Assessment of obstetric history and cervical length as risk factors for preterm birth / Evaluación de la história obstétrica y la longitud cervical como factores de riesgo para el parto prematuro

Introduction: Preterm birth, before 37 weeks of gestation, is the main determinant of neonatal morbidity and mortality and is associated with serious consequences,including compromised quality of life for the affected individual and physical, psychological, and economic costs. Objective: To evaluate the correlation of obstetric history, cervicovaginal infections, and cervical length with preterm birth. A prospective, blind cohort study evaluated 1,370 pregnant women from Ribeirão Preto between 20 and 25 weeks of gestation. Materials and methods: The correlation between obstetric history, cervical length, and gestational age at birth was obtained by calculating the relative risk of the different variables. Results: The distribution of pregnant women according to cervical length (CL) showed a predominance of women with a cervix longer than 2.5 cm (n = 1,308, 95.8%), followed by women with a cervix between 2 and 2.49 cm (n = 42, 3.1%) and < 2 cm (n = 15, 1.1%). Among the 1,370 pregnant women evaluated, 133 had spontaneous preterm birth (< 259 days); 14 (10.5%) preterm births occurred in women under 19 years of age, 105 (79%) in women between 19 and 35 years, and 14 (10.5%) in women older than 35 years. Microbiological analysis showed the growth of Mycoplasma hominis, Ureaplasma urealyticum, and other bacteria in 8, 17, and 16 women with preterm birth, respectively. Among the 133 women with spontaneous preterm birth, CL was < 2.5 cm in 15 women, < 2 cm in 3, < 1.5 cm in 3, and < 1 cm in 2. Conclusion: The identification of pregnant women at high risk for preterm delivery can reduce the incidence of preterm birth. Although no gold standard test exists for the prediction of preterm birth, this study confirms that the measurement of CL is a good individual predictor.

Introducción: El nacimiento pretérmino, antes de las 37 semanas de gestación, es el principal determinante de la morbimortalidad neonatal y se asocia a graves consecuencias,incluyendo el compromiso de la calidad de vida del individuo afectado y costes físicos, psicológicos y económicos. Objetivo: Evaluar la correlación de los antecedentes obstétricos, infecciones cervicovaginales y longitud cervical con el parto prematuro. Estudio de cohorte prospectivo, ciego, evaluando 1.370 gestantes de Ribeirão Preto entre 20 y 25 semanas de gestación. Material y métodos: La correlación entre los antecedentes obstétricos, la longitud cervical y la edad gestacional al nacer se obtuvo calculando el riesgo relativo de las diferentes variables. Resultados: La distribución de las gestantes según la longitud cervical (LC) mostró un predominio de mujeres con cuello uterino mayor de 2,5 cm (n = 1,308, 95.8%), seguidas de mujeres con cuello uterino entre 2 y 2,49 cm (n = 42, 3.1%) y menor de 2 cm (n = 15, 1.1%). De las 1,370 embarazadas evaluadas, 133 tuvieron un parto prematuro espontáneo (< 259 días); 14 (10.5%) partos prematuros se produjeron en mujeres menores de 19 años, 105 (79%) en mujeres de entre 19 y 35 años, y 14 (10.5%) en mujeres mayores de 35 años. Los análisis microbiológicos mostraron la proliferación de Mycoplasma hominis, Ureaplasma urealyticum y otras bacterias en 8, 17 y 16 mujeres con parto prematuro, respectivamente. Entre las 133 mujeres con parto prematuro espontáneo, la CL fue < 2.5 cm en 15 mujeres, < 2 cm en 3, < 1.5 cm en 3 y < 1 cm en 2. Conclusión: La identificación de las gestantes con alto riesgo de parto prematuro puede reducir la incidencia de parto prematuro. Aunque no existe una prueba de referencia para la predicción del parto prematuro, este estudio confirma que la medición de la longitud cervical es una buena predicción individual.

