Prospective controlled study of intravenous ritodrine terbutaline and magnesium sulfate bolus for treatment of acute intrapartum fetal, distress

Tocolytic agents had been used with variable results in the treatment of acute intrapartum fetal distress. We studied 121 cases in this prospective, randomized trial to evaulate the efficacy and mate-nial, fetal and neonatal outcome associated with tocolysis with intravenous bolus of either ritodrine [group A of 32 cases], terbutaline [group B of 30 cases] or magnesium sulfate [Group C of 31 cases]. Group D consited of 29 cases as a control and received no tocolytic therapy. Fetal distress was diagnosed according to abnormal external and internal cardiotocographic [CTG] results during intrapartum fetal monitoring. Recovery of the abnormal fetal heart rate was reported in 81.3%, 76.7% and 54.8% in groups A, B, and C respectively. Fetal and neonatal outcome were favorable with ritodrine and terbutaline use compared to magnesium sulfate and control groups difference was significant depending on neonatal umbilical vein pH and Apgar score. A lower incidence of cesarean section was noticed among women received tocolytic therapy compared to control [P<0.05]. Minor side-effects were reported. Beta-adrenergic agonists are recommended as effective, safe therapy, compared to magnesium sulfate which is less effective with higher fetal and neonatal acidosis and distress

Amniotic fluid and alpha 1 antitrypsin concentration in premature rupture of membranes [PROM]

Alpha - 1 antitrypsin is a natural trypsin inhibitor that is assumed to play a role in preventing PROM. The present study aims at investigating the role of amniotic fluid alpha-1 antitrypsin in PROM. Fifty-seven pregnant women participated in this work. They were classified into 3 groups: Group I comprised 29 pregnant women [30.2 +/- 2.8 weeks] with preterm PROM, group II comprised 18 pregnant women [31.3 +/- 3.2 weeks] with preterm labor but with no PROM and group III comprised 19 pregnant women [34.3 +/- 0.3 weeks] with no preterm labor or PROM. All amniotic fluid samples were obtained by amniocentesis under ultrasound guidance. Amniotic fluid alpha-1 antittypsin was determined by single radial immunodiffusion technique. Amniotic fluid samples were cultured for gram positive and gram negative pathogens.Results of data analysis indicated that amniotic fluid alpha-1 antitrypsin values were significantly lower [P < 0.05] in cases with PROM [9.3 + 10.5 mg/d/] compared with those without PROM, whether having preterm labor [26.9 +/- 8.4 mg/d/] or not [29.8 -15.02 mg/d/]. No significant difference was detected between cases with preterm labor and no PROM and those without either preterm labor or PROM [P > 0.05]. No significant difference was detected between cases with positive cultures [9.94 + 2.39 mg/d/] and those with negative cultures [8.89 +/- 3.38 mg/d/] [P > 0.05]. These data indicate that deficiency of amniotic fluid alpha- 1 antitrypsin may be a major contributor to PROM

Improvement of fetal heart score of by maternal intravenous ritodrine bolus

Seventy seven parturients with abnormal FHR score participated in this work. Thirty eight women were managed conservatively by maternal lateral positioning, oxygen inhalation and stopping oxytocin, if being in use [Group A]. Thirty nine women were managed in the same manner with the addition of an intravenous bolus injection of 6 mg ritodrine in 10 ml saline solution over a period of 3 minutes. Improvement of FHR tracings was more evident in the ritodrine -treated group compared with those treated conservatively, especially in those having suspicious FHR scores or uterine hyperactivity. Improvement of FHR secondary to ritodrine bolus injection was nearly similary achieved in the presence or absence of uterine hyperactivity. A lower incidence of cesarean section was noticed among the ritodrine - treated group. The neonatal Apgar scores was significanty better among the ritodrine - treated group. Some side effects were detected with ritodrine including: tachycardia, hypotension [12.82%], palpitation [20.54%], and vomiting [7.69%]. Ritodrine may, therefore be recommend as an effective and safe treatment of acute intrapartum fetal distress

Fetal acoustic stimulation in early labour: a screening test for candidates of continuous FHR monitoring in low risk parturients

