Fetal head progression during labor is difficult to assess. Digital examination has been shown to be an inaccurate method. Utilizing the ultrasound technology in the delivery room can standardize the way we assess head progression. Intrapartum ultrasound is applicable, for the assessment of the progression of labor and assists the obstetrician, in decision making regarding the need for an assisted delivery. This article summarizes the latest studies regarding the usage of ultrasound in the delivery room and the measurements that are used during delivery.
Intrapartum sonography, Translabial ultrasoundObjective: To assess the behavior and preferred delivery method among Iranian obstetricians in challenging cases. Method Using the revised Jackson personality inventory questionnaire, the attitudes of obstetricians toward cesarean delivery were assessed in challenging childbirth cases. The study was conducted at the Mashhad University of Medical Sciences in Mashhad, Iran. Result Seventy-five obstetricians answered each item reflecting varying levels of preference and risk attitudes. However, a significant number of respondents avoided the risk of requesting a cesarean because of legislation and legal issues. Conclusion Iranian obstetricians prefer low-risk behavior for managing ambiguous delivery cases. Fear of legislation and medicolegal issues appear to be of great importance in this cohort primarily comprising female physicians.
Cesarean delivery ● Risk attitude ● Ambiguous casesBackground 24-h urine protein is traditionally used as a gold standard method for protein estimation. Because of the operational difficulty, there is the necessity to use rapid, convenient, and reliable method of proteinuria estimation. Aim We carried out this study to compare the two rapid methods of protein estimation: dipstick method and spot urine protein creatinine ratio (UPCR) with that of 24-h urine protein in patients of preeclampsia with advanced gestational period. Methodology The values of proteinuria estimated by dipstick method and spot UPCR were compared with that of 24-h urine protein. The strength of correlation was measured by Pearson’s correlation coefficient (r). A p value of\0.05 is considered to be statistically significant. The most discriminant spot UPCR value for detecting significant proteinuria (C300 mg/day) was determined by plotting receiver–operator curve (ROC). Result The value of spot UPCR strongly correlated with 24-h urine protein (r = 0.88 with p value \0.001). The most discriminant spot UPCR value for detecting significant proteinuria (C300 mg/day) was 0.3. The estimation of proteinuria by dipstick method was poorly correlated with 24-h urine protein with r = -0.09. Conclusion Spot UPCR can be used as a rapid and reliable alternative method in preference to 24-h proteinuria in patients of preeclampsia of advanced gestational age.
Purpose First trimester vaginal bleeding (FTVB) does not usually terminate the pregnancy. However, its outcome is a matter of debate. This study sought to assess the outcomes of pregnancies, complicated by FTVB. Methods In this cohort study, 236 gravida 1 and 2 FTVB patients with delivery after 28 weeks of gestational age, admitted to Imam Hossein Hospital during 2009–2010, were evaluated. The control group consisted of 944 gravida 1 and 2 women without any history of vaginal bleeding. Late pregnancy outcomes such as gestational hypertension, preeclampsia, placental abruption, preterm delivery, and premature rupture of membranes in the mothers and low birth weight (LBW), intrauterine growth restriction (IUGR), Apgar score at 5 min\7, and NICU admission in the infants were evaluated. Logistic regression was used for estimation of odds ratios (OR) and 95 % confidence interval. Results Compared to controls, the FTVB cases had more premature rupture of membranes (OR = 10), gestational hypertension (OR = 5.3), and placental abruption (OR = 4.7), while their infants had higher odds of LBW, IUGR, Apgar score at 5 min\7, and admission to NICU too. The incidence of premature rupture of membranes was 3.6 % in the controls and 27.1 % in the cases (RR = 10, P\0.001). The incidence of gestational hypertension and LBW was 1.5 and 7.2 % (P\0.001) in the controls and 6.6 and 12.3 % (P\0.001) in the cases. The other outcomes were similar in both groups. Conclusion FTVB may play a role in the development of late pregnancy outcomes in mothers and infants. Thus, it is recommended to evaluate some interventions on FTVB cases to prevent complications.
Vaginal bleeding, Pregnancy outcomeBackground Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. Although the etiology of preeclampsia (PE) is still unclear, recent studies suggest that its major phenotypes, high blood pressure and proteinuria, are due in part to the disturbed angiogenic process. Study Design This study included the following groups: (1) women with normal pregnancies (n = 150), (2) patients with PE (n = 88), and (3) patients who delivered small growth for date (SGA) neonate (n = 50). Maternal serum concentrations of VEGF, Angi-1, and sTie-2 were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results The median maternal serum concentration of sVEGF and sAngi-1 was lower in normal pregnant women as compared to that in PE and SGA and the differences were statistically significant (P\0.01). In contrast, there is a significant reduction in sTie-2 levels in PE and SGA groups as compared to that in normal pregnancy group (P\0.01). Serum VEGF and Angi-1 were significantly higher in the late onset PE subgroup as compared to that in the early onset PE (P\0.01), but sTie-2 was not significantly different in the 2 subgroups (P[0.05). Serum VEGF, sAngi-1, and sTie-2 were significantly higher and Tie-2 was significantly lower in the severe PE subgroup as compared to that of the milder PE subgroup (P\0.01 for all). Conclusion Patients with PE and those with SGA fetuses have lower median serum concentrations of sTie-2 and higher sVEGF and sAngi-1 than women with normal pregnancies. These findings lend support to the hypothesis that circulating angiogenic proteins may have an important biologic role in PE.
Preeclampsia, Angiopoietin-1, VEGF, Tie-2Objective To compare the efficacy of oral with vaginal misoprostol for induction of labour. Design A randomized trial. Setting Tertiary care hospital.