In Sickness and in Health: Expert Discussions on Abortion Indications, Risks, and Patient-Doctor Relationships in Postwar Poland.

This article analyzes expert debates relating to abortion in Poland between 1956 and 1993, a period when the procedure was legal and accessible. Through the pages of the primary Polish journal for gynecology and obstetrics, Ginekologia Polska, the author traces continuities and ruptures around three major intersecting themes: the procedure's indications, its (dis)connection to health, and the patient-doctor relationship. The journal became a forum showcasing interpretative tensions over indications for abortion and the malleability of the categories "therapeutic" and "social." In addition to these tensions, abortion was represented throughout this period as a potentially risky surgery, although this was initially nuanced with parallel representations of legal abortion combating maternal mortality. During the 1970s, abortion began to be linked to infertility, often in simplistic cause-and-effect terms. Simultaneously, opposition to abortion based on the idea of defense of the nation and fetal "life," surfaced in expert discourse.

[From Physician's Biography of Primarius Ljubica Bosner] / Iz lijecnicke biografije prim. dr. Ljubice Bosner

Previously were published well-known data on Rijeka physician, Dr Ljubica Bosner, about her work in the Ogulin, Bjelovar, Petrinja and Rijeka hospitals during her excellent surgical and gynaecological and obstetric practice. The new and now accessible archives of personal and professional items complete incomplete and unknown biographical information. After her internship, Dr Bosner worked at a public county hospital in Velika Gorica as a secondary doctor at a well-known orthopaedic ward of that hospital. Circumstances of going to the Ogulin hospital with an oath to the reigning King Peter II for fidelity, then her professional activity as a surgeon at the newly opened Foundation Hospital Rebro Zagreb, with occasional departures to the position of director of the hospital and surgeon in Petrinja and Varazdin, and after the war to new positions at the Regional People's Board in Istria, are of particular social and historical interest. Recommendations from her bosses have been found to recognise the profession of surgeon specialist that particularly emphasise her skills, clinical judgment, and performance of major surgical procedures, especially during the war. Her life and medical career went through periods of great crisis between the two world wars (during the Kingdom of Serbs, Croats and Slovenes), then World War II (during the Independent State of Croatia), and after the war and the Republic of Yugoslavia in which she acted as a surgeon. The above data in the biography of Dr Ljubica Bosner are completed by previously unknown and unpublished photographs from her personal and professional surgical life.

Sir James Young Simpson: pioneer of anaesthesia in childbirth.

This year is the 150th anniversary of James Young Simpson's death in 1870. As well as being responsible for the introduction of general anaesthesia into obstetric practice, he made other important contributions to obstetrics and also to surgery as well as in the control of hospital infection.

"A Revolution in Favor of Reproduction"? Gynecology and Obstetrics in the "Third Reich".

During the "Third Reich," the majority of German gynecologists and obstetricians did not hesitate to put themselves at the service of those in power. In 1933, many gynecologists initially only focused on the fact that the biopolitical objectives of the National Socialists matched their own long-standing demands for population policy measures and the early detection and prevention of cancer. In addition, cooperating with the Nazis promised the political advancement of the profession, personal advantages, and the honorary title of Volksgesundheitsführer (national health leaders). As a result, gynecologists exchanged resources with the regime and thus contributed significantly to the implementation of the criminal racial policies of the Nazis. At the congresses of the Deutsche Gesellschaft für Gynäkologie (German Society of Gynecology) "non-Aryan" members, mostly of Jewish descent, were excluded, the law on forced sterilization of 1933 (Gesetz zur Verhütung erbkranken Nachwuchses/Law for the Prevention of Offspring with Hereditary Diseases) was scientifically legitimized, its implementation was propagated, and relevant surgical techniques were discussed with regard to their "certainty of success." In the course of these forced sterilizations, existing pregnancies were also terminated and the victims were misused for illegal scientific examinations or experiments. Drawing upon racial and utilitarian considerations, gynecologists did not even shy away from carrying out late abortions on forced laborers from the East during the Second World War, which were strictly prohibited even under the laws of the time. Some gynecologists carried out cruel experiments on humans in concentration camps, which primarily served their own careers and the biopolitical goals of those in power. The few times gynecologists did protest or resist was when the very interests of their profession seemed threatened, as in the dispute over home births and the rights of midwives. Social gynecological initiatives from the Weimar Republic, which were mainly supported and carried out by gynecologists persecuted for their Jewish descent since 1933, were either converted into National Socialist "education programs" or simply came to an end due to the exclusion of their initiators. German gynecologists had hoped for a large-scale promotion of the early detection of malignant diseases of the uterus and breasts, to which they had already made important contributions since the beginning of the 20th century. But even though the fight against cancer was allegedly one of the priorities of the Nazis, no comprehensive measures were taken. Still, a few locally limited initiatives to this end proved to be successful until well into the Second World War. In addition, German gynecologists established the modern concept of prenatal care and continued to advance endocrinological research and sterility therapy. After the end of the Nazi dictatorship, the historical guilt piled up during this period was suppressed and denied for decades. Its revision and processing only began in the 1990s.

