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