Objective To investigate the suitable mode of induced termination of pregnancy at second and third trimester for women with scarred uterus. Methods A retrospective study was performed in 90 cases of second and third trimester pregnant women with scarred uterus, who requested termination of pregnancy due to medical indications in Beijing Obstetrics and Gynecology Hospital from September 2002 to June 2009. The indications of termination of pregnancy were fetal anomaly, serious pregnant complication and intrauterine fetal deaths. 72 second trimester pregnant women and 18 third trimester pregnant women were included in this study. The interval time of previous operation to this pregnancy were recorded. And it was <2 years in 20 cases and ≥2 years in 70 cases. The patients with normal Hepatic function began to take mifepristone and had an allergic test of Ethacridine Lactate. The method of mifepristone combined with Ethacridine Lactate were adopted when the allergic test was negative (group A, 54 cases). The method of mifepristone combined with earbeprost methylate suppositories were used in the patients who had a positive reaction to the allergic test of Ethacridine Lactate, or who failed to amniotomy to inject Ethacridine Lactate because of oligohydramnios or small gestational age(group B, 36 cases). Record the detail information of every patient. (1) Age, gestational weeks, gravidity and parity. (2) The mode of previous operation (inducing the scar of uterus), previous operation time and indication. (3) The mode of induced labor in this pregnancy, the interval time from administration to uterine contraction, delivery or not and the interval time from induction to delivery. (4) Postpartum hemorrhage, the successful rate of induce labor, placental retention ratio and rupture of uterus or not. Results (1) It had no significant difference between group A and group B in age, gravidity, parity and the interval time of previous operation to this pregnancy (P> 0.05). But there was significant difference between two groups in gestational weeks of induction(16 weeks vs. 25 weeks,P<0.01). (2) It had no significant difference between two groups in successful rate of induction and postpartum hemorrhage(P>0.05), but the time from induction to regular uterine contraction and delivery in group B was significant shorter than that of group A(P<0.01). The rate of delivery with 24 hours in group B was 94%. It was significant higher than that of group A(13%, P<0.01). (3) The rate of retained placenta in group B (31%, 11/35) was significant higher than group A (10%, 5/52), but the ratio of residual of placenta and membranes in group A was significant higher than that of group B(54% vs. 34% ). It was no significant difference in total rate of postpartum complication between two groups. Further analysis was done in relationship of complication and the time of previous operation. It was no significant difference between the over 2 years group and the less 2 years group in the incidence rate of complications including placental retention, residual of placenta and membranes, rupture of uterus, placental abruption and postpartum hemorrhage. (4) There was 1 case of uterine rupture in group B and 1 case of placental abruption in group A. Conclusions Both of methods of mifepristone combined with carboprost methylate suppositories and the mifepristone combined with Ethacridine lactate are feasible to induced second trimester and late trimester termination of pregnancy for women with scarred uterus. But sufficient preoperation preparation and the course of induction and labor careful monitoring must be done to prevent the uterine rupture.

Objective To explore the English newspaper reading activities which are well-suited for medical students. Methods At the end of an optional course News in English, a question-naire investigation was conducted among 86 enrolled students on their degree of preference for the 8 kinds of news reading activities designed for this course. Questionnaire data were processed by SPSS 13.0 software. Percentages were calculated and ANOVA tests were employed to compare the prefer-ence degree between different activities. P<0.05 signifies statistical differences. Results The prefer-ence degree for all the 8 activities were above 3 out of a total of 5. The score for most activities fell between 3 and 4. Each activity was ‘liked’ or ‘loved’ by more than half of students. There was no significant difference either between the scores for the 8 activities, or between the scores of each activ-ity for different semesters(P>0.05). Conclusions The eight types of English news reading activities are well suited for the interest of most medical students. Nevertheless, they still need improving in several aspects to increase students’ interest in newspaper reading and further motivate them in relat-ed English learning activities, including selection of text material.

