有剖宫产史孕妇的改良Bishop评分和引产

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.

早产预测研究:孕妇体重指数与自发性早产及干预性早产的关系

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.

正常体重、超重及肥胖孕妇伴和不伴先兆子痫时瘦素、脂联素及抑素水平的比较

The purpose of this study was to compare adipokines’ levels between women with and without preeclampsia based on maternal body mass index (BMI). Study design: This was a cross-sectional study among third-trimester pregnancies with preeclampsia (PIH) compared with normotensive controls. Serum levels of adiponectin, leptin, and resistin were measured before delivery by radioimmunoassay or enzyme-linked immunosorbent assay (ELISA). Results: The study included 22 normotensive and 77 PIH women. Leptin levels increased with maternal BMI. In patients with severe preeclampsia, overweight, and obese women had increased leptin levels (33.4 ± 14.8 vs 23.0 ± 10.8 ng/mL respectively, P = .02), and decreased adiponectin levels (8.4 ± 5.3 vs 12.6 ± 6.0 ng/mL, P = .03) compared with normal weight women. In women with BMI < 25 kg/m2, adiponectin levels increased in patients with preeclampsia compared with controls (11.5 ± 5.6 vs 9.6 ± 4.6 and 7.0 ± 3.2 ng/mL, respectively, P = .005). There was no association between resistin levels and preeclampsia or maternal BMI. Conclusion: Women with severe preeclampsia and BMI ≥ 25 kg/m2 have decreased adiponectin and increased leptin levels, while normal weight women with preeclampsia have increased adiponectin levels.

先进的超声设备能否改善肥胖型孕妇胎心结构显影

Objective This study was undertaken to determine the effect of advanc ed ultras ound equipment on the ability to visualize fetal cardiac structures in obese gra vid women. Study design Singleton pregnancies undergoing initial ultrasound exam ination between 14 weeks and 23 weeks 6 days were included. Patients were classi fied by body mass index (BMI) (nonobese <BMI < 30 kg/m2] and obese <BMI ≥30 kg/ m2]). The rate of suboptimal ultrasound visualization (SUV) of the fetal heart ( cardiac axis, cardiac position, 4-chamber, and outflow tracts views) was compar ed between patients examined by standard (HDI 3000) or advanced ultrasound equip ment (HDI 5000)-(ATL, Philips Medical Systems, Bothell, Wash). Results Over a 5 -year period, 7029 singleton gestations met inclusion criteria; 2498 (35.5%) w ere clinically obese. There was no difference in gestational age, rate of low am niotic fluid volume, anterior placenta, or vertex fetal presentation between the groups. When the advanced ultrasound equipment was used, SUV of the fetal heart was lower in the nonobese population (20.8%vs 16.4%; P< .001), but not in the obese gravid women (38.1%vs 35.5%; P=.27). However, obese patients who were e xamined by advanced ultrasound equipment after 18 weeks had less SUV of the outf low tracts (28.5%vs 23.1%, P=.04) but not of the 4-chamber view. Conclusion D espite advanced ultrasound equipment,maternal obesity significantly limits visua lization of the fetal heart. However, the advanced ultrasound equipment may some what benefit obese gravid women examined after 18 weeksgestation.