摘要：Objective: To compare maternal and neonatal morbidity associated with two methods to extract the impacted fetal head during Cesarean delivery. Study design: We retrospectively analyzed cases with difficult extraction of the impacted fetal head during Cesarean section. We compared maternal and neonatal outcomes between cases that were delivered by head extraction following pushing through the vagina (“ push” method) and those that were delivered by the reverse breech technique (“ pull” method). Results: We reviewed 3105 Cesarean section reports. Difficult extraction necessitating the “ push” or “ pull” methods was noted in 48 (1.5% ) instances. Women that were delivered by the “ pull” method had significantly lower rate of postpartum fever (5% versus 46% ; odds ratios, 0.06; 95% confidence intervals, 0.007- 0.51) and extensions of the uterine incision (15% versus 50% ; odds ratio, 0.17; 95% CI, 0.04- 0.74) compared to those that were delivered by the “ push” method. Neonatal outcomes were good in all cases. Conclusions: In cases with difficult extraction of the impacted fetal head during Cesarean section, “ pull” method may result in lower maternal morbidity compared to the traditional “ push” method.

摘要：We studied a large cohort of identical twin sisters, utilizing the unique properties of a twin research design to explore the relationship between obstetrical delivery mode and stress urinary incontinence. Study design: An anonymous 67- item survey was completed by 271 identical twin pairs (n = 542) at the world s largest annual gathering of twins. Logistic regression for repeated binary measures was used to evaluate risk factors and accounting for shared genetics within pairs. Results: The twins had a mean age of 47.1 years (range 15 to 85 years), and stress urinary incontinence was reported by 51.8% . Stress urinary incontinence was associated with age (P = .001), parity (P = .001), obesity (P = .002), and birth mode, with vaginal delivery conferring a considerable increase in stress urinary incontinence risk relative to cesarean section (odds ratio 2.28, 95% confidence interval 1.14 to 4.55, P = .019). Conclusion: Vaginal delivery mode represents a potent determinant of stress urinary incontinence, carrying more than twice the risk of cesarean section. This study of identical twins provides new insight into the epidemiology of female incontinence.

摘要：Objective: The objective of this study was to report which preoperative and intraoperative factors influence the success of the tension-free vaginal tape procedure for stress urinary incontinence. Study design: This was a prospective cohort study of 809 patients. In 28 teaching hospitals and 13 local hospitals, 54 gynecologists and urologists performed the tension-free vaginal tape procedure. Results: Before treatment and 2 years postoperatively, the following question from the Urogenital Distress Inventory for stress urinary incontinence was selected to define success or failure: “Do you experience urinary leakage during physical activity, coughing, or sneezing?”Secondary outcome measurement was the outcome of the doctor’s question,“Do you leak during physical activity, coughing, or sneezing?”asked at the 2-year follow-up. Response rate was 78.7%. The success rate was significant higher in all analyses when the surgeons had performed more than 20 tension-free vaginal tape procedures (P = .003; beta = 1.918 [95%confidence interval 1.24-2.97]). General anesthesia had a negative effect on the success of the tension-free vaginal tape (P = .032; beta = 2.21 [95%confidence interval 1.07-4.55]). Conclusions:Inexperience of the surgeon with the tension-free vaginal tape procedure and general anesthesia had a negative effect on the result. We believe that the tension-free vaginal tape should be performed only by experienced surgeons.

摘要：Objective:The purpose of this study was to evaluate differences in morbidity,progression-free interval,and survival in women with advanced epithelial ovarian cancer treated with initial chemotherapy versus initial surgery. Study design:All women with epithelial ovarian cancer who were treated surgically at our hospital between January 1,1995,and January 1,2003,were eligible; the cases of 200 patients met the criteria and underwent retrospective chart review. Results:Ninety-eight patients (49%) had initial chemotherapy,and 102 patients (51%) had initial surgery. Patients who received initial chemotherapy were more likely to have stage IV disease (initial chemotherapy,27%,vs initial surgery,8%; P = .042) and grade 3 disease (initial chemotherapy,73%,vs initial surgery,61%; P = .025). Optimal cytoreduction was achieved more often in patients who received initial chemotherapy (initial chemotherapy,86%,vs initial surgery,54%; P < .001). Only optimal cytoreduction (P = .022),and not treatment choice (P = .089),had an impact on median survival. Conclusion:Initial chemotherapy is a reasonable alternative to initial surgery for the treatment of selected patients with advanced epithelial ovarian cancer.

