1. Unit 11 Maternal-Fetal Medicine

2. Word Formation 1. neo- (new) e.g. neonatal 2. peri- (around) e.g. perinatal 3. hypo- (deficiency) e.g. hypoxic 4. isch- (reduction, deficiency) e.g. ischemia 5. ante- ( before) e.g. antenatal 6. mal- ( bad, abnormal) e.g. malpractie 7. mis- ( wrong ) e.g. miscarriage 8. ect-; ect/o ( outside ) e.g. ectopic 9. brachi- ( arm ) e.g. brachial 10. fet/o ( fetus )

3. Questions to consider 1. Do you know the origin of “cesarean delivery” or “cesarean section” ? “cesarean section” ? 2. Compare vaginal delivery and cesarean delivery. 3. If you were an obstetrician, how would you help your patient to decide the mode of delivery ? your patient to decide the mode of delivery ?

4. History History cesarean section, delivery of an infant by surgical cesarean section, delivery of an infant by surgical removal from the uterus through an abdominal incision. removal from the uterus through an abdominal incision. The operation is of ancient origin: indeed, the name The operation is of ancient origin: indeed, the name derives from the legend that Julius Caesar was born in derives from the legend that Julius Caesar was born in this fashion. this fashion.

5. The origin of the name ‘Caesarean’ is obscure. The origin of the name ‘Caesarean’ is obscure. Although it is commonly linked to Julius Caesar, Although it is commonly linked to Julius Caesar, his mother is known to have been alive at the time his mother is known to have been alive at the time of the invasion of Britain by his Roman army. of the invasion of Britain by his Roman army. It is highly unlikely that she would have survived It is highly unlikely that she would have survived delivery by ‘section’. Some have suggested that the delivery by ‘section’. Some have suggested that the term is derived instead from the Latin verb ‘to cut’, term is derived instead from the Latin verb ‘to cut’, caedare. caedare.

6. Cesarean Section Overview Definition Definition A cesarean section is a surgical procedure in which A cesarean section is a surgical procedure in which incisions are made through a woman's abdomen and incisions are made through a woman's abdomen and uterus to deliver her baby. It is usually performed when uterus to deliver her baby. It is usually performed when a vaginal delivery would put the baby's or mother's life a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been or health at risk, although in recent times it has been also performed upon request for childbirths that could also performed upon request for childbirths that could otherwise have been natural. The WHO recommends otherwise have been natural. The WHO recommends that the rate of Caesarean sections should not exceed that the rate of Caesarean sections should not exceed 15% in any country. In 2006, the rate of U.S. births by 15% in any country. In 2006, the rate of U.S. births by C-section was 31.1%. C-section was 31.1%.

7. 我国剖腹产率近 50% 远高于世卫推荐 15% 上限 2010 年 05 月 09 日 20:56 新华网 新华网广州 5 月 9 日电 ( 记者肖思思 ) 统计数字显示，中 国平均剖腹产率接近 50% ，个别医院甚至超过了 80% ， 远远高于世界卫生组织推荐的 15% 的上限。一些产妇的 错误观念、医院方面的某些倾向性，推动了剖腹产率的 不正常攀升。 今年 2 月，世界卫生组织在医学权威期刊《柳叶刀》发 今年 2 月，世界卫生组织在医学权威期刊《柳叶刀》发 布报告说，针对中国、印度、日本、越南、泰国等 9 个亚 洲国家的调查发现，在 2007 年 10 月至 2008 年 5 月，中国剖 腹产率高达 46.2% ，是世界卫生组织推荐上限的 3 倍以上， 其他 9 个国家的平均值为 27.3% 。

8. Purpose Purpose Cesarean sections, also called c-sections or cesarean Cesarean sections, also called c-sections or cesarean deliveries, are performed whenever abnormal conditions deliveries, are performed whenever abnormal conditions complicate labor and vaginal delivery, threatening the complicate labor and vaginal delivery, threatening the life or health of the mother or the baby. Dystocia, or life or health of the mother or the baby. Dystocia, or difficult labor, is the other common cause of c-sections. difficult labor, is the other common cause of c-sections. The procedure is performed in the United States on The procedure is performed in the United States on nearly one of every four babies delivered—more than nearly one of every four babies delivered—more than 900,000 babies each year. The procedure is often used 900,000 babies each year. The procedure is often used in cases where the mother has had a previous c-section. in cases where the mother has had a previous c-section.

