WHO appropriate technology for birth revisited.

The validity of WHO recommendations for childbirth care are examined. WHO recommendations were published in 2 places: the August 1985 Lancet article on "The Appropriate Technology for Birth" and in the WHO book, "Having a Baby in Europe." Questions have arisen since publication about how the information was derived, the representativeness of the information, the relation to research findings,. and the potential bias. The issue of appropriate birth practices and use of technology had been debated since the 1979 UN International Year of the Child. WHO established a 15-member multidisciplinary perinatal study group to review the literature and an academic and lay publication in 1985 were the result. Birth Conferences were also held nationally in countries applying the WHO birth recommendations. there have been 43 conferences conducted in 23 member states in addition to the US, Canada, Australia, and China; issues were debated and consensus reached. the recent publication by Chalmers et al. (1989) answered many questions. In the publication appendix perinatal technology is distinguished as that technology with 1) reduces the negative outcome of pregnancy and childbirth, 2) is promising but unproven, 3) has unknown effects and requires evaluation, and 4) is unnecessary based on available evidence. An example from the appendix on WHO recommendations for specific birth technology is given in table form for 13 practices recommended and a statement of research support. For example, the recommendations is that women participate in decisions about their birth experiences. Research states that failing to involve women in decisions about their care should be abandoned. Another recommendation is that the healthy newborn must remain with the mother whenever possible, and the research states that separating mothers and babies routinely should be abandoned. No assessment in the Chalmers et al. publication is concerned with perinatal health care policy or setting of policy. The recommendations were developed from survey research, discussion, debate, and carefully controlled and critically evaluated randomized control trials.     

妊娠期适宜增重范围与出生体重的关系研究

目的 探讨正常足月妊娠妊娠期适宜的体重增长范围与出生体重和妊娠结局的关系.方法 采用病例回顾分析的研究方法,对2003年在北京3所医院分娩的正常足月单胎孕产妇共4 504例临床资料进行统计学分析.结果 妊娠期增重(17.12±4.99)kg,出生体重(3 416.55±414.90)g,建议适宜的出生体重在2 900～3499g之间;按照孕前体重指数(BMI)低、中、高3组,妊娠期增重依次递减、出生体重依次递增,推荐的妊娠期适宜增重范围分别为14.00～19.50 kg、13.00～19.00kg和11.00～18.50 kg.结论 建议新生儿出生体重控制在2 900～3 499g之间较为适宜,孕前BMI正常的妇女妊娠期增重应控制在16kg左右,有利于获得最佳妊娠结局.     

The problems and outcome with newborns who are extremely low birth weight, appropriate for gestational age and small for gestational age

The aim of this study is to evaluate the consequences of being extremely low birth weight (ELBW) under 1000 g at birth, small (SGA) or appropriate for gestational age (AGA). METHODOLOGY: A retrospective comparison of two cohorts of ELBW AGA (n = 47) and SGA (n = 38) infants, admitted to the Intensive Care Unite of State Maternity Hospital "Ma?chin Dom" from 01, 1995 to 06, 1998 is carried out. Infants with major congenital anomalies and those, who died in the first two hours of life, being extremely premature and unviable, are excluded. RESULTS AND CONCLUSIONS: The mean birth weight of the AGA group is 863 g, their mean gestational age is 26.6 weeks of gestation and of the SGA group--795 g and 29.6 weeks respectively. In the Sga C-section is preferred in 85%, vs only 34% in the AGA group. SGA babies are with two times greater survival rate (61%) then AGA (32%). The causes of death are similar. The AGA survivors have a greater rate of stage III-IV intraventricular hemorrhage, more prolonged need for ventilatory support (19 vs 12 days for SGA) and oxygen supplementation (37.5 vs 30.7 for the SGA), more difficulties with enteral feeding and their median hospital stay is somewhat longer (81.9 days), compared with those of the SGA (76.6 days). The two groups show a similar rate of respiratory distress syndrome, chronic lung disease, infections and neurological complications among the survivors.     

Endometrial endotoxin, assisted reproductive technology, and preterm birth

The failure of antibiotic prophylaxis to reduce preterm birth in women at risk and the increased rate of preterm birth in singleton pregnancy after ART may have a common explanation: persistent bacterial endotoxin in the endometrium, reported by Kamiyama et al. as an explanation for reduced fertility.     

