Suneet P. Chauhan

Sonographic examination does not predict twin growth discordance accurately

Objective To assess the accuracy of estimating birth weight among twins with discordancy (intra-pair difference in actual birth weight of more than 25%) and to determine the relative accuracy of an intra-pair difference in abdominal circumference (Δ AC) of 20 mm or more or in estimated fetal weight (Δ EFW) of 25% or more for the identification of discordant growth in twins. Methods Over a 6-year period, we identified all nonanomalous twin pairs with gestational ages greater than 23 weeks and sonographic examinations within 3 weeks of birth. Ultrasonographic biometry of both twins included AC, head circumference, and femur length; these indices were used to estimate fetal weight by Hadlocks formula. Likelihood ratios, receiver-operating characteristic curves, and prediction limits were applied to assess the accuracy of the two diagnostic methods to predict an abnormal outcome. Results A total of 242 twin pairs were studied. The mean gestational age among the 21 twins with abnormal growth (30.6 ± 4.6 weeks) was significantly less than among the 221 twins with normal growth (33.2 ± 4.0 weeks) (P < .005). The biometric measurements of fetal parts, sonographic estimate of fetal weight, and actual birth weight for both fetuses were significantly less for discordant twin pairs (P < .05). The accuracy of predicting birth weight, as determined by mean error and percentage of the estimate within 10% of the actual weight, was similar between the groups. Receiver-operating characteristic curves showed that both diagnostic tests yielded areas under the two curves not significantly different from the area under the nondiagnostic line (P > .05). Most important, prediction limit calculations indicated that a 90% certainty that the actual birth weight discordance was at least 25% was achievable only if Δ AC was 172 mm or greater or Δ EFW was 112% or more. Conclusion The most popular current methods (difference in AC or EFW) for predicting discordant growth in twin gestations have limited accuracy when held to a standard for discordance that requires a birth weight difference of at least 25%.

Membrane Sweeping versus Dinoprostone Vaginal Insert in the Management of Pregnancies beyond 41 Weeks with an Unfavorable Cervix

OBJECTIVE:To determine the best method of cervical ripening to prevent postdate inductions in women with an unfavorable cervix at 41 weeks’ gestation.STUDY DESIGN:Women presenting at 41 weeks’ gestation with a Bishop score of ≤4 received daily dinoprostone (Cervidil) vaginal inserts (group I) or daily membrane sweeping (group II).RESULTS:One-hundred and eighty-two women were prospectively randomized with 91 women in each arm. The women in group II, membrane sweeping, had Bishop scores significantly greater on admission for delivery (p < 0.001), had less time elapsed from admission to delivery (p = 0.018), and had fewer labor inductions at 42 weeks (p = 0.04) than the women in group I, the dinoprostone group. In addition, a greater number of women in group II were admitted in spontaneous labor (p = 0.006) than in group I. Total antenatal costs for the membrane sweeping group was

AN OVERVIEW OF SIGMOIDOSCOPIC SCREENING FOR COLORECTAL CANCER BY GYNECOLOGISTS

15,120 versus

An analysis of risk factors associated with blood transfusion in ectopic pregnancy

59,540 for the dinoprostone group.CONCLUSION: Daily membrane sweeping was more effective than dinoprostone administration with fewer postdate inductions at one-fourth the cost.

Limitations of clinical and sonographic estimates of birth weight : Experience with 1034 parturients

Abstract Sigmoidoscopy is a greatly underutilized screening test for colorectal cancer. Because gynecologists have endoscopic skills and sigmoidoscopy is a relatively simple procedure to perform, we suggest integrating it into gynecologic practice. Recommendations of the American Cancer Society regarding sigmoidoscopic screening for colorectal cancer as well as the procedure and its associated complications, indications, and contraindications are reviewed. Factors affecting the use of this procedure, such as physician training and patient complicance, are also examined.

Bishop score: A poor diagnostic test to predict failed induction versus vaginal delivery

Objective: To determine the risk factors associated with blood transfusion in ectopic pregnancy.Methods: A retrospective chart review of the presentation and hospital course of ectopic pregnancies managed over 5 years at two hospitals was undertaken. Thirty-two variables, including demographics, presenting signs and symptoms, and intraoperative findings, were examined in univariate and multivariate logistic modeling.Results: Among 185 patients with histologically confirmed ectopic pregnancies who were managed surgically, 8.6% or 16 women required transfusion. Multivariate analysis of risk factors for blood transfusion demonstrated a statistically significant association with 1) initial hemoglobin <10 g/dL (odds ratio [OR] 38.8, 95% confidence interval [CI] 6.0-356.8) and 2) hCG levels >/= 6500 mIU (OR 18.1, 95% CI 3.6-158.1), as well as 3) abnormal bleeding on presentation (OR 0.08, 95% CI 0.007-0.42. Presence of two of these factors has a sensitivity of 82% (95% CI 48-98%) and a positive predictive value of 33% (95% CI 16-54%). No case had all three factors present.Conclusion: This report is, to our knowledge, the first regression analysis of risk factors for transfusion associated with ectopic pregnancy. It demonstrates that initial hemoglobin and hCG levels as well as abnormal bleeding on presentation are independent risk factors for blood transfusion in ectopic pregnancy.