• 【择期剖宫产后新生儿死亡率和发病率与常规预期管理: 决策分析。】 复制标题 收藏 收藏
    DOI:10.1053/j.semperi.2006.07.010 复制DOI
    作者列表:Signore C,Hemachandra A,Klebanoff M
    BACKGROUND & AIMS: :A number of competing risks and benefits influence the rates of neonatal morbidity and mortality in elective cesarean delivery versus expectant management. To compare these rates, we developed complex decision trees to model the expected outcomes among hypothetical cohorts of 1,000,000 uncomplicated pregnancies undergoing elective cesarean delivery versus 1,000,000 comparable pregnancies undergoing routine pregnancy management. A separate tree was created for each complication, including neonatal death, respiratory morbidity, intracranial hemorrhage, and brachial plexus injury. We found that neonatal mortality was increased among elective cesarean deliveries, but perinatal mortality was higher with routine expectant management due to fetal deaths. Respiratory morbidity was substantially more common among infants delivered by elective cesarean delivery, whereas intracranial hemorrhage and brachial plexus injury were less common. We conclude that the fetal/neonatal impact of elective cesarean is mixed, but any improvement in perinatal health is likely to be small.
    背景与目标: : 在选择性剖宫产与预期管理中,许多竞争性风险和收益会影响新生儿的发病率和死亡率。为了比较这些比率,我们开发了复杂的决策树来模拟假设队列中的预期结果,这些队列中的1,000,000例非复杂妊娠接受选择性剖宫产,而1,000,000例可比妊娠接受常规妊娠管理。为每种并发症 (包括新生儿死亡,呼吸系统疾病,颅内出血和臂丛神经损伤) 创建了单独的树。我们发现,选择性剖宫产分娩的新生儿死亡率增加,但由于胎儿死亡,常规预期治疗的围产期死亡率更高。在择期剖宫产分娩的婴儿中,呼吸系统的发病率明显更高,而颅内出血和臂丛神经损伤则较少见。我们得出的结论是,选择性剖宫产对胎儿/新生儿的影响是混合的,但是围产期健康的任何改善都可能很小。
  • 【造血干细胞移植受者呼吸病毒肺炎的薄层CT表现。】 复制标题 收藏 收藏
    DOI:10.2214/AJR.05.0439 复制DOI
    作者列表:Franquet T,Rodriguez S,Martino R,Giménez A,Salinas T,Hidalgo A
    BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to use serial thin-section CT scans to assess the incidence of respiratory viral infection and lung abnormalities in a large patient population at high risk of pulmonary complications. MATERIALS AND METHODS:The study population consisted of 26 recipients of hematopoietic stem cell transplants who had proven respiratory viral pneumonia. In all cases, thin-section CT scans were obtained before fiberoptic bronchoscopy and bronchoalveolar lavage. The study included only patients in whom bronchoalveolar lavage fluid showed no evidence of organisms other than respiratory viruses. The CT scans were assessed for the presence, extent, and anatomic distribution of ground-glass attenuation, air-space consolidation, nodules, centrilobular branching structures (tree-in-bud), thickening of the bronchovascular bundles, and pleural effusion. RESULTS:Areas of ground-glass attenuation were identified in 24 (92%) of 26 patients and were the only finding in eight patients. Multiple nodules, seen in 17 (65%) of 26 patients, measured 3-10 mm in diameter or were larger than 10 mm. The nodules had a centrilobular or random distribution. A tree-in-bud appearance was seen in six of the patients with centrilobular nodules. This pattern had a bilateral distribution and involved mainly the lower lung zones. CT revealed thickening of the bronchovascular bundles in 16 (61%) of the patients. Thickening was bilateral in 14 and unilateral in two patients. Bronchial wall thickening involved the lower lobes in six patients and had a patchy random distribution in the remaining nine patients. Air-space consolidation was present in nine (35%) of the cases. It had a lobular or subsegmental distribution in eight of the patients and a segmental distribution in one patient. Areas of consolidation were randomly distributed throughout the lungs in all cases. Less common findings included bilateral pleural effusion and bronchial dilatation. CONCLUSION:Respiratory viral infection is common among adult recipients of hematopoietic stem cell transplants, occurring over a wide time span after transplantation. The presence of respiratory viral infection must be considered in any patient with new respiratory symptoms, fever, or findings at CT such as extensive or patchy areas of ground-glass opacities or a mixture of patterns, most commonly ground-glass attenuation, thickening of the bronchial walls, and multiple small nodules.