9. The most common reason that a cesarean section is The most common reason that a cesarean section is performed (in 35% of all cases, according to the United performed (in 35% of all cases, according to the United States Public Health Service) is the woman has had a States Public Health Service) is the woman has had a previous c-section. The "once a cesarean, always a previous c-section. The "once a cesarean, always a cesarean" rule originated when the uterine incision was cesarean" rule originated when the uterine incision was made vertically (termed a "classical incision"); the made vertically (termed a "classical incision"); the resulting scar was weak and had a risk of rupturing in resulting scar was weak and had a risk of rupturing in subsequent deliveries. subsequent deliveries.

10. Today, the incision is almost always made horizontally across the lower end of the uterus (called a low transverse incision), resulting in reduced blood loss and a decreased chance of rupture. This kind of incision allows many women to have a vaginal birth after a cesarean (VBAC).

15. The second most common reason that a c-section is The second most common reason that a c-section is performed (in 30% of all cases) is difficult childbirth performed (in 30% of all cases) is difficult childbirth due to non-progressive labor (dystocia). Difficult labor due to non-progressive labor (dystocia). Difficult labor is commonly caused by one of the three following is commonly caused by one of the three following conditions: abnormalities in the mother's birth canal; conditions: abnormalities in the mother's birth canal; abnormalities in the position of the fetus; or abnormalities in the labor, including weak or infrequent abnormalities in the position of the fetus; or abnormalities in the labor, including weak or infrequent contractions. contractions.

16. The mother's pelvic structure may not allow adequate passage for birth. When the baby's head is too large to fit through the pelvis, the condition is called cephalopelvic cephalopelvic disproportiondisproportion (CPD)( 头盆不称 ). disproportion Another 12% of c-sections are performed to deliver a Another 12% of c-sections are performed to deliver a baby in a breech presentation( 臀先露, 臀位 ) (buttocks baby in a breech presentation( 臀先露, 臀位 ) (buttocksbreech presentationbreech presentation or feet first). Breech presentation is found in about 3% or feet first). Breech presentation is found in about 3% of all births. of all births.

19. In 9% of all cases, c-sections are performed in response In 9% of all cases, c-sections are performed in response to fetal distress, which refers to any situation that to fetal distress, which refers to any situation that threatens the baby such as the umbilical cord ( 脐带 ) threatens the baby such as the umbilical cord ( 脐带 ) wrapped around the baby's neck. This may appear on wrapped around the baby's neck. This may appear on the fetal heart monitor as an abnormal heart rate or the fetal heart monitor as an abnormal heart rate or rhythm. Fetal brain damage can result from oxygen rhythm. Fetal brain damage can result from oxygen deprivation. Fetal distress is often related to deprivation. Fetal distress is often related to abnormalities in the position of the fetus or abnormalities abnormalities in the position of the fetus or abnormalities in the birth canal( 产道 ), causing reduced blood flow in the birth canal( 产道 ), causing reduced blood flow through the placenta. through the placenta.

21. The remaining 14% of c-sections are indicated by other The remaining 14% of c-sections are indicated by other serious factors. One is prolapse( 脱垂, 脱出 ) of the serious factors. One is prolapse( 脱垂, 脱出 ) of the umbilical cord: the cord is pushed into the vagina ahead umbilical cord: the cord is pushed into the vagina ahead of the baby and becomes compressed, cutting off blood of the baby and becomes compressed, cutting off blood flow to the baby. Another is “placental abruption( 胎盘 flow to the baby. Another is “placental abruption( 胎盘placental abruptionplacental abruption 早剥 )," whereby the placenta separates from the 早剥 )," whereby the placenta separates from the uterine wall before the baby is born, cutting off blood uterine wall before the baby is born, cutting off blood flow to the baby. The risk of this is especially high in flow to the baby. The risk of this is especially high in multiple births (twins, triplets, or more). multiple births (twins, triplets, or more).

