Effect of gonadal steroid receptors alterations on the pathophysiology of pelvic organ prolapse and urinary incontinence.

BACKGROUND: The aim of this study was to investigate the contribution of the gonadal steroid receptors expression to the pathophysiological pathways of pelvic organ prolapse (POP) and urodynamic stress urinary incontinence (USUI) after menopause. METHODS: This was a prospective closely-matched controlled clinicopathological study. Immunohistochemistry for estrogen receptor isoform α (ER-α) and ß (ER-ß), as well as for progesterone receptor (PR), was performed on formaline-fixed and paraffin-embedded sections of specimens coming from the pubocervical fascia of postmenopausal women who were allocated into three groups: patients with synchronous POP and USUI (Group A), patients diagnosed with only POP (Group B), and patients without POP or USUI who underwent gynecological surgery for another benign indication (control group, Group C). RESULTS: There was no statistically significant difference among the three groups for age, parity, body mass index, or smoking. The expression of ER-α receptors was found significantly reduced among samples of Group B when compared with control group. Statistically significant reduction not only for ER-α, but for ER-ß, as well, was noticed among samples of Group A, compared to the other two groups. No remarkable differences concerning the density of PR receptors were observed among the three groups. CONCLUSIONS: Alterations of ER-α in the pubocervical fascia and around the urethra in postmenopausal women may play an important role in the pathophysiology of POP. In addition, the risk for developing USUI among POP patients seems to be strongly associated with the reduction of both estrogen receptors (ER-α and ER-ß) expression.

Protein expression in the brain of rat offspring in relation to prenatal caloric restriction.

OBJECTIVE: Intrauterine growth restriction (IUGR) has been associated with decreased supply of crucial substrates to the fetus and affects its growth and development by temporarily or permanently modifying gene expression and function. However, not all neonates born by calorie restricted mothers are IUGR and there are no reports regarding their brain protein expression vis-à-vis that of their IUGR siblings. Here, we investigated the expression of key proteins that regulate growth and development of the brain in non-IUGR newborn pups versus IUGR siblings and control pups. METHODS: Rat brain proteins were isolated from each group upon delivery and separated by two-dimensional gel electrophoresis (2-DE). RESULTS: 14-3-3 Protein, calreticulin, elongation factor, alpha-enolase, fascin, heat-shock protein HSP90 and pyruvate kinase isozymes were significantly increased (p < 0.05) in samples obtained from IUGR newborn pups compared to non-IUGR. Conversely, collapsin response mediator proteins, heat-shock70 and peroxiredoxin2 were decreased in IUGR group compared to non-IUGR. CONCLUSIONS: In our experimental study, IUGR pups showed an altered proteomic profile compared to their non-IUGR siblings and non-IUGR controls. Thus, not all offspring of calorie-restricted mothers become IUGR with the accompanying alterations in the expression of proteins. The differentially expressed proteins could modulate alterations in the energy balance, plasticity and maturation of the brain.

Hofbauer cells morphology and density in placentas from normal and pathological gestations.

PURPOSE: In placentas from uncomplicated pregnancies, Hofbauer cells either disappear or become scanty after the fourth to fifth month of gestation. Immunohistochemistry though, reveals that a high percentage of stromal cells belong to Hofbauer cells. The aim of this study was to investigate the changes in morphology and density of Hofbauer cells in placentas from normal and pathological pregnancies. METHODS: Seventy placentas were examined: 16 specimens from normal term pregnancies, 10 from first trimester's miscarriages, 26 from cases diagnosed with chromosomal abnormality of the fetus, and placental tissue specimens complicated with intrauterine growth restriction (eight) or gestational diabetes mellitus (10). A histological study of hematoxylin-eosin (HE) sections was performed and immunohistochemical study was performed using the markers: CD 68, Lysozyme, A1 Antichymotrypsine, CK-7, vimentin, and Ki-67. RESULTS: In normal term pregnancies, HE study revealed Hofbauer cells in 37.5% of cases while immunohistochemistry revealed in 87.5% of cases. In first trimester's miscarriages and in cases with prenatal diagnosis of fetal chromosomal abnormalities, both basic and immunohistochemical study were positive for Hofbauer cells. In pregnancies complicated with intrauterine growth restriction or gestational diabetes mellitus, a positive immunoreaction was observed in 100 and 70% of cases, respectively. CONCLUSIONS: Hofbauer cells are present in placental villi during pregnancy, but with progressively reducing density. The most specific marker for their detection seems to be A1 Antichymotrypsine. It is remarkable that no mitotic activity of Hofbauer cells was noticed in our study, as the marker of cellular multiplication Ki-67 was negative in all examined specimens.