[A study on the first Chinese translation of Japanese obstetrical monograph Zhu Shi Chan Po Xue].

In the process of modern Western obstetrical knowledge being introduced into China, obstetrical works and textbooks translated from different countries in different period have played an important role.In early stages, most of these obstetrical works were translated from Europe and the United States, such as Fu Ying Xin Shuo and Tai Chan Ju Yao.After the First Sino-Japanese War of 1895, with the Chinese intellectuals setting off a wave of learning from Japan, the view that learning from Japan to improve medicine is more convenient than from Europe and the United States prevailed, so a large number of Japanese obstetrical works were introduced into China.In the late Qing and early the Republic of China, Ding Fubao's Ding Shi Yi Xue Cong Shu contained such obstetric monographs as Zhu Shi Chan Po Xu, Ren Shen Sheng Li Pian, Fen Mian Chan Ru Sheng Li Pian He Bian, and Chan Ke Xue Chu Bu.Zhu Shi Chan Po Xu written by Takenaka Seiken(), which was translated and published in 1908, is the first Chinese translation of Japanese obstetrical monograph in modern China. It contained such knowledge as anatomy, physiology, diagnosis, disease, medicine, surgery, and nutrition and played an important role in the dissemination of Western obstetrical knowledge.

A hypothesis on paradoxical privileged portal vein metastasis of hepatocellular carcinoma. Can organ evolution shed light on patterns of human pathology, and vice versa?

Unlike other carcinomas, hepatocellular carcinoma (HCC) metastasizes to distant organs relatively rarely. In contrast, it routinely metastasizes to liver vasculature/liver, affecting portal veins 3-10 times more often than hepatic veins. This portal metastatic predominance is traditionally rationalized within the model of a reverse portal flow, due to accompanying liver cirrhosis. However, this intuitive model is not coherent with facts: 1) reverse portal flow occurs in fewer than 10% of cirrhotic patients, while portal metastasis occurs in 30-100% of HCC cases, and 2) portal vein prevalence of HCC metastasis is also characteristic of HCC in non-cirrhotic livers. Therefore, we must assume that the route for HCC metastatic dissemination is the same as for other carcinomas: systemic dissemination via the draining vessel, i.e., via the hepatic vein. In this light, portal prevalence versus hepatic vein of HCC metastasis appears as a puzzling pattern, particularly in cases when portal HCC metastases have appeared as the sole manifestation of HCC. Considering that other GI carcinomas (colorectal, pancreatic, gastric and small bowel) invariably disseminate via portal vein, but very rarely form portal metastasis, portal prevalence of HCC metastasis appears as a paradox. However, nature does not contradict itself; it is rather our wrong assumptions that create paradoxes. The 'portal paradox' becomes a logical event within the hypothesis that the formation of the unique portal venous system preceded the appearance of liver in evolution of chordates. The analysis suggests that the appearance of the portal venous system, supplying hormones and growth factors of pancreatic family, which includes insulin, glucagon, somatostatin, and pancreatic polypeptide (HGFPF) to midgut diverticulum in the early evolution of chordates (in an Amphioxus-like ancestral animal), promoted differentiation of enterocytes into hepatocytes and their further evolution to the liver of vertebrates. These promotional-dependent interactions are conserved in the vertebrate lineage. I hypothesize that selective homing and proliferation of malignant hepatocytes (i.e., HCC cells) in the portal vein environment are due to a uniquely high concentration of HGFPF in portal blood. HGFPF are also necessary for liver function and renewal and are significantly extracted by hepatocytes from passing blood, creating a concentration gradient of HGFPF between the portal blood and hepatic vein outflow, making post-liver vasculature and remote organs less favorable spaces for HCC growth. It also suggested that the portal vein environment (i.e., HGFPF) promotes the differentiation of more aggressive HCC clones from already-seeded portal metastases, explaining the worse outcome of HCC with the portal metastatic pattern. The analysis also offers new hypothesis on the phylogenetic origin of the hepatic diverticulum of cephalochordates, with certain implications for the modeling of the chordate phylogeny.

