Abstract:
BACKGROUND:Important clinical, social, and ethical questions are associated with the evaluation and use of surgical approaches aimed at correcting fetal anatomic abnormalities. In particular, the expansion of maternal-fetal surgery to ameliorate nonlethal fetal conditions has intensified the need to address issues about the adequacy of technology assessment and the safety of those who undergo these novel procedures. APPROACH:After discussions at a multidisciplinary conference, we reviewed the development and current practices of maternal-fetal surgery and analyzed the relevant ethical issues concerning the use of maternal-fetal surgery for nonlethal conditions, focusing on the correction of myelomeningocele. FINDINGS:Characterizing nonvalidated maternal-fetal surgery procedures as "innovative therapy" blurs the boundaries between research and therapy and creates uncertainty about the obligations of clinicians and researchers. Further, maternal-fetal surgery raises ethical issues related to maternal risks and benefits, informed consent, distinguishing lethal from nonlethal conditions, withholding unproven treatments, entrepreneurship, and prioritization. RECOMMENDATIONS:To help ensure that maternal-fetal surgery will be studied and eventually applied in a scientifically and ethically sound manner, we offer several recommendations. First, innovation in maternal-fetal surgery should be conducted and evaluated as research. Second, women must be considered research subjects in these trials. Third, the informed consent process must ensure adequate comprehension and genuine voluntariness in those considering participation. Fourth, discriminatory and fearful attitudes toward individuals with disabilities should be addressed explicitly prior to making a decision to proceed with maternal-fetal surgery in an attempt to correct such disabilities. Fifth, maternal-fetal surgery should not be performed for cosmetic indications unless and until there is reliable evidence that maternal-fetal surgery can be performed safely and that long-term side effects on women and their offspring are minimal. Sixth, centers of excellence should be established for conducting research and providing maternal-fetal surgery. Seventh, funding for research on maternal-fetal surgery should be considered in the context of societal needs.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Lyerly AD,Gates EA,Cefalo RC,Sugarman Jdoi
10.1016/s0029-7844(01)01513-7subject
Has Abstractpub_date
2001-10-01 00:00:00pages
689-97issue
4eissn
0029-7844issn
1873-233Xpii
S0029784401015137journal_volume
98pub_type
共识发展会议,杂志文章,评审abstract::The systolic/end-diastolic ratio (S/D) and pulsatility and resistance indices were calculated before and after diagnostic cordocentesis in 46 fetuses, after 19 intravascular transfusions in eight fetuses, and on two occasions 45 minutes apart in eight controls. The fetus was paralyzed with pancuronium (0.3 mg/kg sonog...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract::The vaginal microbiota has great significance in maintaining vaginal health and protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health o...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0000000000001932
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To assess whether primary and secondary vestibulodynia represent different pathologic pathways. METHODS:This was an analysis of archived vestibulectomy specimens from 88 premenopausal women with vestibulodynia (2002-2008). Patient records were reviewed to classify the type of vestibulodynia, duration of symp...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31821c33dc
更新日期:2011-06-01 00:00:00
abstract::Infants delivered preterm often reflect accelerated maturation. The present study examines the occurrence of suboptimal intrauterine growth in infants delivered preterm by comparing their birth weights to the weights sonographically predicted for in utero fetuses at similar gestational ages but who ultimately deliver ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract::Compared with men, at-risk alcohol use by women has a disproportionate effect on their health and lives, including reproductive function and pregnancy outcomes. Obstetrician–gynecologists have a key role in screening and providing brief intervention, patient education, and treatment referral for their patients who dri...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31822c9906
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS:Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(01)01465-x
更新日期:2001-09-01 00:00:00
abstract::The effect of an 8-hour, 3-dose perioperative regimen of cefazolin or placebo was evaluated in 97 patients. Postoperative morbidity occurred in 13 patients (27.1%) in the cefazolin group and in 17 patients (34.7%) who received placebo. The clinical sites of infection were similar in both groups except that wound infec...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:
更新日期:1978-09-01 00:00:00
abstract::A simplified, numerical form for antepartum risk scoring was introduced as a component of the prenatal record for use in all pregancies in a large geographic area under a variety of collection practices. In a population of approximately 1,000,000 with 16,733 deliveries, 19% of the pregnant population scored greater th...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-03-01 00:00:00
abstract::Mothers of children with Down syndrome were surveyed by questionnaire concerning their attitudes about amniocentesis, prenatal genetic counseling, and abortion. Of the 101 who responded, 40 had borne children after giving birth to a child with Down syndrome. Half had amniocentesis in subsequent pregnancies but only ha...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-08-01 00:00:00
abstract:OBJECTIVE:We sought to investigate the prevalence and risk factors for vaginal yeast colonization over a 1-year period. METHODS:We conducted a longitudinal cohort study of 1,248 asymptomatic young women by collecting demographic and behavioral data at baseline, 4, 8, and 12 months. RESULTS:Seventy percent of women we...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000140687.51048.73
更新日期:2004-11-01 00:00:00
abstract::The authors determined the prevalence of certain major congenital disorders among live-born infants of 6509 mothers in a prepaid health plan for the 30-month period of January 1, 1980 through June 30, 1982 who used a wide variety of drugs during the first trimester of pregnancy. The results were similar to those obtai...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-04-01 00:00:00
