使用阴道避孕环与口服避孕药后的子宫内炔雌醇与依托孕烯浓度比较

Objective: To compare uterine tissue concentrations of ethinyl estradiol (EE) and etonogestrel (ENG) after one cycle of use of a contraceptive vaginal ring (NuvaRing;NV Organon, Oss, The Netherlands) or a combined oral contraceptive (COC). Design: Randomized, open-label, pharmacokinetic study. Setting: Obstetrics and gynecology unit. Patient(s): Eight premenopausal women about to undergo hysterectomy but otherwise healthy. Intervention(s): One cycle (17-21 days) of NuvaRing or COC treatment that ended with surgical hysterectomy. Main Outcome Measure(s): Tissue concentrations of EE and ENG in uterine tissue samples taken from the upper myometrium and mid-myometrium, the cervical region, and the endometrium. Result(s): In both groups, concentrations of EE and ENG were similar in uterine tissue taken from the upper myometrium and mid-myometrium and the cervical region. However, compared with the COC group, concentrations of both hormones were markedly lower in tissue samples from the endometrium of women who had been treated with NuvaRing. Conclusion(s): Vaginal administration of hormones with NuvaRing did not produce elevated uterine concentrations of EE and ENG, compared with an oral contraceptive.

足月宫内生长受限:引产还是等待自然分娩?足月宫内生长受限的干预试验(DIGITAT):一项预试验

Objective: To test the hypothesis that in pregnancies with a clinically suspected growth restricted foetus at term, induction of labour is as safe as expectant management, and does not lead to increased obstetrical interventions or perinatal morbidity. Study design: In one obstetric centre, 33 women with a clinically suspected growth restricted foetus at term were randomly allocated after stratification for parity to either induction or to expectant management. Obstetric and neonatal outcome variables were compared. Results: There was a lower gestational age at labour (median 380 weeks versus 401 weeks) with a corresponding tendency to lower birth weight (mean 2428 g versus 2651 g), and a reduced need for ante partum medical surveillance, in the induction group. No significant differences in obstetrical interventions (25% versus 24% ) and neonatal morbidity rates (50% versus 35% ) were found. Conclusion: A larger multicenter study with a sufficient power and long-term follow-up to decide the best policy for the term growth restricted foetus is feasible.

计划分娩方式对孕≥32周的双胎妊娠母儿结局的影响

Objective: To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. Study design: A single-centre retrospective cohort study in twins ≥32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed. Results: During the study period (1999-2002), 164 twins ≥32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3%versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4%versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8%versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage. Conclusion: Our results do not support an elective caesarean section for twin gestations ≥32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%.

足月臀先露计划阴道分娩新生儿出生体重和儿童2岁时的神经发育结局

Objective: The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 years of age and to assess whether the effect is modified by birth weight. Study design: At 2 years of age, all nonrandomized children born in breech position during our participation in the Term Breech Trial were screened for abnormal neurodevelopment with the Ages and Stages Questionnaire. Results: An Ages and Stages Questionnaire at 2 years of age was obtained in 183 of 203 children (90.1% ). Twenty- eight percent of these children showed 1 or more abnormal Ages and Stages Questionnaire domains. There were no differences in the risk of having abnormal Ages and Stages Questionnaire domains between planned vaginal delivery and planned cesarean section (P = .99). There was, however, evidence of interaction between mode of delivery and birthweight, with significantly higher risk in neurodevelopmental delay in children with birth weight greater than 3500 g with planned vaginal birth (adjusted odds ratio for interaction term 3.37; 95% confidence interval 1.14 to 9.95).Conclusion: Based on the Ages and Stages Questionnaire results at 2 years of age, planned vaginal delivery is associated with an increased risk of neurodevelopmental delay at 2 years of age in term breech children with a birthweight greater than 3500 g.