Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,suc...Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.展开更多
Objectives. Invasive cervical cancer that is discovered only after si mple hyst erectomy remains a problem. Little is known about the best management of this gr oup since there are no relevant outcome studies. This st...Objectives. Invasive cervical cancer that is discovered only after si mple hyst erectomy remains a problem. Little is known about the best management of this gr oup since there are no relevant outcome studies. This study aimed to quantify th e benefits of guideline-based treatment by comparing outcome data in patients t reated by inappropriate simple hysterectomy and adjuvant radiotherapy with data in patients treated with primary radical surgery, radiotherapy, or radiochemothe rapy. Methods. Records of 288 patients who had undergone radical hysterectomy wi th pelvic lymphadenectomy or simple hysterectomy were extracted and divided into three groups -radical hysterectomy alone (n = 89), radical hysterectomy and ad juvant radiotherapy (n = 119), and simple hysterectomy with adjuvant radiotherap y (n = 80). Disease-free and overall survival were calculated using Kaplan-Mei er analyses. Results. There was a trend towards better overall survival in the r adical hysterectomy group. Disease-free survival was significantly better in pa tients treated by radical hysterectomy, followed by simple hysterectomy plus rad iotherapy, and then radical hysterectomy plus radiotherapy (PlogrankDFS < 0.002) . When the two radical surgery groups were combined and compared with the subopt imally treated group, no significant differences were seen for overall survival. Conclusion. Postoperative radiotherapy is a good treatment for patients with ce rvical cancer who have undergone suboptimal simple hysterectomy. Appropriate sel ection criteria for further surgery remain to be defined.展开更多
Objective The purpose of this study was to determine whether an intra partum as sessment of amniotic fluid identifies a pregnancy that is at risk for an adverse outcome. Study design Parturients who were admitted for ...Objective The purpose of this study was to determine whether an intra partum as sessment of amniotic fluid identifies a pregnancy that is at risk for an adverse outcome. Study design Parturients who were admitted for delivery were assigned randomly to have the amniotic fluid assessed either by amniotic fluid index or b y the presence of a 2 ×1 pocket. Results The amniotic fluid index was obtained in 499 pregnancies, and the 2 ×1 technique was performed in 501. Oligohydramnio s was diagnosed in 25%of amniotic fluid index pregnancies versus 8%with the us e of the 2 ×1 pocket technique (P < .001). Both techniques failed to identify p atients who underwent an amnioinfusion for fetal distress (P=.864) or who experi enced variable (P=.208) or late decelerations (P=.210) that influenced delivery, fetal distress in labor (P=.220), caesarean delivery for fetal distress (P=.133 ), and admission to neonatal intensive care unit (P=.686). Conclusion Neither th e amniotic fluid index nor the 2 ×1 pocket technique that was undertaken as a f etal admission test identi fies a pregnancy that is at risk for an adverse outco me.展开更多
文摘Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.
文摘Objectives. Invasive cervical cancer that is discovered only after si mple hyst erectomy remains a problem. Little is known about the best management of this gr oup since there are no relevant outcome studies. This study aimed to quantify th e benefits of guideline-based treatment by comparing outcome data in patients t reated by inappropriate simple hysterectomy and adjuvant radiotherapy with data in patients treated with primary radical surgery, radiotherapy, or radiochemothe rapy. Methods. Records of 288 patients who had undergone radical hysterectomy wi th pelvic lymphadenectomy or simple hysterectomy were extracted and divided into three groups -radical hysterectomy alone (n = 89), radical hysterectomy and ad juvant radiotherapy (n = 119), and simple hysterectomy with adjuvant radiotherap y (n = 80). Disease-free and overall survival were calculated using Kaplan-Mei er analyses. Results. There was a trend towards better overall survival in the r adical hysterectomy group. Disease-free survival was significantly better in pa tients treated by radical hysterectomy, followed by simple hysterectomy plus rad iotherapy, and then radical hysterectomy plus radiotherapy (PlogrankDFS < 0.002) . When the two radical surgery groups were combined and compared with the subopt imally treated group, no significant differences were seen for overall survival. Conclusion. Postoperative radiotherapy is a good treatment for patients with ce rvical cancer who have undergone suboptimal simple hysterectomy. Appropriate sel ection criteria for further surgery remain to be defined.
文摘Objective The purpose of this study was to determine whether an intra partum as sessment of amniotic fluid identifies a pregnancy that is at risk for an adverse outcome. Study design Parturients who were admitted for delivery were assigned randomly to have the amniotic fluid assessed either by amniotic fluid index or b y the presence of a 2 ×1 pocket. Results The amniotic fluid index was obtained in 499 pregnancies, and the 2 ×1 technique was performed in 501. Oligohydramnio s was diagnosed in 25%of amniotic fluid index pregnancies versus 8%with the us e of the 2 ×1 pocket technique (P < .001). Both techniques failed to identify p atients who underwent an amnioinfusion for fetal distress (P=.864) or who experi enced variable (P=.208) or late decelerations (P=.210) that influenced delivery, fetal distress in labor (P=.220), caesarean delivery for fetal distress (P=.133 ), and admission to neonatal intensive care unit (P=.686). Conclusion Neither th e amniotic fluid index nor the 2 ×1 pocket technique that was undertaken as a f etal admission test identi fies a pregnancy that is at risk for an adverse outco me.
