Prediction of time until delivery and type of delivery through a comparison of bishop score, ultrasonographically measured cervical length and fetal fibronectin assay

The predictive value of Bishop score, ultrasonographically measured cervical length and fetal fibronectin assay were studied in 146 normal pregnant women at term to predict time and mode of delivery and risk of cesarean delivery. Results showed that the spontaneous onset of labour within 7 days was significantly associated with Bishop score >/= 6 [P=0.01], and with cervical length /= 50 ng/ml [p=0.31]. Both Bishop score >/= 6 and cervical length /= 50 ng/ml and with Bishop score >/= 6 [P=0.01] and that positive fetal fibronectin results at >/= 50 ng/ml and Bishop score are predictive for vaginal delivery rather than cesarean delivery especially if both tests >/= 6 are evaluated together in the same women [positive predictive values were 71.8%, 44.6% and 89.6% respectively]. Failure to detect fetal fibronectin at cervicovaginal discharge at term is predictive to cesarean delivery especially if Bishop score is < 0

Single versus multiple laparoscopic diathermy punctures polycystic ovaries: ovarian morphology and clinical outcome

To evaluate and compare two different techniques of laparoscopic ovarian diathermy in polycystic ovaries: Single puncture technique and multiple punctures technique, as regard ovarian morphology and clinical outcome. Thirty six anovulatory PCO patients were randomly allocated to either single puncture technique [group I: 18 patients] or multiple punctures technique [group II: 18 patients]. Ovarian morphology was sonographically assessed just before and 3 months after the procedures. Clinical outcome was analysed before and at 6, 12 months after the surgery. Single puncture technique as well as multiple puncture technique markedly affected the ovarian morphology. Its significantly [P<0.01] reduced mean ovarian volume, and mean follicular number and significantly [P<0.01] increased the mean follicular diameter. Resumption of regular spontanous menses were insignificantly different between the two techniques [83.3% vs 88.8 at 6 months and 72.2% vs 77.7% at 12 months after the procedures respectively]. Pregnancy rate was significantly higher in single puncture technique than in multiple puncture technique at 6 and 12 months after the procedure [33.3% vs 22.2%, P<0.05 and 55.5%, vs 44.4%, P<0.05 respectively]. In each technique, pregnancy rate was significantly higher at 12 months rather than at 6 months [55.5% vs 33.3%, P<0.01 for single puncture technique and 44.4% vss 22.2% P<0.01 for multiple punctures]. Adhesions were significantly less and of minimal degree following single puncture when compared to that, following multiple punctures [16.7% vs 35.7%, P<0.01] and this may be the cause of the lesser pregnancy rate following multiple puncture technique. Single puncture laparoscopic ovarian diathermy is quite effective as multiple puncture procedure in treating anovulatory PCO patients, correcting the ovarian morphology and resuming regular menses, even it has the advantages of higher pregnancy rate and lesser incidence of postoperative adhesions

Low dose aspirin to prevent pre-eclampsia in high risk group patients

One hundred women at high risk of pre-eclampsia and/or fetal growth retardation were randomly allocated to treatment with low dose aspirin [50 mg] daily from 16th weeks gestation onwards [Aspirin group] or to no aspirin treatment [no treatment group]. Aspirin significantly [P < 0.05] reduced the incidence of pre-eclampsia especially its severe form [P < 0.01], prolonged the gestational age, increased the birth weight [P < 0.05], as well as significantly [P < 0.05] reduced the incidence of fetal growth retardation. It selectively suppressed the maternal platelet thromboxane level by more than 90% [P < 0.001] with sparing the vascular prostacyclin production. Although, low dose aspirin prolonged the maternal neonatal bleeding time, yet it did not produce serious adverse effects to the mother, fetus or newborn. It protects the high risk patients against pre-eclampsia and its associated complications

Intrapartum electronic fetal heart rate assessment in low and moderate risk patients: intermittent or continuous monitoring

