Maya Spira

Prophylactic Pelvic Artery Catheterization and Embolization in Women with Placenta Accreta: Can It Prevent Cesarean Hysterectomy?

We present the outcome of a relatively large cohort of women with suspected placenta accreta who underwent prophylactic pelvic artery catheterization prior to cesarean section. All pregnant women with suspected placenta accreta who delivered in one tertiary center were included in this retrospective study. All patients underwent an elective cesarean section with prophylactic pelvic artery catheterization of internal iliac arteries through femoral or brachial approach. Thirty women underwent prophylactic catheterization; placenta accreta was clinically confirmed in 25 (83.3%) cases. Embolization was performed in 23 cases (76.6%) and hysterectomy in 2 (8%). Median estimated amount of blood loss was 2000 mL (500 to 9000 mL). There were no major catheterization-related complications. Three women had a subsequent pregnancy and uncomplicated delivery by cesarean section. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta is safe and effective in prevention of hysterectomy and should be considered in woman wishing to preserve fertility.

Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study

OBJECTIVE To determine the efficacy of a nonsteroidal anti-inflammatory drug vs. paracetamol in pain relief during medical abortion and to evaluate whether nonsteroidal anti-inflammatory drugs interfere with the action of misoprostol. DESIGN A prospective double-blind controlled study. SETTING University-affiliated tertiary hospital. PATIENT(S) One hundred twenty women who underwent first-trimester termination of pregnancy. INTERVENTION(S) Patients received 600 mg mifepristone orally, followed by 400 microg of oral misoprostol 2 days later. They were randomized to receive ibuprofen or paracetamol when pain relief was necessary. Patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10-14 days after medical abortion. MAIN OUTCOME MEASURE(S) Success rates, as defined by no surgical intervention, and pain scores were assessed. RESULT(S) Ibuprofen was found to be statistically significantly more effective for pain relief after medical abortion compared with paracetamol. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% vs. 8.5%). CONCLUSION(S) Ibuprofen was found to be more effective than paracetamol for pain reduction during medical abortion. A history of surgical or medical abortion was predictive for high pain scores. Despite its anti-prostaglandin effects, ibuprofen use did not interfere with the action of misoprostol.

Head progression distance in prolonged second stage of labor: relationship with mode of delivery and fetal head station

To evaluate the clinical significance of fetal head progression distance (HPD), measured by transperineal ultrasound, during prolonged second stage of labor.

Pubic arch angle in prolonged second stage of labor: clinical significance

To evaluate the clinical significance of the pubic arch angle (PAA) measured by transperineal ultrasound during prolonged second stage of labor.

A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta.

The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta.

Outcomes of fetuses with umbilical cord cysts diagnosed during nuchal translucency examination.

The purpose of this study was to report the outcomes of fetuses with the finding of an umbilical cord cyst during nuchal translucency examination in a low‐risk population.

Measurement of the Fetal Umbilical Cord Insertion–to–Genital Tubercle Length in Early Gestation In Utero Sonographic Study

The purpose of this study was to establish in utero reference ranges for the fetal umbilical cord insertion–to–genital tubercle length in early gestation.

Caput succedaneum thickness in prolonged second stage of labour: a clinical evaluation

Data are scarce regarding the association between the presence of caput succedaneum and the mode of delivery.

P30.22: The head progression distance measured by trans-perineal ultrasound in prolonged 2nd stage of labor: its role in predicting mode of delivery

Objectives: To evaluate, the clinical significance of the head progression distance (HPD), measured by trans-perineal ultrasound, during prolonged second stage of labor. Methods: A prospective study of women, above 37 weeks of gestation, with failure to progress in the second stage of labor was conducted. A TPU approach in a sagital plane, was performed in order to assess the HPD. It’s correlation with fetomaternal characteristics, mode of delivery, and perinatal outcome were evaluated. Results: Sixty six women in prolonged second stage were enrolled in the study. Sixteen (25.8%), delivered by spontaneous vaginal delivery (SVD), twelve (19.4%) delivered by Cesarean delivery, thirty (48.4%) by vacuum extraction, and four (6.5%), by forceps. The mean HPD in cm measured in SVD, vacuum extraction, forceps and Cesarean delivery was 6.6 ± 0.9, 6.5 ± 1.2, 7.7 ± 1.1 and 5.8 ± 1.5 respectively, did not differ between modes of delivery. The only parameter that correlated with HPD was fetal head circumference measured after delivery R = 0.381 P < 0.04 Conclusions: Our study indicate that head progression distance do not predict the mode of delivery at prolonged 2nd stage.

P30.06: Intrapartum translabial sonography: a prospective analysis of various methods to predict the mode of delivery in prolonged second stage of labor

Objectives: The objective was to estimate a reference range of 3D embryo volume using VOCAL for pregnancies between 7 & 11weeks. Methods: This is a cross-sectional study including 60 singleton pregnancies with an E6 (GE, USA)with an endocavitary volumetric 4–9 MHz probe, using VOCAL with a manual tracer at 30◦, the outer aspect of the embryo was drawn manually on every image displayed sequentially in this plane. At the end of the 180◦ rotation, the built in software calculated the volume automatically. Results: The mean CRL was 23.7 ± 9.0 mm (range 9 to 38 mm). Mean fetal volume was 1.7 ± 1.2 cm3 (range 0.35 to 4.0 cm3). There was a strong positive correlation between fetal volume and menstrual age, gestational age and CRL (r = 0.919, 0.938 and 0.941, resp.). Power regression model produced an R2 value of 0.880 with a regression equation (y = 8.657 * ×0.150). The predicted gestational age fitted well with that predicted from CRL with a minimal difference and a P of 0.234. Conclusions: This pilot study demonstrated a strong correlation between fetal volume estimation and crown-rump length measurement for the prediction of gestational age (r = 0.950). Embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 8.657 * ×0.150) for the period from 7 weeks to 10 weeks + 6 days.