    背景与目标:
  • 【肌肉骨骼系统的磁共振成像。第8部分。脊柱,第1节。】 复制标题 收藏 收藏
    DOI:10.1097/00003086-199705000-00037 复制DOI
    作者列表:Gundry CR,Fritts HM
    BACKGROUND & AIMS: Magnetic resonance has assumed a preeminent role in the imaging evaluation of the spine. Owing to its multiplanar capability and superior soft tissue contrast, magnetic resonance imaging is the procedure of choice for a host of spinal disorders including degenerative disc disease, tumor evaluation, trauma, and spinal deformities. It represents the most accurate means of distinguishing between recurrent disc herniation and epidural fibrosis, and it excels at the assessment of many postoperative abnormalities such as infection, adjacent segment disc degeneration, and arachnoiditis. Magnetic resonance imaging is also helpful in the evaluation of numerous diagnostic challenges that are less well resolved by other means. This includes the distinction between disc herniation and epidural hematoma, synovial cyst from nonspecific fibrous thickening of a facet capsule, and the evaluation of numerous other soft tissue abnormalities. Computed tomography, computed tomography myelography, and scintigraphy continue to be useful for numerous specific disorders and in those patients with metal hardware or contraindications to magnetic resonance scanning. Overall, however, magnetic resonance is the imaging procedure preferred for many spinal disorders. This article is the first installment of a 3-part series discussing the role of magnetic resonance imaging of spinal disorders. Section 1 will describe the varying imaging modalities available and their relative advantages and disadvantages. A consideration of magnetic resonance imaging techniques will follow, followed by a discussion of the imaging manifestations of early degenerative disc disease. Section 2 will be devoted to an in depth discussion of specific pathologic processes encountered in patients with degenerative disc disease. Section 3 will end the series with a consideration of postoperative imaging followed by a discussion of spinal deformities, trauma, and neoplasms.

    背景与目标: 磁共振在脊柱的成像评估中发挥了重要作用。由于其多平面能力和出色的软组织对比度,磁共振成像是许多脊柱疾病 (包括退行性椎间盘疾病,肿瘤评估,创伤和脊柱畸形) 的首选方法。它代表了区分复发性椎间盘突出症和硬膜外纤维化的最准确方法,并且擅长评估许多术后异常,例如感染,相邻节段椎间盘退变和蛛网膜炎。磁共振成像也有助于评估许多诊断难题,而其他方法无法很好地解决这些难题。这包括椎间盘突出症和硬膜外血肿之间的区别,关节突囊的非特异性纤维增厚引起的滑膜囊肿,以及对许多其他软组织异常的评估。计算机断层扫描,计算机断层扫描脊髓造影和闪烁显像对于许多特定疾病以及那些具有金属硬件或磁共振扫描禁忌症的患者仍然有用。然而,总的来说,磁共振是许多脊柱疾病首选的成像程序。本文是由3部分组成的系列文章的第一部分,讨论了脊柱疾病的磁共振成像的作用。第1节将描述可用的各种成像方式及其相对的优缺点。随后将考虑磁共振成像技术,然后讨论早期退行性椎间盘疾病的成像表现。第2节将致力于深入讨论退行性椎间盘疾病患者遇到的特定病理过程。第3节将在系列结束时考虑术后影像学,然后讨论脊柱畸形,创伤和肿瘤。
  • 【立体定向脑活检的冰冻切片评估: 188例立体定向目标位置的诊断产量。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Brainard JA,Prayson RA,Barnett GH
    BACKGROUND & AIMS: OBJECTIVE:Use of the image-guided stereotactic brain biopsy has facilitated the diagnosis of previously inaccessible lesions with both safety and reliability. However, few studies have assessed the diagnostic yield of frozen section evaluation of the initial stereotactic target (FS-0). We describe our experience with 188 stereotactic brain biopsies in order to evaluate the diagnostic yield of FS-0.

    DESIGN:Retrospective study of 188 stereotactic brain biopsies from 185 patients.

    SETTING:Tertiary referral center with a high volume of neurosurgical cases including image-guided stereotactic brain biopsies.

    PATIENTS:One hundred eighty-five patients who underwent imaged-guided stereotactic brain biopsy over a 58-month period.

