体外受精-胚胎移植309个卵巢反应不良周期临床分析

目的探讨体外受精-胚胎移植周期中卵巢反应不良的影响因素、预测及处理。方法2005年我们完成取卵周期2352个，其中274例患者309个周期发生卵巢反应不良，选择与其同一日取卵且时间接近的309个周期作为对照，比较两组既往卵巢手术史、促性激素的用量和时间、受精率、妊娠率、流产率、卵巢储备能力预测的指标以及卵巢反应不良组妊娠结局的预测。结果卵巢反应不良组患者年龄、既往卵巢手术史、促性激素的用量和时间均高于对照组（P＜0．001），而受精率、妊娠率显著低于对照组（P＜0．0001）。在卵巢储备能力预测方面，年龄、基础卵泡刺激素（BFSH）、基础卵泡刺激素／黄体生成素（BFSH／LH）、窦卵泡数（AFC）两组均有明显差异（P＜0．001）。在卵巢反应不良组中，年龄≤40岁者妊娠率为25．4％，而年龄）40岁者妊娠率为1．4％，精确fisher概率法比较差异有显著性（P＜0．0001）；在妊娠结局的预测方面，对年龄、BFSH、LH、BFSH／LH、AFC、基础雌二醇（E2）进行回归分析，年龄是首先被引入（OR，0．831；95％可信区间，0．765～0．910；P=0．000），其次是AFC（OR，1．300；95％可信区间，1．025～1．648；P=0．031）。结论既往有卵巢手术史者与卵巢反应不良密切相关；对卵巢反应不良的患者，综合年龄、FSH、BFSH／LH、AFC可以预测卵巢储备能力；卵巢反应不良妇女IVF妊娠率较低，尤其对年龄＞40岁卵巢反应不良的患者，IVF-ET的成功率极低；在妊娠结局的预测方面，年龄、窦卵泡数与妊娠结局密切相关。     

早期宫颈癌锥切标本宫旁浸润的影响因素分析

目的：探讨早期宫颈癌锥切标本宫旁浸润（PI）的影响因素。方法：回顾性分析大连市妇幼保健院2008年1月—2018年2月经宫颈锥切确诊为宫颈癌后行根治性子宫切除术（RH）+腹膜后淋巴结切除术的200例Ⅰa2～Ⅰb1期宫颈癌患者，分析早期宫颈癌PI的影响因素。结果：200例患者中有15例（7.5%）PI阳性，185例（92.5%）PI阴性。单因素分析显示，PI与年龄、病理类型、国际妇产科联盟（FIGO）分期、病理组织学分级、肿瘤大小和切缘状态无关（均P＞0.05），与淋巴脉管间隙浸润（LVSI）和淋巴结转移有关（均P＜0.05）。多因素分析显示，LVSI阳性（OR=5.456，95%CI：1.669～17.833，P=0.005）和淋巴结转移阳性（OR=6.725，95%CI：1.833～24.669，P=0.004）是PI的独立危险因素。结论：早期宫颈锥切标本中LVSI、淋巴结转移与PI有关，可作为PI的预测因子。     

影响极低出生体重儿早期生长赶超的原因

目的 分析极低出生体重儿（very low birth weight infant，VLBWI）在纠正胎龄40周时的生长赶超情况及影响因素。方法 以50例VLBWI作为研究对象。以40周胎龄健康足月儿和15个城市不同胎龄婴儿出生体重为正常值，比较50例VLBWI在出生、出院时及纠正胎龄40周时的小于胎龄儿（small for gestational age，SGA）发生率；分析喂养方式、并发症、辅助治疗等对VLBWI生长赶超的影响。结果 50例VLBWI在纠正胎龄40周时的体重为（3290±640）g，与同胎龄足月儿比较差异无统计学意义（P〉0．05）。50例VLBWI出院时SGA所占比例为64．0％（32／50），明显高于出生时的24．0％（12／50）和纠正胎龄40周时的32．0％（15／50），P均〈0．05。出生时SGA（OR=0．035，95％CI0．003-0．487）、低T3综合征（OR=0．101，95％CI0．013～0．774）及长期使用静脉营养（OR=0．307，95％CI0．097-0．972）是导致VLBWI生长赶超失败的危险因素，而早期开展肠道喂养（OR=8．241，95％CI1．373～49．470）则有利于VLBWI的生长赶超。并发低T3综合征的VLBWI住院4周期间及出院后平均体重增长速度均低于未并发低T3综合征的VLBWI（P均〈0．05）。结论 合理的营养方案、降低并发症的发生率是VLBWI实现早期生长赶超的关键。     

