Abstract:
OBJECTIVE:In about 3% to 4% of all pregnancies at term, the fetal presentation will be noncephalic. External cephalic version (ECV) at term has been shown to decrease the rate of noncephalic presentation at birth and to decrease the rate of cesarean section associated with breech presentation. However, success rates for ECV are low. We did a randomized trial to compare a policy of beginning ECV early, at between 34 and 36 weeks' gestation, and beginning ECV at 37 to 38 weeks' gestation. STUDY DESIGN:At 25 centers in seven countries, 233 women with a singleton breech fetus were randomly assigned to having an ECV procedure done early (at between 34 weeks 0 days and 36 weeks 0 days), or delayed (at between 37 weeks 0 days and 38 weeks 0 days). An experienced practitioner undertook the ECV procedure, and repeat ECV procedures were allowed. Tocolytics and use of epidural analgesia were included as part of the protocol. The primary outcome was the rate of noncephalic presentation at birth. An intention-to-treat analysis was used. RESULTS:Data were received for 232 women, with 116 women in each of the early and delayed ECV groups. Of these, 86.2% in the early ECV group and 67.2% in the delayed ECV group had at least one ECV performed. The rate of noncephalic presentation at birth in the early ECV group was 66 of 116 (56.9%) and 77 of 116 (66.4%) in the delayed ECV group (relative risk [RR] [95% CI] 0.86 [0.70-1.05], P =.09). The rate of serious fetal complications and the rate of preterm birth at <37 weeks were not significantly increased in the early ECV group compared with the delayed ECV group (6.9% vs 7.8%, RR [95% CI] 0.89 [0.36-2.22], P =.69 and 8.6% vs 6.1%, RR [95% CI] 1.42 [0.56-3.59], P =.31, respectively). The rate of cesarean section in the early ECV group was 75 of 116 (64.7%) and 83 of 116 (71.6%) in the delayed ECV group (RR [95% CI] 0.90 [0.76-1.08], P =.32). Neonatal outcomes were comparable in the two groups. The rate of reversion to noncephalic was low in both groups. The majority of women in both groups indicated that they would consider having an ECV in another pregnancy. CONCLUSION:Early ECV performed at 34 to 36 weeks compared with 37 to 38 weeks may reduce the risk of noncephalic presentation at delivery. A large pragmatic trial of early ECV is now required to assess this approach further in terms of cesarean section rates and neonatal outcomes before changes in clinical practice.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Hutton EK,Kaufman K,Hodnett E,Amankwah K,Hewson SA,McKay D,Szalai JP,Hannah MEdoi
10.1067/mob.2003.442subject
Has Abstractpub_date
2003-07-01 00:00:00pages
245-54issue
1eissn
0002-9378issn
1097-6868pii
S0002937803003983journal_volume
189pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Recommendations on preventing primary cesarean delivery removed the previously defined time limits for latent labor (defined as ending at 6 cm) and urged clinicians to avoid cesarean delivery for labor abnormalities in the latent phase. However, relatively little is known about the implications of labor curv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.05.041
更新日期:2019-11-01 00:00:00
abstract::In order to determine if moderate maternal exercise increased uterine activity, a prospective study was done during the last 8 weeks of pregnancy in 17 women. Two forms of exercise were chosen, weight-bearing (running) and non-weight-bearing (stationary bicycle), to study this hypothesis. The results show that with th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90505-8
更新日期:1985-03-15 00:00:00
abstract::Apert syndrome is a rare disorder characterized by coronal craniosynostosis, syndactyly, brachycephaly, midfacial hypoplasia, and central nervous system anomalies, among other malformations. We present a case of Apert syndrome examined at 22 + 0 weeks' gestation. Three-dimensional maximum mode was decisive for the cor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.07.043
更新日期:2005-11-01 00:00:00
abstract::Since previous data suggested hyperresponsiveness to human menopausal gonadotropin by women with low body weight, the daily dose was reduced to 1.5 ampules in patients undergoing in vitro fertilization weighing less than 55 kg. This allowed the extension of treatment to a minimum of 6 days. These changes were associat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90778-8
更新日期:1988-01-01 00:00:00
abstract::A 15-year-old girl with papillary serous carcinoma of the peritoneum was seen with abdominal distention, ascites, and elevated CA 125 tumor marker. After other therapy failed, she achieved complete and continuing remission with paclitaxel. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90046-2
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVES:We investigated whether maternal plasma levels of the placental hormone corticotropin-releasing hormone are elevated in pregnancies complicated by preterm labor. STUDY DESIGN:Mean maternal corticotropin-releasing hormone levels were studied in women who met specific criteria for preterm labor and in women w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)90606-1
更新日期:1992-04-01 00:00:00
abstract::Three cases of persistent urinary incontinence from unrecognized small vesicovaginal fistula after abdominal hysterectomy for benign gynecologic disease are presented. Visualization of urine in the posterior fornix was suggestive; diagnosis was confirmed by methylene blue test and cystoscopy. Two patients had undergon...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90129-9
更新日期:1988-02-01 00:00:00