Hofbauer cells morphology and density in placentas from normal and pathological gestations / Morfologia e densidade das células de Hofbauer em placentas de gestações normais e patológicas

PURPOSE: In placentas from uncomplicated pregnancies, Hofbauer cells either disappear or become scanty after the fourth to fifth month of gestation. Immunohistochemistry though, reveals that a high percentage of stromal cells belong to Hofbauer cells. The aim of this study was to investigate the changes in morphology and density of Hofbauer cells in placentas from normal and pathological pregnancies. METHODS: Seventy placentas were examined: 16 specimens from normal term pregnancies, 10 from first trimester's miscarriages, 26 from cases diagnosed with chromosomal abnormality of the fetus, and placental tissue specimens complicated with intrauterine growth restriction (eight) or gestational diabetes mellitus (10). A histological study of hematoxylin-eosin (HE) sections was performed and immunohistochemical study was performed using the markers: CD 68, Lysozyme, A1 Antichymotrypsine, CK-7, vimentin, and Ki-67. RESULTS: In normal term pregnancies, HE study revealed Hofbauer cells in 37.5% of cases while immunohistochemistry revealed in 87.5% of cases. In first trimester's miscarriages and in cases with prenatal diagnosis of fetal chromosomal abnormalities, both basic and immunohistochemical study were positive for Hofbauer cells. In pregnancies complicated with intrauterine growth restriction or gestational diabetes mellitus, a positive immunoreaction was observed in 100 and 70% of cases, respectively. CONCLUSIONS: Hofbauer cells are present in placental villi during pregnancy, but with progressively reducing density. The most specific marker for their detection seems to be A1 Antichymotrypsine. It is remarkable that no mitotic activity of Hofbauer cells was noticed in our study, as the marker of cellular multiplication Ki-67 was negative in all examined specimens.

OBJETIVO: Em placentas de gestações sem complicações, as células de Hofbauer desaparecem ou se tornam raras após o quarto ou quinto mês de gestação. Entretanto, a imunohistoquímica revela que uma alta porcentagem de células estromais pertencem às células de Hofbauer. O objetivo do presente estudo foi investigar as alterações da morfologia e densidade das células de Hofbauer em placentas de gestações normais e patológicas. MÉTODOS: Foram examinadas 70 placentas: 16 provenientes de gestações normais a termo, 10 de abortos espontâneos no primeiro trimestre, 26 de casos diagnosticados como anormalidade cromossômica do feto, e amostras de tecido placentário com complicações causadas pela restrição de crescimento intrauterino (8) ou pelo diabetes mellitus gestacional (10). Cortes corados com hematoxilina-eosina (HE) foram submetidos a estudo histológico e imunohistoquímico utilizando-se os seguintes marcadores: CD 68, lisozima, antiquimotripsina A1, CK-7, vimentina, e Ki-67. RESULTADOS: Em gestações normais a termo, o estudo HE revelou células de Hofbauer em 37,5% dos casos, enquanto a imunohistoquímica as revelou em 87,5% dos casos. Em abortos do primeiro trimestre e em casos de diagnóstico prenatal de anormalidades cromossômicas fetais, tanto o estudo básico como o estudo imunohistoquímico foram positivos para células de Hofbauer. Em gestações complicadas pela restrição de crescimento intrauterino ou pelo diabetes mellitus gestacional, imunoreação positiva foi observada respectivamente em 100 e 70% dos casos. CONCLUSÕES: As células de Hofbauer estão presentes nos vilos placentários durante a gestação, embora com densidade progressivamente reduzida. O marcador mais específico para sua detecção parece ser a antiquimotripsina A1. Vale salientar que atividade mitótica de células de Hofbauer não foi detectada em nosso estudo, uma vez que o marcador de multiplicação celular Ki-67 foi negativo em todas as amostras examinadas.

