Jorge Burgos

A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term

To determine the factors associated with the success rate of external cephalic version (ECV) for breech presentation at term.

Ovarian hyperstimulation secondary to ectopic secretion of follicle-stimulating hormone. Literature review prompted by a case

OBJECTIVE To present an exceptional clinical case of functional follicle-stimulating gonadotropin secretion by a thorax neuroendocrine carcinoid tumor. DESIGN Case report. SETTING Department of Obstetrics and Gynecology, Cruces University Hospital, Vizcaya, Spain. PATIENT(S) A 26-year-old woman with ovarian hyperstimulation. INTERVENTION(S) Diagnosis algorithm. MAIN OUTCOME MEASURE(S) Successful management of ovarian hyperstimulation. RESULT(S) A 26-year-old woman seen with abdominal pain and swelling had bilateral multicystic ovaries. The diagnosis algorithm revealed the presence of ovarian hyperstimulation but with no due etiology. On the basis of the persistence of high levels of FSH a computed tomographic scan was taken looking for an FSH-producing neuroendocrine tumor. CONCLUSION(S) In idiopathic ovarian hyperstimulation secondary to supraphysiologic secretion of FSH, the presence of an FSH-producing neuroendocrine tumor should be considered. As far as we know, there are no similar cases with a confirmed diagnosis published in the literature.

Clinical score for the outcome of external cephalic version: A two-phase prospective study

Aim:  To design a score based on clinical parameters to predict the outcome of external cephalic versions (ECVs) at term.

Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study.

To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section.

Influence of chorionicity in intra-partum management of twin deliveries.

Objective: To analyze morbidity and mortality in twin pregnancies as a function of the type of delivery and chorionicity. Design: Retrospective cohort study. Methods: Analysis of the type of delivery, intertwin time interval, and perinatal variables of >1000 twin deliveries during a 10-year period. Main outcome measure: Influence of delivery type and chorionicity on perinatal outcome. Results: The rate of cesarean sections was 42.4%. No differences were found as a function of chorionicity or as a function of presentation of the second twin. Cesarean sections were performed after vaginal delivery of the first twin in 1.8% of cases, being more common if the second baby was in a non-cephalic presentation (6.9% vs. 0.4%, p < 0.05). The average twin-to-twin delivery time interval was longer in the cases where the second had a cephalic presentation (8.26 ± 7.75 min vs. 6.81 ± 5.97 min, p < 0.05). The umbilical artery pH was lower the longer the interval between the birth of the twins, both in monochorionic and dichorionic. Conclusions: According to the results, vaginal delivery is as safe as elective caesarean section in twin pregnancies where the first twin is in cephalic presentation and the intrapartum management should not vary due to chorionicity.

Does fetal weight estimated by ultrasound really affect the success rate of external cephalic version

Objective. To determine whether fetal weight estimated by ultrasound on the day the external cephalic version (ECV) is related to the procedures success rate. Design. Retrospective cohort study. Setting. University hospital. Population or sample. Two hundred women with a singleton pregnancy undergoing an ECV attempt between March 2002 and March 2006. Method. Projected birthweight at delivery was calculated. Logistic regression analysis, by grams and by weight intervals, and multiple correspondence analysis were performed to determine whether or not the weight was related to the procedures success. Specific statistical analysis was undertaken to minimize measurement bias in fetal weight estimation. Main outcome measure. Success of ECV in relation to estimated fetal weight. Results. Measurement bias was ruled out because no statistically significant differences were identified with the Students t‐test (p>0.05), Bland–Altmans agreement analysis, and the interclass correlation coefficient analysis (ICC = 0.829; CI95% 0.772–0.871; p<0.01). By logistic regression analysis, a variable relation between fetal weight estimated by ultrasound and ECV success was detected, while multiple correspondence analysis suggested that variations in fetal weight are weakly related to the procedures success or failure. No relation was identified between ECV and birthweight (p = 0.38) when the delivery took place in the same week as the version. Conclusions. Estimated fetal weight before ECV seems not to be related to the outcome of ECV.