Participants: Two hundred women requiring induction of labour. Methods Group A received oral misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients and Group B received vaginal misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients. When the patient entered active stage of labour i.e. clinically adequate constractions of 3/10 min of [40 s duration, and cervical dilatation of with 4 cm, further doses of misoprostol were not administered. Statistical analysis was done using chi-square test and t test.
Result: Both groups were comparable with respect to maternal age, gestational age, indication of induction and initial modified Bishops score Mean number of dosage required for successful induction were significantly less in vaginal group than oral group (in oral groups A were 2.73 ? 0.58, and in vaginal Group B 2.26 ? 0.52, P value\0.0001 highly significant). The induction delivery interval was significantly less in vaginal group than oral group (Group A 15.24 ? 3.47 h Group B 12.74 ? 2.60 h, P\0.0001 highly significant). Oxytocin augmentation required was less in vaginal group. 26 caesarean sections were performed in oral group and 17 caesarean sections were done in vaginal group (P value 0.06 NS). APGAR score, birth weight, NICU admissions showed no difference between the two groups.
Conclusion: This study shows that vaginal route of administration of misoprostol is preferable to oral route for induction of labour when used in equivalent dosage of 50 mcg 6 hourly.
Induction of labour, Misoprostol vaginal route, Induction delivery intervalObjectives : To compare oral misopostol 600 mcg with 10 IU units oxytocin i.m. in the active management of the third stage of labor.
Materials and Methods: A total of 200 pregnant women of 34–42 weeks of gestation delivering vaginally in the Rajendra Institute of Medical Sciences, Ranchi, were selected for study. Hundred women received oral misoprostol 600 mg and 100 women received i.m. oxytocin 10 IU immediately after delivery of the baby and cord clamping by the method of randomization.
Results: In the misoprostol group, mean blood loss is 145 ml, mean duration of the third stage of labor is 3.76 min, and mean fall in hemoglobin is 0.55 g/dl. In the oxytocin group, mean blood loss in 125.6 ml, mean duration of the third stage of labor in 3.50 min, and mean fall in hemoglobin is 0.48 g/dl. There was no significant difference between the two groups with regard to the above mentioned factors. There were 8 cases of PPH in the misoprostol group and 6 cases in the oxytocin group. Twenty-two cases in the misoprostol group and 16 cases in the oxytocin group required additional oxytocics. Adverse effects like shivering and pyrexia were more in the misoprostol group.
Conclusion: Oral misoprostol is as effective as oxytocin in AMTSL and can be used safely in vaginal deliveries for prevention of PPH, especially in non-institutional deliveries and in places of low resource settings.
Misoprostol, Oxytocin, Active management of third stage of labor (AMTSL), Postpartum hemorrhage (PPH)Introduction and Hypothesis: This study aimed to document intraoperative and early postoperative complications associated with the use of vaginal mesh with trocar in pelvic organ prolapse (POP) repair.
Methods: This is a retrospective review of 120 cases of vaginal repair of POP using vaginal mesh. Of the 120 patients, 31 underwent anterior mesh repair (Light mesh 10, Avaulta 1, Perigee 1, and Prolift 19); 35 underwent posterior mesh repair (Light mesh 2, Posterior IVS 17, and Prolift 16); and 54 underwent anterior and posterior mesh (total) repair (Light mesh 8, Prolift 32, and Prolift M 14).
Results: Three bladder injuries (2.5%) and one distal rectal injury (0.8%) occurred during dissection. Three of four organ injuries (75%) had previous prolapse repair. Overall four patients (3%) required transfusion. Urinary retention exceeding 5 days occurred in four patients. Three of them (60%) also underwent TVT-O. Groin pain occurred in two patients one of whom underwent TVT-O. Gluteal pain occurred in one patient. Early mesh exposure occurred in the vaginal cuff of a patient who underwent hysterectomy.
Conclusions: The vaginal mesh procedures may be done with relatively few perioperative complications. However, there is a need for more randomized controlled trials with long-term follow-up to clarify its postoperative long-term complications and morbidities.
Perioperative complications, Vaginal mesh procedures, Pelvic organ prolapsePurpose: This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome.
Method: This retrospective study was performed at a cancer center. Women who underwent LLETZ for sus- pected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher’s exact test was used.
Results: 75 % of all specimens were obtained intact. When the LLETZ specimen was intact, 89 % of smear tests were reported as negative, against 86 % when the specimen was fragmented. Fragmentation was significantly associ- ated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation.
Conclusion: Fragmentation of LLETZ specimens is asso- ciated with an increased likelihood of obtaining a high- grade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.
LLETZ ● Specimen fragmentation ● Cytological outcome ● Colposcopy trainingObjective: To assess the contraceptive efficacy, user acceptability, cycle control, and tolerability of a combined contraceptive vaginal ring for up to 13 cycles.
Materials and Methods: Healthy women coming to the OPD for contraceptive advice were enrolled in this one year study. Each ring was used for three weeks followed by a one-week ring-free period.
Results: A total of 184 women started treatment forming the intent to treat population. Subjects were followed for 13 cycles. Compliance was good with 99 % of cycles in full compliance with specified criteria. In the intent to treat population, no pregnancies occurred giving a Pearl Index of 0. The mean incidence of withdrawal bleeding was 99 % in all cycles. There was 0.16 % incidence of intermenstrual bleeding and 2 % incidence of early withdrawal bleeding. The ring was well tolerated with a low incidence of adverse events.
Conclusion: The ring is an effective contraceptive that is convenient, well tolerated with excellent cycle control, and highly acceptable to users.
Combined vaginal contraceptive ring, Efficacy, Cycle control