摘要：Objective: This study evaluates the relationship between symptoms of pelvic floor disorders, and measurement of pelvic organ prolapse. Study design: This retrospective cross-sectional study assessed prolapse in 905 women in an academic urogynecologic practice using the Pelvic Organ Prolapse Quantification exam. Symptoms were assessed with a Likert symptom questionnaire and the Urogenital Distress Inventory. Relationships between symptoms and prolapse were analyzed using Spearman’ s correlation. Results: Symptoms of “ bulging” correlated moderately to the greatest extent of prolapse (r = 0.4, P <.001). Frequency of bother progressively increases when the leading edge descends from -3 and 0. Between ? 1 and ? 5, 90% of women report bother. Symptoms typically attributed to anterior or posterior wall prolapse did not correlate with descent of the respective compartment. Conclusion: “ Bulging” is the principle symptom that correlates with prolapse severity. We found no discrete anatomic position that discriminates between prolapse as a disease state and normal anatomic variation.

摘要：Objective: Optimizing the cut-off level for a single serum hCG determination around day 15 after oocyte retrieval or ovulation. Study design: Retrospective data analysis. Results: 204 hCG samples >5 IU/L between March and October 1999 taken on day 14, 15 or 16 after oocyte retrieval in 204 patients undergoing IVF or ICSI were analyzed. ROC-curves and optimal cut-off levels to discriminate between viable and non-viable pregnancies were calculated for each day separately. Cut-off levels were found at 76, 142 and 223 IU/L for day 14, 15 and 16, respectively, and were verified by 487 hCG samples >5 IU/L taken between January 2000 and June 2004. Conclusions: A single serum hCG determination on day 14 or 15 is sufficient to discriminate viable pregnancies accurately from non-viable pregnancies.

摘要：Objective: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. Study design: All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS. Results: Twenty-nine women (52% ) had optimal cytoreduction (OC), and 27 (48% ) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA- 125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093). Conclusion: A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.

摘要：Objective: Our aim was to study whether universal screening of all pregnant women by Oral Glucose Challenge Test (OGCT) would identify a higher number of women with Gestational Diabetes (GDM) than risk factor based screening. Study design: A 50 g OGCT test was performed prospectively in 532 unselected women at 26- 28 weeks of gestation. The 1h venous plasma glucose concentration of >7.3 mmol/l was considered as a positive screening result. Patients with a positive OGCT underwent a 75 g 2- h OGTT, which was used as the actual diagnostic test for GDM. When two or all three of the glucose concentrations in OGTT (measured at fasting state and1and 2h afterthe 75g glucose load) were above the 97.5th percentile the patient was considered as having GDM. In addition, women with risk factors for GDM also underwent a 75 g OGTT regardless of the result of the OGCT. Results: A positive 50 g OGCT was obtained in 123 (23% ) of the women. In 15 (12% ) of these, a diagnosis of GDM was established by the subsequent OGTT. Out of the 409 remaining women with a normal OGCT, 148 (36% ) had risk factors for GDM. An OGTT performed in these patients identified 4 additional women with a GDM. Seventy-nine percent of GDM was thus found with 50 g OGCT without regarding risk factors. Forty-seven percent of the women with GDM would have been missed in screening by risk factors only. Conclusions: In our population 50 g OGCT appears to identify a higher number of GDM than risk factor based screening. Combined with risk factor screening a few more cases of GDM would be found.

摘要：Objective: The purpose of this study was to assess the association between previous maternal Toxoplasma gondii (T gondii) infection and risk of fetal death. Study design: This was a population-based prospective cohort of 29,912 pregnant women without acute T gondii infection in Norway. Results: In the study population, 2937 (9.8% ) women had evidence of previous maternal T gondii infection, and 299 (1.0% ) had fetal deaths. We found no association between previous T gondii infection and risk of fetal death at ≥ 20 weeks of gestation. We did find a trend for an increased risk of fetal death at ≥ 16 and < 20 weeks of gestation. However, we noted no association between previous T gondii infection and risk of fetal death at all birth weight categories (≥ 1000, ≥ 500 and <1000, and < 500 g). Conclusion: These data do not indicate an increased risk of fetal death at ≥ 20 weeks of gestation in women with previous maternal T gondii infection.

摘要：Objective: The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Study design: This was a prospective, observational multicenter study of women presenting to 6 gynecology clinics. Demographic data collected included: height, weight, gravidity, parity, and number of vaginal deliveries. Patients were diagnosed with incontinence by questionnaire. Standard univariate logistic regression analyses’ were performed to determine the contribution of pregnancy, mode of delivery, and BMI on the prevalence of urinary and fecal incontinence. Results: One thousand and four women were enrolled over an 18- month period. Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence, respectively. Odds ratio (95% CI) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.46 (1.53- 3.95), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.95 (0.99- 3.80), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 (1.57- 4.07), and any term pregnancy but no vaginal delivery (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 1.30 (0.77- 3.95). Odds ratio (95% CI) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.26 (1.22- 4.19), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.13 (0.43- 2.96), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 (1.30- 4.49), and any term pregnancy but no vaginal deliveries (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 2.15 (0.97- 4.77). BMI and age did not impact these results. Conclusion: Pregnancy increases the risk of urinary and fecal incontinence. Cesarean s