Approach For Pregnant Women Research Articles

Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Objective To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. Methods Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients’ demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. Results No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It’s worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). Conclusion EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.

Is There a Difference in the Proteomic Profile of Stimulated and Unstimulated Saliva Samples from Pregnant Women with/without Obesity and Periodontitis?

This study aimed to compare the proteomic profile of stimulated and unstimulated saliva samples from pregnant women with/without obesity and periodontitis. Pregnant women were allocated into four groups: with obesity and periodontitis (OP); with obesity but without periodontitis (OWP); with normal BMI but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Stimulated saliva (SS) and unstimulated saliva (US) samples were collected, and salivary proteins were extracted and individually processed by proteomic analysis (nLC-ESI-MS/MS). Proteins involved with the immune response process, antioxidant activity, and retina homeostasis were decreased or absent in SS samples from all groups (i.e., Antileukoproteinase, Lysozyme C, Alpha-2-macroglobulin-like protein 1, Heat shock proteins—70 kDa 1-like, 1A, 1B, 6, Heat shock-related 70 kDa protein 2, Putative Heat shock 70 kDa protein 7, Heat shock cognate 71 kDa). Additionally, proteins related to the carbohydrate metabolic process and glycolytic and glucose metabolic process were absent in SS, mainly from OP and OWP (i.e., Frutose-bisphosphate aldose A, Glusoce-6-phosphate isomerase, Pyruvate kinase). Saliva stimulation decreased important proteins involved with immune response and inflammation process in all groups. Unstimulated salivary samples seem to be the best choice for the proteomic approach in pregnant women.

Application of the Pilates method and kinesiotherapeutic approach in pregnant women with low back pain: an integrative review

The gestational period is characterized by several changes in the female body, which come from mechanical and/or hormonal activities. A number of changes take place with the main objective of maintaining and facilitating the healthy development of the fetus. Low back pain is one of the main musculoskeletal complaints referred to during pregnancy, and it is estimated that more than 50% of pregnant women are affected by low back pain, especially in the third trimester of pregnancy. Physiotherapy, through kinesiotherapy and the Pilates method, enables the treatment of gestational low back pain, as well as the prevention of this disorder. Thus, the general objective of the research is to investigate the benefits of the Pilates method and kinesiotherapy in pregnant women with low back pain. Therefore, the specific objectives are to know the biomechanical changes of the gestational period, to understand the most common pathological changes that occur in the pregnancy period, to understand the so-called gestational low back pain, to know about the importance of physiotherapy in the care of pregnant women and to learn about the Pilates method and kinesiotherapy applied in this phase of female life. It is, therefore, an integrative review of the literature of a qualitative nature, and, for its preparation, the following descriptors were used: "Pregnant women", "Lumbar pain", "Pilates method", "Exercise therapy" in Portuguese , English and Spanish. The work was produced in the year 2022, between the months of March and May. The years 2012 to 2022 were established as a delimitation, with emphasis and preference being given to research from the last 5 years. The databases consulted were: Scientific Electronic Library Online (SciELO), PEDRo and the Virtual Health Library (BVS). The main finding of this research was the evidence that the Pilates method is extremely superior to the non-treatment used by the control groups of randomized clinical trials for the treatment of gestational musculoskeletal pain. The Pilates method was also beneficial for controlling the progression of diastasis, increasing mobility, functionality and functional capacity, increasing strength and resistance of the abdominal and pelvic floor muscles. It was also evidenced that the regular practice of physical exercises is recommended for pregnant women, being the moderate intensity, the duration of 150 minutes per week distributed in the frequency of 3 days a week, in sessions that vary between 30 and 60 minutes. Furthermore, it is concluded that kinesiotherapy and the Pilates method have been applied for the treatment and prevention of gestational low back pain. Both are necessary for the improvement of physical conditioning, sleep improvement, pain relief and musculoskeletal discomfort caused by the gestational process.

