Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review

OBJECTIVE: To compile a systematic review of complications related to genetic amniocentesis and chorionic villus sampling (CVS) to provide benchmark data for counseling and performance assessment of individual operators. DATA SOURCES: We searched the MEDLINE database for articles published after January 1, 1995, that reported data for at least 100 women with singleton pregnancies with genetic amniocentesis after 14 weeks of pregnancy and reports of CVS carried out transabdominally between 10 and 14 weeks. METHODS OF STUDY SELECTION: For amniocentesis, 29 articles fulfilled search criteria. Sixteen studies fulfilled search criteria for CVS. TABULATION, INTEGRATION, AND RESULTS: After genetic amniocentesis, pooled pregnancy loss within 14 days was 0.6% (95% confidence interval [CI] 0.5-0.7), rising to 0.9% (95% CI 0.6-1.3) for pregnancy loss before 24 weeks and 1.9% (95% CI 1.4-2.5) for total pregnancy loss. Corresponding figures for CVS were 0.7%, 1.3%, and 2%. The data on multiple insertions showed large heterogeneity, ranging from 0.2% to 2.9% for amniocentesis (pooled risk 2.0%, 95% CI 0.9-3.6) and from 1.4% to 26.6% for CVS (pooled risk 7.8%, 95% CI 3.1-14.2). Only five amniocentesis studies provided controls, but none was matched for gestational age. Pooled relative risks for fetal loss before 28 weeks and total pregnancy loss were 1.46 (95% CI 0.86-2.49) and 1.25 (95% CI 1.02-1.53), respectively. CONCLUSION: Although the risks of pregnancy loss are relatively low, lack of adequate controls tends to underestimate the true added risk of prenatal invasive procedures.     

Risk factors and outcomes associated with a short umbilical cord

OBJECTIVE: To identify risk factors and outcomes associated with a short umbilical cord. METHODS: We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord. Controls (n = 14260) were randomly selected from among births without a diagnosis of short umbilical cord. RESULTS: Case mothers were less likely to be overweight (body mass index 25 or more, odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6, 0.8) and more likely to be primiparous (OR 1.4; 95% CI 1.3, 1.6). Case infants were more likely to be female (OR 1.3; 95% CI 1.2, 1.4), have a congenital malformation (OR 1.6; 95% CI 1.4, 1.8), and be small for their gestational age (risk ratio [RR] 1.6; 95% CI 1.4, 1.9). A short cord was associated with increased risk for maternal labor and delivery complications, including retained placenta (RR 1.6; 95% CI 1.2, 2.3) and operative vaginal delivery (RR 1.4; 95% CI 1.3, 1.5). Adverse fetal and infant outcomes in cases included fetal distress (RR 1.8; 95% CI 1.6, 2.1) and death within the first year of life among term infants (RR 2.4; 95% CI 1.2, 4.6). CONCLUSION: Modifiable risk factors associated with the development of a short cord were not identified. Case mothers and infants are more likely to experience labor and delivery complications. Term case infants had a 2-fold increased risk of death, which suggests closer postpartum monitoring of these infants.     

Teenage pregnancies: obstetric characteristics and outcome

OBJECTIVE: To quantify the age related risk of adverse obstetric outcome in primigravid women less than 20 years of age. STUDY DESIGN: The study sample was drawn from Cardiff Births Survey (a computerized maternity information database) comprising 66,271 pregnancies in the South Glamorgan region during 1990-1999. Pregnancy outcomes of primigravid women were compared in age groups less than 20 years (n=4126) and 20 to <35 years (n=17,615). SPSS version 11 was used for statistical analysis. Student's t-test was used for continuous variables, Chi square, Fishers exact test was used for categorical variables. RESULTS: There was a lower incidence of multiple pregnancies (OR=0.3(0.2-0.4)), spontaneous rupture of membranes >24h (OR=0.7(0.6-0.9)), and pregnancy-induced hypertension (OR=0.8(0.6-0.8)) amongst teenage primigravidae but a higher incidence of anaemia (OR=1.8(1.6-2.0)), and pyelonephritis (OR=1.5(1.1-2.0)). There was a lower incidence of induction of labour (OR=0.7(0.7-0.8)) and use of regional analgesia in the teenage group. Teenage women were more likely to have a spontaneous vaginal delivery (OR=2.1(2.0-2.3)) with a significantly lower incidence of instrumental delivery (OR=0.5(0.5-0.6)), and Caesarean section (OR=0.4(0.4-0.5)). Inspite of a higher incidence of preterm labour (corrected OR=1.4(1.1-1.7)) the perinatal outcome measures between the teenage group and the older group were not significantly different. CONCLUSION: Teenage primigravidae are more likely to have a spontaneous vaginal delivery, without compromising the maternal or neonatal outcome.     