Changes in hormonal profile and seminal parameters with use of aromatase inhibitors in management of infertile men with low testosterone to estradiol ratios.

OBJECTIVE: To compare the effects of 2.5 mg letrozole with those of 1 mg anastrazole daily on the hormonal and semen profiles of a subset of infertile men with low T/E(2) ratios. DESIGN: Prospective, nonrandomized study. SETTING: Reproductive medicine clinic. PATIENT(S): The study group consisted of 29 infertile men with a low serum T/E(2) ratio (<10). INTERVENTION(S): Patients were divided into two groups. Group A included 15 patients treated with 2.5 mg letrozole orally once daily for 6 months, and Group B consisted of 14 patients treated with 1 mg anastrazole orally every day for 6 months. MAIN OUTCOME MEASURE(S): Hormonal evaluation included measurement of serum FSH, LH, PRL, T, and E(2). In all sperm analyses pretreatment and posttreatment total motile sperm counts (ejaculate volume × concentration × motile fraction) were evaluated. RESULT(S): The use of aromatase inhibitors (either letrozole or anastrazole) in cases of infertile men with low T/E(2) ratios improved both hormonal and semen parameters. CONCLUSION(S): This study suggests that some men with severe oligospermia, low T levels, and normal gonadotropin concentration may have a treatable endocrinopathy.

Maternal mortality in Greece, 1996-2006.

OBJECTIVE: To present retrospective data for maternal deaths in Greece from 1996 to 2006. METHODS: Demographic information and information on the causes of death was provided by the Hellenic Statistical Authority. Maternal deaths were assessed by cause of death, maternal age, and place of residence. The maternal mortality ratio (MMR) was estimated and expressed as the number of deaths per 100,000 live births. RESULTS: From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth, yielding a total MMR of 2.63. The leading cause of direct deaths was hemorrhage and that of indirect deaths was cardiac disease. There was a borderline significant decline in the MMR during the study period. The MMR was significantly higher at the extremes of the reproductive age range. CONCLUSION: Maternal mortality in Greece is low; however, no formal data have been published since 1996. Knowledge of the causes of maternal death can lead to the prevention of maternal deaths and safer motherhood.

Role of gonadotropin-releasing hormone antagonist in the management of subfertile couples with intrauterine insemination and controlled ovarian stimulation.

OBJECTIVE: To assess whether the clinical pregnancy rate of patients treated with recombinant FSH and IUI can be improved by the addition of a GnRH antagonist. DESIGN: Prospective, controlled study. SETTING: Reproductive medicine clinic. PATIENT(S): Ninety-three patients with primary or secondary infertility. INTERVENTION(S): Patients were allocated to controlled ovarian stimulation with recombinant FSH (50-150 IU/d) only (control group, n=45) or to recombinant FSH (50-150 IU/d) plus ganirelix (0.25 mg/d, starting when the leading follicle was ≥16 mm; n=48). A single insemination was performed 36 hours after hCG was given (10,000 IU, IM) in both groups. Both groups were allowed at least three cycles. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate, premature luteinization rate, and follicular development. RESULT(S): Clinical pregnancy rate (22% vs. 11%), cumulative pregnancy rate (52% vs. 31%), and number of mature follicles (2.1±1.08 vs. 1.4±0.95) were statistically significantly higher in the ganirelix group compared with the control group. The premature luteinization rate was significantly lower in the ganirelix group (1.7% vs. 17.5%). CONCLUSION(S): The use of a GnRH antagonist in conjunction with controlled ovarian stimulation and IUI significantly increases pregnancy rates and reduces the incidence of premature luteinization.

Comparison of the TVT SECUR System "hammock" and "U" tape positions for management of stress urinary incontinence.