子痫前期发病危险因素分析

目的探讨影响子痫前期发病的危险因素,以预防及早期预测子痫前期的发生。方法回顾性分析96例子痫前期（研究组）患者和192例正常孕妇（对照组）的临床资料,对可能影响其发病的因素进行单因素和logistic回归分析。结果单因素分析显示,患者的年龄、孕产次、贫血、肾病和糖尿病、高血压病史、多胎妊娠、羊水过少、高血压家族史和子痫前期史是子痫前期发病的危险因素（P〈0．05）;logistic回归分析显示,按OR值的大小排序依次为高血压病史（OR值=16．15）、肾病和糖尿病（OR值=10．09）、年龄≥35岁（OR值=6．98）、高血压家族史（OR值=4．67）为子痫前期发病的危险因素（P〈0．05）。结论子痫前期发病为多因素所致,应对具体危险因素孕妇采取针对性预防措施,以降低子痫前期发病和改善患者的预后。     

女性压力性尿失禁发生的危险因素分析

目的 调查城市社区女性压力性尿失禁发生的危险因素。方法 按照1：8随机抽样的方法,抽取福州市鼓楼区6066例妇女。调查项目包括：年龄、职业、文化程度、体重、血压、月经史、孕产史、分娩方式、新生儿体重、慢性疾病(高血压、糖尿病、慢性咳嗽、习惯性便秘)、腹腔或盆腔手术史、生活习惯(吸烟、酗酒、体育锻炼方式等)、尿失禁症状和发生频率、就医情况等。数据采用多因素回归分析。结果 问卷回收率为92．1％(5587／6066)。尿失禁发生率为18．1％,其中压力性尿失禁占8．8％。调查显示,诸因素中年龄[OR：1．010;95％可信限(CI)：1．001—1．025]、高体重指数(OR：1．092;95％CI：1．054—1．132)、高血压(OR：2．342;95％CI：1．026～5．349)、便秘(OR：1．448;95％CI：1．216—1．725)、多次流产(OR：1．306;95％,CI：1．113～1．533)、多次阴道分娩(OR：1．205;95％CI：1．009—1．440)、加腹压助产(OR．1．684;95％CI:1．140—2．489)、会阴直切(OR：2．244;95% CI：1．162～4．334)、会阴裂伤(OR：2．576;95％CI：1．724～3．851)、会阴切口感染(OR：5．988;95％CI：1．936—18．616)是尿失禁发生的危险因素。结论 压力性尿失禁的发生与多种因素有关,尤其与年龄和妊娠、分娩等产科因素关系密切。     

早期常规人工破膜对产程及胎儿与新生儿影响的Meta分析

目的探讨产程中早期常规人工破膜对产程及胎儿或新生儿的影响。方法对“早期人工破膜可增加胎儿心率异常的发生、早期人工破膜的随机化对照试验、早期人工破膜对初产妇发生难产危险的影响、选择性人工破膜对胎心率及产程影响的随机研究、比较早期人工破膜与选择性人工破膜对正常产程影响的临床随机研究和关于产程中主动管理的临床随机研究和Meta分析等6篇文献中的临床随机对照试验结果,使用固定效应模型方法进行Meta分析。结果（1）早期常规人工破膜能够缩短第一产程95min,95％可信区间（CI）为-119．17～-70．52。（2）没有足够证据表明早期常规人工破膜能够对分娩方式产生影响：剖宫产率OR=1．25,95％CI为0．99～1．57,器械阴道助产率OR=1．05,95％CI为0．90～1．24。（3）早期常规人工破膜对第一产程胎心率异常的发生没有影响（OR=0．95,95％CI为0．75～1．21）,但增加第二产程胎心率异常的发生（OR=1．28,95％CI为1．02～1．61）。（4）没有足够证据表明早期常规人工破膜能够对羊水胎粪污染的发生产生影响（OR=1．17,95％CI为0．78～1．73）,但可能降低新生儿1分钟Apgar评分〈7分的发生率（OR=0．71,95％CI为0．49～1．03）。结论常规早期人工破膜可缩短产程,并可能减少新生儿1分钟Apgar评分〈7分的发生;但增加第二产程胎心率异常的发生以及有可能会增加剖宫产率。     