Symptomatic Hydronephrosis and Ureteral Calculi in Pregnancy: A Narrative Review with a Proposed Management Protocol.

Introduction: Approximately 3% of pregnancies are complicated by symptomatic hydronephrosis and up to 0.8% with urolithiasis. Pain, coupled with the possibility of superimposed infection, increases the risks of premature labor and delivery, fetal loss, and caesarian sections. Surgical intervention as well as standard ionizing radiation imaging modalities are typically avoided making this a difficult, high-risk patient cohort to manage. In this study we propose a standardized contemporaneous approach to investigations and management in the pregnant population with acute upper tract pathology analysis. Methods: A literature search of PubMed, Cochrane, and EMBASE databases was performed to identify original, peer-reviewed articles from 2010 onward on the management of ureteral calculi and symptomatic hydronephrosis occurring during pregnancy. Search yielded 5636 articles and after exclusions, 24 full-text articles met inclusion criteria for analysis. Evidence Synthesis: Ultrasound remains the cornerstone of initial investigation with MRI in reserve if the diagnosis remains uncertain. Low-dose CT imaging can be used in limited cases. Conservative approaches for symptomatic hydronephrosis as well ureteral calculi is the preferred initial management option in the well patient. If intervention is required, ureteral stent and nephrostomy can be used with informed consent on the risks and benefits of each. Primary ureteroscopy with definitive stone management in centers with the appropriate expertise can safely deliver excellent stone-free rates and symptomatic improvement. Conclusions: Individualized investigation and management plans following a structured approach in pregnant women with symptomatic hydronephrosis or calculi are discussed. At all stages, the patient, obstetrician, anesthetist, and surgeon should be involved in a shared decision-making approach.

Torsión anexial en una gestación espontánea. A propósito de un caso

Adnexal torsion during pregnancy is a rare event mainly associated with the use of assisted reproductive techniques. However, it can occasionally also occur in spontaneous pregnancies without any predisposing factors. Its nonspecific clinical presentation in addition to the sometimes limited sensitivity of the gold standard test, Doppler ultrasound, leads to difficulty in preoperative diagnosis. For this reason, in most cases it is necessary to perform a laparoscopy in order to directly visualize the twisted ovary to obtain diagnostic confirmation. This is why, nowadays, adnexal torsion continues to be considered a diagnostic dilemma that should not delay the therapeutic approach, since a delay over 48 hours associates several irreversible lesions of the adnexa. At present, laparoscopy is the main surgical approach in pregnant women with suspicion of adnexal torsion due to the safety and advantages it provides. Keywords: Adnexal torsion, pregnancy, ovarian cyst, gynecological laparoscopy

Prophylactic therapeutic plasma exchange in pregnant woman with Familial Chylomicronemia Syndrome – A case report

ContextFamilial Chylomicronemia Syndrome (FCS) is an inherited disease where lack of lipoprotein lipase results in severe hypertriglyceridemia that frequently leads to recurrent acute pancreatitis. Pregnancy in patients with familial chylomicronemia syndrome (FCS) post a risk for mother and baby with potential complications (pancreatitis, miscarriage and death). Therapeutic approach includes strict dietary measures and plasma exchange. Despite the development of new drugs for FCS, their safety in pregnancy has not yet been confirmed. Case descriptionWe present a case of a young, pregnant female with FCS who had miscarriage in the past during one episode of acute pancreatitis. Due to the inability to achieve lower TG levels with current therapy, from 27-th week of pregnancy we have started prophylactic therapeutic plasma exchange (two times per week). Patient was followed up until the delivery of a healthy baby boy and did not experience an episode of acute pancreatitis. ConclusionsWith adequate supervision and monitoring therapeutic plasma exchange represents a safe approach in pregnant women with FCS in order to reduce TGs and prevent pancreatitis. Therefore, we prevented potential complications for both mother and child.