24. A third factor is "placenta previa," in which the placenta placenta previaplacenta previa covers the cervix partially or completely, making vaginal delivery impossible. In some cases requiring c-section, the baby is in a transverse position, lying horizontally across the pelvis, perhaps with a shoulder in the birth canal. The mother's health may make delivery by c-section The mother's health may make delivery by c-section the safer choice, especially in cases of maternal diabetes, the safer choice, especially in cases of maternal diabetes, hypertension, genital herpes, malignancies of the hypertension, genital herpes, malignancies of the genital tract, and preeclampsia ( 先兆子痫 ) (high blood genital tract, and preeclampsia ( 先兆子痫 ) (high blood pressure related to pregnancy). pressure related to pregnancy).

39. Understanding the Text Understanding the Text Para. 1 obstetrical care---- 产科护理 wholesale----in large quantities; on a very large scale 成批的 ; 大规模的 成批的 ; 大规模的 delivery---- 分娩 advent----n. (fml.) the arrival or coming of sb. or sth. 出现 ; 来临 出现 ; 来临 in vitro fertilization---- 体外受精 Question: 1. What changes in obstetrical care are mentioned in this paragraph ? mentioned in this paragraph ?

40. Para. 2 maternal and neonatal---- 母婴的 primiparous patients---- 初产妇 blood bank---- 血库 era----times 时代 proceed to---- 继续, 接着 vaginal delivery---- 阴道 ( 自然 ) 分娩 adverse outcome---- 不良后果 perinatal care---- 围产期护理

41. labor---- 分娩 neonatal intensive care units---- 新生儿重症监护室 pregnancies---- 妊娠 Questions: 2. What are the possible reasons for decreased risk in cesarean section according to this paragraph ? cesarean section according to this paragraph ? 3. What are the changes in perinatal care in modern times ? times ?

42. Para. 3 decry----argue against 诋毁 ; 大声反对 dispassionate---- 平心静气的 ; 不带偏见的 convergent---- combined 会聚的 ; 集中的 Question: 4. What is the trend discussed in this paragaph ? Do you have your own opinion about this issue ? you have your own opinion about this issue ?

43. Para. 4 mean----adj. average neonate----newborn baby gestation----pregnancy assisted reproductive technology---- necessitate----to make something necessary 使成为必需 Question: 5. Are there any new features of 21st-century pregnancy ? Give examples. pregnancy ? Give examples.

44. Para. 5 evidence-based recommendations---- 循证医学 vaginal breech deliveries---- elective----( 课程 ) 选修的 ; 可以选择的 ; 有选择倾向的 hypoxic-ischemic encephalopathy---- vacuum extraction---- 胎头吸引器 parallel----v. comfortable with---- 习惯于

45. perpetuate----vt. 使永久存在 ; 使不朽 self-perpetuating----adj. ever lasting 可永远继续的 ; 能使自身永久存在的 可永远继续的 ; 能使自身永久存在的 antenatal fetal surveillance---- Question: 6. What do you know about evidence-based recommendations ? Give examples form this paragraph. recommendations ? Give examples form this paragraph.

46. 循证医学 (evidence-based medicine, ebm) 循证医学 (evidence-based medicine, ebm) 是最好的临床研究证据与临床实践 ( 临床经验、临床 是最好的临床研究证据与临床实践 ( 临床经验、临床 决策 ) 以及患者价值观 ( 关注，期望，需求 ) 的结合。 决策 ) 以及患者价值观 ( 关注，期望，需求 ) 的结合。 Ebm 是运用最新、最有力的科研信息，指导临床医生采 Ebm 是运用最新、最有力的科研信息，指导临床医生采 用最适宜的诊断方法、最精确的预后估计和最安全有 用最适宜的诊断方法、最精确的预后估计和最安全有 效的治疗方法来治疗病人。 Ebm 强调医师应认真地深 效的治疗方法来治疗病人。 Ebm 强调医师应认真地深 思熟虑地将目前所得到的最佳证据，用于对每一个患 思熟虑地将目前所得到的最佳证据，用于对每一个患 者进行健康服务时的决策。使提供的医疗服务建立在 者进行健康服务时的决策。使提供的医疗服务建立在 目前所能获得的证据基础上。 目前所能获得的证据基础上。