新疆策勒县宫颈癌的流行病学调查研究

目的通过新疆和田地区策勒县宫颈癌的流行病学调查结果,探讨降低宫颈癌发病率和病死率的有效措施.方法2003-07-2004-07,以新疆策勒县城及各乡镇周边村的已婚妇女为调查对象,进行问卷调查、妇科检查及宫颈涂片,凡宫颈涂片为非典型细胞以上者在阴道镜下行宫颈活检.结果共调查8020例,其中资料完整可供统计者7971例.发现宫颈癌患者42例,发病率527/10万.平原及山区发病率分别为436/1O万及844/10万.宫颈癌发病率随着年龄的增加而增高.单因素Logistic回归统计分析结果显示,早婚、早孕、早产、多孕、多婚次及宫颈糜烂为宫颈癌的危险因素.多因素Logistic回归分析显示,初婚年龄≤16岁的妇女患宫颈癌的危险是≥18岁的3.54倍（OR=3.54,95%CI 1.26～9.93）,P＜O.05.宫颈糜烂Ⅱ度者患宫颈癌的危险性是正常宫颈者的5.17倍（OR=5.170,95%CI 1.71～15.59）,P＜0.01;宫颈糜烂Ⅲ度者是11.95倍（OR=11.95,95%CI2.14～66.53）,P＜O.01.结论新疆策勒县是宫颈癌高发区,应在该地区对30岁以上的女性定期行宫颈涂片检查.早婚及宫颈糜烂是该地区宫颈癌发病的主要危险因素.     

尾加压素Ⅱ基因多态性与妊娠期糖尿病遗传易感性的关系

目的探讨尾加压素Ⅱ基因rs228648位点单核苷酸多态性与妊娠期糖尿病（GDM）发病的关系。方法应用聚合酶链反应-限制性内切酶片段长度多态性（PCR—RFLP）技术;采用病例一对照研究的方法,对中国北方地区无血缘关系的70例GDM孕妇（GDM组）和70例正常妊娠妇女（对照组）的尾加压素Ⅱ基因rs228648位点（G—A）进行单核苷酸多态性分析。结果（1）两组孕妇尾加压素Ⅱ基因rs228648位点各基因型频率分布均符合Hardy-Weinberg平衡榆验,具有群体代表性。（2）GDM组孕妇尾加压素Ⅱ基因rs228648位点G等位基因频率为70．7％,对照组为57．9％,两组比较,差异有统计学意义（P〈0．05）;GDM组孕妇尾加压素Ⅱ基因rs228648位点A等位基因频率为29．3％,对照组为42．1％,两组比较,差异也有统计学意义（P〈0.05）。而两组孕妇的G／G基因型频率比较（分别为52．9％和41．4％）,差异无统计学意义（P〉0．05）。（3）尾加压素Ⅱ基因rs228648位点的A／A基因型频率与GDM组呈负相关关系,经多因素logistie同归分析显示,其OR值为0．312,OR值的95％可信区间为0．108～0．900（P=0．031）。结论尾加压素Ⅱ基因rs228648位点单核苷酸多态性可能在GDM遗传易感性中起重要作用。G等位基因可能与GDM发生有关,而尾加压素Ⅱ基因rs228648位点的A型纯合子可能是GDM的重要保护因素。     

宫颈癌HPV型别与预后的关系

目的：探讨不同型别人乳头瘤病毒（HPV）与宫颈癌临床病理及预后的关系。方法;用PCR-RFLP方法,以E6-E7区共用引物对171的宫颈癌组织进行了HPV分型检测。结果：HPV总阳性率为87.7％,其中HPV16为50．3％,HPV18为29．8％,HPV其他型7．6％。在9例有盆腔淋巴结转移的患者中,HPV18阳性的有6／9,高于HPV16的yg和HPVV阴性的1／9（P＜0．05）。HPV18阳性宫颈癌患者的5年存活率为15．2％,低于HPV16阳性的73．1％与HPV阴性的58．3％（P＜0．01,P＜0．05）。在与宫颈癌预后有关的临床、病理及HPV型别的多因素分析中,HPV18与癌周间质细胞反应为有关因素。结论：提示HPV18为影响宫颈癌患者预后的不良因素,HPV分型检测将有助于宫颈癌患者的预后判断。     