早产预测

早产是新生儿及幼儿死亡的主要原因,同时也是婴幼儿神经和呼吸系统发育异常等长期疾病的主要原因。准确的早产预测不仅对早产的诊治起着重要的作用,避免不必要的早产发生,同时也可避免过度的干预治疗。本文从早产的风险因素、临床预测及生物标志物等方面对早产预测进行讨论。     

会阴切开术与阴道分娩

1背景 会阴切开术是在第二产程末或分娩过程中，用剪刀或手术刀切开会阴，并需缝合修补的一种扩大阴道口的外科手术（Thacker 1983）。     

Inpatient hospitalizations in women with and without assisted reproductive technology live birth

Purpose

The aim of this study is to evaluate frequency of hospitalization before, during, and after assisted reproductive technology (ART) treatment by cycle outcome.

Methods

Six thousand and one hundred thirty women residing in Massachusetts undergoing 17,135 cycles of ART reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SARTCORS) from 2004 to 2011 were linked to hospital discharges and vital records. Women were grouped according to ART treatment cycle outcome as: no pregnancy (n = 1840), one or more pregnancies but no live birth (n = 968), or one or more singleton live births (n = 3322). Hospital delivery discharges during 1998–2011 were categorized as occurring before, during, or after the ART treatment. The most prevalent ICD-9 codes for non-delivery hospital discharges were compared. Groups were compared using chi square test using SAS 9.3 software.

Results

The proportion of any hospitalization was 57.0, 58.3, and 91.3% for women with no pregnancy, no live birth, and ART singleton live birth, respectively; the proportion of non-delivery hospitalizations was 30.4, 31.0, and 28.3%, respectively. The non-ART delivery proportion after ART treatment did not differ by group (33.4, 36.2, and 36.9%, respectively, p = 0.17). Most frequent non-delivery diagnoses (including fibroids, obesity, ectopic pregnancy, depression, and endometriosis) also did not differ by group. A secondary analysis limited to only women with no delivery discharges before the first ART cycle showed similar results.

Conclusions

All groups had live birth deliveries during the study period, suggesting an important contribution of non-ART treatment or treatment-independent conception to overall delivery and live births. Hospitalizations not associated with delivery suggested similarity in morbidity for all ART patients regardless of success with ART treatment.

     

Advances in fetal genetic diagnosis and therapy: Ethical issues and appropriate technology in cost-restrained countries

The advent of ultrasound in the 1970s heralded a milestone that could give real-time information about fetal abnormalities, and thereby improve diagnostic accuracy. This knowledge could not be used effectively to benefit the fetus for which it was intended. The 1980s saw science catching up with diagnostic advances, and fetal abnormalities could realistically be treated with an expectation of satisfactory outcomes. As a result, parents could have realistic expectations of having healthy children. Prenatal diagnosis is the first step towards this realisation, as diagnosis can be followed by intrauterine treatment. Scientists have realised that, if an abnormality can be corrected prenatally, prognosis can be improved significantly, as the initial problem does not necessarily threaten the fetus; therefore, if the prenatal condition can be dealt with early, then the downstream repercussions can be eliminated. In this chapter, we address ethical issues in prenatal diagnosis and fetal therapy.     

WHO recommendations for misoprostol use for obstetric and gynecologic indications

BackgroundMisoprostol, a prostaglandin E₁ analog, stimulates uterine contractility and cervical ripening. A number of randomized trials and systematic reviews have evaluated its use in obstetric and gynecologic conditions. Misoprostol is inexpensive, stable at room temperature, and available in more than 80 countries, making it particularly useful in resource-poor settings. WHO recognizes the crucial role of misoprostol in reproductive health and has incorporated recommendations for its use into 4 reproductive health guidelines focused on induction of labor, prevention and treatment of postpartum hemorrhage, and management of spontaneous and induced abortion.Methods and resultsAll guidelines were prepared in accordance with the WHO Handbook for Guideline Development. The process included: identification of priority questions and critical outcomes; retrieval of evidence; assessment and synthesis of evidence; formulation of recommendations; and planning for dissemination, implementation, impact evaluation, and updating. The present report summarizes recommendations for misoprostol use in line with each guideline.ConclusionThe present comprehensive reference document was designed to enable clinicians and policy makers to quickly access and compare recommendations for the use of misoprostol in various reproductive health settings.