This work was done to investigate the value of fetal acoustic stimulation test in early labour as a predictor of fetal outcome and its usefulness as a screening test. One hundred and sixty four low risk parturients, with a singleton fetus in cephalic presentation, gestational age 37 - 41 weeks and in latent phase of labour with cervical dilatation less than 4cm were screened by the admission test for 20 minutes followed by fetal acoustic stimulation test. Abnormal response to fetal acoustic stimulation test [type II and III] was observed in 3.35% after reactive admission test and in 11.1% after equivocal admission test compared to 66.7% after ominous admission test [P < 0.001, < 0.05 respectively]. The incidence of fetal distress after reactive admission test and normal fetal acoustic stimulation test [type IA and IB] was 1.4% compared to 20% with reactive admission test and abnormal fetal acoustic stimulation [P < 0.01]. Equivocal or ominous admission test with normal fetal acoustic stimulation was associated with 10% incidence of fetal distress compared to 60% with equivocal or ominous admission test and abnormal fetal acoustic stimulation [P < 0.05]. The negative predictive value of fetal acoustic stimulation test was 98.1% and its positive predictive value was 40% compared to 26.7% for admission test. Fetal acoustic stimulation test in early labour appears to be a valuable screening test to label parturients for low, or high, risk category for intrapaturn fetal distress. In addition the test overcomes the problems of interpretation of equivocal traces

Cervical ripening by extra-amniotic normal saline instillation versus prostaglandin - E2 vaginal tablets

Seventy-five pregnant patients with unripe cervix [Bishop score < /= 4] were randomly subjected to two treatment protocols for cervical ripening. Group A consisted of 40 pregnant women managed by extra-amniotic saline instillation at a rate of 1 ml/minute. Group B consisted of 35 pregnant women who received prostaglandin-E2[3mg] vaginal tablets. Cervical ripening occured over a significantly shorter mean duration among group A [4.04 +/- 1.29 hours] compared to group B [7.78 +/- 2.64 hours] [P < 0,01]. Mean post-ripening Bishop score was significantly higher in group A [7.07 +/- 0.38] compared to group B [5. 2 +/- 0.77] [P < 0.01]. Oxytocin stimulation was more frequently required [P < 0.05] and at a significantly nigher mean dose [< 0.05] following cervical ripening with extraamniotic saline instillation. A significantly longer mean total induction-delivery time [P < 0.05] and a significantly higher incidence of uterine hyperstimulation and abnormal FHR tracing [P < 0.01] were encountered among the prostaglandin-treated group. There was no significant difference between the two groups regarding the mode of delivery and the neonatal condition at birth [P > 0.05]. No serious side effects were registered in either group. Thus, extra-amniotic saline instillation may be considered as a cheap, effective, safe and tolerable method of cervical ripening that is always available

Ultrasound assessment of postoperatpive residual urine volume improving accuracy through a new calculation method

Postmicturition catheterization is the usual method for assessment of postoperative residual urine volume. Ultrasonography, though non-invasive, comfortable and safe compared with catheterization, is still accused as being inaccurate. The present study attempted to revive the ultrasound method by improving its accuracy through the usage of the combined formulae for volume estimation of the ellipsoid utilizing the most reliable measurement parameters. One hundred and fifty postoperative female patients were investigated. The ultrasound-estimated volumes were compared with the actual volumes measured following catheterization. Nonsignificant differences were detected at volumes between 100 cc. and 300 cc. [P > 0.05]. Significant differences were detected at urine volumes below 100 cc. [P < 0.01]. Such error was not due to missing positive cases [sensitivity 100%], but was due to underestimation in 8.9% of cases with urine volumes larger than 100 c.c. [specificity 91.1%]. Similarly, though the sensitivity of ultrasound was 100% at volumes above 300 c. c, significant differences were detected between ultrasonography and catheterization [P < 0.05]. This was due to overestimation in 2.1% of cases with urine volumes less than 300 cc [specificity 57.9%]. Through the usage of the present calculation method, ultrasonography may, therefore, be considered an accurate method of estimation of postoperative residual urine volume

Intrauterine insemination [IUI] using swim-up technique or percoll gradient technique versus timed intercourse in the management of unexplained infertility

Forty-eight patients with unexplained infertility were subjected to 3 treatment protocols. They were randomly divided into 3 groups. Group I comprised 13 patients who were treated by induction of superovulation and timed intercourse through 17 treatment cycles. Group II included 16 patients who were treated by induction of superovulation and IUI using husbands washed sperm prepared by the swim-up technique through 19 treatment cycles. Group III. on the other hand, included 19 patients who were similarly treated but with IUI utilizing Percoll gradient technique, through 23 treatment cycles. The clinical pregnancy rates/treated cycles were 5.9% in the first group, 10.5% in the second group and 13% in the third group. Induction of superovulation and IUI with husbands capacitated sperm especially using Percoll gradient technique may he beneficial for treatment of patients with unexplained infertility