abstract::In November, 1978, the fetal heart rate nonstress test (NST) was instituted as the primary screening procedure for the evaluation of fetal well-being at Vanderbilt University Hospital. The results of the first 1,000 patients tested are presented. The stillborn rate within 8 days of a reactive NST was 6.4 per 1,000, wi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)32583-2
更新日期:1981-09-15 00:00:00
abstract::To determine the usefulness of the assays of maternal serum alpha-fetoprotein, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in prenatal diagnosis of fetal alcohol syndrome, these proteins were followed in 35 problem drinkers (greater than 100 gm of ethanol weekly) and in 14 abstinent women thro...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90286-3
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:Our purpose was to evaluate our experience with a statewide, multiple-marker Down syndrome screening program. STUDY DESIGN:The results of 18,712 screening tests performed from July 1, 1991, to Oct. 31, 1992, were reviewed. Amniocentesis and aneuploidy detection rates were compared with the experience of a pr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90007-6
更新日期:1993-10-01 00:00:00
abstract::Prostacyclin is a potent vasodilator produced by both maternal and fetal tissues that dilates the umbilical placental vasculature in vitro. To test the hypothesis that prostacyclin dilates the fetal placental circulation in vivo, we measured blood flow by the radioactive microsphere technique in six unanesthetized nea...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90303-7
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine whether microbial DNA hybridization is a useful method to study bacterial vaginosis in asymptomatic pregnant women. STUDY DESIGN:Vaginal specimens were collected at <26 weeks' gestation from 230 women, and analyzed for bacterial vaginosis by both Gram stain using Nu...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.01.068
更新日期:2005-09-01 00:00:00
abstract::Predictive tests for the identification of women at high risk of the development of preeclampsia are critical to allow the most appropriate preventive measures. Preeclampsia is a vasospastic condition of pregnancy characterized by early and enhanced vascular reactivity to endogenous pressor agents. Exercise tolerance ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91077-p
更新日期:1990-09-01 00:00:00
abstract::Simulation in obstetrics allows us to practice in a safe environment. Simulations can improve the performance of individuals and obstetric teams. The evidence is overwhelming that, with simulated practice, obstetricians improve their technical and communication skills. Evidence is emerging that simulation ultimately m...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2011.09.012
更新日期:2012-06-01 00:00:00
abstract::A letter is written in response to a report by Drs. Beric, Kupresanin, and Hulka (Am. J, Obslet Gynecol. 114: 273, 1972) which stated that the Karman catheter is not suitable for terminating pregnancies beyond Week 6 of pregnancy. The use of a Karman catheter in terminating pregnancies of 7-10 weeks resulted in 47% t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(73)91070-3
更新日期:1973-05-15 00:00:00
abstract:OBJECTIVE:We sought to evaluate changes in bowel symptoms after rectocele repair and identify risk factors for persistent symptoms. STUDY DESIGN:We conducted ancillary analysis of a randomized surgical trial for rectocele repair. Subjects underwent examinations and completed questionnaires for bowel symptoms at baseli...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2012.06.054
更新日期:2012-11-01 00:00:00
abstract::Previous studies have reported that cigarette smoking is a major source of exposure to cadmium (Cd). This study was carried out to determine the degree of exposure to Cd of pregnant women who smoke and to determine the degree of exposure to Cd of pregnant women who smoke and to determine the disposition of the Cd in t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90786-4
更新日期:1982-04-15 00:00:00
abstract:OBJECTIVE:The purpose of this study was to characterize gestational profiles of biochemical markers that are associated with preeclampsia in the blood of pregnant women in whom preeclampsia developed later and to compare these markers with the markers of women who were delivered of small-for-gestational-age infants wit...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.122969
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the continuing effectiveness of active management of labor, a protocol that involves early detection and correction of dystocia with oxytocin in spontaneous cephalic nulliparous labor, by analysis of the contribution of this cohort to a doubled overall nulliparous ce...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.05.072
更新日期:2004-09-01 00:00:00
abstract::An analysis of United States birth certificate records for the calendar year 1977 indicated that women who failed to seek prenatal care were at increased risk of delivery of a low-birth weight infant, even after social factors were considered. However, the strength of association, as well as the population impact, bet...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90681-6
更新日期:1983-04-01 00:00:00
abstract::As a corollary to a case-control study evaluating the risk of pelvic inflammatory disease (PID) among users of an intrauterine contraceptive device (IUD), Papanicolaou smears were studied to detect the presence of actinomycetes. Forty-six PID case patients and 108 control patients were included in the corollary study....
