Transvaginal Ultrasonographic Cervical Measurement in Predicting Failed Labor Induction and Cesarean Delivery for Failure to Progress in Nulliparous Women

The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress

Electrohysterographic characterization of the uterine myoelectrical response to labor induction drugs

[EN] Labor induction is a common practice to promote uterine contractions and labor onset. Uterine electrohysterogram (EHG) has proved its suitability for characterizing the uterus electrophysiological condition in women with spontaneous labor. The aim of this study was to characterize and compare uterine myoelectrical activity during the first 4h in response to labor induction drugs, Misoprostol (G1) and Dinoprostone (G2), by analyzing the differences between women who achieved active phase of labor and those who did not (successful and failed inductions). A set of temporal, spectral and complexity parameters were computed from the EHG-bursts. As for successful inductions, statistical significant and sustained increases with respect to basal period were obtained for EHG amplitude, mean frequency, uterine activity index (UAI) and Teager, after 60¿ for the G1 group; duration, amplitude, number of contractions and UAI for the G2 group, after 120¿. Moreover, Teager showed statistical significant and sustained differences between successful and failed inductions (1.43±1.45 µV2.Hz2.105 vs. 0.40±0.26 µV2.Hz2.105 after 240¿) for the G1 group, but not in the G2 group, probably due to the slower pharmacokinetics of this drug. These results revealed that EHG could be useful for successful induction prediction in the early stages of induction, especially when using Misoprostol.This research project was supported by the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund (DPI2015-68397-R) and by the company Bial SA.Benalcazar-Parra, C.; Ye Lin, Y.; Garcia Casado, J.; Monfort-Orti, R.; Alberola Rubio, J.; Perales Marín, AJ.; Prats-Boluda, G. (2018). Electrohysterographic characterization of the uterine myoelectrical response to labor induction drugs. Medical Engineering & Physics. 56:27-35. https://doi.org/10.1016/j.medengphy.2018.04.002S27355

Oxygen embolism after hydrogen peroxide irrigation of a vulvar abscess

We report a case of venous oxygen embolism in a 33‐yr‐old healthy woman after irrigation of a vulvar abscess with 25 ml of 3% hydrogen peroxide. Venous oxygen embolism was diagnosed by the development of sudden hypoxia associated with a decrease in end‐tidal carbon dioxide concentration from 5.3 kPa to 3.2 kPa, and a ‘mill‐wheel' sound on cardiac auscultation soon after injection of the solution. The patient responded to corrective treatment including the Trendelenburg position and 100% oxygen. She made an uneventful recovery. We discuss the possible causative mechanism of this embolism, the different diagnostic methods, and the controversial aspects of available treatments. We emphasize that hydrogen peroxide is a dangerous and unsuitable agent for routine wound irrigation and debridement. Br J Anaesth 2002; 88: 597-

Oxygen embolism after hydrogen peroxide irrigation of a vulvar abscess

We report a case of venous oxygen embolism in a 33-yr-old healthy woman after irrigation of a vulvar abscess with 25 ml of 3% hydrogen peroxide. Venous oxygen embolism was diagnosed by the development of sudden hypoxia associated with a decrease in end-tidal carbon dioxide concentration from 5.3 kPa to 3.2 kPa, and a 'mill-wheel' sound on cardiac auscultation soon after injection of the solution. The patient responded to corrective treatment including the Trendelenburg position and 100% oxygen. She made an uneventful recovery. We discuss the possible causative mechanism of this embolism, the different diagnostic methods, and the controversial aspects of available treatments. We emphasize that hydrogen peroxide is a dangerous and unsuitable agent for routine wound irrigation and debridement