Nitrous oxide for analgesia in external cephalic version at term: prospective comparative studya

Abstract Objective: The objective of this study was to analyze the effect of using inhaled nitrous oxide (N2O) for analgesia in external cephalic version (ECV) at term on the success rate of the procedure, on pain, and on obstetric and perinatal outcomes. Methods: A prospective comparative cohort study among 300 women with singleton pregnancy in breech presentation at term undergoing an ECV with inhaled N2O in a 50:50 mix with oxygen for analgesia and 150 ECVs with no analgesia. Results: The success rate was 52.3% in the N2O cohort and 52.7% in the controls (P=0.94), whereas the median level of pain was statistically lower in women given N2O (median, 6; range, 4–7, vs. median, 7; range, 5–8; P<0.01). This improvement is mainly from a 49% decrease in severe pain. There were no significant differences in the rate of complications associated with the ECV, in the rate of cesarean sections, or in perinatal outcomes. Furthermore, there were no severe complications secondary to N2O inhalation. Conclusions: N2O inhalation at a concentration of 50% for analgesia during ECV decreases the level of severe pain experienced by women, appears to be safe both for mother and child, and has no influence on the success rate of ECV or the perinatal outcomes.

Induction at 41 weeks increases the risk of caesarean section in a hospital with a low rate of caesarean sections.

Objective: To analyse the impact of a change in the management of prolonged pregnancies from inducing labour at 42+0 to induction at 410–6. Design: Retrospective cohort study. Methods: Analysis of 3563 single pregnancies with cephalic presentation of ≥ 41 weeks of gestation delivered in Cruces University Hospital (Spain). Two cohorts were compared corresponding to before and after the change in the policy on induction. Main outcome measures: Induction rate, vaginal delivery rate, newborn morbidity and mortality. Results: The overall rate of caesarean sections in the patients included in the study was 12.8% (19.5% among those induced and 8.4% among those in whom the onset of labour has been spontaneous). The caesarean section rate in cohorts 410–6 and 42+0 were 14.1% and 11.4%, respectively (p = 0.01). Though there were more newborns with umbilical cord blood ph<7.10 in cohort 410–6 than in the other group (8.7% versus 4.5%; p < 0.01), no significant differences were found between cohorts in 5-min Apgar score < 7, number of admissions to the neonatal care unit or perinatal mortality. Conclusion: The induction of labour during week 41 in prolonged pregnancies may increase the rate of caesarean sections in hospitals with low rates of caesarean sections.

Oxytocin versus dinoprostone vaginal insert for induction of labor after previous cesarean section: a retrospective comparative study

Abstract Objective: To compare the efficacy and safety of two methods for induction of labor after previous cesarean section. Methods: To compare 247 women with a previous cesarean section who were induced with a dinoprostone vaginal insert and 279 women with a previous cesarean section induced with oxytocin, between 2001 and 2008. We evaluated vaginal delivery rate, maternal morbidity and newborn morbidity and mortality. Results: The overall rate of vaginal delivery was 65.2%. We did not find significant differences between induction with dinoprostone vaginal insert and oxytocin in the rate of cesarean section performed (35.6% vs. 34.1%, P=0.71). There were nine cases of uterine rupture (rate of 1.7%), of which four occurred with dinoprostone vaginal insert and five when using oxytocin (P=0.89). We found no significant differences in neonatal outcomes. Conclusions: Both tested methods appear to be equally safe and effective for induction of labor in women with a previous cesarean section.

Análisis del dolor en la versión cefálica externa

Resumen Objetivo Analizar el dolor materno durante la version cefalica externa. Material y metodos Estudio prospectivo en 71 pacientes, en el Hospital de Cruces, entre abril de 2005 y abril de 2006, mediante una encuesta personal tras la version. Esta incluia una «escala numerica» de evaluacion del dolor, asi como preguntas relacionadas con el procedimiento. Se han analizado los resultados en funcion del exito o fracaso del procedimiento. Resultados La tasa de exito global fue del 50,7%. Todas las gestantes lo toleraron bien y no hubo ninguna complicacion. La mediana global de dolor fue 7; fue 5 en las versiones con exito frente a 8 en las que fracaso (p Conclusiones La version cefalica externa es un procedimiento bien tolerado, probablemente debido a su brevedad, si bien es un procedimiento no exento de dolor.