国内B族链球菌定植的妊娠晚期孕妇妊娠结局的meta分析

目的 根据国内报道的关于妊娠晚期孕妇B族链球菌（GBS）定植的妊娠结局研究进行meta分析,以期得到GBS引起的孕妇及新生儿不良结局的可靠证据,探索对于孕妇筛查分离培养GBS的意义和价值。方法 在“CNKI中国知网”“Pubmed”“Cochrane”“Embase”多个数据库,检索时间为建库至2022年中国的相关研究,使用Review Manager 5.4软件进行meta分析。结果 共计筛选8项研究,剖宫产、早产、胎膜早破、产后出血和产褥感染5个结局指标的综合OR值为2.94,95%的可信区间为（2.33,3.72）。新生儿窒息与新生儿住院的OR值分别为2.24、1.17,95%可信区间分别为（0.90,5.55）和（0.85,1.60）。胎儿窘迫与新生儿肺炎的OR值分别1.89、5.00,95%的可信区间为（1.17,3.05）和（1.82,13.74）。结论 妊娠晚期GBS定植可能是妊娠不良结局的影响因素,在非感染性妊娠结局中其风险值需要进一步的研究,作为产褥感染以及新生儿败血症的风险因素可能更具有意义。妊娠晚期孕妇筛查分离培养GBS在预防孕妇和新生儿感染性疾病具有一定的意义和...     

Maternal and Perinatal Outcomes Among Adolescents and Mature Women: A Hospital-Based Study in the North of Mexico

Study ObjectiveTo compare maternal and newborn pregnancy outcomes from adolescents and mature women.Design, Setting, and ParticipantsA cross-sectional study was carried out in a public hospital, including women with singleton pregnancies, who were classified according to their age, as follows: group 1: younger than 16 years old (n = 37), group 2: 16-19 years old (n = 288), and group 3: 20-34 years old (n = 632).Interventions and Main Outcome MeasuresInformation on clinical characteristics, gynecological and obstetric history, pregnancy complications, and perinatal outcomes was obtained through interviews and from clinical records.ResultsThirty-four percent of deliveries were from adolescents. Mature women were more likely to have prepregnancy overweight or obesity than adolescents (odds ratio [OR] = 2.4, 95% confidence interval [CI], 1.7-3.4). The frequency of maternal complications during pregnancy or delivery was not different between groups. Birth asphyxia was more frequent in group 2 (P = .02). Women with inadequate prenatal care had an increased risk of preterm deliveries (OR = 1.64; 95% CI, 1.06-2.54) and of having newborns with low birth weight (OR = 2.02; 95% CI, 1.22-3.35). Weight of newborns from noncomplicated pregnancies was lower in group 1 (P = .02), after adjustment for prepregnancy body mass index, gestational weight gain, preterm delivery, and newborn sex.ConclusionThe frequency of maternal and perinatal complications was similar in adolescents and mature women. Birth weight was decreased in noncomplicated pregnancies of adolescents younger than 16 years of age. Adequate prenatal care might be helpful in prevention of some adverse perinatal outcomes.     

Prevalence and risk factors of HPV infection among high-risk rural and urban Lithuanian women

AIMS: To investigate the prevalence, persistence and risk factors of high oncogenic risk human papillomavirus (HPV) among urban and rural women of reproductive age coming to consult a gynaecologist. METHODS: A prospective cohort study in urban (Kaunas) and rural (Marijampole) regions of Lithuania. The data were collected in 8 healthcare institutions from women seeking consultation of gynaecologists using a questionnaire for finding out demographic, social, behavioural and biomedical factors. HPV DNA was determined by molecular hybridization method (hybrid capture version II) determining HPV of high oncogenic risk. RESULT: 1,120 women participated in the study. The prevalence of high-risk HPV among the studied women was 25.1%. It was higher among the urban women than among the rural women. The prevalence of high-risk HPV was increased if the subjects had 2 or more sexual partners during the last 12 months (OR 2.81; 95% CI 1.83-4.32), were 19 years of age or younger (OR 2.68; 95% CI 1.47-4.91), were smoking (OR 1.81; 95% CI 1.16-2.81), and had secondary or lower education level (OR 1.43; 95% CI 1.01-2.04). This infection was obviously associated with high- and low-grade squamous intraepithelial changes of the cervix (OR 1.66, 95% CI = 1.08-2.53). CONCLUSION: The incidence rate for cervical cancer in Lithuania is one of the highest in comparison with other European countries. HPV infection was also particularly common in the studied population. About one-fourth of the women were infected with high-risk HPV infection. Young and less educated women were found to be the group that was most exposed to HPV, and therefore public health interventions and education seem to be essential in programs aimed at reducing the incidence of cervical cancer.     

