role of some labor admission tests in the prediction of the perinatal outcome in high-risk pregnancies

To study the role of some labor admission tests [Cardiotocography CTG, vibroacoustic stimulation VAS-, biophysical profile scoring BPP and Doppler] in the prediction of the perinatal outcome in high risk pregnancies. Prospective randomized comparative study. Labor ward of the Department of Obstetrics and Gynecology, - El Minia University Hospital, El Minia, Egypt, Four hundred high risk pregnant women in spontaneous early labor [cervical dilatation 3-5 cm] with singleton pregnancy, vertex presentation with estimated gestational age between 37 to 42 weeks. Patients were randomly allocated into 4 matched groups- 100 patients each - according to the admission test done as follow; Group I: Cardiotocography CTG group; Group II: Vibroacoustic stimulation VAS group; Group III: Biophysical profile BFP group; Group IV: Doppler group. The predictive values [sensitivity, specificity, positive and negative predictive values PPV and, NPP and accuracy] and the relative risk RR with 95% confidence interval [95% CI] of labor admission tests for the prediction of the perinatal outcome. BPP had the highest statistically significant sensitivity [70%] followed by VAS [66.7%] among admission tests [P<0.05, for each]. BPP had the highest statistically significant positive predictive value PPV [77.8%] among admission tests [P < 0 05]. The specificity and NPP of admission tests were comparable [P > 0.05, for each]. The RR [95% CI] for adverse [poor] perinatal outcome with abnormal admission test was statistically significant for abnormal [<6] BPP [23; 95% CI [7.3 5:75.74]] followed by VAS [10.5; 95% CI [4.14 : 20.64] 1 [p<0.05, for each]. The RR [95% CI] of non-reactive CTG and abnormal Doppler were statistically insignificant [P>0.05, for each]. Of all admission tests the predictive value of BPP appears to be the most statistically significant BPP has the highest sensitivity followed by VAS. The BPP has the highest PPV of all admission tests. The RR of abnormal [low] BPP for the prediction of poor [adverse] perinatal outcome is the most statistically significant followed by VAS among labor admission tests. The predictive value of intra-partum Doppler is midway between VAST and CTG. CTG has a poor predictive value among labor admission tests due to high false positive results; addition of another complementary test is recommended. Larger randomized controlled trials are recommended to establish the exact role of labor admission tests in low and high risk pregnancy population

Management of early missed abortion by methotrexate and/or misoprostol

The purpose of this study was to compare the efficacy and side effects of the use of either intramuscular [i.m.] methotrexate or vaginal misoprostol alone or in combination in women with early 1[st] trimester missed abortion. Ninety women with early missed 1[st] trimester intrauterine pregnancy at < 9 weeks gestation were included in this study. The study sample was randomized into 3 groups. The 1[st] group included 30 women who received 50mg/m[2] i.m. methotrexate on day 1 and then followed up at weekly intervals up to day 21. The 2[nd] group included 30 women who received 800 micro g vaginal misoprostol on day 1 and if there was no response on day 4, they received a repeat dose and were reassessed on day 7. The 3[rd] group included 30 women who received 50 mg/m[2] i.m. methotrexate followed 3 days later by 800 micro g vaginal misoprostol and were reassessed on day 7. All women were recruited from the attendants of Gynecology Department, El-Minia University Hospital. Complete abortion occurred in 53.33% in 1[st] group, 86.66% in 2[nd] group and 93.33% in the 3[rd] group. The complete abortion rate in the 3[rd] group was significantly higher than that of both 1[st] and 2[nd] groups [p < 0.05]. The failure rate was 46.66% in 1[st] group, 13.33% in 2[nd] group and 6.66% in the 3[rd] group. No serious side effects were found in all study groups. The combination of methotrexate and misoprostol is more effective method for early missed abortion than when either drug is used alone