Cohort Study Of Consecutive Women Research Articles

Weight-based thyroid dosing vs fixed dosing during pregnancy for subclinical hypothyroidism: A retrospective cohort study.

Thyroid hormones play a crucial role in foetal growth and neurocognitive development. Our aim was to compare a weight-based dosing method of starting thyroxine to a fixed-dose method in newly diagnosed women with subclinical hypothyroidism during pregnancy. We performed a retrospective cohort study of consecutive women with newly diagnosed subclinical hypothyroidism during pregnancy seen at Mount Sinai Hospital and Women's College Hospital, Toronto, Canada 2015-2018. We identified women that were treated based on pre-pregnancy weight and those that were given a fixed dose of 50 mcg/day. The percent of women who reached the target TSH of <2.5mIU/L within 4-8weeks was compared using a chi-squared test and a logistic regression model, adjusting for age, initial TSH and gestational age treatment was started. 393 women were included: 252 treated using a fixed-dose approach; 141 treated based on pre-pregnancy weight. In the unadjusted analysis, there was no difference between the groups in the percentage of women in the target range within 4-8weeks (89.6% in the fixed-dose group vs 88.8% in the weight-based group (p=.954)). However, after adjustment for between-group differences in age, initial TSH and gestational age treatment was started, there was a significantly greater odds of achieving the target range using the weight-based dosing (OR 4.26 (1.60-11.7), p=.004). Treating women with newly diagnosed subclinical hypothyroidism during pregnancy with a weight-based strategy increased the odds of reaching the target TSH range within 4-8weeks. Clinicians caring for these women should consider this approach when starting treatment during pregnancy.

Proteinuria as a novel risk factor for allogeneic blood transfusion irrespective of single or twin pregnancy

Objective: To clarify whether isolated proteinuria (IP) is an independent risk factor for blood transfusion (BT) for postpartum hemorrhage (PPH), and whether risk factors for BT identified in single pregnancy also apply to twin pregnancy. Materials and Methods: A retrospective cohort study of consecutive women who gave birth at Jichi Medical University Hospital, Japan, between 1 April 2006 and 31 December 2016 was performed. Single or diamniotic twin deliveries producing healthy infants of ≥ 22 weeks were included. We analyzed the correlations between BT and 13 candidate risk factors that may be potentially associated with PPH in single and twin pregnancies. Results: We included 11,423 pregnancies: 10,523 (92.2%) single and 900 (7.8%) twin pregnancies. In single pregnancies, multivariate analysis indicated that placenta previa (PP), abruptio placentae, IP, chronic or gestational hypertension, preeclampsia (PE), HELLP syndrome, and tocolytic treatment (OR: 10.4, 19.1, 3.7, 3.6, 4.0, 18.9, and 2.0, respectively) were independent factors for the increased risk of allogenic BT. In twin pregnancies, multivariate analysis revealed that PP, abruptio placentae, IP, PE, and HELLP syndrome were independent factors for the increased risk of allogeneic BT (OR: 8.3, 103, 3.9, 4.3, and 39.6, respectively). Conclusion: IP was a novel risk factor for BT in both single and twin pregnancies. Although risk factors for BT were very similar between single and twin pregnancies, intravenous tocolysis was and was not a risk factor in single and twin pregnancies, respectively.

Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study.

To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes. This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first-trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age. Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early-pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Lower daily carbohydrate consumption than recommended by the Institute of Medicine is common among women with type 2 diabetes in early pregnancy in Denmark

AimsTo secure adequate carbohydrate supply in pregnancy, the Institute of Medicine (IOM) recommends a minimum amount of carbohydrates of 175 g daily. Currently a low carbohydrate diet is a popular health trend in the general population and this might also be common among overweight and obese pregnant women with type 2 diabetes (T2D). Thus, we explored carbohydrate consumption among pregnant women with T2D including women with type 1 diabetes (T1D) for comparison. MethodsA retrospective cohort study of consecutive women with T2D (N = 96) and T1D (N = 108), where dietary records were collected at the first antenatal visit. ResultsAmong women with T2D and T1D, bodyweight at the first visit was 90.8 ± 22 (mean ± SD) and 75.5 ± 15 kg (P < 0.001) while HbA1c was 6.6 ± 1.2% (49 ± 13 mmol/mol) and 6.6 ± 0.8% (48 ± 8 mmol/mol), P = 0.8, respectively. The average daily carbohydrate consumption from the major carbohydrate sources was similar in the two groups (159 ± 56 and 167 ± 48 g, P = 0.3), as was the level of total daily physical activity (median (interquartile range)): 215 (174–289) and 210 (178–267) metabolic equivalent of task-hour/week (P = 0.9). A high proportion of women with T2D and T1D (52% and 40%, P = 0.08) consumed fewer carbohydrates than recommended by the IOM. The prevalence of ketonuria (≥4 mmol/L) was 1% in both groups. ConclusionsIn early pregnancy, a lower daily carbohydrate consumption than recommended by the IOM was common among women with T2D. The results were quite similar to women with T1D, despite a markedly higher bodyweight in women with T2D. Reassuringly, ketonuria was rare in both groups.

