role of umblical artery velocimetry in the management of postdate pregnancy

The purpose of this study was to assess the clinical value of Doppler ultrasound as regards pregnancy outcome in postdate pregnancy. Ninety-four pregnant women clinically diagnosed as postdate pregnancy were regularly monitored with Doppler velocity wave-form recording of umbilical arteries. The results showed that cases with abnormal Doppler umbilical artery velocity had higher incidence of operative delivery and neonatal intensive care admission at birth. There was a significant risk of acidosis and hypoxia in cases with absent or reversed end diastolic flow as indicated by significant changes of umbilical artery pH, PO2, PCO2, base deficit and bicarbonates. Doppler study of the umbilical artery blood flow is an important criterion during the assessment of postdate pregnancies

Endovaginal versus transabdominal assessment of bleeding during early pregnancy

This study was aimed at evaluating the accuracy, diagnostic and prognostic values of vaginal ultrasound as compared to abdominal ultrasound in women with vaginal bleeding in early pregnancy. A prospective study of 196 women consecutively were admitted to Northern Area Armed Forces Hospital. Saudi Arabia, with vaginal bleeding and provisionally diagnosed as threatened abortion or suspected ectopic pregnancy. Both transabdominal and vaginal ultrasound examinations were done to all eases and the results were compared to the clinical pregnancy outcome and statistically analyzed. Fifteen non pregnant cases were excluded from the study. Among 181 women of the study, 111 cases [16.3%] had clinically intact pregnancy. Vaginal US diagnosed an intrauterine pregnancy with fetal pole and cardiac activity in 111 cases at first examination while abdominal US reported that in 97 eases only. The difference was statistically significant. Anembryonic pregnancy was suspected in 38 cases by abdominal US, while vaginal US detected fetal pole in 15 out of these cases and diagnosed anembryonic pregnancy in 23 cases [P< 0.05]. Missed abortion was suggested in 23 cases with abdominal US, while vaginal US detected cardiac activity in larger number of cases and diagnosed missed abortion only in 11 cases [P< 0.05] and coinciding with the clinical outcome. Ectopic pregnancy was surgically diagnosed in eight cases who were vaginally diagnosed, while abdominal US strongly suggested ectopic in three cases out of eight, the difference was highly significant [P< 0.01]. There were no significant differences in diagnosis of complete abortion, incomplete abortion and hydatiform mole with the use of either abdominal or vaginal US. Vaginal scan is an accurate, informative diagnostic measure in early pregnancy complications. It has a higher diagnostic and prognostic values compared to abdominal scan in pathological diagnosis of intact pregnancy, missed abortion, anembryonic and ectopic pregnancies. It is recommended to he carried out at the time of pelvic examination when the clinical indication was first encountered

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