摘要：Objective: The purpose of this study was to compare 2- dimensional and 3- dimensional power- Doppler imaging diagnostic performance for the prediction of ovarian cancer in complex adnexal masses. Study design: Sixty- nine complex adnexal masses in 60 women (mean age, 48.4 years [range, 17- 82 years]) were evaluated by 2- dimensional and 3- dimensional power- Doppler imaging for differentiating benign from malignant masses. Complex adnexal mass was defined in the presence of at least 1 of the following features: solid areas, thick papillary projections, thick septa, or purely solid echogenicity. One examiner performed 2- dimensional power- Doppler imaging, and a second examiner performed 3- dimensional power- Doppler imaging. All masses were removed surgically, and definitive diagnosis was obtained. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for both techniques. Results: Forty- five tumors (65.2% ) were proved to be malignant, and 24 tumors (34.8% ) were proved to be benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 2- dimensional power- Doppler imaging were 97.8% , 87.5% , 93.6% , 95.5% , and 94.2% , respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 3- dimensional power- Doppler imaging were 97.8% , 79.2% , 89.9% , 95% , and 91.3 % respectively. There were no statistical differences in sensitivity and specificity (McNemar test: P =. 250) Conclusion: Three- dimensional power- Doppler imaging did not have a better diagnostic performance than 2- dimensional power- Doppler imaging for the discrimination of benign from malignant complex adnexal masses.

摘要：Objectives: To describe the natural history of pyelectasis from its detection in the second trimester to delivery, its capability to predict renal pathology and whether prenatal development of pelvic dilatation is correlated to its postnatal evolution. Study design: A retrospective analysis involving 375 fetuses with a complete urological follow- up. Prenatal ultrasound was correlated with the results of postnatal investigation and frequency of postnatal surgery was established. Results: Two- hundred and eighty cases underwent at least two examinations before birth. 73.1% were male fetuses. 57.4% had a bilateral pyelectasis. Prenatal evolution of pelvic dilatation was the following:18.6% of the cases normalized, in 34.6% of the cases the dilatation reduced but did not disappear, in 30.7% it remained unchanged, while it worsened in 16.4% . One case from the first group, three cases from the second, seven cases from the third and 11 cases from the fourth needed surgical treatment. 1.9, 7.2, 18.6, 23.9% of cases respectively worsened after birth in the four groups (trend: P=0.001). Conclusions: Prenatal diagnosis of pyelectasis improves the outcome of these children due to a surgical approach that avoids renal damage. There is a good correlation between prenatal evolution and postnatal outcome, although a postnatal follow- up is opportune in those cases that normalized before birth.

摘要：Objective: To assess the effect of body mass index (BMI) on the tendency of pregnant women to vomit and on their general condition during pregnancy. Study design: We included patients in this study who presented to our gynecological emergency room and clinic during their first trimester of pregnancy. All women completed a questionnaire assessing obstetrical and physical characteristics, including gravidity, parity, gestational age, height and weight for BMI calculation. Women were requested to report the number of vomiting episodes per day and their general condition using a 1 to 10 scale (1- good, 10- bad). Patients were allocated to either a low- frequency group (0- 1 vomiting episodes per day) or to a high- frequency group (2 and more vomiting episodes per day). Results: Sixty- one consecutive women were included in the study. The low frequency group consisted of 35 women and the high frequency group included the remaining 26 women. The BMI was significantly lower in the high frequency group as compared to the low frequency group (21.8 ± 3.5 versus 24.4 ± 4.7, respectively; P < 0.05). Patients in the high frequency group also reported a worse general condition than those in the low frequency group (7.6 ± 2.2 versus 3.5 ± 2.1, respectively; P < 0.05). Conclusion: Patients with higher frequency of vomiting episodes during the first trimester of pregnancy tend to have a lower BMI score and a worse general condition than patients with low frequency of vomiting episodes.

摘要：Objective: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. Study design: Fiftynine patients were included. The Bishop score was evaluated upon admission, weeks gestational age. Ultrasonographic measurement of cervical length was done within 24 h after entry. Delivery before 37 weeks gestational age was the primary endpoint. Attending obstetricians were blinded to the results of echography. Results: Preterm delivery rate was 39%(23/59). The risk of preterm delivery was significantly increased when the Bishop score was greater than or equal to 6 (OR=4.45 [1.41-14.01]) or when ultrasonographic cervical length was less than or equal to 27 mm (OR=4.04 [1.32-12.3]), but digital examination was the only independent risk factor in multivariate analysis. Sensitivity, specificity, positive and negative predictive value for digital examination and ultrasonography were respectively 74, 61, 55 and 79%, 70, 64, 55 and 77%. Combination of digital examination and ultrasonography did not yield better results. Conclusion: In our series, prediction of preterm delivery was not improved by ultrasonography compared to digital examination. The size of the cervical shift observed in most patients hospitalized for preterm labor may render ultrasonography less relevant in identifying patients anticipated to deliver prematurely.

