Prospective multi-centre randomised trial comparing induction of labour with a double-balloon catheter versus dinoprostone.

This randomised controlled study compared the efficacy of double-balloon catheter versus vaginal prostaglandin E2 (dinoprostone) for induction of labour. In total, 825 pregnant women with cephalic presentation and an unfavourable cervix undergoing induction for conventional indications were randomised to double-balloon or vaginal dinoprostone (3 mg) groups. There was a significantly higher failure rate for labour induction in the balloon group (relative risk: 1.25, 95% confidence interval [CI]: 1.02-1.49). Median induction time was 27.3 h in the balloon group and 29.8 h in the dinoprostone group (difference not significant). After 24 h, 55.3% had given birth in the balloon group versus 54.3% in the dinoprostone group. Additional oxytocin stimulation was used more often in the balloon (46%) compared with that in the dinoprostone (34%) (relative risk: 1.34 (95%CI 1.16 -1.54) group. Caesarean section rates and neonatal outcome were similar. Overall, the two methods for induction were comparable with regard to efficacy and safety.

Reproducibility of 3-Dimensional Ultrasound Measurements of Placental Volume at Gestational Ages 11 - 14 Weeks.

OBJECTIVE: To evaluate the reproducibility of placental volume using three-dimensional ultrasound. METHODS: The VOCAL (Virtual Organ Computer-aided AnaLysis) technique involves rotating an image of an object along an established axis using predefined angles. This provides a number of sections to measure manually, resulting in the object being displayed with an estimated placental volume. Four predefined angles 30°, 15°, 9°, and 6°, creating 6, 12, 20 and 30 sections, respectively. Measurements of placenta volumes in 21 women with singleton pregnancies were performed at gestational age 11-14 weeks by a single consultant in Foetal Medicine and later processed by two observers. The intraobserver reproducibility between all four angles was calculated as the mean Coefficient of Variation. Interobserver reproducibility was assessed by Interclass Correlation Coefficient (ICC), Limits of Agreement (LOA) and illustrated in Bland-Altman plots. RESULTS: There was no significant difference in intraobserver variability between the four angles, p = 0.19, but a trend towards a lower coefficient of variation with the smallest angle was observed. A high intraobserver reproducibility was found using the 6° angle (ICC = 0.918 (0.812 - 0.966) and 0.983 (0.960- 0.993), LOA = [-22.9- 22.5] and [-14.3 - 12.1]), but interobserver reproducibility showed a wide range of agreement (LOA = [-50.5- 34.8]), particularly in cases with u-shaped placentas. CONCLUSION: The low interobserver reproducibility of VOCAL measurements of placentae requires significant differences between normal and abnormal cases if the technique should be implemented for clinical use.