Is uterine depth measurement by trans-vaginal ultrasound alone as accurate as measurement carried out by trans-abdominal ultrasound-guided trial transfer?

To assess the reliability of trans-vaginal-scan [TVS] in measuring the uterine depth [UD] in comparison with ultrasound-guided trial-transfer [UTT]. This prospective study was conducted in 66 consecutive patients undergoing in-vitro fertilization and embryo transfer [IVF-ET]. The study took place in a private IVF center in Jeddah, Saudi Arabia between November 2013 and January 2014. The patients underwent UD measurements using TVS and UTT, sequentially. All scans were performed by a single sonographer, and all UTT were carried out by a single physician who was blinded to the TVS measurement. The median [95% confidence interval] UD measurement using the TVS method was 6.9 cm [5.0-12.5] and UTT was 7.1 cm [5.9-13.5], [p<0.0001]. Fifteen patients [22.7%] had a difference of >1 cm between the 2 measurement modalities [group-B]. When measured by UTT, 93.3% of patients in group-B had UD >/= 8 cm, compared with 9.8% of patients in group-A, [p<0.0001]. Group-B had a significantly longer uterine cavity when measured by UTT [p<0.0001], and a trend towards significance when measured by TVS [p=0.055]. The TVS measurements generally underestimated UD when compared with UTT. Trans-vaginal-scan is less reliable than UTT and should not be used as a substitute. Larger sample-size studies involving different personnel, and equipment is needed

Predictors of cesarean section following elective post-dates induction of labor in nullipara with uncomplicated singleton vertex pregnancies

Although post-dates is among the most common indications for induction of labor, no studies have identified the predictors of cesarean section [C/S] in that population. The high cesarean rate in our institution for this group of women triggered us to assess different induction practices to elicit potential causes. We conducted a hospital-based retrospective cohort analysis using chart reviews of all nullipara women with induced labor at the Children's and Women's Health Centre of British Columbia, Vancouver, Canada, during the 2-year period, April 1998 to March 2000. The C/S rate was compared among 3 groups of women who were divided according to their induction method. Three hundred and thirty-nine women meeting the inclusion criteria were induced. Of the 25 women who received oxytocin ideally and the 111 women who did not, 7 [28%] and 53 [48%] were delivered by C/S, [x2=3.228 p=0.07; relative risks 0.59 [95% confidence interval 0.30, 1.13]]. A significantly lower C/S rate [x2=21.9, p<0.0005] was found among women induced with prostaglandin [PG] alone [19.4%] compared with those induced with PG and oxytocin, whether oxytocin was given ideally [38.3%] or not ideally [45.4%]. Of women who received oxytocin, there was no difference in chorioamnionitis [x2=0.485, p=0.49] between those who had an early membrane rupture [with or pre-oxytocin, 22.4%] and those who had membrane rupture following a period of oxytocin infusion [18.5%]. The need for oxytocin or less than 2 doses of PG is associated with increased risk of C/S. Whether oxytocin was given according to protocol [ideally] or not, made no difference to the C/S risk in this population