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90552-x
更新日期:1982-07-01 00:00:00
abstract::Several copper and cupric ion sources were shown to kill or inhibit the growth of Neisseria gonorrhoeae in vitro. The media used was GC Agar Base supplemented with Isovitalex. Pure copper shot, cupric sulfate, and cupric chloride were used as copper sources. E. coli and Neisseria meningitis were used in addition to...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(73)90889-2
更新日期:1973-05-01 00:00:00
abstract::Photosensitization of the endometrium was attempted in vitro and in vivo by intrauterine administration of 5-aminolevulinic acid, which is converted to the photosensitizer protoporphyrin IX. Protoporphyrin IX was found in both functional and basal layers of the endometrial glands at concentrations nine and 10 times hi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90435-2
更新日期:1995-12-01 00:00:00
abstract::The choroid plexus cyst is one of many malformations of the central nervous system that can be detected in utero by ultrasonography. Choroid plexus cysts occur in 2.3% of fetuses. Because previous reports have shown an association between choroid plexus cysts and chromosomal anomalies, we analyzed 82 prenatally diagno...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90192-0
更新日期:1989-05-01 00:00:00
abstract::The kinetics of prostaglandins instilled vaginally has been studied in the maternal and fetal circulations, with observation of changes in the stable prostaglandin E2 metabolite 11-deoxy-13,14-dihydro-15-keto-11 beta,16-cyclo-prostaglandin E2. After the administration of prostaglandin E2, 10 mg in a wax-based pessary,...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90752-7
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:We recently reported that nitric oxide was associated with increased mortality among pregnant rats with intrauterine infection. In our current study we investigated the expression of different isoforms of nitric oxide synthases and nitric oxide in the nonpregnant rat uterus with experimental intrauterine infe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70499-0
更新日期:1999-09-01 00:00:00
abstract::The diagnosis of fetal asphyxia requires a blood gas and acid-base assessment demonstrating a significant metabolic acidosis. However, the fetus may tolerate an asphyxial insult without central nervous system injury because of the fetal cardiovascular adaptation to hypoxemia. Prediction of the significance of an asphy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/0002-9378(88)90456-5
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:Our purpose was to study maternal blood and amniotic fluid concentrations of homocysteine and relevant vitamins in relation to neural tube defects. STUDY DESIGN:Concentrations of total homocysteine, folate, and vitamins B12 and B6 were measured in maternal blood and amniotic fluid of 27 women carrying a fetu...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(95)90474-3
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Cesarean scar pregnancy and cervical pregnancy are unrelated forms of pathological pregnancies carrying significant diagnostic and treatment challenges, with a wide range of treatment effectiveness and complication rates ranging from 10% to 62%. At times, life-saving hysterectomy and uterine artery embolizat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.03.010
更新日期:2016-09-01 00:00:00
abstract::Neurofibromatosis adversely affects reproductive performance. Fetal growth retardation as a complication of pregnancy in patients with neurofibromatosis had not been widely documented. The present cases suggest that pregnant patients with neurofibromatosis may have an increased risk for growth-retarded babies. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80167-9
更新日期:1987-08-01 00:00:00