OBJECTIVE: To assess the efficacy and complications associated with use of the TVT SECUR System device with placement of the tape in either a "hammock" or "U" position for management of stress urinary incontinence (SUI). METHODS: A prospective study of patients with SUI allocated into one of two groups: "hammock" or "U" tape placement. Preoperative urodynamic results were compared with results at the 6-month and 1-year follow up. Outcome measures were objective cough test assessment and subjective patient responses to a questionnaire at follow up. RESULTS: Of 82 patients included in the study, 43 comprised the "hammock" group and 39 comprised the "U" group. The objective cure rate at 1-year follow up was 62.8% (n=27) in the "hammock" group and 71.8% (n=28) in the "U" group. At 1-year follow up, the subjective cure, improvement, and failure rates for the "hammock" group were 60.5%, 13.9%, and 25.7% respectively, and 69.2%, 12.8%, and 17.9% respectively, for the "U" group. CONCLUSION: The efficacy of the TVT SECUR System was lower (<72%) than the cure rates reported for other TVT procedures; further studies are required.

Epidemiology of female urinary incontinence in the Greek population: EURIG study.

INTRODUCTION AND HYPOTHESIS: We estimated the current prevalence of urinary incontinence (UI) in the female Greek population, estimated the prevalence of the subtypes of UI, and assessed its impact on patients' quality of life. METHODS: The study was performed by personal interview based on structured questionnaires, and 2,000 Greek women (from the whole of Greece) aged between 20 and 80 years old participated in the study. RESULTS: The prevalence of UI in a female Greek population comprising women aged between 20 and 80 years was 27%. The impact was proportional to the frequency and severity of the UI. UI had no effect or only a mild effect on patients' quality of life. CONCLUSION: Significant improvement is required in patient information about the nature of UI and its effects on life, and about available treatments (conservative and surgical), and their efficacy and complications.

Abnormal progesterone and corticotropin releasing hormone levels are associated with preterm labour.

INTRODUCTION: This study examined whether maternal plasma progesterone and corticotropin releasing hormone (CRH) concentrations can predict the likelihood of preterm labour. MATERIALS AND METHODS: Maternal plasma progesterone and CRH concentrations were examined in a total of 51 women. The subject cohort included 20 women who were followed from the beginning of the third trimester (28 to 34 weeks gestation), half of whom delivered early preterm and half of whom were not in labour and subsequently delivered at full term (n = 10 per group). In a follow-up experiment, 31 women who were admitted during labour for delivery were examined, 15 of whom delivered preterm and 16 of whom delivered at full term. Comparisons between women who delivered preterm and those who delivered at full term were made by t-tests. RESULTS: Mean progesterone concentration was approximately 30% lower at 28 to 34 weeks gestation in women who delivered prematurely than in women who delivered at term (P < 0.001). Meanwhile, mean CRH concentration was 6-fold higher at 28 to 34 weeks gestation in women who experienced spontaneous preterm labour than in those who went into labour at term (P < 0.001). Preterm mothers had lower progesterone (P < 0.05) and CRH (P < 0.01) levels during active labour than full-term mothers. Progesterone levels normalised within 24 hours of delivery in preterm mothers, while CRH levels remained slightly elevated (P < 0.01). CONCLUSIONS: Maternal progesterone and CRH measurements taken early in the third trimester may be of use as biochemical markers of pregnancies at high risk of premature labour.

Prevalence of different HPV types and estimation of prognostic risk factors based on the linear array HPV genotyping test.

The aim of the study was to evaluate the prevalence and risk factors of HPV in a gynecologic population attending outpatient clinics using two new molecular tests. The Amplicor HPV test and the Linear Array (LA) HPV Genotyping test were used for the detection of HPV DNA in 320 women. Multiple logistic regression was used to identify independent prognostic factors of HPV positivity. The agreement between the two methods in terms of their qualitative results was 89.3% (kappa: 0.63). Based on the LA results, the overall prevalence of HPV DNA was 49.1%, 95% confidence interval (95% CI: 43.5%, 54.7%). The prevalence of high-risk HPV types was 30.3%. The predominant types were HPV-6 (24.8%) and HPV-16 (20.4%). Among women with normal cytology, the prevalence of HPV was much higher in those presenting other findings, such as inflammation, than those without other abnormal findings (49.5% vs. 31.5%). On the basis of multivariate analysis, the risk of HPV infection was higher among women with multiple sexual partners [>3 vs. 1: OR = 3.1, 95% CI: (1.5, 7.2)], Pap smear findings [low/high-grade lesions vs. negative: OR = 2.8, 95% CI: (1.2, 6.5)], the presence of warts [yes vs. no: OR = 3.0, 95% CI: (1.5, 6.3)] and no history of child birth [no vs. yes: OR = 2.6, 95% CI: (1.0, 6.7)]. Younger age was an additional risk factor for HPV infection with carcinogenic genotypes [OR for 1 year increase = 0.93, 95% CI: (0.89, 0.98)].