Objective To study the changes of intrapartum cesarean rate, cesarean indications and pregnancy outcomes after the new partogram applied. Methods Totally 3 290 pregnant women trying to vaginal delivery which were managed according to the new partogram in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from August to October in 2014 (new partogram group) were involved;2 987 pregnancy women trying to vaginal delivery from May to July in 2014 which were managed according to the old partogram (old partogram group) were involved as control. The intrapartum cesarean rate, cesarean indications and the pregnancy outcomes between the two groups were analyzed. Results The rate of intrapartum cesarean delivery was 8.50%(254/2 987) in old partogram group, and was significantly higher than that in new partogram group (6.2%, 204/3 290;P<0.01). Cesarean indications in old partogram group included 18 labor protraction (7.1%, 18/254), 82 labor arrest (32.3%, 82/254), 44 relative cephalopelvic disproportion (17.3%, 44/254), 80 fetal distress (31.5%, 80/254), 23 intrauterine infection (9.1%, 23/254) and 7 cesarean delivery on maternal request (CDMR;2.8%, 7/254) . Cesarean indications in new partogram group included 33 labor arrest (16.2%, 33/204), 71 relative cephalopelvic disproportion (34.8%, 71/204), 73 fetal distress (35.8%, 73/204) and 22 intrauterine infection (10.8%, 22/204), 5 CDMR (2.5%, 5/204). There were no significant differences in incidence of asphyxia neonatorum and puerperal morbidity (P>0.05), but the incidence of postpartum hemorrhage in new partogram group was higher than the old partogram group [6.9% (14/204) versus 1.6% (4/254), P<0.05]. Conclusion After the new partogram applied, the rate of intrapartum cesarean delivery is significantly decreased, but the incidence of postpartum hemorrhage is increased.

Objective To investigate the value of fasting plasma glucose (FPG) in 75 g oral glucose tolerance test (OGTT) on the diagnosis of gestational diabetes mellitus (GDM).Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jan.2010 and Dec.2010 were collected.All patients had normal FPG at first trimester,and accepted 75 g OGTT after abnormal 50 g glucose challenge test (≥7.8 mmol/L).According to the result of OGTT,they were divided into 12 groups,and Chisquare test was used to analyze the role of FPG of OGTT in GDM diagnosis.Results According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria,15.0％ (980/ 6516) of this group of pregnant women was diagnosed with GDM by FPG (≥5.1 mmol/L) of OGTT in this study.Then,the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level (FPG level interval 0.1 mmol/L).As FPG level rose,the incidence of GDM also rose (X2 =282.175,P =0.000).Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L (X2 =274.364,P=0.000).When FPG level was lower than 4.2 mmol/L(22.1％,1226/5536),the incidence of GDM diagnosed by OGTT was 3.6％ (44/1226).And when FPG level of OGTT was higher than 4.8 mmol/L,the incidence of GDM was 26.2％ (298/1138).Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT,and GDM low-risk women whose FPG ≤4.2 mmol/L do not need OGTT.

The clinical data of 8 patients with the fourth-degree laceration of perineum, who were admitted in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2004 to December 2010, were reviewed retrospectively. The causes and clinical strategies were analyzed. The fourth-degree laceration of perineum was mainly caused by improper skills of midwifery, too faster labor,insufficient estimation of fetal-weight and perineal condition and obstetric forceps in this group of patients.Primary suture was performed and all cases achieved complete healing. The improvement of midwifery skill,carefully monitoring the uterine contraction, accurate evaluation of condition of perineum and the fetal-weight and good communication between patients and midwives are the key points to prevent the fourth-degree laceration of perineum.

Objective To discuss the MRI features and pathogenic mechanisms of lung cancer intramedullary spinal cord metastasis (ISCM). Methods Four cases with clinically and 3 cases pathologically proved lung cancer ISCM were analyzed retrospectively. Turbo spin-echo sequence T 1 and T 2 weighted images were acquired in all patients. T 1 weighted images were obtained after intravenous administration of Gd-DTPA in all patients. Results A total of 7 ISCM were displayed by MR studies. The tumor occurred in thoracic cord (3/7) and in medullary cone (4/7). The tumor involved the central aspect of the cord. The lung cancer ISCM showed hypointensity (n=1) or isointensity (n=6) on T 1WI and hyperintensity on T 2WI. The extensive cord enlargement with cyst formation or syringomyelia was common. On contrast study, all tumors showed marked homogenous enhancement with clear borders. Conclusion The lung cancer ISCM usually presented as solitary lesions with marked contrast enhancement. The extensive cord enlargement was common in all patients. Because of the limitation in the evaluation of lung cancer ISCM on MRI, definite diagnosis of lung cancer ISCM depended on combination of clinical and MRI data.