High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy.

OBJECTIVE: To examine the relationship between pregravid body mass index (BMI), elevated cholesterol level, and the development of hypertensive disorders of pregnancy. METHODS: We studied 15,262 women who gave birth between 1991 and 1995. Pregravid exposures including BMI and self-reported history of elevated cholesterol were ascertained by biennial mailed questionnaires. Gestational hypertension or preeclampsia was confirmed by medical record review according to standard criteria. Proportional hazards analysis was used to adjust for potential confounding variables. RESULTS: We confirmed 216 cases of gestational hypertension and 86 cases of preeclampsia. The risk of gestational hypertension increased as pregravid BMI increased (P < .01). Compared with women with a pregravid BMI of 21-22.9 kg/m2, the relative risk (RR) of gestational hypertension was 1.6 (95% confidence interval [CI] 1.0, 2.3) for women with BMI of 23-24.9 kg/m2, 2.0 (95% CI 1.3, 3.0) for BMI 25-29.9 kg/m2, and 2.6 (95% CI 1.6, 4.4) for BMI over 30 kg/m2. Leaner women (BMI less than 21 kg/m2) had a reduced risk (RR 0.7, 95% CI 0.4, 1.0). For preeclampsia, the RR of women with pregravid BMI over 30 kg/m2 was 2.1 (95% CI 1.0, 4.6) (P for trend 0.09). A history of elevated cholesterol was not associated with the risk of gestational hypertension (RR 0.9, 95% CI, 0.6, 1.4). In contrast, the RR of preeclampsia in women with a history of elevated cholesterol was 2.0 (95% CI 1.2, 3.3). CONCLUSION: Pregravid BMI and hypercholesterolemia could identify women at higher risk for hypertensive disorders during pregnancy.     

Does smoking increase risk of ovarian cancer? A systematic review

OBJECTIVES: Although early reports suggested that smoking was not associated with ovarian cancer risk, recent studies have reported positive associations for cancers of the mucinous subtype. We sought to clarify the relationship between smoking and ovarian cancer by histological subtype. METHODS: We conducted a systematic literature review and meta-analysis of studies investigating the association between smoking and risk of the different histological subtypes of epithelial ovarian cancer. Eight population-based case-control studies, one pooled analysis of case-control studies, and one cohort study met the inclusion criteria. Summary relative risks (RR), 95% confidence intervals (CI), and tests for heterogeneity were generated from random effects models. RESULTS: Combined, these studies included a total of 910 women with mucinous and 5564 with non-mucinous ovarian cancers. There was a significant doubling of risk of mucinous ovarian cancer in current smokers compared to never smokers (summary RR 2.1, 95% CI 1.7-2.7), but no increased risk of serous (1.0, 95% CI 0.8-1.2) or endometrioid (0.8, 95% CI 0.6-1.1) cancers and a significant risk reduction for clear cell cancers (0.6, 95% CI 0.3-0.9). The risk of mucinous cancer increased with increasing amount smoked but returned to that of never smokers within 20-30 years of stopping smoking. CONCLUSIONS: Meta-analysis suggests that current smoking doubles a woman's risk of developing mucinous ovarian cancer. Stopping smoking returns the risk to normal in the long term. Smoking may thus be one of the few modifiable factors offering potential for primary prevention of mucinous ovarian cancer.     

Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder

A retrospective review of 237 initial, fresh nondonor IVF cycles in which all embryos generated during the cycle were transferred on either day 2 (n = 109) or day 3 (n = 128) were evaluated with regards to reproductive outcomes. Patients who underwent a day 2 ET had similar conception (18% vs. 16%; relative risk [RR], 1.1; 95% confidence interval [CI], 0.64-1.95), clinical pregnancy (13% vs. 16%; RR, 0.8; 95% CI, 0.44-1.55), implantation (6% vs. 7%; RR, 0.9; 95% CI, 0.50-1.68), and live-birth (10% vs. 16%; RR, 0.7; 95% CI, 0.32-1.29) rates as those who underwent a day 3 ET.     

Incomplete pregnancies and ovarian cancer risk.

The role of spontaneous and voluntary abortions was assessed in a case-control study conducted in Milan, northern Italy on 953 cases of epithelial ovarian cancer (median age, 54) and 2500 control subjects (median age, 52) in hospital for acute diseases other than malignant, gynecological, or hormonal disorders. Overall the inverse relationship between total number of incomplete pregnancies and ovarian cancer risk was statistically significant, estimated relative risks (RRs) being, respectively, 0.9 (95% confidence interval (CI), 0.7-1.1) for one abortion and 0.8 (95% CI, 0.6-1.0) for two or more as compared to none. Furthermore, the protections afforded by spontaneous and voluntary abortions were well comparable (RRs 0.7 and 0.8 for > or = 2 spontaneous and voluntary abortions, respectively, versus none). While the protective effect of incomplete pregnancy was not explicable in terms of other characteristics of women nor significantly different across strata of reproductive factors or oral contraceptive use, it seemed more marked in women whose ovarian cancer occurred below age 50. Etiologically, these findings suggest that interrupted pregnancy per se and not predisposition to spontaneous abortion affects ovarian cancer risk.     

Paradoxical adolescent reproductive decisions

OBJECTIVE: To determine why teenagers who say they do not plan to parent if they become pregnant fail to use contraceptives consistently enough to avoid conceiving by default. METHODS: A racially diverse group of 333 inadequately contracepting, nulligravida teens, 45 (13.5%) of whom did not plan to parent if they became pregnant was studied. Participants completed scales assessing traditional teen pregnancy risk factors, deterrents to contraceptive use, expectations about the effect of pregnancy, the desire to remain non-pregnant, and sexual behavior. RESULTS: Teens who said they would not parent if pregnant were less apt to report boyfriends who wanted them to conceive (RR=0.7; 95% CI=0.5-0.9) and deterrents to contraceptive use (RRs around: 0.6; 95% CI: 0.3-0.9) and more apt to anticipate that childbearing would negatively impact their lives (RR: 1.9; 95% CI: 1.6-2.2), to want to remain non-pregnant (RR: 2.2; 95% CI: 1.8-2.4), and to have used contraception at last sexual intercourse (RR: 1.8; 95% CI: 1.3-2.4). In the group that did not intend to parent the only difference between those who had and had not used contraception at last intercourse was their willingness to plan for sexual activity (OR: 4.6; 95% CI: 1.3-16.7). CONCLUSION: This study suggests that further progress toward preventing unwanted teen pregnancies might be made by dispelling the notion that for young, unmarried women, unplanned sexual intercourse is preferable to planned sexual intercourse.     

World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries

Objective  To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia.
Design  Multicentred, randomised, controlled, double-blinded trial.
Setting  Antenatal care clinics and Hospitals in four countries.
Population  Pregnant women between 14 and 22 weeks' gestation.
Method  Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery.
Main outcome measures  Pre-eclampsia, low birthweight, small for gestational age and perinatal death.
Results  Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of pre-eclampsia (RR: 1.0; 95% CI: 0.9–1.3), eclampsia (RR: 1.5; 95% CI: 0.3–8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9–1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8–1.1), small for gestational age (RR: 0.9; 95% CI: 0.8–1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6–1.2) were also unaffected.
Conclusion  Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.     

Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands

OBJECTIVE: This study was performed to determine the prevalence of GBS and to identify GBS colonisation risk factors in a multicultural population of pregnant women in The Netherlands. We calculated predictive values of cultures in pregnancy for intrapartum GBS carriage. STUDY DESIGN: From a total of 1702 women visiting several antenatal outpatient departments, rectovaginal swabs were collected at 35-37 weeks' gestation. In 761 women swabs were repeated at time of delivery. Carriage of GBS late in third trimester and at time of delivery was analysed in relation to age, parity, ethnicity and socio-economic status. RESULTS: Twenty-one percent was GBS carrier late in pregnancy. Compared to Europeans, African women were at a higher risk (29%, RR 1.4, CI 1.1-1.7) and Asian women were at lower risk (13%, RR 0.6, CI 0.4-0.8) for GBS carriage. No differences in colonisation were found between women with respect to age, parity or socio-economic background. Positive predictive value of GBS carriage at 35-37 weeks' gestation for carriage at time of parturition was 79% and negative predictive value was 93%. CONCLUSIONS: It was not possible to identify a group of pregnant women at high risk for GBS colonisation. Predictive values of antenatal genital group B streptococci cultures at 35-37 weeks' gestation for intrapartum GBS carriage are lower than previously reported.     

Endometritis does not predict reproductive morbidity after pelvic inflammatory disease

OBJECTIVE: We investigated the association between endometritis and reproductive morbidity. STUDY DESIGN: Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility. RESULTS: Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates. CONCLUSION: Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, endometritis/UGTI was not associated with reproductive morbidity.     

重度妊娠高血压综合征患者胎盘组织细胞凋亡及其调控基因 …

目的　研究细胞凋亡及其调控基因在重度妊娠高血压综合征 (妊高征 )发生、发展中的作用。方法　对 40例正常晚孕妇女 (对照组 )和 40例重度妊高征患者 (观察组 )的胎盘组织进行分析。用DNA缺口原位末端标记 (TUNEL)技术检测细胞凋亡 ;免疫组织化学方法检测促进和抑制凋亡基因 (bax/bcl 2 )的表达。结果　对照组胎盘细胞滋养细胞、合体滋养细胞中凋亡指数分别为 ( 1.1±0 .9) %、( 41.8± 1.5 ) % ;bax阳性率分别为 ( 1.0± 0 .9) %、( 2 8.9± 9.7) % ;bcl 2阳性率分别为 ( 2 .2±0 .8) %、( 2 2 .9± 0 .7) % ,总bax/bcl 2为 0 .7～ 1.7。观察组胎盘细胞滋养细胞、合体滋养细胞的凋亡指数分别为 ( 4.3± 1.2 ) %、( 45 .3± 1.4) % ;bax阳性率分别是 ( 2 .2± 0 .8) %、( 42 .5± 11.7) % ;bcl 2阳性率分别是 ( 3 .2± 0 .8) %、( 2 3 .3± 7.8) % ;总bax/bcl 2为 1.0～ 3.2。即 :对照组胎盘中有一定量的细胞凋亡、bax、bcl 2表达 ,bax/bcl 2表达间呈平衡趋势 ;观察组中细胞凋亡明显增高 (P <0 .0 1) ,bax表达也明显增强 (P <0 .0 1) ,bcl 2表达仅呈增高趋势 ,但差异无显著性 (P >0 .0 5 ) ,bax/bcl 2比值明显增高(P <0 .0 1)。结论　细胞凋亡及其调节基因的表达间具有一致性 ;细胞凋亡、bax/bcl 2表达     

Effects of lifetime exercise on the outcome of in vitro fertilization

OBJECTIVE: To estimate whether exercise before the first cycle of in vitro fertilization (IVF) affects cycle outcomes. METHODS: A total of 2,232 patients were prospectively enrolled before undergoing their first cycle of IVF for the treatment of infertility from 1994-2003 at three IVF clinics in the greater Boston area. The primary IVF outcomes of interest included successful live birth and four points of cycle failure: cycle cancellation, failed fertilization, implantation failure, and pregnancy loss. Unconditional logistic regression adjusting for observed confounders was used to quantify the relation between self-reported exercise and cycle outcome. RESULTS: In general, women who reported regular exercise were no more likely to have a live birth compared with those women who did not report exercise (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7-1.0; P = .07). Women who reported exercising 4 hours or more per week for 1-9 years were 40% less likely to have a live birth (OR 0.6, CI 0.4-0.8) and were almost three times more likely to experience cycle cancellation (OR 2.8, CI 1.5-5.3) and twice as likely to have an implantation failure (OR 2.0, CI 1.4-3.1) or pregnancy loss (OR 2.0, CI 1.2-3.4) than women who did not report exercise. In general, women who participated in cardiovascular exercise had a 30% lower chance of successful live birth (OR 0.7, CI 0.6-0.9) than women who reported no exercise. CONCLUSION: Regular exercise before in vitro fertilization may negatively affect outcomes, especially in women who exercised 4 or more hours per week for 1-9 years and those who participated in cardiovascular exercise. LEVEL OF EVIDENCE: II-2.     