Tension-free vaginal tape in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape.

BACKGROUND: Data about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited. OBJECTIVE: Assessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP. DESIGN, SETTING, AND PARTICIPANTS: Thirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center. MEASUREMENTS: Preoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2-3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6 mo (range: 12-28 mo). RESULTS AND LIMITATIONS: Overall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients' answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured. CONCLUSIONS: The TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures.

Estrogen receptor alpha and beta in uterine fibroids: a basis for altered estrogen responsiveness.

OBJECTIVE: To investigate the relative expression and the DNA-binding status of estrogen receptors alpha and beta in fibroids and normal myometrial tissue to explore the molecular basis of altered estrogen responsiveness of leiomyomas. DESIGN: Biopsy samples from uterine fibroids and adjacent normal myometrial tissue at the follicular phase of the menstrual cycle. SETTING: Aretaieio University Hospital and the National Hellenic Research Foundation, Athens, Greece. PATIENT(S): Thirty-five patients who underwent hysterectomy or myomectomy because of myoma symptoms. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Deoxyribonucleic acid-binding status of estrogen receptors alpha and beta. RESULT(S): The level of messenger RNA expression of estrogen receptor alpha and beta and the level of estrogen receptor as a whole are increased on average to a similar extent in leiomyomas compared with normal myometrium. Occasionally, however, estrogen receptor alpha is disproportionately increased in leiomyomas, and this appears to increase the amount of estrogen receptor alpha that binds to the estrogen-responsive element of estrogen target genes as homodimer rather than as heterodimer with estrogen receptor beta. CONCLUSION(S): The estrogen receptor alpha-to-estrogen receptor beta expression ratio rather than the individual expression levels determines the fraction of DNA-binding homodimers of estrogen receptor alpha and possibly the growth potential of myomas.

Quality of life in relation to TVT procedure for the treatment of stress urinary incontinence.

BACKGROUND: The aim of the study was to assess the impact of tension-free vaginal tape (TVT) procedure as anti-incontinence surgery on patients' urinary symptoms and quality of life. METHODS: Ninety-eight patients participated in the study. All patients were operated for urodynamic stress incontinence with the TVT procedure. Patients with prolapse more than first degree according to International Continence Society classification, previous anti-incontinence surgery, detrusor overactivity, or intrinsic sphincter deficiency were excluded from the study. Patients' quality of life assessment was performed with the use of the short form of Incontinence Impact Questionnaire and short form of Urinary Distress Inventory (UDI-6). RESULTS: Mean follow-up time was 12.4 +/- 4.2 months (range: 6-18 months). The cure rate for TVT procedure was 87.6%. There was a statistically significant improvement of quality of life postoperatively. In addition, the domains of UDI-6 concerning irritative symptoms and stress urinary incontinence symptoms showed statistically significant improvement postoperatively, while the domain concerning obstructive symptoms did not show statistically significant difference. CONCLUSIONS: Tension-free vaginal tape procedure as anti-incontinence surgery significantly improves the quality of life in female patients with urodynamic stress incontinence.

Tension-free vaginal tape versus tension-free vaginal tape obturator in women with stress urinary incontinence.

BACKGROUND: To assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator in women with urodynamic stress incontinence. METHODS: Prospective, randomized study. Initially, 91 patients were included in the study and 89 of them were available at 12 months follow-up. Forty-six patients were subjected to classic TVT procedure and 43 to transobturator vaginal tape from inside to outside (TVT-O) operation. There was no significant difference between the groups for age, BMI, menopausal status and prolapse. No patients had cystocele greater than stage I. Subjective and objective cure and improvement rate, mean operative time, hospital stay and complications incidence were assessed. RESULTS: Mean operative time was significant shorter in the TVT-O group (17.4 +/- 6.9 min) compared to the TVT group (26.7 +/- 8.6 min). There was no significant difference in the duration of hospital stay between two groups. The objective cure rate for TVT group was 89%, the improvement rate was 6.5%, the failure rate was 4.3% and the subjective cure rate 73.9%. The objective cure rate for TVT-O group was 90%, the improvement rate was 7.6%, the failure rate was 2.5% and the subjective cure rate 76.7%. The hemoglobin loss ranged between 1.0 +/- 0.5 g/dl for TVT group and 0.9 +/- 0.4 g/dl for TVT-O group. CONCLUSION: The TVT-O technique presents success rates comparable to the classic TVT method in the short term.

