摘要：Objective: The purpose of this study was to identify factors that predict a decision to interrupt a pregnancy in which there are fetal anomalies in the second trimester. Study design: The New Jersey Fetal Abnormalities Registry prospectively recruits and collects information on pregnancies (≥15 weeks of gestation)-from New Jersey residents in whom a fetal structural anomaly has been suspected by maternal-fetal medicine specialists. Enrolled pregnancies that have major fetal structural abnormalities identified from 15 to 23 weeks of gestation were included. Outcomes were classified as either elective interruption or a natural pregnancy course, which might include a spontaneous fetal death or live birth. Predictors of elective interruption of pregnancy were examined with univariable and multivariable logistic regression analyses. Results: Of the 97 cases, 33%of the women (n = 32) interrupted the pregnancy. Significant variables in the regression model that were associated with a decision to interrupt a pregnancy were earlier identification of fetal anomalies (19.0 ±2 weeks of gestation vs 20.5 ±2 weeks of gestation; P=.003), the presence of multiple anomalies (78% 25/32 vs 52% 33/63 ; P = .01 , and a presumption of lethality (56% 18/32 vs 14% 9/65 ; P = .0001). These variables corresponded to an odds ratio for pregnancy interruption of 4.2 (95%CI, 1.0, 17.0) for multiple anomalies, 0.8 (95%CI, 0.7, 1.0) for each week of advancing gestational age, and 36.1 (95%CI, 2.9, 450.7) for presumed lethal abnormalities. Conclusion: Early diagnosis, the identification of multiple abnormalities, and an assessment of likely lethality of fetal anomalies are important factors for the optimization of parental autonomy in deciding pregnancy management.

摘要：Objective:The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. Study design:We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least once weekly. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. Results:The fetal death rate was 5 of 193 pregnancies (2.6%; 95%CI,1.1,5.9); the prospective risk of stillbirth per pregnancy after 32 weeks of gestation was 1.2%(95%CI,0.3%-4.2%). Conclusion:Under intensive surveillance,the prospective risk of fetal death in monochorionic-diamniotic pregnancies after 32 weeks of gestation is much lower than reported and does not support a policy of elective preterm delivery.

摘要：Objective:The purpose of this study was to identify which biological processes may be involved in normal labor. Study design:Transcriptional profiles for chorioamniotic membranes (n = 24) and blood (n = 20)were generated from patients at term with no labor (TNL) and in labor (TIL). Results:Expression of 197 transcripts (P ≤.02) differentiated TIL and TNL chorioamniotic membrane samples. Gene Ontology analysis indicated that TIL samples had increased expression of multiple chemokines and transcripts associated with neutrophil and monocyte recruitment. Microarray results were verified using quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) with independent samples. Transcriptional profiles from blood RNA revealed no Gene Ontology category enrichment of discriminant probe sets. Conclusion:Labor induces gene expression changes consistent with localized inflammation,despite the absence of histologically detectable inflammation.

摘要：Objective:The purpose of this study was to investigate the safety and efficacy of alvimopan,a novel peripherally acting mu-opioid receptor antagonist,in patients who undergo simple total abdominal hysterectomy. Study design:Women (n = 519)-were randomized (4:1) to receive alvimopan 12 mg (n = 413) or placebo (n = 106)≥2 hours before the operation then twice daily for 7 days (hospital and home). Adverse events were monitored up to 30 days after the last dose of study drug was administered. Efficacy was assessed for 7 postoperative days. Results:Overall,the most common adverse events were nausea,vomiting,and constipation; < 5%of patients discontinued use because of adverse events. Alvimopan significantly accelerated the time to first bowel movement (hazard ratio,2.33; P < .001). Average time to first bowel movement was reduced by 22 hours,with more frequent bowel movement and better bowel movement quality found in the treatment cohort. Conclusion:Alvimopan has a safety profile that is similar to that of placebo and provides significantly improved lower gastrointestinal recovery in women who undergo simple total abdominal hysterectomy.