Comparison of vacuum extraction delivery between the conventional metal cup and the new soft rubber cup.

To compare the effectiveness and complications of vacuum extraction delivery between the conventional metal cup and the silicone rubber cup. A prospective randomized clinical trial of 90 pregnant women requiring assisted vaginal delivery who met the predetermined criteria for vacuum extraction were allocated to delivery by the Malstrom metal cup (46 cases) or the silicone rubber cup (44 cases). The two groups were similar in respect of age, parity gestational age and indications for assisted vaginal delivery. The mean and median numbers of tractions and time from cup application to delivery were not significantly different between the groups. The overall success rate was higher in the metal cup (89.1%) than in the rubber cup (79.5%) but not significantly different. The silicone cup was more likely to fail in cases of occiput posterior position, excessive caput, and severe degree of molding. There were no significant differences between groups in terms of Apgar scores, birth canal injury, and maternal blood loss. Scalp injuries occurred more frequently with the metal than with the rubber cup (P = 0.006). Vacuum extraction delivery with the silicone rubber cup is associated with reduced scalp injuries but has a greater tendency to fail when the fetus presents in occiput posterior position, has excessive caput or severe degree of molding.

Comparison of intracervical and intravaginal misoprostol for cervical ripening and labour induction in patients with an unfavourable cervix.

OBJECTIVE: To compare the efficacy of intracervical versus intravaginal misoprostol for cervical ripening and labour induction at term in patients with an unfavourable cervix. METHOD: A total of 100 pregnant women with indications for induction of labour and unfavourable cervix (Bishop score < or = 4) were randomly assigned to receive either 100 ug misoprostol administered intracervically (50 cases) or intravaginally (50 cases). RESULTS: No significant differences were noted between intracervical and intravaginal misoprostol in terms of Bishop score change, (score 7.2 vs score 7.5), interval from gel insertion to vaginal delivery (17.0 hours vs 16.4 hours), meperidine as analgesic requirement (80% vs 76%), route of delivery and perinatal outcome. Uterine tachysystole occurred in 24 per cent and 32 per cent in the intracervical and intravaginal groups respectively which did not significantly differ, however, all could be rapidly resolved by terbutaline injection. No evidence of fetal distress was noted in these events. Spillage of gel out of the cervix was observed in 70 per cent of patients receiving intracervical misoprostol. Fever was observed in one patient of each group. No other serious side effects were found in both groups. One patient in the intravaginal group had postpartum hemorrhage due to delayed placental separation and uterine atony. CONCLUSION: The two routes of misoprostol gel application appear to be safe and equally effective in ripening cervix and inducing labour, however, the intravaginal application is more convenient to administer practically compared with the intracervical.

Accuracy of ultrasonic fetal weight estimation: a comparison of three equations employed for estimating fetal weight.

This study was conducted to compare the accuracy in estimating the fetal weight of three equations with ultrasound in 104 pregnant women. Equation I log 10 (EFW) = 1.85479 + 0.09008 (BPD) + 0.02466 (AC) Equation II log 10 (EFW) = 2.24784 + 0.09122 (FL) + 0.002798 (BPD x AC) -0.0010112 (AC x FL) Equation III log 10 (EFW) = -1.7492 + 0.166 (BPD) + 0.046 (AC) - 2.646 (AC x BPD)/1000 There was no difference in either the overall mean errors of 95 per cent CI among the three equations, except in the least error for equation II in these with birthweight of less than 2,000 grams and for equation III in these with birthweight of more than 3,000 grams. It was concluded, therefore, that predictions based on either equation I or II developed from local Thai population, which have an almost identical overall mean error when compared with one another or with Shepard's (i.e. equation III), can be used in our clinical.

Sonographic femur length/abdominal circumference ratio in normal pregnancies among Thais.

The relationship between sonographically measured foetal length (FL) and abdominal circumference (AC) (expressed as FL/AC ratio * 100) was studied in 455 normal pregnancies between the 14th and 40th gestational weeks. By analysis of 1,197 measurements for each parameter, this ratio was found to be independent of menstrual age, with a normal range after 21 weeks (mean + 2 S.D.) of 2038 + 2.6. This mean ratio is different from the values of a previous western study (22+2). The ratio obtained from the Thai study hopefully will be the baseline for the Thai population and may be used for further study about intrauterine growth retardation.