Androgen levels in the third trimester of pregnancy in patients with preeclampsia.

OBJECTIVE(S): To investigate if testosterone levels are higher in patients with preeclampsia compared to normotensive pregnant patients. STUDY DESIGN: The levels of serum total and free testosterone, dehydroepiandrosterone sulfate, androstenedione and sex hormone binding globulin were estimated in 28 patients during the third trimester of pregnancy with established preeclampsia and 25 normotensive women. RESULTS: No statistically significant differences were noted between the two groups regarding the maternal age, gestational age, body mass index (BMI) haematocrit and neonatal sex. The mean+/-S.D. total testosterone and free testosterone levels were significantly higher (p < 0.01) in the group with preeclapsia compared to the control group. The values of DHEA-S, androstenedione and sex hormone binding globulin were lower in the group with preeclampsia but the difference did not reach statistical significance. CONCLUSION(S): The levels of total and free testosterone appear to be higher in patients with preeclampsia compared to normotensive pregnant women during the third trimester of pregnancy. This difference could indicate an involvement of testosterone in the pathophysiology of preeclampsia and stimulates research in the potential role of anti-androgens in the management of preeclampsia.

The influence of vacuum extractor on fetal oxygenation and newborn status.

AIM: The aim of this study was to determine the effects of vacuum extractor assisted delivery on fetal oxygenation and acid-base balance. METHODS: Sixty-one women were enrolled in the present study. The subjects were divided into two groups. Group A, consisting of 39 women, had normal vaginal deliveries. Group B, consisting of 22 women, underwent a vacuum extractor assisted vaginal delivery. Fetal arterial oxygen saturation (SpO2) monitoring was used in all women after full cervical dilatation. After delivery, umbilical artery pH, pCO2, pO2 and base deficit (BDecf) levels were determined in all neonates. RESULTS: The mean FSpO2 value in Group A was 51.53+/-5.87% and in Group B 48.03+/-6.39% (p<0.03). The mean cord pH value in fetuses of Group A was 7.26+/-0.05, and in Group B 7.17+/-0.09. There was also a significant difference between the two groups with regards to mean pO2, pCO2 and BDecf values. CONCLUSIONS: Vacuum assisted vaginal delivery was associated with lower fetal arterial oxygen saturation levels as well as lower cord blood pH values compared to those seen after unassisted vaginal delivery. Although decreased, however, the above parameters remained within normal ranges.

Severe variable decelerations and fetal pulse oximetry during the second stage of labor.

OBJECTIVES: The aim of the study was to investigate the usefulness of fetal pulse oximetry in cases of severe variable decelerations in the second stage of labor. METHODS: It is a prospective study including 58 patients. Thirty-eight patients (group A) had a normal uncomplicated labor and 20 patients (group B) developed severe variable decelerations during the second stage of labor. All patients were primiparous with normal pregnancies and had electronic fetal monitoring of labor in conjunction with fetal pulse oximetry. An estimation of fetal pH and base deficit was performed at delivery in all patients. RESULTS: There was no statistically significant difference in relation to maternal age and gestational age between the two groups. Group A patients did not delivered neonates with metabolic acidosis. Six out of 20 (group B) patients delivered neonates with a pH <7.10 despite a fetal pulse oximetry reading of >30%. CONCLUSIONS: It appears that fetal pulse oximetry is not capable of detecting pre-acidotic or acidotic fetuses during the second stage of labor in patients with severe variable decelerations and the management of such patients should be supported by fetal scalp pH when indicated or otherwise the obstetrician should expedite delivery either with assisted operative delivery or cesarean section. Fetal heart rate monitoring was introduced into clinical practice over 30 years ago. It continues to be the predominant method of intrapartum fetal surveillance despite worries about its accuracy and efficacy.