abstract::Severe fetal hydrops was diagnosed at 34 weeks' gestation. Funipuncture revealed a normal 46,XX karyotype and a hematocrit of 20%. Cesarean delivery was performed. Neonatal blood testing showed blood type B positive, positive direct and indirect Coombs, and an anti-B antibody titer of 1:64. The maternal blood group wa...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Neuroleptic malignant syndrome (NMS) is characterized by a tetrad of mental status changes, extrapyramidal symptoms, hyperpyrexia, and autonomic instability and can develop after the use of antipsychotics. CASE:A young, multiparous woman presented at 26 weeks of gestation with acute psychosis and was treate...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31822864af
更新日期:2012-02-01 00:00:00
abstract::This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::This review is designed to provide a broad view of fetal cardiovascular response to fetal distress. The presentation focuses on data obtained from laboratories working with fetal sheep, or occasionally fetal monkeys, instead of attempting to interpret data resulting from human fetal studies. Human fetal studies are un...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1977-03-01 00:00:00
abstract:OBJECTIVE:We investigated the relationship between low maternal age and neonatal survival among extremely preterm twins. METHODS:This was a retrospective cohort study on live births of extremely preterm twins delivered to teenaged mothers (aged 15-19 years) in the United States within the period 1995 through 1998. Ove...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000126724.91988.fa
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:In an effort to minimize injuries associated with closed laparoscopic entry, many surgeons use a 10-mm standard open laparoscopy technique. Disadvantages of this open technique are that it requires a larger incision, fascial sutures, and does not always achieve an airtight seal. Although 5-mm laparoscopics w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001202
更新日期:2016-03-01 00:00:00
abstract::Serial measurements of amniotic fluid volume were made using a tracer dilution technique in sheep during the last half of gestation. No consistent trends were observed in amniotic fluid volume changes over this period. Disappearance of tracer-labeled urea and water from the amniotic fluid was observed at various gesta...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVES:To document individual variations in the rise in insulin requirements during type I diabetic pregnancies, to relate the degree of increase to maternal characteristics and fetal outcome, and to examine these factors in a subgroup of patients experiencing a large fall in insulin requirement in the third trimes...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-02-01 00:00:00
abstract::The incidence of spontaneously occurring premature labor in insulin-dependent diabetic pregnancies is unclear, because previous studies have been confounded by a high rate of iatrogenic prematurity. The purpose of this study was to determine, in a large population of insulin-dependent diabetic pregnant women, the rate...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract::A successful pregnancy occurred in the first year after liver transplantation. The patient was treated with prednisolone, azathioprine, and low-dose cyclosporine A. A healthy girl of 2260 g (fifth to tenth percentile) was born at 38 weeks. ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
abstract::Forty-eight of 100 pregnant women received a 100-g (nonfasting) glucose screening test at about 28 weeks' gestation, followed by a 100-g glucose tolerance test. Another 52 received a 100-g (nonfasting) glucose polymer screening test followed by a 100-g glucose polymer tolerance test. Mean plasma glucose one hour after...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:
更新日期:1985-10-01 00:00:00
abstract::Seventy-five high-risk pregnancies were studied in order to define the clinical value of the analysis of fetal blood flow velocity waveforms in early screening for growth retardation. Recordings were obtained at 26-28 weeks' gestation, in the absence of ultrasonographic signs of growth retardation, using a pulsed dupl...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:To evaluate a quality improvement protocol for venous thromboembolism prevention in postoperative gynecologic cancer patients. METHODS:On January 1, 2006, we initiated a universal protocol of dual prophylaxis with sequential compression devices and three times daily heparin (or daily low molecular weight hep...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1097/AOG.0b013e31818b1486
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:To evaluate fetal outcome and long-term impact of very early preterm premature rupture of membranes (PROM). METHODS:In a retrospective cohort study, 78 women with singleton pregnancies who delivered at the Oulu University Central Hospital between 1990 and 1996 and who had early PROM, between the 17th and 30t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00213-0
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Cyclic vomiting syndrome is a condition that consists of recurrent episodes of vomiting occurring between periods of normal health, with no apparent organic cause of vomiting. We report the sentinel case of pregnancy complicated by preexisting cyclic vomiting syndrome. CASE:A primigravida presented at 8 wee...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181a458e0
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Vaginal aplasia occurs in 1 in 5,000-10,000 female live births. In this report, we evaluated a novel dual-force vaginoplasty technique for treatment of 11 patients with segmental vaginal aplasia. TECHNIQUE:The principle of the approach is to thin the atretic part between two counteracting forces. The instru...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001974
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:An existing model for fourth-degree laceration repair uses beef tongue with plastic or vinyl tubing. This modified model substitutes beef tripe for the anal mucosa and chicken leg muscles for the anal sphincter muscle analogs to create a realistic model. METHOD:Tripe is tunneled through the body of the trim...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001908
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:To investigate the value of the combined use of vaginal ultrasonography and endometrial sampling in the office for the diagnosis of endometrial disease in postmenopausal women. METHODS:One hundred forty consecutive postmenopausal women presenting with uterine bleeding or endometrial cells on cervical cytolog...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0029-7844(94)00421-9
更新日期:1995-03-01 00:00:00
abstract::Although not all multifetal pregnancies occur after the use of assisted reproductive technology, fertility treatments have contributed significantly to the increase in multifetal pregnancies. In almost all cases, it is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/AOG.0000000000002302
更新日期:2017-09-01 00:00:00