Determination of fetal occiput position by ultrasound during the second stage of labor.

OBJECTIVE: To investigate whether ultrasonography is superior to vaginal examination for determination of fetal occiput position during the second stage of labor. METHODS: We conducted a prospective cohort study of 44 parturients. During the second stage of labor, an attending obstetrician performed a vaginal examination to detect fetal occiput position. This was followed by combined abdominal and perineal ultrasound examination. The two methods were compared to the true position. Results were analyzed using Student's t test for quantitative parameters. McNemar's and Fisher's exact tests were applied in order to examine differences between the study groups. RESULTS: The error rate in detecting fetal occiput position was significantly lower using the ultrasound technique (6.8%) compared to vaginal examination (29.6%, p = 0.011). Parity, maternal body mass index or fetal weight had no influence on the error rate. CONCLUSIONS: Ultrasonographic determination of the fetal position is an accurate technique and is superior to vaginal examination.

A matched controlled study of Kielland's forceps for transverse arrest of the fetal vertex.

This study attempted to determine whether delivery with Kielland's forceps for deep transverse arrest is less favourable than other instruments. One hundred and forty-six women who underwent rotation and delivery with Kielland's forceps between 1994 and 1997 were matched by parity and birth weight to one of two control groups: delivery by non-rotational forceps or the vacuum extractor. No significant differences were found in maternal or neonatal outcome (vaginal lacerations, 3rd- or 4th-degree perineal tears, postpartum haemorrhage, fever, blood transfusion, duration of hospitalisation, Apgar score, asphyxia, scalp trauma, admission to the intensive care unit or neonatal hospitalisation). The incidence of heart rate abnormalities prior to instrumental delivery was similar. The 'failure to deliver' rate (8.9% after Kielland's forceps) was not different to the 7.5% and 6.8% found in each control group. These data indicate that the outcome after Kielland's forceps delivery is similar to other instrumental deliveries if performed by experienced obstetricians.

Determination of fetal lung maturity from amniotic fluid microviscosity in high-risk pregnancy.

During a 3-year period, 377 samples of amniotic fluid, free of blood and meconium and obtained from a total of 471 patients, were examined by the fluorescence polarization technique to estimate fetal lung maturity. Fluorescence polarization values of 287 samples from normal and abnormal pregnancies were correlated with gestational age. A total of 272 pregnancies comprising cases complicated by toxemia, placental insufficiency, placenta previa, premature contractions, and diabetes mellitus, and including a control group of 37, were studied to discern the effect of such pathologic conditions on the usual decline of fluorescence polarization (FP) values with increasing gestational age. No complicated pregnancy had values significantly different from those of the control group, except for pregnancies complicated by diabetes mellitus. The threshold of fetal lung maturity as related to respiratory distress syndrome (RDS) was determined in correlation with the lecithin: sphingomyelin (L:S) ratio. FP values of 0.311 +/- .005 corresponded to an L:S ratio of 2.0. An FP value of 0.316 +/- .005 is recommended as a practical threshold related to the clinical outcome of the newborn as regards RDS. The technique was found reliable, simple, and accurate and has been of great value in the antenatal diagnosis of fetal lung maturity.