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.

摘要：Objective: To evaluate the association between maternal body mass index and obstetrical outcome in patients with a prior cesarean undergoing a trial of labor versus elective repeat cesarean. Study design: A perinatal database between 1991 and 1997 was used to identify secundipara at term after a previous cesarean section. In different groups according to maternal body mass index, the rates of successful vaginal birth after caesarean, uterine scar separation, and other obstetrical outcomes were evaluated. Results: Of 8580 patients with a prior cesarean, 1862 (21.7%) underwent an elective repeat cesarean and 6718 (78.3%) underwent a trial of labor. Maternal body mass index correlated inversely with the rate of successful vaginal birth after caesarean but not with the rate of uterine scar separation. After adjustment for confounding factors including maternal age, birth weight, induction of labor, and preeclampsia, maternal body mass index remained associated with a lower rate of successful vaginal birth after cesarean. Conclusion: Maternal body mass index is an independent factor associated with a lower rate of successful vaginal birth after cesarean.

摘要：Objective: We aimed to determine whether second- trimester abortion using isosorbide mononitrate (IMN) in addition to gemeprost is more effective and reduces side effects compared with gemeprost alone. Study design: Eighty women who were age 13 to 23 weeks’ gestation were randomly assigned to receive per vaginam either IMN 40 mg (group 1, 40 women) or placebo (group 2, 40 women) in addition to gemeprost 1 mg up to 3 times daily 3 hours apart for 2 days. Analysis of variance, a χ 2 test, and a multivariate analysis were performed. Results: Of the 72 women analyzed, 68% (group 1) and 38% (group 2) underwent abortion within day 1 (P <. 05). However, group 1 was associated with more headache (18% of women) 3 hours after induction compared to group 2 (0% of women, P=.038). Conclusion: IMN in addition to gemeprost is effective for second- trimester abortion, but is associated with more headache compared with gemeprost alone.

摘要：Objective: The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. Study design: This was a secondary analysis of the Maternal- Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. Results: Five hundred ninety- seven (20.5% ) of 2910 women were obese. Obese women had fewer spontaneous preterm births at < 37 weeks of gestation (6.2% vs 11.2% ; P <. 001) and at < 34 weeks of gestation (1.5% vs 3.5% ; P =. 012). Women with a body mass index of < 19 kg/m2 had 16.6% spontaneous preterm birth, with a body mass index of 19 to 24.9 kg/m2 had 11.3% spontaneous preterm birth, with a body mass index of 25 to 29.9 kg/m2 had 8.1% spontaneous preterm birth, with a body mass index of 30 to 34.9 kg/m2 had 7.1% spontaneous preterm birth, and with a body mass index of ≥ 35 kg/m2 had 5.2% spontaneous eterm birth (P <. 0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P =. 001). Obese women had lower rates of cervical length < 25 mm (5% vs 8% pr.; P =. 012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39- 0.83; P =. 003). Conclusion: Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

摘要：Objective. To evaluate and compare HER2/neu protein overexpression and gene amplification in uterine serous papillary endometrial cancer (USPC). Study design. Immunohistochemical (IHC) and fluorescent in situ hybridization (FISH) assays were used to analyze and compare HER2/neu protein expression and gene amplification, respectively, in paraffin blocks from 26 women harboring stage IA to IV USPC treated at the University of Arkansas for Medical Sciences from 1997 to 2004. Chromosome 17 polysomy status by FISH was also assessed in all specimens. Results. Moderate-to-strong expression of HER2/neu protein was noted in 16 (62% ) of 26 USPC samples evaluated, with 7 (27% ) samples showing moderate staining (2? ) and 9 (35% ) showing strong staining (3? ) for HER2/neu. Amplification of the ERBB2 gene by FISH was observed in 11 of the 26 (42% ) cases. Protein overexpression and gene amplification were found to correlate in 100% (9 of 9) of the 3? positive tumors and 2 out of 7 (29% ) of the 2? positive tumors. Heterogeneity was noted in 3 cases in the amplification of the HER2/neu gene within the same tumor samples with pockets of amplified tumor cells amidst nonamplified tumor cells. None of the 10 USPC cases scored by IHC as 0 or 1? was found positive for ERBB2 amplification by FISH. Conclusions. Amplification of the HER2/neu oncogene represents a common finding in USPC. FISH analysis should be used for confirmation of gene amplification in USPC showing 2? expression of HER2/neu. Prior screening and selection of appropriate immunohistochemistry-positive areas may be beneficial in the selection of some USPC patients undergoing FISH analysis.

摘要：目的评估美国高龄父亲对孕产妇及围产期结局的影响。设计引用国家生命统计系统公布的数据,采用基于人群的回顾性队列研究方法。背景美国。人群研究对象为2007--2016年记录在案的40529905名活产婴儿及其父母亲。父亲年龄按10年间隔分组:<25、25-34、35-44、45-54和55岁及以上。