    RESULTS:The patients studied included 107 males and 78 females (mean age 48 years). Eleven (6%) biopsies were nondiagnostic. Diagnoses from FS-0 included a neoplastic condition in 96 (73%) of 131 cases and a nonneoplastic condition in 23 (50%) of 46 cases. In 119 (67%) of 177 cases, a diagnosis was reached at FS-0. A correct diagnosis was made on subsequent frozen section in 28 (16%) of cases, including 21 (16%) of 131 neoplasms and 7 (15%) of nonneoplastic conditions. In 15 (54%) of 28 cases, the correct diagnosis was made on the second frozen section; in 25 (89%) of 28, the correct diagnosis was made by the fourth frozen section. In 14 (11%) of 131 neoplastic cases, a sampling error relative to the lesion resulted in an inaccurate diagnosis at FS-0. A significant error in diagnosis occurred in three cases (1.7%).

    CONCLUSIONS:We conclude that (1) because 58 (33%) of 177 diagnosed cases in our series would have been potentially misdiagnosed if only one biopsy had been taken at the stereotactic target, frozen section evaluation or cytologic examination of material at the time of surgery should be performed routinely to ensure that adequate tissue has been obtained for purposes of diagnosis; (2) taking up to four biopsies increases the diagnostic yield (from 67% to 89% in this series); and (3) neoplastic lesions are more likely to be definitively diagnosed at FS-0 than non-neoplastic lesions.

    背景与目标: 目标 : 使用图像引导的立体定向脑活检有助于安全可靠地诊断先前无法接近的病变。然而,很少有研究评估初始立体定向目标 (FS-0) 的冷冻切片评估的诊断产量。我们描述了188例立体定向脑活检的经验,以评估FS-0的诊断性。
    设计 : 对185例患者的188例立体定向脑活检进行回顾性研究。
    设置 : 三级转诊中心,提供大量神经外科手术病例,包括图像引导的立体定向脑活检。
    患者 : 在58个月内接受了图像引导的立体定向脑活检的一百八十五例患者。
    结果 : 研究的患者包括107名男性和78名女性 (平均年龄48岁)。11例 (6% 例) 活检无诊断性。FS-0的诊断包括131例中的96例 (73% 例) 的肿瘤状况和46例中的23例 (50% 例) 的非肿瘤状况。在177例中的119例 (67% 例) 中,在FS-0时达到诊断。对28例 (16% 例) 的随后冷冻切片进行了正确诊断,其中包括21例 (16% 例) 的131肿瘤和7例 (15% 例) 的非肿瘤性疾病。28例中的15例 (54% 例) 在第二冷冻切片上做出正确诊断; 28例中的25例 (89% 例) 在第四冷冻切片上做出正确诊断。在131例肿瘤病例中的14例 (11% 例) 中,相对于病变的采样误差导致FS-0时诊断不准确。在三例 (1.7%) 中发生了明显的诊断错误。
    结论 : 我们得出的结论是 :( 1) 因为如果仅在立体定向目标处进行了一次活检,那么我们系列中的177例中有58例 (33% 例) 可能会被误诊,在手术时,应常规进行冷冻切片评估或材料的细胞学检查,以确保已获得足够的组织以进行诊断; (2) 最多进行四次活检可提高诊断率 (从本系列的67% 增加到89%); (3) 肿瘤性病变比非肿瘤性病变更有可能在FS-0时被明确诊断。
  • 【剖腹产率上升对健康的影响。】 复制标题 收藏 收藏
    DOI:10.1097/EDE.0b013e318068646a 复制DOI
    作者列表:Belizán JM,Althabe F,Cafferata ML
    BACKGROUND & AIMS: :Caesarean section (C-section) rates are rising in many middle- and high-income countries, with the justification that higher rates of C-section are associated with better outcomes. A review of 79 studies comparing outcomes of elective caesarean sections with vaginal deliveries, including both observational studies and randomized trials, suggests that caesarean sections may have substantially greater risks than vaginal deliveries. In this issue of Epidemiology, Leung and colleagues present data from Hong Kong on morbidity in offspring related to C-section. Such studies are needed to widen the scope of possible health outcomes related to elective C-sections, including such endpoints as maternal satisfaction and women's relationship with their child. Testing of interventions to reduce unnecessary C-sections is also needed, with strategies to enhance the role of women in the process of their obstetric care.
