Intrapartum fetal heart rate patterns: correlation with apgar score and umbilical cord blood pH and gases in preterm labour

A prospective study of 106 preterm pregnancies [28-36 weeks gestational age] were admitted in active labor to the Labor Ward of Northern Area Armed Forces Hospital, KSA, during 15-month period starting March 1992. Continuos intrapartum fetal heart rate [FHR] records were analyzed and statistically compared to neonatal outcome as reflected by Apgar scores and umbilical cord blood pH and gases. Abnormal intrapartum fetal heart patterns were reported in 42 cases and correlated well with low 5-minutes Apgar scores and neonatal blood acidosis [cord blood pH < 7.25]. In this group, neonatal resuscitation and endotracheal intubations were significantly higher compared to cases with normal FHR patterns. Moreover, the cesarean section rate was significnatly higher compared to cases with normal FHR patterns. In the abnormal FHR group, there was no significant difference in the cord blood pH values between cases of vaginal and abdominal deliveries. Normal FHR patterns were associated with a good outcome as regard neonatal acidosis and Apgar scores. In conclusion, a normal intrapartum FHR patterns predicts a good fetal tolerance to the stress of preterm labor. With abnormal FHR patterns, neonatal asphyxia and low Apgar scores would be expected and prompt obstetric intervention is required including all measures necessary for neonatal resuscitation

randomized comparative study on the effect of the use of vacuum extraction with metal or silastic cups versus outlet forceps delivery in the second stage management of nulliparas on maternal and neonatal complications

A prospective study was designed to determine the effectiveness and safety of different outlet instrumental deliveries. One hundred and fifty two nulliparas women for whom instrumental delivery was decided and had the criteria for low forceps delivery, were randomized to low forceps, vacuum extraction with the conventional metal cup or the silastic rubber cup. Forceps delivery had the lowest significant failure rate [9.8%] compared to metal cup and silc-cup deliveries [17% and 18.5%]. However, there was a significant greater incidence of maternal soft tissue injuries in the forceps group [45%] compared to 16.7% in the silc-cup and 23.4% of the metal vacuum extractors. Neonatal scalp injuries were significantly higher in the forceps group [47%] compared to silc-cup group [20.4%], while the difference was not significant as regards the metal cup group [40%]. There was a significant increase in neonatal morbidity for the metal cup group compared with silc-cup delivery, specially scalp trauma and cephalohematomata. There were no significant differences in the Apgar score, neonatal jaundice, retinal hemorrhages, intracranial hemorrhage and umbilical artery, pH between the metal cup, the silc- cup, the vacuum extractors and forceps groups. Based on these findings, the vacuum extractor is effective instrument outlet delivery with less maternal morbidity compared to forceps delivery. The silicon cup is preferred to metal cup due to less neonatal morbidity. Although the forceps is the most effective instruments, but due to the associated maternal morbidity, its use is limited to selected cases as preterm and uncooperative parturients

Endovaginal versus transabdominal assessment of bleeding during early pregnancy

This study was aimed at evaluating the accuracy, diagnostic and prognostic values of vaginal ultrasound as compared to abdominal ultrasound in women with vaginal bleeding in early pregnancy. A prospective study of 196 women consecutively were admitted to Northern Area Armed Forces Hospital. Saudi Arabia, with vaginal bleeding and provisionally diagnosed as threatened abortion or suspected ectopic pregnancy. Both transabdominal and vaginal ultrasound examinations were done to all eases and the results were compared to the clinical pregnancy outcome and statistically analyzed. Fifteen non pregnant cases were excluded from the study. Among 181 women of the study, 111 cases [16.3%] had clinically intact pregnancy. Vaginal US diagnosed an intrauterine pregnancy with fetal pole and cardiac activity in 111 cases at first examination while abdominal US reported that in 97 eases only. The difference was statistically significant. Anembryonic pregnancy was suspected in 38 cases by abdominal US, while vaginal US detected fetal pole in 15 out of these cases and diagnosed anembryonic pregnancy in 23 cases [P< 0.05]. Missed abortion was suggested in 23 cases with abdominal US, while vaginal US detected cardiac activity in larger number of cases and diagnosed missed abortion only in 11 cases [P< 0.05] and coinciding with the clinical outcome. Ectopic pregnancy was surgically diagnosed in eight cases who were vaginally diagnosed, while abdominal US strongly suggested ectopic in three cases out of eight, the difference was highly significant [P< 0.01]. There were no significant differences in diagnosis of complete abortion, incomplete abortion and hydatiform mole with the use of either abdominal or vaginal US. Vaginal scan is an accurate, informative diagnostic measure in early pregnancy complications. It has a higher diagnostic and prognostic values compared to abdominal scan in pathological diagnosis of intact pregnancy, missed abortion, anembryonic and ectopic pregnancies. It is recommended to he carried out at the time of pelvic examination when the clinical indication was first encountered