Outcomes in an obstetrical population with hereditary thrombophilia and high tobacco use

Objective: The purpose of this study was to examine birth outcomes in women treated or untreated for thrombophilia during pregnancies affected or not by tobacco exposure.Methods: This was a retrospective cohort study of consecutive women from a single maternal fetal medicine clinic who delivered between January 2009 and December 2013. We compared birth outcomes by four groups of thrombophilia and smoking combinations and then by treated or untreated groups.Results: Of the 8889 pregnant women in this study, 113 had thrombophilia and 97 received treatment. Thromboprophylaxis included: low molecular weight heparin, aspirin, unfractionated heparin, folic acid, and combinations of these. Smokers with thrombophilia had significantly higher rates of preeclampsia, intrauterine growth restriction, preterm birth (<37 weeks gestation) and low birth weight (all p ≤ .001). Conversely, this group had significantly lower rates of hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) and placental abruption. Women with thrombophilia who received thromboprophylaxis had lower rates of adverse birth outcomes, reaching significance for preterm birth <32 weeks gestation (4.3% versus 21.1%, p = .026).Conclusion: Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.

User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women.

Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception. To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation. Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation. Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred. Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.

Invasive placental disease: the impact of a multi-disciplinary team approach to management

Purpose: To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD).Materials and methods: This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan. Outcomes were compared between cases delivered prior to and after the MDT process was started.Results: There were 47 pregnancies with IPD, of which 31 (66.0%) were suspected antenatally and 40 (85.1%) had a prior uterine surgery. An MDT approach was performed in 19 (40.4%) cases. In the MDT group, there were longer operative times (260 min versus 181 min, p = 0.0001), less blood loss (1200 mL versus 2500 mL, p = 0.009), less administration of blood products (47.4% versus 85.7%, p = 0.005), and higher intraoperative lowest mean arterial pressures (MAPs) (57 mmHg versus 48 mmHg, p = 0.002, when compared to the No-MDT (n = 28) approach. No differences were found for other outcomes.Conclusion: Clinically meaningful improvements of less blood loss, fewer transfusions, and higher intraoperative MAPs suggest that MDT cases were more stable intraoperatively, which over a larger number of patients, should translate into improved outcomes.

Ovarian stimulation for infertility treatment and cancer risk: An Italian cohort study.

534Background: With the increasing practice of infertility treatments, concerns were raised about the long-term effects of hormonal ovarian stimulation, especially regarding the risk of breast, endometrial and ovarian cancer. We evaluated the long term cancer incidence in women enrolled into fertility programs from 1980 to 2005. Methods: This is a retrospective cohort study of consecutive women entered into fertility programs in 4 italian centers operating in areas covered by Cancer Registries. Eligibility criteria included premenopausal woman aged 20 to 41 years, who received at least 1 cycle of ovarian stimulation in the context of an Assisted Reproductive Technology (ART) treatment. The primary endpoint was breast cancer (BC) incidence; secondary endpoints were incidence of cervical, endometrial and ovarian cancer. Cancer incidence was assessed by linkage with databases of Cancer Registries. The relationship between ovarian stimulation and cancer incidence was assessed using region specific standardize...

