Predicting intrapartum fetal compromise using the fetal cerebro-umbilical ratio.

INTRODUCTION: The aim of this study was to explore the association between the cerebro-umbilical ratio measured at 35-37 weeks and intrapartum fetal compromise. METHODS: This retrospective cross sectional study was conducted at the Mater Mothers' Hospital in Brisbane, Australia. Maternal demographics and fetal Doppler indices at 35-37 weeks gestation for 1381 women were correlated with intrapartum and neonatal outcomes. RESULTS: Babies born by caesarean section or instrumental delivery for fetal compromise had the lowest median cerebro-umbilical ratio 1.60 (IQR 1.22-2.08) compared to all other delivery groups (vaginal delivery, emergency delivery for failure to progress, emergency caesarean section for other reasons or elective caesarean section). The percentage of infants with a cerebro-umbilical ratio <10th centile that required emergency delivery (caesarean section or instrumental delivery) for fetal compromise was 22%, whereas only 7.3% of infants with a cerebro-umbilical ratio between the 10th-90th centile and 9.6% of infants with a cerebro-umbilical ratio > 90th centile required delivery for the same indication (p < 0.001). A lower cerebro-umbilical ratio was associated with an increased risk of emergency delivery for fetal compromise, OR 2.03 (95% CI 1.41-2.92), p < 0.0001. DISCUSSION: This study suggests that a low fetal cerebro-umbilical ratio measured at 35-37 weeks is associated with a greater risk of intrapartum compromise. This is a relatively simple technique which could be used to risk stratify women in diverse healthcare settings.

The obstructed hemivagina, ipsilateral renal anomaly, and uterine didelphys triad and the subsequent manifestation of cervical aplasia.

STUDY OBJECTIVE: To compare a case series of the obstructed hemivagina, ipsilateral renal anomaly and uterine didelphys triad with the literature, with a focus on a subset of patients with cervical aplasia. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series was conducted of all patients with the triad managed between 2005-2013 at a tertiary center for adolescent gynecology. RESULTS: Similarities in this cohort, compared to the literature, included heterogeneity of presentation, presence of endometriosis, and asymmetry of affected side. Notable differences included 1 patient with a 16p11.2 microdeletion and 2 patients with subsequent unilateral cervical aplasia. All patients underwent magnetic resonance imaging for diagnosis. Vaginal septum division was performed in 8 cases and excision in 1 case. Both cases with cervical aplasia ultimately underwent hemi-hysterectomy, and highlight the implications of this rare variant in regards to its existence, limitations of magnetic resonance imaging in this context, and suggestions for improvement in diagnosis and management. CONCLUSION: The complexity of these cases, especially the evolving manifestation of cervical aplasia postoperatively, illustrates the need to recognize limitations in imaging and divergence in definitive management.

The effect of different forms of monocular occlusion on measures of central visual function.

The purpose of this study was to determine whether clinically used measures of central visual function were influenced by the method of monocular occlusion used. Twenty young visually normal subjects were tested both monocularly and binocularly using an Australian Vision Chart No. 5 (which includes high and low contrast letters) and the Pelli-Robson letter chart. During monocular assessments, the non-tested eye was occluded with either a translucent (frosted) diffuser, a +1.50 D (fogging) lens, or a white opaque occluder. A significant difference in monocular sensitivity between the three occluder types was found for Pelli-Robson contrast sensitivity, and the high and low contrast letter acuities, with poorest performance being recorded with the opaque occluder in all cases. The same trend was evident in the derived binocular summation ratios which were found to vary with the type of occluder used before the non-tested eye, as well as with the visual function measured. The data imply that binocular interactions occur during 'monocular' testing of central visual function and that these interactions vary with the method of occlusion used. The clinical ramifications of these results are discussed.