Risk of uterine rupture with the use of prostaglandin E2 for induction of labor in women with a previous cesarean section scar

To determine the risk of symptomtic uterine rupture in women induced with prostaglandin E[2] vaginal tablet [PGE[2]] after 1 previous cesarean section. A cohort study of all women with a live singleton fetus undergoing a trial of labor [TOL] after a previous low - transverse cesarean delivery was performed in King Faisal Armed Forces Hospital, Saudi Arabia. The current analysis was limited to women at term with 1 prior cesarean delivery. We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor and those in which labor was induced by PGE[2] vaginal tablets. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analysis. Of 3200 trials of labor, 960 [30%] were PGE[2] induced and 2240 [70%] were spontaneous labor. The uterine rupture rate with PGE[2] - induced trial of labor [24 / 960; 2.5%] was significantly higher than with a spontaneous trials of labor [11 / 2240; 0.50%; P = 0.01]. In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin augmentation, birth weight, gestational age, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with PGE[2] - induced trial of labor was 5.1 [95% confidence interval, 1.9 -14.2]. For women with one prior cesarean delivery, induction of labor with PGE[2] is associated with an almost 5 - fold greater risk of uterine rupture than those who deliver after spontaneous labor

Prediction of small-for-gestational age infents by quantitative assessment of diastolic notch in uterine artery flow velocity waveforms

To assess the performance and clinical usefulness of the notch depth index [NDI] in predicting small-for-gestational age infants [SGA] in comparison to the previously defined abnormalities in uterine blood flow velocity waveforms; peak systolic over protodiastolic velocities [A/C] ratio. Presence of protodiastolic notch and resistance index [RI]. This prospective clinical study included evaluation of pulsed Doppler abnormalities uterine artery velocity waveforms in 673 nulliparae with normal singleton pregnancies at 16-18 weeks and at 26 weeks gestation. Main outcome measures: Delivery of small for gestational age [SGA] infants. SGA developed in 11% of nulliparae. Although early Doppler screening was associated with high false positive results, yet two-stage screening avoided false negative cases. NDI was found to be a better predictor than other Doppler indices [A/C ratio, protodiastolic notch and RI]. NDI improved, both sensitivity and PPV as determined by other Doppler indices. NDI measurements were clinically useful in predicting for gestational age infant than other conventional Doppler indices