Uncertain post-term pregnancy: induction or surveillance?

This study aimed to evaluate the safety of unlimited fetal surveillance in women with uncertain post-term pregnancy compared with routine induction of labor at 42 weeks apparent gestation. This study included 120 women with singleton uncomplicated pregnancies at 42 weeks apparent gestation. Women were allocated randomly into two groups: Group I fetal surveillance for unlimited duration suing standard cardiotocography, amniotic fluid maximum pool depth and fetal kick count and group II routine induction at 42 weeks. The main outcome measures were antepartum fetal death, intrapartum management, mode of delivery and neonatal outcome. The results showed that women in surveillance group had shorter duration of labor [mean +/- SE, 6.5 +/- 0.4 hours vs 9.1 +/- 0.4 hours] and lower incidence of oxytocin use [42% vs 80% OR 0.2, 99% CI = 0.07-0.6]. There was also significantly less cesarean section rate in the fetal surveillance group [10% vs. 28%, OR 0.3, 99% CI = 0.2 - 0.6]. Meanwhile, there was no difference in the perinatal outcome. The results suggested that in women with uncertain post-term pregnancy, fetal surveillance yield easier labor [shorter duration and less use of oxytocin] and more chance for vaginal delivery than routine induction at 42 weeks without clear impact on the perinatal outcome

Ultrasound hysterosalpingography as a preliminary infertility investigation

This study aimed to evaluate the diagnostic efficiency of transvaginal sonographic hysterosalpingography [HSG] for detection of tubal patency. Thirty-two women with unknown tubal patency undergoing routine infertility investigations were included in this study. Isotonic saline was injected into the uterine cavity through an endocervical catheter in the preovulatory phase of the cycle. X-ray HSG was performed on the next day and laparoscopy was carried out in the late secretory phase. Complete consistency with laparoscopic findings was found in 75% of cases using US-HSG compared with 81% by X-ray HSG [difference not significant]. Partial consistency was also demonstrated in insignificantly different proportions by the two techniques [12.5% versus 6.25%, respectively]. Complete inconsistency was found in similar proportions of cases [12.5%]. All parameters of diagnostic efficiency for US-HSG and X-ray HSG were not significantly different. It was concluded that ultrasound hysterosalpingography using isotonic saline with its safety and diagnostic efficiency is a promising technique for preliminary assessment of tubal patency in infertility patients. Its use may reduce the need for X-ray HSG and laparoscopy, particularly in case of demonstrating tubal patency