[William Hunter (1718-1783): his legacy three hundred years from his birthday]. / William Hunter (1718-1783): su legado a trescientos años de su nacimiento.

The aim of this paper is to evaluate some aspects of the life of William Hunter (1718-1783), and to argue that he deserves a better place in history as he was one of the most outstanding figures in British medicine of the 18th century. A Scotsman, Presbyterian, from a family without means or connections, he underwent a classic education at the University of Glasgow, completed with apprenticeships with William Cullen and Alexander Monro first in Scotland, and then in London, with William Smellie, James Douglas and James Wilkie, in anatomy, obstetrics and surgery, respectively. Despite initial disadvantages, he was highly successful as an anatomist, educator, surgeon, man-midwife, artist, gentleman and collector. He moved and had influences in the highest medical, cultural and social circles of his time, was named Physician Extraordinary to Queen Charlotte, and was a member of many scientific, medical and cultural societies in Great Britain and in France, such as the Royal Society, the Royal College of Physicians and the Societé Royale de Médicine of Paris. His museum was notable in its magnitude and its diversity, including anatomical preparations, coins, shells, plants, birds, insects, fossils, and minerals. He donated his great museum to the University of Glasgow. His figure has been relegated mainly due to the absence of heirs, individuals or institutional, that could have cared for, maintained, and increased his legacy as happened with his brother John.

Métodos de preparação para o parto: um estudo sobre materiais impressos publicados no Brasil em meados do século XX / Methods of childbirth preparation: a study of printed matter published in Brazil in the mid-twentieth century

Resumo Discute-se a difusão das práticas de parto natural por meio da análise dos livros Parto natural: guia para os futuros pais, escrito pelo obstetra americano Frederick Goodrich Jr. em 1950 e publicado no Brasil a partir de 1955, e Parto natural sem dor, escrito pelo obstetra brasileiro George Beutner, em 1962. Ambos tiveram boa entrada na cultura brasileira e influenciaram a forma de pensar o parto e de parir, tanto no âmbito da obstetrícia brasileira como no que concerne às representações das mulheres. A partir das contribuições de Roger Chartier e das concepções sobre medicalização, concluímos que essas novas práticas de preparação do parto compartilhavam as visões médicas sobre o parto e o nascimento predominantes no período.

Abstract The article explores the dissemination of natural childbirth practices through an analysis of the books Parto natural: guia para os futuros pais, written by U.S. obstetrician Frederick Goodrich Jr. in 1950, under the title Natural Childbirth: a manual for expectant parents, and first published in Brazil in 1955, and of Parto natural sem dor, written by Brazilian obstetrician Beutner in 1962. Both books found a place in Brazilian culture and influenced thinking about childbirth and delivery in the field of Brazilian obstetrics and in representations of women. Based on Roger Chartier's contributions and on concepts of medicalization, we conclude that these new practices for childbirth preparation shared the period's prevalent medical views of childbirth and delivery.

