胎方位异常的管理：面先露

面先露发病率低,但处理不当极易出现严重母儿合并症。面先露时胎头俯屈不良,下降及内旋转均发生困难,足月儿很难自然分娩。如不能及早识别与妥善处理,面先露危害母儿生命安全。本文就面先露早期识别与处理进行阐述。     

初产妇头位分娩100例产程图分析

对５０例头位难产的初产妇（异常组）及５０例头位顺产的初产妇（对照组）的产程图进行分析。结果表明：异常组潜伏期、活跃期时限明显大于对照组（Ｐ＜０．００１），宫颈扩张速度和胎头下降速度都明显小于对照组（Ｐ＜０．００１）。异常组产后出血量、总产程、手术产率、新生儿窒息率都明显高于对照组（Ｐ＜０．００１）。异常组５０例中，经过积极处理后，有３８例阴道分娩，占７６％。提示：产程中应用产程图对发现产程异常、指导产程处理和识别难产具有非常重要的意义。     

Nuchal cord position in breech presentation: case report

Nuchal cord position in breech presentation has been previously reported and classified into two types. We report a case of breech presentation with nuchal cord. Prenatal ultrasound showed a single nuchal cord inserted into the placenta located on the mid-posterior uterine wall at the level of the fetal neck. Elective cesarean section was performed at 37 weeks. We discuss the clinical significance of nuchat cord.     

External version from breech position to head presentation near term

The external version of fetus from breech into a head presentation is one of the methods to avoid maternal and fetal risk by Cesarean section and by vaginal delivery. As a supposition, we see a technique which is undangerous for mother and fetus. Our procedure corresponds in many points with a practice, which is published by B. Westin. The sober patient is positioned head down on the side of fetus small parts. Then an intravenous infusion is given over 30 min with 2 micrograms fenoterol (Partusisten)/min. The version is performed in many single and little steps. It needs time, a soft hand and the readiness of the Cesarean section. In 104 of 242 patients with breech presentation there was the indication with fulfilled suppositions for such a version. The success-rate was nearly 50%. In no case there was a complication. The rate of Cesarean section past turning was clearly reduced in contrary to breach presentation. The fetal outcome was clearly better. The version of breach presentation is recommended.     

Multicentric human papillomavirus infections of the female genital tract: correlation of viral types with abnormal mitotic figures, colposcopic presentation, and location

Human papillomavirus deoxyribonucleic acid (DNA) was identified by Southern blot hybridization in 21 of 24 patients with multicentric anogenital lesions and in 46 of 61 individual lesions. Type 6/11 was present in nine patients, type 16 in one, an undetermined type in one, and more than one type in ten patients. Mixed types were present in eight of 46 virus-positive individual lesions. Abnormal mitotic figures were found in 16, 87, and 75% of lesions associated with type 6/11, type 16, and mixed types, respectively. Colposcopic presentation or location of lesions was not predictive of viral types. The relatively high rate of mixed human papillomavirus types in multicentric lesions and in single lesions, and the lack of absolute correlation between viral types and abnormal mitotic figures, suggest that lesions should be removed to prevent viral transmission and possible progression to carcinoma.     

Labor induction with misoprostol.

Misoprostol, a prostaglandin E(1 ) analog, is widely used in the United States for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. Multiple trials have proved that misoprostol is an effective agent for cervical ripening and labor induction in term pregnancy; however, investigations continue regarding the optimal dose, dosing regimen, and route of administration. Uterine contraction abnormalities are often found in association with higher misoprostol doses. Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effective agent for cervical ripening and labor induction when used in a judicious and cautious fashion.