Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease.

OBJECTIVE: The purpose of this study was to assess postmenopausal women with endometrial fluid collection and the risk of significant endometrial or cervical disease. METHODS: A retrospective chart review was conducted of 343 postmenopausal women with endometrial fluid collection on pelvic sonography. Medical records were reviewed to identify women who underwent an evaluation of the endometrium with endometrial biopsy, hysteroscopy, or hysterectomy after the sonographic examination. Clinical and sonographic characteristics were compared between women with diagnoses of cervical or endometrial cancer or hyperplasia (nonbenign group) and women with benign conditions (benign group). RESULTS: The endometrium was significantly thicker in the nonbenign group compared with the benign group (mean +/- SD, 9.9 +/- 7.4 versus 5.9 +/- 4.1 mm; P = .016). None of the patients with adenocarcinoma of the endometrium had endometrial thickness of 3 mm or less, but 2 with endocervical cancer did. Echogenic fluid in the endometrial cavity was significantly more likely to be found in the nonbenign group compared with the benign group (45.8% versus 4.8%; P < .01). Multivariate logistic regression analysis revealed that echogenic fluid in the endometrial cavity was the only significant risk factor for nonbenign conditions (odds ratio, 10.94; 95% confidence interval, 2.67-44.84; P < .01). CONCLUSIONS: Postmenopausal women with endometrial fluid collection on sonography should undergo endometrial sampling if the endometrial lining is thicker than 3 mm or the endometrial fluid is echogenic. If the lining is 3 mm or less and the endometrial fluid is clear, endometrial sampling is not necessary, but we recommend endocervical sampling to rule out endocervical cancer.     

Is antiretroviral therapy during pregnancy associated with an increased risk of preterm delivery, low birth weight, or stillbirth?

BACKGROUND: Data on complications of pregnancy associated with antiretroviral therapy are limited. Some small studies have demonstrated an increased preterm delivery rate, but a recent retrospective United States multisite study did not concur with these findings. Our objective was to investigate whether antiretroviral therapy was associated with adverse pregnancy outcome at a single site. METHODS: Using prospectively gathered data, women were identified who were determined to be human immunodeficiency virus positive before or during pregnancy who sought care at our prenatal clinic and who gave birth at the University of Miami/Jackson Memorial Medical Center from 1990 through 2002. The outcome measures were preterm delivery, low birth weight, and stillbirth. RESULTS: The cohort included 999 women who received antiretroviral therapy during pregnancy (monotherapy in 492, combination therapy without a protease inhibitor [PI] in 373, and combination therapy with a PI in 134) and 338 women who did not receive therapy. After adjustment for possible confounders, only combination therapy with a PI was associated with an increased risk of preterm delivery, compared with any other combination (odds ratio, 1.8 [95% confidence interval, 1.1-3.0]). There were no differences in rates of low birth weight and stillbirth, regardless of therapy. CONCLUSION: Compared with monotherapy and combination therapy without a PI, only combination therapy with a PI was associated with an increased risk of preterm delivery.     

Outcome of pregnancies among Hispanics: revisiting the epidemiologic paradox

OBJECTIVE: To evaluate the outcome of pregnancies among Hispanics in a tertiary care hospital in Miami, Florida. STUDY DESIGN: Retrospective study of all women who delivered in our institution over an 11-year period. Outcome variables were stratified by race/ethnicity groups: Hispanics, non-Hispanic blacks and non-Hispanic whites. Variables included rates of low birth weight (LBW), preterm delivery (PTD) and other selected pregnancy outcomes. RESULTS: Thirty-five percent were of Hispanic origin, mainly of Caribbean, Central American and South American origin. Hispanics had the lowest rate of LBW (9%) when compared to blacks, non-Hispanics (18%) and white non-Hispanics (11%) (p < 0.0001). Hispanic women were less likely to deliver prematurely, at < 37 weeks (adjusted odds ratio [AOR] 0.68, 95% CI 0.65-0.91, p < 0.0001), < 32 weeks (AOR 0.57, 95% CI 0.52-0.63, p < 0.0001) and < 28 weeks (AOR 0.66, 95% CI 0.51-0.65, p < 0.0001). Hispanic women were less likely to have preterm premature rupture of membranes (AOR 0.66, 95% CI 0.58-0.75, p < 0.0001). CONCLUSION: Hispanics have the lowest PTD and LBW rates when compared to non-Hispanic whites and blacks.