The Cultural Assessment Model as an Evaluation Indicator for Nutritional Adequacy in Pregnant Women with Pre-eclampsia

BACKGROUND: Pre-eclampsia is one of the complications of pregnancy in many communities with low socioeconomic conditions. The lack of intake of quality nutrition can be a precipitating factor in the occurrence of this complication. AIM: This study aims to find out the nutritional adequacy for pregnant women through the transcultural model assessment using correlational design and a cross-sectional approach in pregnant women at the third trimester. MATERIALS AND METHODS: The diagnosis of pre-eclampsia was identified through a blood pressure of 140/90 mmHg and proteinuria. There were 222 samples with purposive sampling. The data were obtained through questionnaires and the interview results were used as secondary data. The data were analyzed using the Chi-square test, odds ratio (OR) with confidence intervals (CI) of 95%, and the alpha value of 0.05. RESULTS: The analysis of the nutritional adequacy with the incidence of pre-eclampsia confirmed that the carbohydrate with OR of 5.250 (OR = 3.545, 95% CI = 2.098, 13.158), folic acid (OR = 16,838, 95% CI = 2.222, 127.64), and vegetable (OR of 4.00, 95% CI = 1.619, 9.885) which are related to the incidence of pre-eclampsia. CONCLUSION: The fulfillment of the daily nutrition of pregnant women is greatly influenced by the culture and myth developed in society. An assessment using the transcultural model approach can give a lot of information about the influence of culture in pregnant women’s daily life.

Holistic Approach in Pregnant Women with COVID-19

Koronavirüs hastalığı (COVID-19) yeni keşfedilen bir korona virüs türünün neden olduğu bir enfeksiyon hastalığıdır. İlk vakalar 2019’un Aralık ayında Çin’in Wuhan şehir merkezinde görülmüştür. Korona virüs salgının hızla yayılması ile Dünya Sağlık Örgütü tarafından ‘Uluslararası Öneme Sahip Acil Halk Sağlığı Durumu’ olarak ilan edilmiştir. Hastalığın ciddi enfektivitesi ve gebelik üzerine olan etkilerinin büyük ölçüde bilinmemesi nedeni ile gebelik süreci ile ilgili endişeler de artmaktadır. Gebelik immün sistemin kısmi olarak baskılandığı bir durumdur ve mevcut kanıtlar COVID-19 enfeksiyonunun gebelikte Şiddetli Akut Solunum Yolu Sendromu (SARS-CoV) ve Orta Doğu Solunum Sendromu’na (MERS-CoV) neden olan virüslere oranla daha az agresif seyrettiğini gösterse de gebeler özel bakım gerektiren, hastalığa karşı dayanıksız bir popülasyon olarak düşünülmelidir. Pandemi sürecinde gebelerin özel bakımının ve ihtiyaçlarının karşılanmasında, holistik bakıma olan ihtiyaç artmaktadır. COVID-19 hastalığında gebelerin bakımı, modern sağlık bakım kavramlarının yanı sıra holistik (bütünsel) bir yaklaşımla ele alınmalıdır. Gebelerin özel bakımının karşılanması ve hastalığın yönetiminde holistik bakım yöntemi ebelere ve hemşirelere rehberlik edebilir. Gebelerin tüm salgın sürecinde holistik bakım alması bakımın kalitesinin artması açısından önemlidir.

Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden.

Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking. We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved. During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174). In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that obstetric units in regions with low SARS-CoV-2 burden enforce rational use of personal protective equipment and diligent screening protocols using targeted questionnaires, whereas SARS-CoV-2 laboratory testing should be performed only in screen-positives: those with high clinical suspicion of COVID-19 and/or suspected epidemiological history.