47. 循证医学是基于证据的医学，是近年来在世界范围内 循证医学是基于证据的医学，是近年来在世界范围内 新兴起最权威的一种医学研究方法。它具有采用大范 新兴起最权威的一种医学研究方法。它具有采用大范 围、多样本、双盲实验来检验药物疗效的等特点。 围、多样本、双盲实验来检验药物疗效的等特点。 大范围，就是循证医学研究要收入大量的病例，然后 大范围，就是循证医学研究要收入大量的病例，然后 分为用药组和对照组，这些病例所患的疾病是相同的， 分为用药组和对照组，这些病例所患的疾病是相同的， 用药组使用同一种药物治疗，对照组采用另一种药物 用药组使用同一种药物治疗，对照组采用另一种药物 治疗，最后比较两种药物的疗效。 治疗，最后比较两种药物的疗效。

48. 多样本，就是在研究中收入的病例，尽管所患 多样本，就是在研究中收入的病例，尽管所患 的疾病相同，但各人的自身条件不同，如年龄不同， 的疾病相同，但各人的自身条件不同，如年龄不同， 体质不同，只有多样本才能保证所研究的药物适用 体质不同，只有多样本才能保证所研究的药物适用 于所有人 ; 双盲实验，就是医生与患者都不知道使用 于所有人 ; 双盲实验，就是医生与患者都不知道使用 的是哪种药物，最后按编号统计使用药物后的疗效， 的是哪种药物，最后按编号统计使用药物后的疗效， 这样最大程度地保证了药物疗效的客观性。由此可 这样最大程度地保证了药物疗效的客观性。由此可 见，循证医学研究是评价药物疗效最科学、最公正 见，循证医学研究是评价药物疗效最科学、最公正 的方法，因此能得出真正值得患者信赖的用药依据。 的方法，因此能得出真正值得患者信赖的用药依据。

49. Para. 6 quantify---- 量化 malpractice---- 医疗事故 average----v. premium---- 保险金, 保费 claim----n. 索赔 sue---- v. 起诉 ; 控告 cite----v. 引用 ; 引证 ; 举例 legal jeopardy---- allege----v. ( 无证据的 ) 指控 ; 声称

50. Question: 7. What is the dilemma of doctors mentioned in this pragraph ? What’s your choice if you were the doctor ? pragraph ? What’s your choice if you were the doctor ?

51. Para. 7 pelvic organs---- ectopic gestation---- placenta previa---- placenta accreta---- context----situation Question: 8. What reasons for opposing cesarean section are suggested in this paragraph ? suggested in this paragraph ?

52. Para. 8 gestational diabetes---- permanent brachial plexus injury---- in utero--- 在子宫内 breech presentation---- nonreassuring----worrying tracing----detecting reinforce----strengthen perception----opinion Question: 9. What does this paragraph mainly talk about ?

53. Para. 9 center on/ focus on assume----take 承担 in exchange for----for the sake of measure----n. (sing.) a certain amount or quantity; some but not much 一定数量 / 程度 ; 有些 ( 但不多 ) but not much 一定数量 / 程度 ; 有些 ( 但不多 ) e.g. The play achieved a measure of success. e.g. The play achieved a measure of success. threshold----n. 门槛, 入口 ; 开端, 起点 Question: 10. Are there any new criteria on cesarean section nowadays ? nowadays ?

54. Para. 10 trade-off---- n. balance entail----(fml.) to make sth. necessary; to involve e.g. This is going to entail a lot of hard work. congruent with----consistent with counsel----vt. to advise or recommend; to give professional advice to sb. with a problem advice to sb. with a problemQuestion: 11. Faced with rising cesarean rate, what are the doctors’responsibilities ? doctors’responsibilities ?

55. Phrases in the Text 1. cesarean delivery 2. obstetrical / perinatal care 3. in vitro fertilization 4. primiparous patients 5. blood bank 6. maternal and neonatal complications 7. neonatal intensive care units 8. premature neonates 9. assisted reproductive technology

56. 10. evidence-based recommendations 11. uterine rupture 12. hypoxic-ischemic encephalopathy 13. vacuum extraction 14. neonatal birth injury 15. maternal perineal trauma 16. operative vaginal delivery 17. antenatal fetal surveillance 18. pelvic organs

57. 19. reproductive health 20. ectopic gestation 21. placenta previa / accreta 22. gestational diabetes 23. permanent brachial plexus injury 24. in utero 25. breech presentation 26. practicing obstetricians 27. clinical trials