超声测量宫颈长度与剖宫产术后阴道分娩成功的相关性

目的:分析剖宫产术后阴道分娩(VBAC)的影响因素。方法:选取剖宫产术后阴道试产(TOLAC)的114例孕妇。超声测定其宫颈长度,根据最终是否成功VBAC分为成功组和失败组,采用单因素和多因素Logistic回归分析影响VBAC的因素,观察宫颈长度是否是影响VBAC的独立因素。结果:TOLAC成功率为46.49%。单因素分析显示,成功组和失败者的年龄、出血量、孕产次、距上次剖宫产时间、上次是否进入产程、分娩孕周、阴道分娩史等比较,差异均无统计学意义(均P0.05);成功组的自然临产率和分娩镇痛率均较失败组高(均P0.05),新生儿体重低于失败组(P0.05)。Logistics多因素分析显示,自然临产和宫颈长度为VBAC的独立影响因素,自然临产(B=3.014,P0.001,OR=20.372)为TOLAC成功的保护因素,宫颈长度为TOLAC成功的危险因素(B=-0.091,P0.05,OR=0.913)。成功组的平均宫颈长度(19.86±11.05)mm,明显短于失败组[(28.61±7.75)mm](P0.01)。宫颈长度每减少1mm对TOLAC成功的优势比为1.095。结论:自然临产是TOLAC成功的有利因素,超声测量的宫颈长度为TOLAC成功率的独立影响因素。     

Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes

Objective

To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis.

Study design

A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders.

Results

Out of 219,612 singleton deliveries in 1988–2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p < 0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p < 0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p < 0.001), placental abruption (3.6% vs. 0.7%, p < 0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p < 0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p < 0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p < 0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4–2.9; p < 0.001), UTI (OR 10.3; 95% C.I 4.8–22.1; p < 0.001) and younger maternal age (OR 0.96; 95% C.I 0.93–0.99; p = 0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7–3.9; p < 0.001).

Conclusion

Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery.     

Tubal ligation frequency in Oklahoma women with cervical cancer

Objective

Infrequent Pap screening is an important risk factor for cervical cancer. We studied the association between contraceptive methods, screening frequency, and cancer.

Methods

Women (n = 2004) enrolled in the cross-sectional Study to Understand Cervical Cancer Endpoints and Determinants (SUCCEED) underwent colposcopy to evaluate an abnormal Pap test. Questionnaire data were compared between those with cervical intraepithelial neoplasia (CIN) 3/adenocarcinoma in situ (AIS) and those with invasive cancer to identify factors associated with cancer. Logistic regression was used to calculate age-stratified measures of association between contraceptive method and Pap frequency as well as tubal ligation (TL) and cancer risk.

Results

In all age groups, women with TL were more likely to have had no Pap screening in the previous 5 years compared to women using other contraception: 26-35 years (OR 4.6, 95% CI 2.4-8.6; p < 0.001), 36-45 years (OR 3.8, 95% CI 2.1-7.0; p < 0.001), and 46-55 years (OR 2.2, 95% CI 1.0-4.9; p = 0.050). Subjects with cancer (n = 163) were more likely to have had a TL (41% vs. 21%, p < 0.001) than those with CIN 3/AIS (n = 370). Age-stratified analyses showed increased odds of tubal ligation in women with cancer versus those with CIN 3/AIS between 25 and 45 years, with a significant increase in women 26 to 35 years old (OR 3.3, 95% CI 1.4-8.1; p = 0.009). Adjusting for Pap frequency changed the effect only slightly, suggesting that increased risk was not fully mediated by lack of screening.

Conclusion

Contraceptive type is associated with Pap screening. Women with TLs obtain less frequent Pap testing and may be at an increased risk for cervical cancer.     

