Serum and cervico-vaginal glycodelin concentrations as predictors of successful implantation after embryo transfer.

OBJECTIVE: Evaluation of glycodelin (Gd) concentrations in serum and cervico-vaginal secretions as a predictor for implantation after ICSI. MATERIALS AND METHODS: Prospective study on 50 women undergoing ICSI where long protocol ovarian stimulation was used. Serum and cervico-vaginal lavage Gd concentrations were measured then rates of biochemical and clinical pregnancy were detected and predictive value was evaluated using logistic regression analysis. RESULTS: Using cut-off values of 2.2 ng/ml and 1.9 ng/ml for serum and cervico-vaginal Gd concentrations respectively for biochemical pregnancy and values of 2.7 ng/ml and 1.3 ng/ml respectively for clinical pregnancy, there was no significant difference regarding sensitivity (72% & 56%, and 72% & 89%, respectively and respectively). Specificity was statistically similar for biochemical pregnancy (72% and 89%, respectively) while specificity was significantly higher for clinical pregnancy using cervico-vaginal Gd concentration of 1.3 ng/ml (88%) compared to serum Gd concentration of 1.9 ng/ml (53%). CONCLUSION: Glycodelin appears to be a promising marker for implantation after IVF/ICSI.

Intrapartum fetal head circumference and estimated fetal weight as predictors of operative delivery.

OBJECTIVE: To assess intrapartum sonographic measurements of fetal head circumference (HC) and estimated fetal weight (EFW) to predict operative delivery. METHODS: In a prospective study, 200 spontaneously parturient primiparous women aged 20-30 years were enrolled at a teaching hospital in Cairo, Egypt, between October 2, 2015, and January 28, 2016. HC and EFW were measured by transabdominal ultrasonography. After delivery, the association between type of delivery and ultrasonography findings was assessed. RESULTS: Intrapartum HC and EFW were significantly higher among women with operative delivery (n=76) than among those with normal vaginal delivery (n=124; P<0.001 for both). Intrapartum HC of 36.8 cm or more was associated with an increased risk of operative delivery (relative risk [RR] 2.87, 95% CI 1.87-4.41), as was EFW of 3920 g or more (RR 3.69, 95% CI 2.13-6.40). The area under the receiver operating characteristic curve was 0.807 and 0.748 for HC and EFW, respectively (P<0.001 for both). At 36.8-cm cutoff, HC had 44.7% sensitivity, 91.9% specificity, 77.3% positive predictive value (PPV), and 73.1% negative predictive value (NPV). At 3920-g cutoff, EFW had 68.4% sensitivity, 82.3% specificity, 70.3% PPV, and 81.0% NPV. Intrapartum HC and EFW were directly correlated with second-stage duration (P=0.005 and 0.002, respectively). CONCLUSION: Intrapartum HC and EFW seem to be good predictors of operative delivery.