Ectopic pregnancy risk with assisted reproductive technology procedures

OBJECTIVE: To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS: The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. RESULTS: Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. CONCLUSION: Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2.     

Reproductive and dietary risk factors for epithelial ovarian cancer in China

OBJECTIVE: A case-control study was conducted to investigate the effects of reproductive and dietary risk factors on ovarian cancer risk in China. METHODS: Cases were 254 patients with histologically confirmed epithelial ovarian cancer. Controls were 652 women without neoplasm and long-term dietary modifications. Information was collected using a structured questionnaire on sociodemographic and reproductive characteristics, diet, medical and family cancer history. The risks of ovarian cancer were assessed by multivariate logistic regression analysis. RESULTS: The adjusted odds ratios (OR) for women having at least two full-term pregnancies, two or more incomplete pregnancies, and first full-term pregnancy at 21-25 years of age were 0.45 (95% CI 0.3-0.8), 0.56 (95% CI 0.4-0.8), and 0.40 (95% CI 0.2-0.8), respectively, compared with nulliparity. The OR of ever lactation was 0.50 (95% CI 0.3-0.8) and oral contraceptive was 0.48 (95% CI 0.3-0.7), while postmenopausal women appeared to have an increased risk with OR 1.48 (95% CI 1.0-2.3). For the highest versus the lowest quartile intakes of nutrients, the OR were 2.17 (95% CI 1.3-3.8) for fat, 0.36 (95% CI 0.2-0.6) for fibre, 0.26 (95% CI 0.2-0.5) for carotene, 1.59 (95% CI 0.9-2.7) for retinol, 0.31 (95% CI 0.2-0.5) for vitamin C, and 0.41 (95% CI 0.2-0.7) for vitamin E, with significant dose-response relationships. CONCLUSION: It is evident that full-term and incomplete pregnancies, lactation, and oral contraceptive use can reduce the ovarian cancer risk. Moreover, consumption of foods low in fat but high in fibre, carotene and vitamins appears to be protective against ovarian cancer in Chinese women.     

Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories

OBJECTIVE: To evaluate rectal diclofenac in the relief of perineal pain after trauma during childbirth. DESIGN: A randomised, double-blind trial. SETTING: Delivery Suite, Women's and Children's Hospital, South Australia. POPULATION: Women with a second-degree (or greater) perineal tear or episiotomy. METHODS: Women were randomly allocated to either diclofenac or placebo suppositories (Anusol), using a computer-generated randomisation schedule with stratification for parity and mode of birth. Treatment packs contained two x 100 mg diclofenac or two placebo suppositories, the first being inserted when suturing was complete, and the second 12-24 hours after birth. Women were asked to complete questionnaires at 24 and 48 hours after birth relating to their degree of perineal pain using the validated Short Form McGill Pain Questionnaire. MAIN OUTCOME MEASURES: Pain scores at 24 and 48 hours after birth. RESULTS: A total of 133 women were recruited, with 67 randomised to diclofenac suppositories and 66 to placebo. Women in the diclofenac group were significantly less likely to experience pain at 24 hours while walking (RR 0.8; 95% CI 0.6 to 1.0), sitting (RR 0.8; 95% CI 0.6 to 1.0), passing urine (RR 0.6; 95% CI 0.4 to 1.0) and on opening their bowels (RR 0.6; 95% CI 0.2 to 0.9) compared with those women who received placebo. These differences were not sustained 48 hours after birth. CONCLUSIONS: The use of rectal non-steroidal anti-inflammatory drug suppositories is a simple, effective and safe method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.     