William Hunter (1718-1783): su legado a trescientos años de su nacimiento / William Hunter (1718-1783): his legacy three hundred years from his birthday

The aim of this paper is to evaluate some aspects of the life of William Hunter (1718-1783), and to argue that he deserves a better place in history as he was one of the most outstanding figures in British medicine of the 18th century. A Scotsman, Presbyterian, from a family without means or connections, he underwent a classic education at the University of Glasgow, completed with apprenticeships with William Cullen and Alexander Monro first in Scotland, and then in London, with William Smellie, James Douglas and James Wilkie, in anatomy, obstetrics and surgery, respectively. Despite initial disadvantages, he was highly successful as an anatomist, educator, surgeon, man-midwife, artist, gentleman and collector. He moved and had influences in the highest medical, cultural and social circles of his time, was named Physician Extraordinary to Queen Charlotte, and was a member of many scientific, medical and cultural societies in Great Britain and in France, such as the Royal Society, the Royal College of Physicians and the Societé Royale de Médicine of Paris. His museum was notable in its magnitude and its diversity, including anatomical preparations, coins, shells, plants, birds, insects, fossils, and minerals. He donated his great museum to the University of Glasgow. His figure has been relegated mainly due to the absence of heirs, individuals or institutional, that could have cared for, maintained, and increased his legacy as happened with his brother John.

Ocitocina sintética e a aceleração do parto: reflexões sobre a síntese e o início do uso da ocitocina em obstetrícia no Brasil / Synthetic oxytocin and hastening labor: reflections on the synthesis and early use of oxytocin in Brazilian obstetrics

Resumo O artigo reflete sobre o processo de medicalização do parto, tendo como foco específico o desenvolvimento da ocitocina sintética em 1953. Investiga a vida social da ocitocina, isto é, sua sintetização, estabilização e uso em obstetrícia para acelerar o trabalho de parto. Por meio do levantamento em dois periódicos brasileiros de obstetrícia da época, é analisado o início do uso da ocitocina sintética no Brasil, a partir do final da década de 1950, e os argumentos dos obstetras acerca da recomendação ou não desse uso. É observada, nesse período, a centralidade cada vez maior do obstetra no parto, bem como a recomendação do uso encadeado de diferentes intervenções - com destaque para a ocitocina - visando menor tempo de trabalho de parto.

Abstract This article reflects on the medicalization of childbirth, focusing on the development of synthetic oxytocin in 1953. Specifically addressed is the social life of oxytocin; in other words, its synthesis, stabilization, and use in obstetrics to hasten labor. Two Brazilian obstetrics journals of this era were surveyed to analyze the early use of synthetic oxytocin in Brazil in the late 1950s, along with obstetric arguments for or against its use. Notable in this period is the increasingly central role of the obstetrician in childbirth, as well as the recommendation to use different interventions linked together (particularly oxytocin) to shorten labor.

Fontes para a história da ginecologia e obstetrícia no Brasil / Sources for the history of gynecology and obstetrics in Brazil

Resumo Este artigo se insere no debate sobre a medicalização do parto no Brasil, a partir do levantamento de fontes realizado em bases de dados de bibliotecas brasileiras, e apresenta como objetivo principal a disponibilização sistematizada dos títulos das publicações científicas especializadas existentes nas áreas de ginecologia e obstetrícia no século XX, especialmente na primeira metade desse século. Considerando a relevância da análise de periódicos na construção do conhecimento científico no Brasil, assim como a importância das revistas especializadas na constituição e no desenvolvimento de especialidades médicas, apresentou-se um detalhamento desses acervos, considerando localização, período de publicação e local de produção, apresentando mais detidamente o acervo situado na biblioteca da Maternidade-Escola da Universidade Federal do Rio de Janeiro.