Objective To investigate the incidence and pregnancy outcomes of premature rupture of membranes (PROM) in pregnant women in Beijing.Methods A retrospective multicenter study of 18 534 cases delivered in Beijing Obstetrics and Gynecology Hospital,Beijing Friendship Hospital,Daxing MCH Hospital and Tongzhou MCH Hospital from January 2011 to December 2011,was conducted.Results Among 18 534 cases,PROM occurred in 4 504 cases (24.30％),including 3 910 cases of in term PROM (21.10％) and 594 cases of preterm PROM (3.20％).The incidence of premature delivery was 6.17％ (1 144/18 534),and among 1 144 cases of premature delivery 547 cases were PROM (47.81％);the incidence of PROM was 22.75％ (3 957/17 390) in term delivery.The overall cesarean section (CS) rate was 48.50％ (8 989/18 534) and that in pregnant women with PROM was 35.55％ (1 601/4 504),but the CS rate in pregnant women without PROM was 52.66％ (7 388/14 030).The rate of postpartum hemorrhage was 13.12％ (210/1 601)in CS cases and 4.17％ (121/2 903) in vaginal delivery cases (x2 =121.361,P=0.000).The mean hospital stay for PROM was (5.3±2.9) d in CS cases and (4.3±2.3) d in vaginal delivery cases (t =-12.136,P =0.000).Conclusions Without severe maternal or fetal complications,the incidence of PROM is relatively high in Beijing region and PROM may not increase the maternal or fetal complications.Vaginal delivery is the main mode of delivery for PROM.Cesarean section may not cause less neonatal complications,but may lead to more postpartum hemorrhage and longer hospital stay.

Objective To investigate the risk factors associated with abnormal cervical cytology findings in pregnant women. Methods From Sep. 2007 to Sep. 2008, 12 112 pregnant women who underwent their antenatal examinations at 12-36 gostational weeks in Beijing Obsteties and Gynecology Hospital were enrolled in this study. They were all excluded from the following pathologic obstetrics factors including threatened abortion, premature rupture of membranes or placental previa Thinprep cytology test (TCT) were given at their first examination, meanwhile, a personal clinic file was established to record her occupation, education, address, family income, nationality, age of first intercourse, number of sex partners, contraception, marriage and pregnancy, current gynecologic diseases, family history of gynecologic tumors, history of gynecologic diseases and smoking and result of pelvic examination. Those risk factors leading to abnormal cervical cytology were analyzed. Results The complete clinical data were collected from 11 906 cases(98.30%, 11 906/12 112). It was found that 10 354 women were shown with normal TCT result, however, 1134 women (9.52%, 1134/11 906) with atypical squamaous cells of undetermined significance(ASCUS), 112 women (0.94%, 112/11 906) with atypical glandular cells of undetermined significance(AGUS), 229 women (1.92%, 229/11 906) with low grade squamaous intraepithelial(LSIL),74 women (0.62%, 74/11906) with high grade squamaous intraepithelial(HSIL). Multiple factorial non-conditioned logistic regression analysis showed that age of first sexual intercourse (OR_(ASCUS)=2.90, OR_(AGUS)=7. 32), number of sex partners (OR_(AGUS)=1.49, OR_(AGUS)=2. 02), number of abortion (OR_(ASCUS)=1.68,OR_(AGUS)=3.50) were correlated with ASCUS and AGUS. In LSIL group and HSIL group, age of first sexual intercourse (OR_(LSIL)=6. 34, OR_(HSIL)=9.26), number of sex partners (OR_(LSIL)=1.69, OR_(HSIL)=1.6.5),number of abortion (OR_(LSIL)=1.53, OR_(HSIL)=5. 33), smoking (OR_(LSIL)=1.84, OR_(HSIL)=1.77) were remarkable variables. The infection of human papilloma virus (HPV) and trichomonas vaginitis were correlated with abnormal cervical cytology(including ASCUS, AGUS, LSIL and HSIL) significantly (P< 0.01). Columnar epithelium dystopia were also significantly correlated with abnormal cervical cytology (χ~2=43. 269, P=0. 000). However, abnormal cervical cytology was uncorrelated with degrees of Columnar epithelium dystopia. Conclusions The risk factors associated with abnormal cervical cytology in pregnant women were the same with those of non-pregnant women.

