Population control: part 2: China

China, by introducing a nationwide program for severely limiting births, has managed a decline in its rate of growth from the nearly 3% of 25 years ago to the 1.7% of today. Chinese officials believe that this present rate of growth may be reduced even further as younger generations are encouraged to marry late and to limit their family size to 2 children. A significant factor influencing China's successful population limitation effort has been the elevation of the status of women. This extends to attitudes towards female children in that now the mother is encouraged to look favorably on female offspring. Regarding contraceptive practice, women in both rural and urban areas are acceptors of IUDs, oral contraceptives, and tubal ligation. Men in urban areas use the condom freely, but in the rural areas, the men are more reticent and conservative. Very few males have vasectomies. Generally, the decision on birth control methods is left to the individual couple. Although contraception rather than abortion is the preferred practice, abortion is regarded acceptable for child spacing and after the birth of a 2nd child. Careful and up-to-date record keeping is considered essential for evaluating family planning programs and monitoring progress.     

PRACTICES: Part 2: Factors Affecting Use

This, the second of a two-part article, describes the findings of a national survey of practicing certified nurse-midwives (CNMs) regarding factors that affect the use of eight second-stage maternal positions. Lower CNM self-reported autonomy scores were associated with the use of the lithotomy and dorsal supine positions; maternal preference and higher CNM self-reported autonomy scores were associated with the use of the nonlithotomy positions. The use of nonlithotomy positions is one nontechnologic way to enhance the normal process of birth.     

Review: Feto-placental vascularization: a multifaceted approach

Doppler Ultrasound allows the in vivo study of feto-placental hemodynamics. Doppler flow velocity waveforms (FVW's) obtained from the umbilical arteries reflect downstream blood flow impedance, thus giving indirect evidence of vascular villous tree characteristics. Pulsatility Index, which quantifies FVW's, decreases throughout normal pregnancy, indicating decreasing impedance and is often higher in cases of fetal growth restriction (FGR). Different approaches (morphometrical, morphological, mathematical, immunohistochemical and molecular) have contributed to elucidation of which anomalies of the vascular villous tree underlie Doppler findings. 3D ultrasound may be useful in the study of feto-placental perfusion. However, the unsolved question is why developmental villous tree anomalies occur. Crucial to the success of future research is definition of the population studied based on the uniform and correct definition of FGR.     

子宫乳头状浆液性癌与子宫内膜乳头状腺癌生物学行为的临床分析

目的：分析子宫乳头状浆液性癌及乳头状内膜腺癌的病理形态和生物学行为的特点。方法：对５６例含乳头状结构的子宫内膜癌患者行回顾性分析。其中子宫乳头状浆液性癌１５例，乳头状子宫内膜腺癌４１例。以普通子宫内膜腺癌１６０例作为对照。结果：各组诊断时，晚期病例的比例依次为２６．７％、１４．６％、５．６％（Ｐ＜０．０５）。宫外扩散率依次为５３．３％、２０．８％、１２．１％（Ｐ＜０．０１）。深肌层受侵犯的比例分别为７５．０％、４１．７％、３２．３％（Ｐ＜０．０１）。Ⅰ、Ⅱ期的５年生存率则各为４５．７％、６１．９％、９０．３％（Ｐ＜０．０１）。子宫乳头状浆液性癌以上腹部播散为主，未控率高达４６．２％。子宫内膜乳头状腺癌以盆内扩散为主，复发转移率达３１．０％。结论：乳头状结构的存在是子宫内膜癌的预后不良因素；子宫内膜乳头状腺癌的预后介于乳头状浆液性癌和普通子宫内膜腺癌之间。