312. Treatment of Hepatitis C After Identification of Infection During Universal Screening Approach in Pregnant Women

BackgroundIdentifying asymptomatic individuals with hepatitis C virus (HCV) infection is challenging. Pregnancy presents a unique opportunity to screen women for HCV and then link those positive to care. Universal screening in pregnant women, however, is not recommended by CDC or ACOG. Further, treatment with direct antiviral agents (DAAs) are not currently approved for pregnant women but are warranted following delivery and breastfeeding. We sought to compare treatment uptake before and after universal screening in pregnant women was implemented as the standard of care in our institution and then determine if universal screening leads to increased treatment after pregnancy.MethodsA retrospective analysis of risk-based HCV screening in pregnant women was used for the first period (2014–2015) and a prospective design was used following 18 months of universal screening (2016–2017). Prenatal data were collected from all pregnant women that sought care at our institution in the prospective part of the study. We tested for differences in relevant outcomes (e.g., screening rates, rate of those eligible for treatment, and those who actually received treatment) between the two periods. Finally, we performed a cost-effective analysis of universal screening considering treatment rates.ResultsDuring the universal screening period, more women were screened for HCV and diagnosed with chronic infection. Universal screening was not associated with a significant increase in the odds of women receiving treatment after pregnancy. The increased cost for universal screening was $1060 per patient, resulting in an ICER of $219,391 per additional treatment received or $57,734 per quality-adjusted life-year (QALY) gained, which is below the willingness-to-pay threshold to be cost-effective. Universal screening, however, is cost-effective with an ICER well below the established willingness-to-pay threshold of $100,000 per QALY gained, if all women eligible for treatment receive therapy.ConclusionUniversal screening may not lead to a significant increase in the odds that pregnant women receive DAAs therapy after pregnancy. Barriers to linkage to care should be addressed in an effort to increase antiviral therapy for these women and universal screening should be implemented within this patient population. Disclosures All authors: No reported disclosures.

Physical birth outcomes in neonates prenatally exposed to buprenorphine - our first experiences

Introduction/Objective. Buprenorphine appears generally similar to, and in some cases superior to, methadone in terms of maternal, fetal, and neonatal outcomes. The objective of the study was to assess some physical birth outcomes in neonates prenatally exposed to buprenorphine. Methods. During a seven-year period, nine patients have been treated with buprenorphine during their pregnancy. All women underwent interview, clinical investigations, biochemical analysis, toxicological screening, viral markers for hepatitis B, C, HIV, with regular check-ups by an obstetrician and a psychiatrist. Newborn outcomes included: birth weight in grams, birth length in centimeters, physical anomalies, head/chest circumference in centimeters, Apgar score at 1 minute / 5 minutes, gestational age (weeks), newborn length of hospital stay in days, breast-feeding, the newborn?s need for pharmacologic treatment after delivery. Results. The mean birth weight was 2,991.11 ? 37 g; birth length was 49.44 ? 2.29 cm; head circumference was 33.11 ? 0.78 cm; chest circumference was 32.33 ? 1 cm; first minute Apgar score was 8.22, fifth minute 9.22; age at delivery was 38.77 ? 1.09 weeks; hospitalization after delivery 4.44 ? 1.13 days. None of the newborns had physical anomalies. Six of the newborns were breastfed. Conclusion. Buprenorphine is a safe and important part of a complete comprehensive treatment approach in pregnant women with opioid use disorder. Buprenorphine treatment of maternal opioid use disorder indicated a low risk of preterm birth, normal birth weight and length, head and chest circumference, Apgar score, short hospitalization after delivery.

