study comprised 77 women who were evaluated 2 years afier undergoing treatment for menorrhagia and were 550 years of age. Vaginal hysterectomy was performed on 39 women, and 38 had endometrial resection. Using a general health survey questionnaire, an anxiety depression tool, and a sexual rating scale, the authors reviewed each group. Of those who underwent endometrial resection, 33 (86.8%) were very satisfied or satisfied, compared with 37 (94.8%) of those who underwent vaginal hysterectomy. In the endometrial resection group, four patients underwent a subsequent hysterectomy. In this group, eight patients reported amenorrhea, four reported monthly spotting, ten reported hypomenorrhea, and 12 reported normal periods.
. . . Commentaryz For the last 10 years, there has been a growing debate about the appropriate treatment for menorrhagia that fails to respond to conservative therapy. Until the rapid rise in the use of the hysteroscope, the almost universal opinion was that hysterectomy was the treatment of choice. Since the use of the hysteroscope has made endometrial ablation an ahernative, the decision has become more complex. These authors have compared both forms of therapy in a relatively small number of cases. Their conclusion is that both methods result in a high percentage of satisfied pa-
May/June 1998
A major finding in these reports and others is the importance of patient choice. For some patients, preserving the uterus is important, and these patients are candidates for ablation. Others prefer to have a hysterectomy. ACOG Patient Education Pamphlet APO08 on understanding hysterectomy can help explain this operative procedure to patients. Informed consent is important, not only for legal reasons, but also because it allows the patient to participate in treatment decisions. Surveys have shown that patients usually are much more satisfied if they have been made an integral part of the decisionmaking process.
High-Impact Sports Do Not DamagePelvic Structure Nygaard IE. Doa prolonged high-impact activity contribute to later urinary incominence? A retrospective cohort study of female Olympians. Obstet Gynecol l997;90: 718-22.
Synopsis: In a retrospective cohort study, US female Olympians who competed in gymnastics, swimming, and track and field between 1960 and 1976 were asked to complete a questionnaire. One hundred four women responded (51.2Oh).The purpose was to determine the prevalence of symptoms of stress and urge incontinence. Athletes who participated in highimpact sports (gymnastics, track and field) were compared with athletes who participated in a low-impact sport (swimming). Athletes of high-impact sports were more likely to report incontinence while competing than were swimmers (35.8% versus 4.5O’o). Swimmers were more likely to be parous than were competitors of highimpact sports (83.3% versus 60.7%). There was no difference in the prevalence of stress incontinence between the groups. The author concludes that high-impact sports did not predispose Ql998 by the Amerwn Collegeof Obstetrwans and Gynecolog;sts Publishedby Ekewr ScienceINK 1085~f%62/9.86550