年轻宫颈癌患者的病理特点和预后分析

目的比较年轻宫颈癌患者（≤35岁）和年龄大的患者（〉35岁）的病理特点和预后差异,初步探讨年轻宫颈癌患者的预后特点。方法采用回顾性分析的方法,通过小年龄≤35岁（研究组）患者与大年龄〉35岁（对照组）患者进行比较,分析年轻宫颈癌患者的预后因素和预后特点。结果 2002年1月至2004年12月间共有352例患者,其中年龄≤35岁者51例（14.5%）,〉35岁者301例（85.5%）。肿瘤期别在两组间存在差别,差异有统计学意义（P=0.001）：研究组ⅠA2期、ⅠB2期患者数多于对照组（9.8%vs0.3%,P=0.03;33.3%vs22.9%,P=0.04）;肿瘤病理学类型在两组间的差异有统计学意义,研究组中非鳞癌患者所占比例大于对照组（19.6%vs5.3%,P〈0.001）。研究组和对照组患者的平均生存时间分别为81.8个月和91.0个月,未发现两组患者的生存曲线存在统计学差异。对年龄≤35岁的患者使用Cox模型进行单因素及多因素分析,结果显示淋巴结转移（HR=20.515,P〈0.001）、间质深层浸润（HR=4.358,P〈0.001）、肿瘤分化（HR=3.688,P〈0.001）、肿瘤体积（直径是否超过4cm）（HR=3.206,P〈0.001）和分期（HR=3.020,P〈0.001）是影响预后的危险因素;多因素分析发现淋巴结转移（HR=11.858,P〈0.001）、肿瘤分化（HR=2.666,P=0.001）、肿瘤分期（HR=2.011,P〈0.001）是影响预后的高危因素。结论年龄≤35岁的宫颈癌患者更容易出现非鳞状细胞癌;未发现年轻宫颈癌患者（≤35岁）和年龄大患者（〉35岁）在预后方面存在差异;对于年轻患者淋巴结转移、肿瘤分化差、间质深层肿瘤浸润、肿瘤为巨块型（直径超过4cm）和临床分期高与预后不良有关,其中肿瘤分期、淋巴结转移和肿瘤分化是独立的预后因素。     

Postoophorectomy Estrogen Use and Breast Cancer Risk

OBJECTIVE:: To estimate whether the protective effect of premenopausal bilateral oophorectomy on breast cancer risk is mitigated by estrogen therapy use after surgery. METHODS:: In pooled data from four population-based case-control studies spanning 1992-2007, we examined estrogen use after total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) and subsequent breast cancer risk. We identified cases of postmenopausal invasive breast cancer in women (n=10,449) aged 50-79 years from three state tumor registries and age-matched control group participants without breast cancer (n=11,787) from driver's license and Medicare lists. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and estrogen use were queried during structured telephone interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression. RESULTS:: Breast cancer risk comparisons were made relative to women who experienced natural menopause and never used hormones. Overall, breast cancer risk increased 14% among women currently using estrogens after TAHBSO (OR 1.14, 95% CI 1.03-1.28), 32% for estrogen durations less than 10 years (OR 1.32, 95% CI 1.11-1.57), and 22% for estrogen initiation within 5 years of TAHBSO (OR 1.22, 95% CI 1.09-1.37). Among women who underwent early TAHBSO (younger than 40 years), 24-30% decreases in breast cancer risk were observed among both never (OR 0.70, 95% CI 0.55-0.88) and current (OR 0.76, 95% CI 0.61-0.96) estrogen users. CONCLUSION:: Unopposed estrogen use does not negate the reduction in breast cancer risk associated with early (younger than 40 years) bilateral oophorectomy. However, initiating estrogen therapy after TAHBSO at ages 45 and older can increase breast cancer risk and should be considered carefully. LEVEL OF EVIDENCE:: II.     

Perineal talc exposure and subsequent epithelial ovarian cancer: a case-control study

OBJECTIVE: To evaluate the role of talcum powder use as a risk factor for the development of epithelial ovarian cancer. METHODS: In a case-control study, 499 patients with epithelial ovarian cancer were frequency matched for age at diagnosis (-5 years) with a control population of 755 patients. The odds ratio (OR) for the development of epithelial ovarian cancer was estimated using logistic regression analysis with adjustment for age at diagnosis, parity, oral contraceptive use, smoking history, family history of epithelial ovarian cancer, age at menarche, menopausal status, income, education, geographic location, history of tubal ligation, and previous hysterectomy. RESULTS: Two hundred twenty-one of 462 patients (47.8%) in the study population and 311 of 693 patients (44.9%) in the control population had ever used talcum powder (OR 0.92; 95% confidence interval [CI] 0.24, 3.62). A significant association between duration of talc use and development of epithelial ovarian cancer was not demonstrable for 1-9 years (OR 0.9; 95% CI 0.6, 1.5), for 10-19 years (OR 1.4; 95% CI 0.9, 2.2), or for more than 20 years (OR 0.9; 95% CI 0.6, 1.2). To eliminate the possible confounding variable of surgery for the management of ovarian cancer, we omitted 135 patients in the study population who underwent hysterectomy within 5 years of the diagnosis of ovarian cancer. Within this subgroup of patients, tubal ligation or hysterectomy among talc users still failed to demonstrate an increased risk for the development of ovarian cancer (OR 0.9; 95% CI 0.4, 2.2). CONCLUSION: A significant association between the use of talcum powder and the risk of developing epithelial ovarian cancer is not demonstrable, even with prolonged exposure.     