Progress of induced labor in trial of labor after cesarean delivery

The purpose of this study was to compare the first stage of labor progress in women who undergo an induction of labor after cesarean delivery with women who have spontaneous labor after cesarean delivery. We conducted a retrospective cohort study of consecutive women who had been admitted for delivery with a vertex-presenting fetus who achieved vaginal delivery after cesarean delivery. We compared women who underwent an induction of labor after cesarean delivery with women with spontaneous labor after cesarean delivery. Labor curves were constructed with a repeated-measures analysis; interval-censored regression was used to estimate the median time spent to dilate 1 cm, stratified by induction status, and adjusted by obesity, macrosomia, epidural, and previous vaginal delivery. Of 473 laboring women with a previous cesarean delivery, 234 women (49%) were induced. After adjustment for obesity, macrosomia, epidural, and previous vaginal delivery, women who underwent an induction had significantly longer labors than those women who experienced spontaneous labor. The median time to dilate from 4-10 cm took 5.6 hours (95% confidence interval, 1.8-18.0 hours) in the induction group and 3.2 hours (95% confidence interval, 1.0-10.3 hours) in the spontaneous labor group (P < .01). The time to progress 1 cm in dilation from 3-7 cm was different; however, after 7 cm, the time to progress 1 cm was not statistically different. Women who undergo an induction of labor after cesarean delivery have a longer latent labor phase, but a similar active phase than those women who experience spontaneous labor. When making the diagnosis of labor dystocia for women who undergo an induction of labor after cesarean delivery, clinicians should use the same normative standards for labor treatment of women without a previous cesarean delivery as has been shown in previous work.

Ultrasound-guided retrieval of lost intrauterine devices using very fine grasping forceps: a case series

AimTo assess the efficacy of a novel ultrasound-guided procedure for the retrieval of intrauterine contraceptive devices (IUDs) when the threads are not visible at the external cervical os (‘lost threads’).MethodsThis...

Maternal Obesity and Rectovaginal Group B Streptococcus Colonization at Term.

Objective. To test the hypothesis that maternal obesity is an independent risk factor for rectovaginal group B streptococcus (GBS) colonization at term. Study Design. Retrospective cohort study of consecutive women with singleton term pregnancies admitted in labor at Barnes-Jewish Hospital (2004–2008). Maternal BMI ≥ 30 Kg/m2 (obese) or <30 Kg/m2 (nonobese) defined the two comparison groups. The outcome of interest was GBS colonization from a positive culture. Baseline characteristics were compared using Student's t-test and Chi-squared or Fisher's exact test. The association between obesity and GBS colonization was assessed using univariable and multivariable analyses. Results. Of the 10,564 women eligible, 7,711 met inclusion criteria. The prevalence of GBS colonization in the entire cohort was relatively high (25.8%). Obese gravidas were significantly more likely to be colonized by GBS when compared with nonobese gravidas (28.4% versus 22.2%, P < 0.001). Obese gravidas were still 35% more likely than nonobese women to test positive for GBS after adjusting for race, parity, smoking, and diabetes (adjusted OR 1.35 [95% CI 1.21–1.50]). Conclusion. Maternal obesity is a significant risk factor for GBS colonization at term. Further research is needed to evaluate the impact of this finding on risk-based management strategies.

Changes in Fetal Heart Tracing Characteristics after Magnesium Exposure

The aim of this study is to describe the changes in term fetal heart tracings after magnesium exposure. This was a retrospective cohort study of consecutive women delivering at a gestational age of ≥ 37 weeks with severe preeclampsia, receiving magnesium for seizure prophylaxis. Overall 90 minutes of electronic fetal monitoring (30 before magnesium, 30 during magnesium bolus, and 30 during steady state infusion) was prospectively interpreted by formally trained and blinded research nurses using American Congress of Obstetricians and Gynecologists guidelines. Multivariable analyses were performed using generalized estimating equations, comparing preexposure patterns to bolus, and steady state. Out of the 238 women evaluated, an average decrease of 2.4 beats per minute (p = 0.02) was found after magnesium bolus. This persisted into the steady state (p < 0.01). Minimal/absent variability increased during bolus infusion (odds ratio [OR] 2.40, 95% confidence interval [CI] 1.10-5.62) but corrected by steady state (OR 1.44, 95% CI 0.76-2.80). There were no significant changes in the fetal heart rate (FHR) baseline < 120, tachycardia, or presence of accelerations or decelerations. Exposure to magnesium is associated with a transient decrease in variability and a clinically insignificant decrease in FHR baseline without an increased incidence in bradycardia or category change.

Labor Progression in Teenage Women

Compare labor progression in first and second stages in women < 18 years with those ≥18 years. Retrospective cohort study of consecutive women at term that reached the second stage of labor between 2004 and 2008. The first stage in women < 18 years was compared with women ≥18 years. Average labor curves were constructed and median time spent to progress 1 cm in dilation and total time from 4 to 10 cm was estimated. Time spent pushing and total duration of second stage were compared between groups. Analyses were then stratified by parity. There was no significant difference in progress of the first stage of labor between women < 18 years and those ≥18 years. In the second stage, nulliparous teenage women were less likely to have a duration > 60 or 120 minutes. Laboring women < 18 years should be managed with the same expectations of labor as women ≥18 years.