Abstract This article contributes to the debate about the medicalization of childbirth in Brazil through a literature review of databases of Brazilian libraries. Its main goal is to enable the systematized availability of specialized scientific publications in gynecology and obstetrics in the twentieth century, especially 1900 to 1950. In view of the importance of the analysis of journals in the development of scientific knowledge in Brazil and the importance of specialized journals in constituting and developing medical specializations, details of these archives are presented, including their location, when they were published, and where they were produced, paying particular attention to the archive in the library of the Teaching Maternity Hospital (Maternidade-Escola) of the Universidade Federal do Rio de Janeiro.

A concorrência na arte de partejar na cidade do Rio de Janeiro entre 1835 e 1900 / Competition in the arts of midwifery in the city of Rio de Janeiro from 1835 to 1900

Resumo Este artigo discute a concorrência entre parteiras e médicos na oferta dos serviços de partos na cidade do Rio de Janeiro entre 1835 e 1900. Foram analisadas as atas da congregação, os livros do curso de partos e de termos de exames de verificação de médicos, cirurgiões, boticários e parteiras da Faculdade de Medicina do Rio de Janeiro, além de anúncios e propagandas de médicos e parteiras nas colunas "Anúncios" e "Indicações Úteis" do Jornal do Commercio . Observa-se como o aumento do número de médicos-parteiros e seus discursos científicos contribuíram para que as parteiras se vissem obrigadas a diversificar a clientela, instalando-se e atendendo em áreas populares e inóspitas.

Abstract The article discusses competition between midwives and doctors offering birth-related services in the city of Rio de Janeiro from 1835 to 1900. The research analyzed minutes from meetings, textbooks on births, and terms from qualification examinations for physicians, surgeons, apothecaries, and midwives at the Rio de Janeiro Medical School (Faculdade de Medicina do Rio de Janeiro), as well as announcements by and advertisements for doctors and midwives in columns featuring advertisements and useful recommendations in the Jornal do Commercio newspaper. An increase in the number of delivery physicians, and their scientific discourses led midwives to feel an obligation to diversify their clientele, consequently establishing themselves and working in lower-class and inhospitable areas.

A medicalização do parto no Brasil a partir do estudo de manuais de obstetrícia / The medicalization of childbirth in Brazil through the study of obstetrics handbooks

Resumo Nesta nota de pesquisa apresento um relato preliminar da pesquisa de doutorado em saúde da criança e da mulher que estou realizando no Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz. Elegi como objeto de estudo a difusão dos saberes e práticas relativas ao parto. Optei em realizá-lo por meio da análise dos manuais de obstetrícia. Analiso manuais publicados no Brasil, entre 1980 e 2011, e pretendo contribuir para a construção de uma assistência ao parto no qual a mulher e suas necessidades sejam o centro no processo de tomada de decisões sobre os cuidados, intervenções e procedimentos a serem dispensados no trabalho de parto e no parto.

Abstract In this research note, I present a preliminary account of doctoral research in women's and children's health at the Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz. The aim is to study the spread of knowledge and practices relating to childbirth by analyzing obstetrics handbooks published in Brazil between 1980 and 2011, contributing to the development of childbirth care in which the woman and her needs are at the center of the decision-making process about which care, interventions, and procedures are to be dispensed during labor and childbirth.

[The savior of mothers and newborns, whom we shall always be proud of: Ignác Semmelweis (1818-1865). One who defeated the disease, yet could not convince the people, Doctor of Medical Sciences and Surgery, Master of Obstetrics, Professor of Theoretical and Practical Obstetrics at the Pest Royal Hungarian University of Sciences]. / Az anyák és az újszülöttek megmentoje, akire mindig büszkék leszünk: Semmelweis Ignác (1818­1865). Aki legyozte a kórt, de nem gyozte meg a kort, az orvostudományok és a sebészet doktora, szülészmester, a Pesti Királyi Magyar Tudományegyetemen az elméleti és gyakorlati szülészet nyilvános, rendes tanára.

