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Various Doppler sonographic appearances and challenges in prenatal diagnosis of vasa praevia.

Rupture of vasa praevia is associated with a high rate of fetal or neonatal mortality. Since the recent development of color and spectral Doppler sonography, prenatal diagnosis of vasa praevia has been increasing but is not yet consistent. We report 2 cases that were diagnosed prenatally, enabling cesarean section to be performed under optimal conditions to prevent complications. A better knowledge of the characteristic Doppler sonographic appearances and the risk factors associated with vasa praevia could greatly facilitate the prenatal diagnosis of this condition and hence the fetal prognosis.

Adult↗

Decision-to-delivery interval for instrumental vaginal deliveries: vacuum extraction versus forceps.

OBJECTIVE: The aim of this study was to assess the decision-to-delivery interval for forceps delivery and vacuum extraction. STUDY DESIGN: A retrospective analysis of all instrumental deliveries over a 1-year period in a delivery ward of a university tertiary health care facility was performed. The decision-to-delivery interval was compared between forceps delivery and vacuum extraction. RESULTS: The decision-to-delivery interval was 8.6+/-5.4 and 13.8+/-6.2 min for forceps and vacuum deliveries, respectively (P=0.0001). CONCLUSION: It appears that it is quicker to accomplish forceps delivery than vacuum extraction.

Decision Making↗

Vasa previa.

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Female↗

One-blade rotation of a persistent posterior vertex.

Fifteen women in labor at term with no evidence of protraction or arrest disorder successfully underwent a single-blade rotation of the fetus from occipitoposterior to occipitoanterior position. There were no failures, no fetal injuries, and no significant maternal trauma. This method of forceps rotation appears to be a safe alternative to current methods of managing occipitoposterior positions.

Female↗

Transverse uterine incision for cesarean delivery of the transverse-lying fetus.

Low-isthmic transverse uterine incision was performed in 66 patients during Cesarean section indicated for transverse fetal lie. No significant differences were noted in the 1 and 5 min Apgar scores among fetuses delivered before or after rupture of the membranes. In only 5 (7.6%) of these cases was the incision converted into an inverted-T. The 1 min Apgar score was significantly lower in this group (6.0 +/- 1.3) compared to the rest of the group (7.5 +/- 1.7, P less than 0.01), however, the 5 min score showed no significant difference. No significant complications were noted in the post-operative course of mother and fetuses. We concluded that the transverse uterine incision is safe for the Cesarean delivery of the transverse-lying fetus.

Adult↗

Caesarean section survey in Galway--1973 through 1987.

We review the trend, indications and maternal mortality with caesarean section at University College Hospital Galway from 1973 to 1987. The caesarean section rate (CSR) rose from 6.06% in 1973 to 10.18% in 1987, primary sections from 3.58% to 6.51% and repeat sections from 2.49% to 3.67% during the same interval. The four major indications for section were cephalopelvic disproportion, foetal distress, previous section and malpresentations. Lower segment caesarean section was the commonest operation and a slight increase in the classical operation was noted due to an increased intervention in prematurity. The maternal mortality rate was 11.2/10,000 in the 15-year period and the complications leading to death were ultimately ascribable to primary postpartum haemorrhage. Strategies for reduction in the CSR are discussed.

Adult↗