Umbilical Cord Prolapse and Perinatal Outcomes

Objective: To study the prevalence and perinatal outcomes of pregnancy with umbilical cord prolapse. Study design: Retrospective descriptive study. Subjects: The equal or more than 24 weeks gestational age pregnant women with umbilical cord prolapse who delivered at Ramathibodi Hospital from 1 January 1998 to 31 December 2007. Materials and methods: Maternal and fetal data from medical records of umbilical cord prolapse cases were reviewed for parity, age, gestational age, fetal presentation, status of membranes, interval from diagnosis to delivery, modes of delivery, fetal weight and Apgar scores, then the data were analyzed. Main outcomes: Prevalence of umbilical cord prolapse, severe birth asphyxia (Apgar scores at 1 minute ≤ 3) and perinatal mortality. Results: There were 42 cases of umbilical cord prolapse from 25,707 deliveries (prevalence 0.16%). Nine fetuses (21.4%) were severe birth asphyxia and six fetuses (14.2%) die. The perinatal mortality was 0.2 per 1,000 live births. The mean interval from diagnosis to delivery was 25.1ฑ8.5 minutes. Conclusion: The prevalence of umbilical cord prolapse was 0.16%, the perinatal outcomes demonstrated by the severe birth asphyxia was 21.4% and the perinatal mortality was 0.2 per 1,000 live births

Efficacy of intraumbilical vein Methylergonovine maleate on duration of third stage of labor

Objective: To study the efficacy of intraumbilical vein Methylergonovine maleate on duration of third stage of labor.Materials and Methods: Eighty-four term pregnant women undergoing vaginal delivery at Ramathibodi Hospital without risk factors were randomly assigned to receive 1 ml of Methylergonovine maleate (0.2 mg/ml) plus 0.9%NaCl 19 ml (n=42) or 0.9%NaCl 20 ml (n=42) by intraumbilical vein injection within one minute after cord clamping. Placenta was delivered by control cord traction technique. The duration of third stage of labor and side effects at one hour later were analysed.Results: There were no statistically significant difference among 2 groups regarding age, gestational age, parity, birth weight, placental weight and estimated blood loss. The duration of third stage of labor in Methylergonovine maleate group showed no statistically significant difference in compare with 0.9% NaCl group (5.97±3.28 Vs 6.53±4.56 minutes respectively, P>0.05). No side effects were observed in both groups.Conclusions: Intraumbilical vein Methylergonovine maleate had no effected on the duration of third stage of labor

Intrapartum Sonographic Measurement of Amniotic Fluid Volume for Prediction of Poor Fetal Outcomes in Low Risk Pregnancy

Objective: To determine the diagnostic value of intrapartum amniotic fluid volume, with single deepest pocket (SDP) technique, for prediction of poor fetal outcomes in low risk pregnancy.Materials and Methods: A cross-sectional study was conducted on 454 low risk singleton term pregnancies who delivered from April 2012–August 2012 at Ramathibodi Hospital. Ultrasonography estimated SDP was performed as an admission test and then continuous intrapartum electronic fetal monitoring (EFM) was done. Oligohydramnios was defined as a SDP ≤ 2.0 cm. The criteria for diagnosis of poor fetal outcomes were Apgar score at 5 minute ≤ 7, meconium stained amniotic fluid, abnormal EFM and neonatal intensive care unit (NICU) admission. Results: A total 454 low risk singleton pregnancies was enrolled. Thirty eight cases (8.4%) were diagnosed as oligohydramnios by SDP technique and 19 cases of these had poor fetal outcomes. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of SDP ≤ 2.0 cm for prediction of poor fetal outcomes were 20.9%, 94.8%, 82.7%, and 50.0%, respectively. After subgroup analysis, the sensitivity and specificity of oligohydramnios for prediction of meconium stained amniotic fluid was 25.4%, 94.2% and abnormal EFM was 25.0%, 92.9%, respectively. The relative risk of oligohydramnios with meconium stained amniotic fluid and abnormal EFM were 3.7 (95% CI; 2.3, 6.0) and 3.6 (95%CI; 1.7, 7.5), respectively. However, the significance of low Apgar score at 5 minute and NICU admission could not be evaluated due to low incidence. Conclusion: The intrapartum assessment of oligohydramnios by SDP ≤ 2.0 cm had high specificity for prediction of poor fetal outcomes and also was associated with increased risk of meconium stained amniotic fluid and abnormal EFM

Sonographic Measurement Fetal Abdominal Circumference and Fetal Abdominal Subcutaneous Tissue Thickness for Predicting Fetal Macrosomia

Objective:To evaluate the value of the sonographic measurement of fetal abdominal circumference (AC) and fetal abdominal subcutaneous tissue thickness (FASTT) for predicting fetal macrosomia.Material and Method:This prospective study was studied in term singleton pregnant women between February 2013 and January 2014. The fetal AC and FASTT were examined in all cases and fetal deliveries were within 24 hours. The fetal birth weight greater than 4,000 g. is macrosomia. Fetal AC and FASTT cut off values for predicting fetal macrosomia were analyzed.Results:This study included 302 pregnant women with median gestational age of 39 weeks (range 37 - 41). The prevalence of fetal macrosomia was 6.9%. At the cut off values of fetal AC ≥ 36.7 cm and FASTT ≥ 10.0 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 95.2% and 81.0%, 93.2% and 86.8%, 51.3% and 31.5%, 99.6% and 98.4% and 93.4% and 86.4%, respectively.Conclusion: The sonographic measurements of fetal AC and FASTT were useful for predicting fetal macrosomia