Obstetric risks of pregnancy in women less than 18 years old

OBJECTIVE: To quantify the age-related risks of adverse outcome during pregnancy in women less than 18 years old. METHODS: We analyzed data from 341,708 completed singleton pregnancies in the North West Thames region between 1988 and 1997. Pregnancy outcomes were compared by age at delivery in women less than 18 years old (n = 5246) and 18-34 years old (n = 336,462); women 35 years old or older (n = 48,658) were excluded. Data are presented as percentages of women less than 18 and 18-34-year-old women, with adjusted odds ratios (OR) and 99% confidence intervals (CI). RESULTS: Pregnancy in women less than 18 years old was associated with increased risk of preterm labor before 32 weeks' gestation (OR 1.41, CI 1.02, 1.90), maternal anemia (OR 1.82, CI 1.63, 2.03), chest infection (OR 2.70, CI 1.21, 6.70), and urinary tract infection (OR 1.60, CI 1.11, 2.31), but less obstetric intervention. Operative vaginal delivery (OR 0. 46, CI 0.41, 0.56), elective cesarean (OR 0.47, CI 0.35, 0.65), or emergency cesarean (OR 0.45, CI 0.38, 0.53) were all less likely in women aged less than 18 years. Women less than 18 years old were no more likely to have stillbirths (OR 0.75, CI 0.42, 1.34) or small-for-gestational-age infants (OR 0.95, CI 0.82, 1.09) than women aged 18-34 years. CONCLUSION: Pregnant women less than 18 years old were more likely to deliver preterm than older women. In most other respects they have less maternal and perinatal morbidity and were more likely to have normal vaginal deliveries.     

A population-based study of squamous cell vaginal cancer: HPV and cofactors.

BACKGROUND: Little is known about the etiology of in situ or invasive squamous cell cancer of the vagina. It is thought that some vaginal cancers may have the same etiology as cervical cancer. It is also not known whether in situ and invasive vaginal cancer share the same etiologic factors. We conducted a study to evaluate risk factors for in situ and invasive vaginal cancer and their potential relationship to prior exposure to human papillomaviruses (HPV). METHODS: A population-based case-control study included 156 women with squamous cell in situ or invasive vaginal cancer diagnosed between January 1981 and June 1998 and 2041 control women identified through random-digit dialing in western Washington state. Cases and controls were interviewed in person and provided blood samples; archival tumor tissue was retrieved for cases. Blood samples were tested for antibodies to HPV, and tumor tissue was tested for HPV DNA. RESULTS: Women with vaginal cancer were more likely to have five or more lifetime sexual partners (OR = 3.1, 95% CI 1.9 to 4.9), to have an early age at first intercourse (<17 years OR = 2.0, 95% CI 1.2 to 3.5), and to be current smokers at diagnosis (OR = 2.1, 95% CI 1.4 to 3.1) than control women. Approximately 30% of all cases had been treated for a prior anogenital tumor, most often of the cervix. Prior hysterectomy was a risk factor only among women who had no history of prior anogenital cancer (OR = 3.9 95% CI 2.5 to 6.1). Antibodies to HPV16 L1 were strongly related to risk of vaginal cancer (OR = 4.3, 95% CI 3.0 to 6.2). We detected HPV DNA in tumor blocks from over 80% of the patients with in situ and 60% of the patients with invasive cancers. CONCLUSIONS: In situ and invasive vaginal neoplasia have many of the same risk factors as cervical cancer, including a strong relationship to HPV infection. Women who have been treated for a prior anogenital cancer, particularly of the cervix, have a high relative risk, although low absolute risk, of being diagnosed with vaginal cancer.