    背景与目标: : 在许多中高收入国家,剖腹产 (剖腹产) 率正在上升,理由是剖腹产率高与更好的结果相关。对79项研究进行了比较,包括观察性研究和随机试验,比较了选择性剖腹产与阴道分娩的结果,表明剖腹产的风险可能比阴道分娩大得多。在流行病学》中,Leung及其同事介绍了香港与剖腹产有关的后代发病率的数据。需要进行此类研究,以扩大与选择性剖腹产有关的可能健康结果的范围,包括产妇满意度和妇女与孩子的关系等终点。还需要测试干预措施以减少不必要的剖腹产,并制定战略以增强妇女在产科护理过程中的作用。
  • 【Alfathesin用于剖腹产麻醉诱导。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Mahomedy MC,Downing JW,Mahomedy YH
    BACKGROUND & AIMS: :Anaesthesia was induced with Alfathesin (60 - 70 mul/kg) in 50 healthy mothers undergoing elective Caesarean section. Anaesthesia was maintained with nitrous oxide, oxygen, muscle relaxants and controlled ventilation. The mothers were tilted laterally throughout the operation. Blood gas studies done on the mothers before induction and at delivery, revealed a mild respiratory alkalosis associated with a moderate degree of metabolic acidosis, which appeared to increase during anaesthesia. Umbilical cord blood gas analyses indicated a mild degree of fetal respiratory acidosis (mean pCO2 Uv 45,3
    背景与目标: : 在接受选择性剖腹产的50名健康母亲中,用Alfathesin (60 - 70 mul/kg) 诱导麻醉。用一氧化二氮,氧气,肌肉松弛剂和受控通气维持麻醉。母亲在整个手术过程中横向倾斜。在诱导前和分娩时对母亲进行的血气研究显示,轻度呼吸性碱中毒与中度代谢性酸中毒相关,在麻醉期间似乎有所增加。脐带血气分析表明胎儿呼吸性酸中毒程度较轻 (平均pCO2 Uv 45,3
  • 【剖宫产术后手术部位感染: 实施3项改变,提高患者护理质量。】 复制标题 收藏 收藏
    DOI:10.1016/j.ajic.2013.04.020 复制DOI
    作者列表:Corcoran S,Jackson V,Coulter-Smith S,Loughrey J,McKenna P,Cafferkey M
    BACKGROUND & AIMS: BACKGROUND:Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. METHODS:A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision. RESULTS:A total of 710 patients were surveyed before the interventions, and 824 patients were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions, and 40 (4.9%) had an SSI after the interventions (P < .001; odds ratio, 0.27), with 90% and 83%, respectively, detected after hospital discharge. In multivariate analysis, obesity (P = .002) and the use of absorbable suture materials for skin closure (P = .008) were significantly associated with a higher SSI rate before the interventions; however, only obesity was associated with a higher SSI rate after the quality program. CONCLUSION:Surveillance of SSI rates after CS followed by 3 interventions contributed to a significant reduction in SSI rate and improved patient care.
    背景与目标:
  • 【银屑病和银屑病关节炎治疗指南: 第2节。银屑病关节炎: 以生物制剂为重点的治疗护理概述和指南。】 复制标题 收藏 收藏
    DOI:10.1016/j.jaad.2008.02.040 复制DOI
    作者列表:Gottlieb A,Korman NJ,Gordon KB,Feldman SR,Lebwohl M,Koo JY,Van Voorhees AS,Elmets CA,Leonardi CL,Beutner KR,Bhushan R,Menter A
    BACKGROUND & AIMS: :Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this second of 5 sections of the guidelines of care for psoriasis, we give an overview of psoriatic arthritis including its cardinal clinical features, pathogenesis, prognosis, classification, assessment tools used to evaluate psoriatic arthritis, and the approach to treatment. Although patients with mild to moderate psoriatic arthritis may be treated with nonsteroidal anti-inflammatory drugs and/or intra-articular steroid injections, the use of disease-modifying antirheumatic drugs, particularly methotrexate, along with the biologic agents, are considered the standard of care in patients with more significant psoriatic arthritis. We will discuss the use of disease-modifying antirheumatic drugs and the biologic therapies in the treatment of patients with moderate to severe psoriatic arthritis.
    背景与目标: 银屑病是一种常见的、慢性的、炎症性的多系统疾病,主要表现为皮肤和关节,影响大约2% 的人群。在银屑病护理指南的5个部分中的第二个部分中,我们概述了银屑病关节炎的主要临床特征,发病机制,预后,分类,用于评估银屑病关节炎的评估工具以及治疗方法。尽管轻度至中度银屑病关节炎患者可以使用非甾体类抗炎药和/或关节内类固醇注射治疗,但使用可缓解疾病的抗风湿药,尤其是甲氨蝶呤以及生物制剂被认为是标准的治疗在具有更严重的银屑病关节炎的患者中。我们将讨论缓解疾病的抗风湿药和生物疗法在中度至重度银屑病关节炎患者治疗中的应用。
  • 【客座社论: 关于眼睛晶状体的光散射和荧光的特别部分。】 复制标题 收藏 收藏
    DOI:10.1117/12.254396 复制DOI
    作者列表:Pierscionek BK
    BACKGROUND & AIMS: :This Special Section Guest Editorial provides an overview of the topical area and an introduction to the articles featured in the special section.