136 Systematic delivery approach at 37 weeks of gestation in preeclampsia: Maternal and neonatal outcomes

Introduction A systematic delivery approach in pregnant women diagnosed with preeclampsia could avoid risks to both mother and newborn. A study about these outcomes could guide this practice. Objectives Evaluate epidemiological characteristics and compare maternal and neonatal outcomes in gestations with and without preeclampsia. Methods Prospective study with 40 women was developed in Guilherme Alvaro Hospital- Santos/Sao Paulo/Brazil (December/2015–May/2016). Study group: 20 women with preeclampsia according to NHBPEP – National High Blood Pressure Education Program (2000), > 37 weeks. Control group: 20 pregnant women with single and live fetus, > 38 weeks, without comorbidities. Exclusion criteria for study group: twin pregnancy, fetal anomalies and gestational age under 37 weeks. Control group exclusion criteria: twin pregnancy, gestational age under 38 weeks, cesarean/ forceps/ induced vaginal delivery and comorbidities. Maternal variables: age, gestational age at delivery, previous pregnancy history, body mass index (BMI), comorbidities, length of hospital stay, intensive care unit admission, previous preeclampsia and delivery route. Neonatal variables: birth weight, adequacy weight for gestational age, Apgar score, meconium fluid at delivery, intensive care unit admission, acute respiratory distress syndrome, cardiopulmonary arrest, jaundice, oxygen therapy and intrahospital mortality. The statistical comparisons were made using Fisher’s exact test and Tukey multiple comparisons method. Data analysis was performed by calculating odds ratio adoption hypothesis and the rejection level of 0,05. Results Comparison between preeclampsia and normal pregnancies in maternal and neonatal outcomes (* = p 0 , 05 ): Download : Download high-res image (201KB) Download : Download full-size image Conclusions Preeclampsia is more often associated with maternal and neonatal adverse outcomes when compared to the healthy pregnancies. Women diagnosed with preeclampsia appears to be older, have higher body mass index, longer hospital stay (including intensive care unit) and have previous preeclampsia more often than those without this comorbidity. There is a lack of significance in comparing neonatal outcomes between the systematic delivery approach at 37 weeks and the control groups.

Screening cytomegalovirus, rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status.

To determine the prevalence of acute cytomegalovirus (CMV), rubella and T. gondii infections among pregnant women who had no serological status tested for these microorganisms prior to pregnancy in a metropolitan area. A cross-sectional study was undertaken between January 2009 and January 2013 in 1,258 women presenting for their first antenatal visit (between 6 and 11 weeks of gestation). All women were tested for IgG and IgM antibodies. Subsequently, avidity test was utilized for inconclusive results. They were followed until delivery and all newborns were examined by a pediatrician. Presence of IgM antibody positivity alone was not detected in any women. Avidity test excluded primary infection in 15 out of 16 (93.7 %) women who were positive for both IgG and IgM antibodies. Amniocentesis was performed in one case with borderline IgG avidity for T. gondii. No primary infections were detected in any newborn for the infections screened. The prevalences of IgG antibodies were 95 % for rubella, 84.1 % for CMV and 23.1 % for T. gondii. Assessment of IgG and IgM antibodies followed by IgG avidity testing for inconclusive results may be an acceptable approach in pregnant women with unknown serological status prior to pregnancy. Utilization of IgG avidity as a supplemental test prevented unnecessary intervention in IgG and IgM antibodies positive patients. No primary infection was detected for CMV, rubella and T. gondii infections in the urban population screened.

Corrimentos vaginais em gestantes: comparacao da abordagem sindromica com exames da pratica clinica da enfermagem

Estudo avaliativo de abordagem quantitativa, com amostra de 104 gestantes, com o objetivo de comparar os achados de infecções vaginais em gestantes obtidos por meio do fluxograma de corrimento vaginal com exames presentes na prática clínica da Enfermagem. Os dados foram coletados por meio de entrevista e exame ginecológico realizados de janeiro a julho de 2011. O fluxograma não se mostrou eficaz na identificação de candidíase e tricomoníase, apresentou baixa sensibilidade (0,0%; 50%) e valor preditivo positivo (0,0%; 3,6%) para as duas infecções e baixa especificidade para tricomoníase (46%). Mostrou-se satisfatório para vaginose bacteriana, com alta sensibilidade (100%), valor preditivo negativo (100%) e acurácia (74%). Conclui-se que o emprego do fluxograma precisa ser reavaliado, visto que não foi eficaz em identificar infecções importantes em gestantes. Os esforços para o desenvolvimento de testes eficazes devem ser contínuos, com intuito de prevenir a disseminação de infecções e reduzir tratamentos desnecessários.

