Assisted delivery of high floating fetal head: a comparison of vacuum-assisted delivery with manual extraction.

Background: It is a well-established obstetric practice to use a vacuum device to assist in delivery of the fetal head at cesarean delivery. As a vacuum sauce, the hospital piped-vacuum supply is often used. However, no study has compared the safety and efficacy of vacuum-assisted delivery with the traditional manual extraction. Objective: Compare the safety and efficacy of delivery of the high floating fetal head using a soft cup vacuum extractor with the traditional manual extraction. Methods: This randomized study included 90 cases of caesarean sections with vacuum-assisted delivery using the soft cup vacuum extractor (V group) and 90 cases of caesarean sections with manual extraction of the head (M group). The hospital piped-vacuum supply was used to develop the required vacuum. Operative and postoperative maternal and neonatal data of importance were analyzed using Student t-test for continuous variables and Chi Square test for categorical variables. Results: The U-D interval (the time of entry into the uterus until the full delivery of the fetal head) was significantly prolonged (p<0.001) in M group (86.3±53.9 and 65.3±31.2 seconds, respectively). Mean blood loss in the V group was higher (576.7±182.9 mL and 504.4±204.9 mL, respectively). However, this difference was not statistically significant (p=0.306). There was no difference in the Apgar scores and resuscitation in the newborns of the two groups. Infants did not show evidence of any scalp remarks. Conclusion: The extraction of the fetal head at caesarean section with vacuum extractor was a non-traumatic and rapid method that did not need the prolonged fundal compression and thus avoid unwanted consequences.

The accuracy of gestation-adjusted projection method in estimating birth weight by sonographic fetal measurements in the third trimester.

OBJECTIVES: 1. To assess the accuracy of the gestation-adjusted projection method in estimating birth weight in Thai pregnant women. 2. To determine the efficiency of the gestation-adjusted projection method for the detection of low actual birth weight, normal birth weight, and large fetus groups. STUDY DESIGN: Diagnostic clinical trial. MATERIAL AND METHOD: The present study was conducted on 328 uncomplicated pregnancies that were monitored at the Department of Obstetrics and Gynecology, Charoenkrung Pracharuk Hospital during the period of August I to November 30, 2006. The fetal biometry was measured by ultrasound at 34 weeks' gestation or after Fetal weight was calculated according to Hadlock's formula. The extrapolation technique is based on the gestation-adjusted projection (GAP) method. The accuracy of the method was assessed by analyzing the weight predictions in relation to the actual birth weight (ABW). Main outcome measurements were simple error absolute error absolute percentage error and accuracy within 10% of ABW. RESULTS: The accuracy within 10% of ABW was 76.5% (95% CI 71.9, 81.1). The estimation tended to be underestimated (-134.5 +/- 235.2 grams). The mean of absolute error and of absolute percentage error were 226.2 +/- 148.8 grams and 7.2 +/- 4.5% respectively. The smallest observed mean difference was obtained in the large fetus group (birth weight > 4,000 grams) and the largest one was obtained in the normal birth weight group (birth weight 2,500-4,000 grams). The accuracy amongst possible contributing factors were compared and analyzed. The sensitivity and specificity for prediction of birth weight (BW) lower than 2,500 grams (g); 2,500-4,000 g and more than 4,000 g were 60% and 93.8%; 92.5% and 56.5%; 33.3% and 98.8%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of each BW group were 38.7% and 97.3%; 96.6% and 36.1%; 20% and 99.4%, respectively. The post-test likelihood when the test is negative of each BW group was 2.7%, 63.9%, and 0.6%, respectively. The likelihood ratio of a positive result (LR+) and negative result (LR-) of each BW group were 10 and 0.4; 2.1 and 0.1; 33 and 0.8, respectively. The test efficiency (TE) of each BW group was 91.7%, 89.9%, and 98.2%, respectively. CONCLUSION: The GAP of estimated fetal weight (EFW) is able to accomplish the prediction of BW in Thai pregnant women with good accuracy. The diagnostic performance of this method for detection of low birth weight (LBW) and large fetus group are acceptable because of its high specificity, high NPV high LR+, and low post-test likelihood ratio when the test is negative.

Adverse pregnancy outcomes after a false-positive second trimester serum screen for Down syndrome in Thai pregnant women.

OBJECTIVE: To determine whether a false-positive second trimester serum screen for Down syndrome in Thai pregnant women is predictive of adverse pregnancy outcomes. MATERIAL AND METHOD: The relationship between adverse pregnancy outcomes in women and a false-positive screening for Down syndrome was investigated in a case-control study. The Double-marker maternal serum screening for Down syndrome (alpha-fetoprotein and free beta-hCG) was performed on Thai pregnant women between 14 and 21 weeks 'gestation at Charoenkrung Pracharuk Hospital from March 1998 to August 2002. The pregnancy outcomes of 165 women having false positive serum screening (risk ratio at least 1.270; study group) were compared to the outcomes of 165 control patients having negative serum screening results (control group). The outcome indices analyzed were preterm delivery, low birth weight newborn, small-for-gestational age newborn, preeclampsia, placenta previa, and fetal death. RESULTS: The incidence of adverse pregnancy outcomes was 18.2% in the study group and 15.2% in the control group (odds ratio = 1.244; 95% confidence interval = 0.696, 2.225; p = 0.46). Women in the study group delivered at a significantly lower birth weight of newborns than women in the control group did (3088.1 +/- 543.9 versus 3229.1 +/- 454.6 g, respectively; p = 0.011). No significant differences in adverse outcomes was discovered after the comparisons between the study group and the control group. preterm delivery 11 of 165 (6.6%) versus 5 of 165 (3%), p = 0.124; low birth weight newborn 11 of 165 (6.6%) versus 6 of 165 (3.6%), p = 0.213; small for gestational age newborn 4 of 165 (2.4%) versus 0 of 165 (0%), p = 0.123; preeclampsia 16 of 165 (9.7%) versus 12 of 165 (7.3%), p = 0.429; placenta previa 4 of 165 (2.4%) versus 4 of 165 (2.4%), p=1; fetal death 1 of 165 (0.6%) versus 0 of 165 (0%), p=1. CONCLUSION: The present findings revealed no apparent increase in the adverse pregnancy outcomes analyzed in women with false positive Down syndrome screening test.