摘要：Objectives The purpose of this study was to compare the efficacy of cervical ripening with 2 Foley catheter balloon volumes. Study design Pregnant women admitted for induction of labor with a term singleton gestation were randomly assigned for cervical ripening by a balloon inflated with 30 mL or 80 mL of sterile saline. Results Two hundred and three women were included in the analysis. Ripening of the cervix with the larger balloon volume was associated with a significantly higher rate of postripening dilatation of 3 cm or more (76.0%vs 52.4%, P <.001). In primiparous women, the larger balloon volume resulted in a significantly higher rate of deliveries by 24 hours (71.4%vs 49%, P <.05), and a significantly less requirement of augmentation with oxytocin (69.3%vs 90.4%, P <.05). Conclusion Ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80 mL provided effective more dilatation, faster labor, and decreased need for oxytocin than with a balloon inflated with 30 mL of sterile saline.

摘要：Objective: The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms. Study design: Seventyone consecutive pregnant women with gastrointestinal complaints and 72 agematched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed. Results: The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6%versus 63.8%, respectively, P>0.05). The incidence of dyspeptic complaints were 53.5%in HPseropositive and 40.9%in HPseronegative women (P>0.05). The prevalence of cytotoxin associated gene A positivity among H. pyloriseropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5%versus 45.7%, respectively, P=0.002). Among HPseropositive women, the incidence of dyspeptic complaints was significantly higher in cagApositive patients compared to the cagAnegative ones (65.6%versus 34.2%, respectively, P=0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pyloriseropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0%versus 34.8%, respectively, P=0.021). Conclusion: Cytotoxin associated gene A-positive, virulant H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.

摘要：Objective: Precise determination of fetal head position in labor is a prerequisite for safe instrumental deliveries, and essential for the assessment of labor progress. Recent studies have cast serious doubts on the accuracy of the time-honored digital vaginal examination (DVE) in comparison to transabdominal ultrasound scans (TUS). However, transabdominal imaging is technically difficult with a deeply engaged fetal head in the second stage of labor. We examined the accuracy and time requirements of transvaginal scans (TVS) in the second stage of labor for determination of fetal head position. Study design: Sixty laboring women in the second stage of labor with a deeply engaged fetal head were examined by experienced nurse midwives and senior residents. Fetal head position was recorded as “ time on a 12- hour clock." Subsequently, TUS and TVS were independently performed by a skilled sonographer. Accuracy and time requirements for all 3 examinations were recorded. Results: Fetal head position could be determined in all cases by TVS, but not in 7 cases and 9 cases by DVE and TUS, respectively (P < .03; P < .008). A discrepancy of 60° or more between the DVE and TUS or TVS was found in 13/60 cases (21.7% ) and 14/60 cases (23.3% ), respectively. A ≥ 90° discrepancy was found in 9/60 cases (15% ) and 12/60 cases (20% ), respectively (P <.02 for comparison of TUS and TVS). In 5 cases, the digital examination erroneously perceived an occiput posterior position as occiput anterior. No significant differences in fetal head position were detected between TUS and TVS, when the examination was technically feasible. The mean time (± SD) required for determining fetal head position was shortest for TVS (8.7 ± 5.8 seconds) in comparison to DVE (22.7 ± 14.6 se-conds; P < .0001) or TAS (31.7 ± 19.1 seconds; P < .0001). Conclusion: Transvaginal sonography was the most successful and accurate method for determination of fetal head position in the second stage of labor, and required

摘要：Objectives The purpose of this study was to evaluate the association between preinduction modified Bishops score and obstetric outcome, including successful vaginal birth after prior cesarean (VBAC) and uterine rupture in patients with a previous cesarean undergoing induction of labor. Study design Medical records of all patients who had an induction of labor after a previous cesarean in our institution between 1988 and 2002 were reviewed. Patients were divided into 4 groups according to the modified Bishops score (0 to 2, 3 to 5, 6 to 8, and 9 to 12). The rates of successful VBAC, symptomatic uterine rupture, and other obstetric outcomes were evaluated in each group. Multivariate regression analyses were performed to adjust for confounding factors. Results Out of 685 women included in the study, 187 (27.3%) had a modified Bishops score <2, 276 (40.3%) of 3 to 5, 189 (27.6%) of 6 to 8, and 33 (4.8%) of 9 to 12. The rate of successful VBAC significantly correlated with the modified Bishops score (57.5%, 64.5%, 82.5%, and 97.0%, respectively, P <.001). However, the rate of uterine rupture was not statistically significant between the groups (2.1%, 1.8%, 0.5%, 0.0%, P=.48). After adjusting for confounding variables, a modified Bishops score ≥6 remained associated with successful VBAC (odds ratio [OR] 2.07, 95%CI 1.28-3.35, P <..001). Conclusion The modified Bishops score before induction of labor is an independent factor associated with successful VBAC.