Over a period of 12 months, pregnant women [1008 women] with low or moderate risk factors were studied to compare the intermittent versus continuous fetal heart rate monitoring during first stage of labour for early detection of fetal distress, as well as mode of delivery and neonatal outcome. 503 women were randomly allocated to continuous monitoring [C-group] and 508 women to intermittent monitoring [I-group]. There was no significant difference between the two groups in the incidence of abnormal FHR tracing, however suspicious FHR tracing was significantly [P < 0.05] more frequent in C group. In I-group, FHR monitoring was performed for 52.3% of first stage time, compared with 88.5% in the C-group [P < 0.001]. Ventose or forceps deliveries were significantly [P < 0.05] more in C group than in I group. The incidence of cesarean section for fetal distress was non significantly different [1.4% and 1.8% in I group and C-group respectively]. There was no significant differences in the neonatal outcome as regard the Apgar scoring, umbilical artery blood pH, admission to neonatal care unit or neonatal death. In pregnant women with mild or moderate risk factors, intermittent FHR monitoring can be considered safe and effective, and at the same time less costy when compared to continuous monitoring

Ultrasonic fetal breathing movements observation is it diagnose true preterm pains

Fifty women with painful uterine contractions, occurring between 32 - 36 weeks of gestation were enrolled in this study to evaluate the predictive value of ultrasonic fetal breathing movements observation to diagnose true preterm pains and delivery. Out of 10 women [20%] showed absent fetal breathing movements, 8 women [80%] delivered within 24 - 48 hours. While out of 40 women [80%] showed present fetal breathing movements only one [2.5%] delivered within the same period. The absence of fetal breathing movements on ultrasound, has a predictive value for diagnosis of true preterm pains and delivery with sensitivity of 89%, specificity of 95%, positive predictive value of 80% with very high significant value [P <0.0001]

Laparoscopic ovarian electrocoagulation in infertile patients with polycystic ovarian syndrome

Forty-two women ovulated following ovarian diathermy, within a period of 21 +/- 5.6 [mean +/- SD] days. Most of the ovulation was stimulated with antiestrogen and/or human menopausal gonadotrophin to which women were previously resistant. Thirty-two women were conceived. Most of it occurred in the first 3-6 months after ovarian diathermy. 78.1% [25 women] of pregnancies continued till term, 15.6% [5 women] were ended with abortion and 6.3% [2 women] with ectopic pregnancy. The results were encouraging to consider laparoscopic ovarian electrocoagulation as next step in treating infertile polycystic ovarian patients who are resistant to antiestrogen and/or gonadotrophins

Management of intrauterine fetal death after 12 weeks gestation: comparison of two prostaglandins

Thirty two patients, who had intra-uterine fetal death after 12 weeks of pregnancy were studied to compare the efficacy of 2 different prostaglandin analogues to manage such cases. Dinoprostone given as vaginal tablets was studied in 15 patients, while sulprostone given as intramuscular injections was studied in 17 patients. In sulprostone group expulsion of dead fetus was achieved in 100% of cases at all gestational ages, while in dinoprostone group expulsion achieved only in 26.7% [P <0.001] mostly in those cases at late gestational ages, the number of doses and total doses were significantly [P <0.001] less in sulprostone group. Induction-expulsion time was significantly [P <0.001] less in sulprostone group [8.3 +/- 4.1 hours] than in dinoprostone group [33.4 +/- 16.2 hours]. Complete expulsion was more common [75%] in dinoprostone group than in sulprostone one [35.5%]. Most common complication was emesis [60%] in dinoprostone group and abdominal pains [53%] in sulprostone group

Prognosis of very early pregnancy hormonal assay or ultrasonic examination

Single serum hCG, serum progesterone levels and ultrasonic evaluation were used to predict the pregnancy outcome in 119 women, pregnant at < 8 weeks gestation. The mean serum progesterone level was significantly [P <0.001] higher in normal pregnancy [23.3 + 6.3 ng/ml] than in abnormal gestations [9.6 + 2.2 ng/ml]. Single serum progesterone was predictive of pregnancy outcome with sensitivity of 99%, and positive predictive value of 88%. Single serum hCG was not predictive of the pregnancy outcome, while ultrasonic evaluation at < 8 weeks was poorly predictive of the pregnancy outcome. Single serum progesterone estimation at cut off level 20 ng/ml, can differentiate between normal pregnancy and abnormal gestation, and is more predictive for pregnancy outcome at < 8 weeks gestation, than the ultrasonic evaluation at the same gestational period, and so it was advisable to do this test, in pregnant women having past history of previous one or more abortion or those with previous history of ectopic pregnancy