Normal First Stage of Preterm Labor

To compare first-stage labor patterns in women in preterm labor to those in labor at term. We performed a retrospective cohort study of consecutive women admitted from 2004 to 2008 with viable (≥ 24 weeks) vertex singleton gestations who reached the second stage of labor. Labor curves for preterm and term labor were created using a repeated-measures analysis with polynomial modeling. Interval-censored regression was used to estimate and compare median time of progression of labor. Multivariable analyses were performed to adjust for smoking, obesity (body mass index ≥ 30), induction, and nulliparity. The adjusted model was stratified by parity and induction of labor. Of 5,612 consecutive births, 224 were preterm (<37 weeks) and 5,388 were term (≥ 37 weeks). Preterm first-stage labor progressed significantly faster than term labor (median time 4 to 10 cm: 3.3 hours versus 4.5 hours, p < 0.01). When stratified by parity, preterm labor progressed significantly more rapidly than term labor in both nulliparous and multiparous women (median time 4 to 10 cm: 3.7 hours versus 4.9 hours [p = 0.04] in nulliparous women and 2.5 hours versus 4.3 hours [p = 0.01] in multiparous women). Women in preterm labor progress more rapidly through the first stage of labor than women at term.

First-trimester growth discordance and adverse pregnancy outcome in dichorionic twins

To evaluate the association between first-trimester growth discordance and adverse pregnancy outcome in dichorionic twin pregnancies. This was a retrospective cohort study of consecutive women with dichorionic twin pregnancies undergoing an ultrasound scan at our institution between 7 and 14 weeks' gestation. Study groups were defined by the presence or absence of ≥ 11% crown-rump length (CRL) discordance. Pregnancies were excluded if one twin was dead on initial ultrasound or if a termination was performed. The primary outcome was loss of one or both fetuses before 20 weeks. Secondary outcomes included fetal anomaly, fetal demise after 20 weeks (stillbirth), small-for-gestational-age (SGA) at birth, admission to the neonatal intensive care unit (NICU) and preterm delivery before 34 weeks. Of 805 dichorionic twin pregnancies undergoing first-trimester ultrasound, 610 met the inclusion criteria. Eighty-six had ≥ 11% CRL discordance and, of these, nine (10.5%) had a fetal loss at < 20 weeks (risk ratio (RR) 7.8 (95% CI, 3.0-20.5)). In the surviving pregnancies, an increased risk of fetal anomalies was seen (27.3 vs 17.4%, RR 1.6 (95% CI, 1.1-2.4)). In surviving pregnancies unaffected by anomalies, no increased risk of stillbirth, SGA, NICU admission or delivery before 34 weeks was noted in the discordant group. A post-hoc power analysis demonstrated 80% power to detect a five-fold increase in the risk of stillbirth and 90% power to detect a two-fold increase in other outcomes. Dichorionic pregnancies in which a CRL discordance of at least 11% is noted are at increased risk for fetal anomalies and fetal loss prior to 20 weeks' gestation. However, patients can be reassured that, in the absence of structural anomalies, CRL discordance does not appear to be associated with other adverse outcomes in continuing pregnancies, although the power to detect small increases in the risk of stillbirth may have been limited by the sample size.

Time to Delivery after the First Course of Antenatal Corticosteroids: A Cohort Study

The optimal time interval between administration of antenatal corticosteroids and delivery is 1 to 7 days. This study evaluates the timing of the first course of antenatal corticosteroids in clinical practice. We performed a retrospective cohort study of consecutive women who had received antenatal corticosteroids and/or delivered between 24 and 34 weeks of gestation. Time between administration of corticosteroids and delivery was compared between women with different causes of anticipated preterm deliveries: symptomatic preterm labor with intact membranes; preterm premature rupture of the membranes; (pre)eclampsia; hemolysis, elevated liver enzymes, and low platelet count; intrauterine growth restriction; vaginal blood loss; and suspected fetal distress. We included 439 women of whom 348 (79%) completed the course of corticosteroids. In women with a complete course, 143 (41%) delivered within 7 days. The median interval between the course and delivery was 11 days and varied between 41 days in women with vaginal blood loss, 25 days in women with spontaneous preterm labor with intact membranes, and 8 days in women with preeclampsia ( P < 0.001). In women with spontaneous preterm labor with intact membranes and in women with vaginal blood loss, we can benefit substantially from a more accurate discrimination of women who need corticosteroids immediately and women who do not.

