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Start Over Author "Ralph" Journal american journal of obstetrics and gynecology
2,459 results on '"Ralph"'

10. Accuracy of self-assessment of gestational duration among people seeking abortion

Author

Lauren J. Ralph, Katherine Ehrenreich, Rana Barar, M. Antonia Biggs, Natalie Morris, Kelly Blanchard, Nathalie Kapp, Ghazaleh Moayedi, Jamila Perritt, Elizabeth G. Raymond, Kari White, and Daniel Grossman

Subjects
Abortion, Spontaneous, Mifepristone, Self-Assessment, Pregnancy, Obstetrics and Gynecology, COVID-19, Humans, Abortion, Induced, Female, Gestational Age, General Medicine, Misoprostol
Abstract

Mifepristone, used together with misoprostol, is approved by the United States Food and Drug Administration for medication abortion through 10 weeks' gestation. Although in-person ultrasound is frequently used to establish medication abortion eligibility, previous research demonstrates that people seeking abortion early in pregnancy can accurately self-assess gestational duration using the date of their last menstrual period.In this study, we establish the screening performance of a broader set of questions for self-assessment of gestational duration among a sample of people seeking abortion at a wide range of gestations.We surveyed patients seeking abortion at 7 facilities before ultrasound and compared self-assessments of gestational duration using 11 pregnancy dating questions with measurements on ultrasound. For individual pregnancy dating questions and combined questions, we established screening performance focusing on metrics of diagnostic accuracy, defined as the area under the receiver operating characteristic curve, sensitivity (or the proportion of ineligible participants who correctly screened as ineligible for medication abortion), and proportion of false negatives (ie, the proportion of all participants who erroneously screened as eligible for medication abortion). We tested for differences in sensitivity across individual and combined questions using McNemar's test, and for differences in accuracy using the area under the receiver operating curve and Sidak adjusted P values.One-quarter (25%) of 1089 participants had a gestational duration of70 days on ultrasound. Using the date of last menstrual period alone demonstrated 83.5% sensitivity (95% confidence interval, 78.4-87.9) in identifying participants with gestational durations of70 days on ultrasound, with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.79-0.85) and a proportion of false negatives of 4.0%. A composite measure of responses to questions on number of weeks pregnant, date of last menstrual period, and date they got pregnant demonstrated 89.1% sensitivity (95% confidence interval, 84.7-92.6) and an area under the receiver operating curve of 0.86 (95% confidence interval, 0.83-0.88), with 2.7% of false negatives. A simpler question set focused on being10 weeks or2 months pregnant or having missed 2 or more periods had comparable sensitivity (90.7%; 95% confidence interval, 86.6-93.9) and proportion of false negatives (2.3%), but with a slightly lower area under the receiver operating curve (0.82; 95% confidence interval, 0.79-0.84).In a sample representative of people seeking abortion nationally, broadening the screening questions for assessing gestational duration beyond the date of the last menstrual period resulted in improved accuracy and sensitivity of self-assessment at the 70-day threshold for medication abortion. Ultrasound assessment for medication abortion may not be necessary, especially when requiring ultrasound could increase COVID-19 risk or healthcare costs, restrict access, or limit patient choice.

Published
2021

30. Bleeding complications with tension-free vaginal tape operation

Author

Kolle, Dieter, Bader, Arnim, Tamussino, Karl, Enzelsberger, Hermann, Hanzal, Engelbert, Ralph, George, Tammaa, Ayman, Riss, Paul, and Preyer, Oliver

Subjects
Hysterectomy -- Health aspects, Vagina -- Hemorrhage, Vagina -- Health aspects, Vagina -- Care and treatment, Health
Abstract

A study to analyze bleeding problems with tension-free vaginal tape (TVT) operations in a national registry is presented. Bleeding complications are seen in less than 3% of the 5578 TVT operations while it is observed that in most cases the bleeding was managed conservatively and only 0.8% of the cases required conversion or reoperation.

Published
2005

31. The role of ultrasound evaluation in the detection of early-stage epithelial cancer

Author

Fishman, David A., Bozorgi, Kenny, Cohen, Leeber, Tamura, Ralph, Blank, Stephanie V., Timor-Tritsch, Ilan, Shulman, Lee, Schwartz, Peter E., and Singh, Diljeet

Subjects
Pregnant women -- Health aspects, Ultrasound imaging -- Usage, Ovarian cancer -- Diagnosis, Epithelial tumors -- Diagnosis, Health
Abstract

The usefulness of sonography in the detection of early-stage epithelial ovarian cancer in asymptomatic high-risk women who participated in the National Ovarian Cancer Early Detection Program is examined. The study demonstrated the limited value of diagnostic ultrasound examination as an independent modality for the detection of early-stage epithelial ovarian cancer in asymptomatic women who are at increases risk for disease.

Published
2005

43. Five-year results after anti-incontinence operations

Author

Tamussino, Karl F., Zivkovic, Franjo, Pieber, Doris, Moser, Franz, Haas, Josef, and Ralph, George

Subjects
Urinary incontinence, Health
Abstract

Anterior colporrhaphy may be effective in women with mild urinary incontinence but the Burch colposuspension should be used for women with severe incontinence. This was the conclusion of a five-year follow-up of 327 women who received either operation for urinary incontinence.

Published
1999

44. Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome

Author

Yaron, Yuval, Cherry, Michele, Kramer, Ralph L., O'Brien, Joseph E., Hallak, Mordechai, Johnson, Mark P., and Evans, Mark I.

Subjects
Pregnancy, Complications of -- Diagnosis, Chorionic gonadotropin, Alpha fetoproteins, Health
Abstract

The same blood tests that are used to detect Down syndrome can detect other complications of pregnancy such as preeclampsia, miscarriage, premature labor, fetal growth restriction, fetal death, and placental abruption. The test measures alpha fetoprotein, unconjugated estriol, and human chorionic gonadotropin.

Published
1999

46. Managed health care and resident education

Author

Golditch, Ira M., Anderson, Ralph J., and Williams, Sterling B.

Subjects
Residents (Medicine) -- Training, Obstetrics -- Study and teaching, Managed care plans (Medical care) -- Surveys, Health
Abstract

Managed care appears to be impacting many resident training programs. Researchers surveyed 210 directors of obstetrics-gynecology resident training programs. Sixty-three percent felt that obstetrician-gynecologists should be the primary care physician for women but over 20% said their contracts with managed care organizations restricted or limited the involvement of their residents in the care of patients. Fifty-nine percent of the programs have seen a drop in the number of patients and 47% have experienced budget cutbacks.

Published
1998

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