Objective To investigate safety and efficacy of dinoprostone suppositories(0.8 mm) used in cervical ripening and labor induction in women with term premature rupture of the membranes.Methods One hundred women of term monocyesis with premature rupture of the membranes,head presentation,bishop score less than 6(test group)and 180 women with intact fetal membranes(control group)were enrolled into this multicenter,prospective clinical study.The vaginal delivery system was inserted into the posterior foruix,and the patients were recumbent for 2 hours after insertion.The interval time from using dinoprostone suppositories to uterine contraction,to labor and delivery were recorded.The following index were also recorded and compared,including the mean inserted time of dinoprostone suppositories,fetal heart beat,meconium stained amniotic fluid,hyperstimulation of uterus and the other complications,mode of delivery,stage of labor,postpartum hemorrhage,status of neonates.Results Three cases intest group and 23 casesin control group weren't in labor within 24 hours.The rate of labor within 24 hours in test group was significant higher than that in control group(97.0% vs.87.2%,P<0.01).It was observed that 73 cases undergoing vaginal deliveries(75.3%,73/97)and 24 cases undergoing cesarean section dehveries(24.7%,24/97)in test group and 107 cases undergoing vaginal delivery(68.2%,107/157)and 50 cases undergoing cesarean section delivery(31.8%,50/157)in control group,when compared the rate of vaginal or cesarean section deliveries between two group,it didn't reach statistical difference (P >0. 05). It had no significant difference in the interval time from using dinoprostone suppositories to labor starting and the mean inserted time and the total labor time between two groups ( P > 0.05 ). The incidence of uterine tachysystole was 11.3% (11/97) in test group and 19. 1% (30/157) in control group (P>0. 05), which did not reach statistical difference (P>0. 05). There wasn't neonatal asphyxia in both groups. Conclusion It was safe and efficient to use dinoprostone suppositories for cervical ripening and induction of term pregnancy with premature rupture of the membranes, however, monitoring should be intensified.

Objective To investigate the influencing factors of low birth weight infants (LBWI) in China in order to provide evidence for lowering the incidence of LBWI and improving the perinatal outcomes.Methods Clinical data were obtained from 14 different provinces, municipalities or autonomous regions in Northeastern, Northwestern, Northern, Central, Eastern, Southern and Southwestern of China, covering 39 hospitals of different levels.A total of 112 441 newborns were collected from January 1 to December 31 in 2011.After exclusion of those cases with incomplete information, miscarriage before 28 weeks of gestation, induction due to fetal malformation or intrauterine fetal death, 103 678 cases were restrospectively analyzed.Questionnaires were filled out and all data were recorded in computer network databases.Clinical data included maternal age, education background, height, weight, parity, histories of abnormal pregancy and comorbidities and complication.Independent sample t-test, Chi-square test, unvariate and ultivariate unconditional Logistics regression analysis were performed.Results The incidence of LBWI in mainland China was 7.21％ (7 474/103 678), 61.43％ (5 260/8 562) for preterm babies, and 2.33％ (2 214/95 116) for full-term babies.Univariate analysis showed that LBWI were associated with maternal age, education background, height, pregestational body mass index (BMI), weight gain during pregnancy, cord length, smoking, parity, histories of abnormal pregancy, gestational diabetes mellitus (GDM), preterm birth, hypertensive disorders in pregnancy, anemia, premature rupture of membranes and abnormal amniotic fluid volume.The following unconditional binary logistic regression analysis for those factors with P ＜ 0.3 in unvariate analysis showed that preterm birth (OR=46.246, 95％CI: 41.484-51.555), hypertensive disorders during pregnancy (OR=5.031, 95％CI: 4.325-5.853), histories of intrauterine fetal death ≥ 1 times (OR=2.446, 95％CI: 1.479-4.044), oligohydramnios (OR=2.068, 95％CI:1.659-2.578), pregestational BMI ＜ 18.5 (OR=1.637, 95％CI: 1.415-1.893), spontaneous abortion ≥ 1 times (OR=1.362, 95％CI: 1.043-1.777), age ≤ 20 (OR=1.332, 95％CI: 1.046 1.695), anemia (OR=1.230, 95％CI: 1.017-1.488) and premature rupture of membranes (OR=1.154, 95％CI:1.016-1.311) were risk factors for LBWI.The higher the maternal education level, weight gain, BMI and height, the lower the LBWI incidence.The risk factors of LBWI in premature small for gestational age (SGA) infants were hypertensive disorders during pregnancy and histories of intrauterine fetal death ≥ 1 times.The higher the maternal height and weight gain during pregnancy, the lower the incidence of LBWI in premature SGA infants.Conclusions The main influencing factors for LBWI are preterm birth and hypertensive disorders during pregnancy.In addition, LBWI is also associated with socioeconomic and genetic factors.