    背景与目标: : 本特殊部分来宾社论概述了主题领域,并介绍了特殊部分中的文章。
  • 【剖宫产术中通过腹部子宫切除术成功治疗子宫脱垂。】 复制标题 收藏 收藏
    DOI:10.1007/s00404-012-2563-4 复制DOI
    作者列表:Karataylı R,Gezginç K,Kantarcı AH,Acar A
    BACKGROUND & AIMS: PURPOSE:Uterine prolapse complicating pregnancy is extremely rare. This report presents the surgical correction of uterine prolapse during cesarean section. CASE:We report a case of a 33-year-old woman with twin gestation who admitted to obstetric clinic with labor pain and total uterine prolapse at 33 weeks of gestation. An emergent cesarean section was performed for the indication of acute fetal distress. At the same operation, following cesarean delivery, abdominal hysteropexy using rectus fascia strips was performed successfully. On control performed 6 months later, patient was examined and it was detected uterine prolapse had regressed and babies were uneventful. CONCLUSION:This surgical method offers effective treatment of uterine prolapse.
    背景与目标:
  • 【在紧急剖腹产过程中引起急性肺水肿的嗜铬细胞瘤。】 复制标题 收藏 收藏
    DOI:10.1177/0310057X0703500319 复制DOI
    作者列表:Golshevsky JR,Karel K,Teale G
    BACKGROUND & AIMS: :We report a case of severe acute pulmonary oedema following induction of general anaesthesia for emergency caesarean section. After several hours of aggressive resuscitation, both mother and child had a favourable outcome. Postoperative investigation of acute renal failure demonstrated a supra-adrenal mass. Further investigation confirmed bilateral phaeochromocytoma as the cause of her condition. A literature review confirmed this to be a rare but important clinical entity, owing to its high mortality. Antenatal diagnosis greatly improves survival. Magnesium sulphate appears to be a useful and safe agent to employ in cases of undiagnosed hypertensive obstetric emergencies.
    背景与目标: : 我们报告了一例在进行紧急剖腹产的全身麻醉后引起的严重急性肺水肿。经过几个小时的积极复苏,母亲和孩子都有了良好的结果。急性肾衰竭的术后检查显示肾上腺上肿块。进一步的调查证实了双侧嗜铬细胞瘤是她病情的原因。文献综述证实,由于其高死亡率,这是一种罕见但重要的临床实体。产前诊断大大提高了生存率。硫酸镁似乎是在未诊断的高血压产科紧急情况下使用的有用且安全的试剂。
  • 【在选择性剖腹产时使用侧面倾斜或骨盆楔形施加的骨盆角度的比较。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2044.2012.07332.x 复制DOI
    作者列表:Kinsella SM,Harvey NL
    BACKGROUND & AIMS: :Lateral table tilt or a pelvic wedge are commonly used to reduce inferior vena cava compression during obstetric anaesthesia in the supine position. Direct measurement of pelvic angle allows individual assessment of the effectiveness of these manoeuvres in achieving a tilted position. We observed routine practice during caesarean section after random allocation to one or other of these methods. The anaesthetist managing the case was asked to position the women after induction of spinal anaesthesia using either left table tilt or a wedge under the right hip. We then measured pelvic angle in all women, and the table angle in women who had table tilt. The mean (SD [range]) pelvic angle was 20.2° (8.1° [9°-37°]) in 18 women with table tilt and 21.0° (7.5° [10°-36°]) in 17 women with a wedge. The mean (SD [range]) table angle was 12.4° (3.1° [8°-21°]) in the women with table tilt. There was a significant difference between table angle and pelvic angle in the women with table tilt (p = 0.0003), but no significant difference in pelvic angle between the table tilt and wedge groups. Measurement of table angle does not represent pelvic position adequately in the majority of women. However, this study showed that lateral table tilt and a pelvic wedge were equally effective in producing tilt of the pelvis.