Using a Multidisciplinary Approach for Pregnant Women With Nicotine Dependence and Co-occurring Disorders

Smoking during pregnancy increases the risk of complications during pregnancy, including low birth weight and prematurity. While smoking prevalence among pregnant women has been declining, pregnant women with co-occurring disorders struggle with smoking cessation not only because they are managing their psychiatric and substance-related conditions but also because they are at greater risk for a number of psychosocial stressors, such as poverty, domestic violence, and limited support. In addition, obstetric, substance abuse, and psychiatric treatment for pregnant women is often fragmented and uncoordinated, resulting in poor health outcomes for mother and baby. The goal of this clinical forum is to demonstrate the potential for multidisciplinary treatment providers and community members to work together toward successfully meeting the complex needs of pregnant women with co-occurring disorders. Following the case presentation, we outline the ways in which patients and their obstetric, psychiatric, and substance abuse treatment providers can work together as a team, often incorporating members of the broader community. In this context, we provide brief overviews of effective pharmacotherapy approaches, psychosocial interventions, as well as community-based interventions for tobacco cessation among pregnant women with co-occurring disorders. In addition, we outline an organizational change model to systematically address tobacco use in clinical settings that serve these patients. We demonstrate that even small efforts to coordinate care can have large payoffs in terms of outcomes for mothers and their babies.

Assessment of intra-hepatic and intra-muscular lipid in obese pregnant women: an application of 3-tesla MRI

BackgroundInsulin resistance is exaggerated in both pregnancy and in obesity: obese pregnant women may display earlier onset or exaggerated insulin resistance which could contribute to some of the pregnant pathology...

Universal Screening Versus Case Finding for Detection and Treatment of Thyroid Hormonal Dysfunction During Pregnancy

Undiagnosed, untreated thyroid disease in pregnant women has a significant risk of adverse outcomes for both the mother and baby. Screening to identify pregnant women who are hypothyroid or hyperthyroid has been advocated using 2 approaches; the first is universal screening of all pregnant women and the second is a case-finding approach (which involves screening only pregnant women with symptoms of thyroid disease). Both these approaches are controversial. Recent published guidelines recommended using case-finding approach for pregnant women identified as high risk for thyroid disease. However, a report published soon after the guidelines demonstrated that screening of only high-risk pregnancies failed to detect 30% of women with hypothyroid and nearly 70% of hyperthyroid women. Currently, no medical organization recommends universal screening for thyroid disease. This randomized study investigated the effectiveness of thyroid disease treatment during pregnancy on the incidence of maternal and neonatal adverse outcomes and compared the ability of universal screening and case-finding to detect thyroid dysfunction. A total of 4562 women in their first trimester of pregnancy were randomized to either case-finding approach (n = 2282) or universal screening (n = 2280). Women in the 2 groups were classified as high risk or low risk based on the presence of risk factors for thyroid disease. Women with hypothyroidism were defined as having thyroid stimulating hormone (TSH) greater than 2.5 mIU/L and being positive for thyroid peroxidase antibody, and women with hyperthyroidism were defined as having undetectable TSH concentration and elevated free T 4 . The sera of all women in the universal screening group and women at high-risk in the case-finding group were immediately tested for TSH, free T4, and thyroid peroxidase antibody. Women with hypothyroidism were treated with levothyroxine; women with hyperthyroid were managed with anti-thyroid medication. There were no significant differences in adverse outcomes between the universal and case-finding screening groups. Fewer low-risk women in the universal screening group had adverse outcomes compared with low-risk women in the case-finding group. The majority of women with thyroid disease were missed by the case-finding approach. These findings show that screening pregnant women for thyroid disease using the case-finding approach is not associated with a greater decease in adverse outcomes than universal screening. Adverse outcomes appear to be less likely among low-risk women in the universal screening group than among low-risk women in the case-finding group.