Alcohol abuse during pregnancy: changes in frequency in a large urban hospital

The reported frequency of alcohol abuse during pregnancy was studied in a large urban public hospital in Dallas, Texas. During 1977-1980, 5602 pregnant women were surveyed and 0.7% (95% confidence interval 0.6-0.8%) reported abusing alcohol during pregnancy. In 1987, 1.4% (95% confidence interval 1.3-1.5%) of 1032 pregnant women, who were surveyed before delivery, reported alcohol abuse according to the same definition used 10 years earlier. The increase in the frequency of reported alcohol abuse during pregnancy between 1977-1980 and 1987 is statistically significant (P less than .05).     

Vaginal prostaglandin E2 gel versus tablet in the induction of labour at term--a retrospective analysis.

Our aim in this retrospective analysis was to compare labour outcomes between 145 consecutive women with unfavourable cervices, who received prostaglandin E2 vaginal gel (1-2 mg) for labour induction over a 3-month period, and 149 women receiving a prostaglandin E2 vaginal tablet (3 mg) over the following 3 months. Our results showed that cervical dilatation in the gel group was significantly more than in the tablet group at transfer to labour ward [4 cm (SD 2.5 cm) versus 3.3 cm (SD 2 cm), mean difference -0.7, 95% CI -1.2 to -0.2, P=0.01), with fewer women requiring oxytocin augmentation, but this was not statistically significant (41.4% versus 50%, RR 0.8, 95% CI 0.7-1.1). There were no significant differences in the mode of delivery in the number delivering vaginally within 24 hours of the induction (60.4% in the gel group versus 56.2% in the tablet group, RR1.1, 95% CI 0.9-1.4), in the number of doses of PGE2 administered, or in the neonatal outcomes between the two groups. In conclusion, there were no significant differences in labour or neonatal outcomes between prostaglandin E2 gel or tablet use in the induction of labour in this retrospective analysis.     

米非司酮配伍米索前列醇抗早孕蜕膜与绒毛细胞凋亡及其调控基 …

目的 探讨细胞凋亡及其调控基因Ｂ－细胞淋巴瘤／白血病－２（ｂｃｌ－２）,ｂｃｌ－２相关Ｘ蛋白（ｂａｘ）基因的表达与药物终止早孕的关系,方法 对随机采用米非司酮负吸收（１５例米非司酮组）米非司酮并米索前列醇（米索）（１４例,米非司酮米索组）,负压吸收（１５例,对照组）终止早孕经碘化丙锭染色的蜕膜与绒毛组织,应用流式细胞定性定量分析技术进行ＤＮＡ分析,采用免疫荧光标记对Ｂｃｌ－２,ｂａｘ基因蛋白进行分     

Intrapartum chlorhexidine vaginal irrigation and chorioamnion and placental microbial colonization.

OBJECTIVES: To determine whether intrapartum chlorhexidine vaginal irrigation reduces microbial colonization of the chorioamnion or placenta. METHODS: Secondary analysis was made of a randomized trial. Cultures for aerobic and anaerobic bacteria, Mycoplasma species and Ureaplasma urealyticum were performed using standard isolation techniques. RESULTS: The placentas of 83 trial participants allocated to chlorhexidine and 93 allocated to placebo underwent evaluation. These two groups were statistically balanced for risk factors for infection. Aerobic bacteria were isolated from 47% of the chlorhexidine placentas vs. 51% of the placebo placentas (relative risk 0.9, 95% confidence interval 0.7-1.3), anaerobic bacteria from 30% and 35%, respectively (0.8, 0.5-1.3), group B streptococcus from 12% and 15% (0.8, 0.4-1.7), U. urealyticum from 18% and 29% (0.6, 0.4-1.1), Mycoplasma species from 6% and 11% (0.6, 0.2-1.6), and any organism from 57% and 67%, respectively (0.8, 0.7-1.1). CONCLUSIONS: Intrapartum chlorhexidine vaginal irrigation was associated with non-significant reductions in the rates of placental microbial isolation.