Ashis Sau

Vacuum extraction: is there any need to improve the current training in the UK?

Objective.  The objective of this study was to assess the use and efficacy of delivery by vacuum extraction or ventouse in routine clinical practice and to assess some aspects of the procedure that may reflect the quality of training in this technique.

Third Trimester Intrauterine Fetal Death Caused by Arterial Aneurysm of the Umbilical Cord

Umbilical artery aneurysm (UAA) of the umbilical cord is an extremely rare lesion, with only 8 reported cases in the English-language literature; 7 of these were associated with significant fetal morbidity or mortality and 4 were associated with fetal trisomy 18. We report an additional case of UAA with normal karyotype that resulted in intrauterine growth restriction and fetal demise. It has been suggested that these aneurysms cause fetal hypoxia and intrauterine fetal death, either by compression of the umbilical vein or by acute kinking of the umbilical cord. Cytogenetic analysis should be performed in all cases diagnosed with this unusual lesion, and placental mosaicism for trisomy 18 should be excluded.

Nonsurgical diagnosis and management of ectopic pregnancy

Laparoscopy is not mandatory for the diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan together with colour Doppler and estimation of quantitative β‐human chorionic gonadotrophin (β‐hCG). The role of expectant management in ectopic pregnancy is limited. Spontaneous resolution occurs only in selected groups of women typically with an unruptured ectopic pregnancy and an initial β‐hCG of <1o00 miu/ml, which is declining. Measurement of serum progesterone levels may be helpful in identifying this group. Systemic methotrexate administration is a promising treatment in patients with early and unruptured ectopic pregnancy. It preserves fertility with no morbidity of surgery.

Management of red cell alloimmunized pregnancies using conventional methods compared with that of middle cerebral artery peak systolic velocity

The aim of this retrospective study was to find out the effect of change in the management of red cell alloimmunized pregnancies from conventional method of amniocentesis to the Doppler assessment of middle cerebral artery peak systolic velocity (MCA‐PSV). There were 29 alloimmunized pregnancies affected by red cell antibodies. Ten cases were managed by amniocentesis and another 19 were managed by MCA‐PSV measurements. The antenatal management and perinatal outcome of both groups are presented. This study suggests that the non‐invasive monitoring should be the method of choice to monitor alloimmunized pregnancies.

Treatment of unruptured ectopic pregnancy with methotrexate

Ectopic pregnancy is an increasing health risk for women throughout the world. The modern diagnostic technology allows earlier detection of ectopic pregnancy. With early diagnosis there is a trend towards more conservative approach in the management. Although medical management with methotrexate has been used successfully in the USA for a decade, the experience in the UK is limited. A recent postal survey (1) has shown that less than 4% of hospitals in the UK are routinely using medical treatment for ectopic pregnancy. We report our experience in managing unruptured ectopic pregnancy with methotrexate.