Semmelweis finally achieved results from his persistent research work. Those being the scientific analysis of clinical statistical data and his animal experiments, which recognized the dreadful disease of puerperal fever and its prevention. "He not only discovered the real cause of puerperal fever but he also created antiseptic prophylaxis, which he introduced in obstetrics and laid the foundations of modern surgery (asepsis). The theory and practice of asepsis stemmed from the discovery of the etiology of puerperal fever and therefore originating from the genius idea of Semmelweis. The discoveries of bacteriology by Lister, Pasteur and Koch only provided a scientific proof of the intuitive statements of Semmelweis." Semmelweis was a pioneer of clinical etiological research whose findings were aggressively disapproved by his colleagues due to earlier medical misunderstandings. Semmelweis is given due respect by posterity as a remuneration, to all the bitterness that he had suffered throughout his life. Semmelweis is considered the savior of mothers and infants. The Hungarian nation is very proud of him as he is one of our models whose oeuvre is acknowledged not only in Hungary but throughout the world. The message of his short, tragic yet effective life is eternal. The figure of Ignác Semmelweis is depicted as a statue and is placed in Chicago among the statues of the most innovative doctors and health care professionals of the world. The statue of Semmelweis is next to the statues of Louis Pasteur and Wilhelm Conrad Röntgen. "Semmelweis reflex" is a new expression which appeared and spread in English speaking countries. The word does not relate to a medical phenomenon but describes a social phenomenon when experts or the whole society automatically rejects discoveries and new recognitions without examination or justification. This phenomenon frequently occurs, even in our times. Orv Hetil. 2018; 159(26): 1041-1054.

[Study on the first translated obstetrics book Tai chan ju yao (Essentials in Obstetrics)].

In 1893, Wan Tsun-mo translated and published Tai chan ju yao (Essentials in Obstetrics), the first monograph of western obstetrics in modern China, symbolizing the independence of obstetrics from such maternal and child books as Fu ying xin shuo and Fu ke jing yun tu shuo, which occupies an important position in the history of the development of modern Chinese obstetrics. The book introduced anatomy, physiology, pathology, embryology, diagnostics, surgery, pharmacology and other knowledge of obstetrics in a catechismal form, and had a detailed discussion of such advanced obstetrical technologies as antiseptic, anesthesia, forceps and cesarean section for the first time.Judging from the content and translation of Tai chan ju yao, this book has already possessed the basic knowledge system of modern obstetrics, though the translation appeared to be somewhat jerky and not elegant and the terminology needing to be further improved, it was not only used as an important medium for the introduction of obstetrical knowledge, but also of great clinical value.However, its influence was so weak that later researchers seldom mentioned this book.

Risk and Reputation: Obstetricians, Cesareans, and Consent.

When physicians performed cesarean sections in the nineteenth century, they customarily sought agreement from all present before proceeding. In contrast, after the introduction of electronic fetal monitoring in the late 1960s, obstetricians obtained permission for a cesarean by offering a choice that ensured consent-give birth by cesarean or give birth vaginally to a damaged or dead baby. This article argues that the manner in which physicians obtained consent for cesareans in the nineteenth century was one factor that kept the cesarean rate low, while the manner in which physicians obtained consent in the late twentieth and early twenty-first centuries was one factor driving up the cesarean rate. The dissimilar approaches to consent did serve a common purpose, however. Each preserved physicians' reputations. With the surgery likely to end in a woman's death in the nineteenth century, consensus ensured that a bad outcome would be a shared burden. And because the fetal monitor, in exaggerating the risks of vaginal birth, changed the nature of the malpractice climate for obstetricians, the late-twentieth-century approach to consent similarly protected physicians. As one early twenty-first-century obstetrician quipped, "You don't get sued for doing a C-section. You get sued for not doing a C-section."