    背景与目标: : 侧卧台倾斜或骨盆楔形通常用于减轻仰卧位产科麻醉期间的下腔静脉压迫。直接测量骨盆角度可以单独评估这些动作在实现倾斜位置方面的有效性。在随机分配给这些方法中的一种或另一种后,我们观察了剖腹产期间的常规做法。要求处理该病例的麻醉师在使用左表倾斜或右臀部下方的楔形物诱导脊柱麻醉后对妇女进行定位。然后,我们测量了所有女性的骨盆角度,以及有桌子倾斜的女性的桌子角度。18位倾斜的女性平均 (SD [范围]) 骨盆角度为20.2 ° (8.1 ° [9 °-37 °]),17位楔形女性为21.0 ° (7.5 ° [10 °-36 °])。在倾斜桌子的妇女中,平均 (SD [范围]) 桌子角度为12.4 ° (3.1 ° [8 °-21 °])。台倾斜妇女的台角和骨盆角度有显著性差异 (p   =   0.0003),但台倾斜组和楔形组的骨盆角度无显著性差异。在大多数女性中,测量桌子角度并不能充分代表骨盆位置。然而,这项研究表明,侧面倾斜和骨盆楔形在产生骨盆倾斜方面同样有效。
  • 【评估选择性剖腹产的脊柱麻醉后的阻滞: 不同的问题如何影响同一刺激的发现。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijoa.2013.05.010 复制DOI
    作者列表:Nor NM,Russell IF
    BACKGROUND & AIMS: BACKGROUND:A block to touch to T5 is widely used to indicate an adequate level of block for caesarean section with spinal anaesthesia. However, two studies using a "block to light touch" to T5 as their end-point, had a high requirement for intraoperative analgesia and their results cast doubt on the adequacy of a block to touch to T5. On enquiry, these two papers did not assess complete block to touch, but asked mothers when the touch sensation "was the same as" a control stimulus. The difference between these two assessment methods is unknown. The current study presents prospectively collected sensory block data which included both block to touch and the level when touch was the same as a control stimulus. METHODS:The levels of block were assessed using a Neurotip®. The mother was asked four questions to assess the block: first touch level, first sharp level, touch same as control and sharp same as control. RESULTS:The first touch level was a median of two dermatomes lower than the touch same as a control level [IQR 0-3, range 0-6]. Block level assessment methods using first sharp and touch same as control were equivalent. CONCLUSION:When describing a sensory block, not only is it necessary to indicate the exact stimulus used, but it is important to define the actual question asked of the patient. Clinically, block assessment using the first sharp level and touch same as control are equivalent.
    背景与目标:
  • 【在先前剖宫产的妇女中同时进行铜T插入与医学终止妊娠。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Gupta I,Mahajan U,Sawhney H
    BACKGROUND & AIMS: :The event rates up to 1 year after insertion of a Copper-T IUD were compared in 76 women who had 1 or more cesarean sections, and were given their IUD immediately after medical termination of pregnancy, and in 76 women matched for age and parity but normal vaginal deliveries. The cesarean group had abortion performed under general anesthesia; the vaginal group had iv diazepam and paracervical block. All subjects were less than 11 weeks gestation. They were followed up at 7 days, 6 weeks, and 3 monthly intervals for 1 year. No perforations or pregnancies occurred. Incomplete abortion caused expulsion in 2.6% of women in both groups, and removal in 6.5 and 5.3%, in the cesarean and control groups respectively, and was responsible for most discontinuations. It was concluded that IUD insertion is safe after medical termination of pregnancy in women with a history of cesarean section, depending on the skill of the surgeon.
    背景与目标: : 比较了76名剖宫产1次或更多次,并在医学终止妊娠后立即给予宫内节育器的妇女和76名年龄和胎次匹配但阴道分娩正常的妇女插入铜-T宫内节育器后1年的事件发生率。剖宫产组在全麻下进行人工流产术; 阴道组静脉注射安定和宫颈旁阻滞。所有受试者妊娠均少于11周。对他们进行了7天,6周和3个月的随访,为期1年。没有发生穿孔或怀孕。不完全流产导致两组2.6% 的妇女被驱逐,剖宫产组和对照组分别在6.5和5.3% 中被驱逐,这是大多数中止的原因。结论是,根据外科医生的技能,有剖宫产史的妇女在医学终止妊娠后插入宫内节育器是安全的。
  • 【剖宫产后阴道分娩的预测模型还能预测与分娩试验相关的发病概率吗?】 复制标题 收藏 收藏
    DOI:10.1016/j.ajog.2008.06.039 复制DOI
    作者列表:
    BACKGROUND & AIMS: OBJECTIVE:The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). STUDY DESIGN:Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. RESULTS:Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. CONCLUSION:A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.
    背景与目标:

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