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

Endometrial thickness and pregnancy rates in infertile couples undergoing artif cial insemination homologous [AIH]

To determine wheather endometrial sonography in the Late follicular phase could predict the success of AIH in infertile couples. The study included 46 patients with infertility due to poor semen parameters who presented at the infertility clinics of Northern Area Armed forces Hospital and Jubail General Hospital and were monitored for endometrial growth during late follicular phase till timing of AIH during 142 treatment cycles. A significant higher [P < 0.05] endometrial thickness was observed in the 18 women who conceived [9.2 +/- 0.7 mm] compared with 28 women who failed to conceive [7.1 +/- 0.6 mm] after repeated AIH trials. A thickness of more than 8 mm at the day of AIH was reported in 81 treatment cycles with pregnancy achievement in 16 cases while endometrial thickness of 6 to 8 mm was reported in 46 cases with a pregnancy occurrence of 2 cases after AIH. This difference in pregnancy rates was statistically significant No pregnancy reported in cases of AIH with endometrial thickness of 5 mm or less. A significant higher mean endometrial growth rate of 0.8 +/- 0.07 mm / day was reported in the group that achieved pregnancy compared with only 0.3 +/- 0.02 mm / day in the non-conception group. Ultrasonographic monitoring of endometrial thickness is relatively non invasive, and may improve our ability to select women who have a higher chance to conceive, following AIH and others with a less chance who may better to be postponed to another treatment cycle

role of antepartum computed tomographic pelvimetry in trial of labour after previous caesarean section

To evaluate the role of antenatal CT pelvimetry in choosing the appropriate delivery method for patients with prior caesarean delivery in view of the obstetric and perinatal outcome. A prospective study of the outcome of trial labour among pregnant women with prior caesarean section between October, 1992 and December 1993. All women had singleton term vertex pregnancy, accepting trial labour and with no contraindications for trial labour. Eighty two patients had fulfilled the study criteria and were allocated to either inadequate pelvis group [48 cases] or to adequate pelvis group [34 cases] according to data obtained by antenatal CT pelvimetry. Seventy two percent [59/82] of the study patients had successful vaginal deliveries. Seventy one percent [34/48] of inadequate pelvis group delivered vaginally and twenty nine percent [14/48] required a caesarean delivery after a trial of labour. With adequate pelvis, vaginal delivery was 74% [25/34] and caesarean delivery was 26% [9/34] after trial labour. No significant difference between study groups as regard occurrence of vaginal delivery after prior caesarean birth. Significant, higher incidence of intrumental vaginal deliveries, I perineal trauma, blood loss, longer hospital stay and neonatal jaundice were reported among cases with inadequate peivis. Perinatal outcome including Apgar scores, cord gases and neonatal complications was comparable in both study groups. Pregnant women after prior one caesarean delivery should be allowed to trial labour regardless of pelvimetric results in absence of other obstetric indications for C.S. Antenatal pelvimetry is helpful in identification of women who are more liable for operative vaginal delivery and should be monitored more closely in labour

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