Relationship Between Body Mass Index and Robotic Surgery Outcomes of Women Diagnosed With Endometrial Cancer

This is a prospective evaluation of the outcome of minimal invasive surgery using robotics in function of the body mass index (BMI) of patients. This is a prospective cohort study of consecutive women undergoing surgery for endometrial cancer at a tertiary care facility since the initiation of a robotic program in December 2007. Surgical and personal outcome variables as well as quality of life and postoperative recovery were assessed using a combination of objective and subjective/self-report questionnaires. Women were divided into 3 groups based on their BMI. Comparative analyses among nonobese (n = 52), obese (n = 33) and morbidly obese (n = 23) women were performed on the outcome measures after surgery. The mean BMI and the range in each of the BMI categories was 25 kg/m² (18.7-29.4 kg/m²), 34 kg/m² (30.1-38.4 kg/m²), and 46 kg/m² (40.0-58.8 kg/m²). Women with higher BMI tended to be more frequently affected with comorbidities such as diabetes (15.4%, 26.0%, and 27.3%, respectively; P = 0.32) and hypertension (55.8%, 69.6%, and 69.7%, respectively; P = 0.19). Despite these differences, surgical console time (P = 0.20), major postoperative complications (P = 0.52), overall wound complications (P = 0.18), and median length of hospitalization in days (P = 0.17) were not statistically different among the 3 groups. Only 5.6% of women needed a mini laparotomy all of which were performed for the removal of their enlarged uterus, which could not be delivered safely via the vagina, at the end of the surgical procedure. There was no increased conversion to laparotomy due to increased BMI. Women in all 3 groups reported rapid resumption of hygiene regimens and chores, little need for narcotic analgesia, and high satisfaction with the procedure. Obese and morbidly obese patients with endometrial cancer are also good candidates for robotic surgery. These women benefit considerably from minimal invasive surgery and have little perioperative complications.

Effect of placenta previa on fetal growth

To estimate the association between placenta previa and abnormal fetal growth. Retrospective cohort study of consecutive women undergoing ultrasound between 15 and 22 weeks. Groups were defined by the presence or absence of complete or partial placenta previa. The primary outcome was intrauterine growth restriction (IUGR), defined as a birthweight <10th percentile by the Alexander growth standard. Univariable, stratified, and multivariable analyses were used to estimate the effect of placenta previa on fetal growth restriction. Of 59,149 women, 724 (1.2%) were diagnosed with a complete or partial previa. After adjusting for significant confounding factors (black race, gestational diabetes, preeclampsia, and single umbilical artery), the risk of intrauterine growth restriction remained similar (adjusted odds ratio, 1.1; 95% confidence interval, 0.9-1.5). The presence of bleeding did not impact the risk of growth restriction. Placenta previa is not associated with fetal growth restriction. Serial growth ultrasounds are not indicated in patients with placenta previa.

Acanthosis Nigricans Among Women With Gestational Diabetes Mellitus and Risk of Adverse Pregnancy Outcomes

Acanthosis nigricans (AN) is a cutaneous manifestation of insulin resistance (1). Among women with gestational diabetes mellitus (GDM), it is not known whether AN is associated with greater need for insulin therapy in pregnancy or adverse perinatal outcomes. We performed a prospective cohort study of consecutive women with GDM or impaired glucose tolerance and a singleton pregnancy referred to the Diabetes in Pregnancy Clinic at St. Michael's Hospital in inner city Toronto. Patients received dietary counseling and began blood glucose testing four times a day. At the initial clinic visit, each woman was examined for AN of …

Sexual assault victims: Factors associated with follow-up care

This study was undertaken to describe patient, assault, and examination characteristics associated with compliance with follow-up in sexual assault victims. We conducted a retrospective cohort study of consecutive women presenting to an urban hospital after sexual assault over a 36-month period. We compared those who did and did not follow-up by using standardized history, examination, and data collection forms. Eight hundred twelve women met inclusion criteria; 288 (35.5%) attended follow-up. Young age (odds ratio [OR] = 2.70), assault at home (OR = 1.90), amnesia (OR = 1.80), alcohol use (OR = 1.55), genital trauma (OR = 1.55), and receipt of postexamination medications (OR = 1.87) were associated with greater follow-up; homelessness (OR = 0.30), psychiatric diagnosis (OR = 0.34), assault by an intimate partner (OR = 0.47), and cocaine use (OR = 0.29) with less. Although only 35.5% of sexual assault victims seek follow-up, we found many factors positively and negatively associated with this. These findings may inform care strategies designed to improve follow-up for women who are at risk for significant sequelae.