Epidemiological studies of obstetric ultrasound examinations in Denmark 1989-1990 versus 1994-1995

BACKGROUND: The purpose of the study was to describe number, type, time and place for all obstetric ultrasound examinations that pregnant women in Denmark had performed during their pregnancies. Further, to compare these results with results from a similar national survey performed five years previously. METHODS: During a two-week period in February 1990 and a two-week period in May 1995, all delivery departments in Denmark (1990: 57/1995: 49) participated in two identical designed studies with the aim as described above. For all women who delivered in these periods variables were recorded from the women's case records and after interview. After the exclusion of 108/145 women without complete registrations, the material consisted of 2268/2315 women; approximately 3.7%/3.4% of all deliveries in Denmark 1990/1995. The chi2 and t-test were used for statistical analyses with a statistical significance level of 5%. RESULTS: Of all obstetric ultrasound examinations 99%/96% took place in hospitals. Twenty/seven percent of the women had no examination during their pregnancies. The mean number of obstetric ultrasound examinations was 1.5/1.9 for all women and 1.9/2.1 for women who had at least one examination. In total 40%/54% of the women were offered a screening examination. Women with an offer of screening had a mean number of examinations: 1.8/2.0 and women without an offer: 1.3/1.9 (1990: p<0.05; 1995: non-significant). CONCLUSION: The studies have shown an increasing number of women with an offer of ultrasound screening and in general an increased use of ultrasound examinations in obstetrics during the five year period 1990-1995 in Denmark.     

The usage of pregnancy tests in one health district.

OBJECTIVE: To investigate the total number of pregnancy tests performed and the proportion that are repeated in one health district. To relate these results to the number of conceptions. DESIGN: Collection of data related to the numbers of pregnancy tests performed from all sources. Surveys of women booking for antenatal care or undergoing nonroutine obstetric ultrasound examination. SETTING: One health district in the south of England. RESULTS: About five pregnancy tests were performed for each proven pregnancy. Nearly two-thirds of tests were purchased over the counter, the remainder being carried out by hospital laboratories and pregnancy advisory services. Very few women had their pregnancy diagnosed on clinical grounds alone and a small number of ultrasound examinations were apparently performed in lieu of chemical tests. Repeated testing was more likely in primiparous women (P < 0.005). CONCLUSIONS: Chemical pregnancy tests appear to be trusted more than clinical examination for the diagnosis of pregnancy by women and doctors. When there is no medical urgency, women who want formal confirmation of pregnancy should be advised that home testing kits will provide the quickest results.     

The diagnostic and therapeutic role of ultrasound in obstetrics

Since its introduction, the role of ultrasound has continuously evolved for the past 40 years. New developments in the field of screening for pregnancy disorders have led to changes in the clinical application of ultrasound in the care of women with normal and complicated pregnancies. At the recommended intensities for obstetric examination, ultrasound is safe, without adverse effects on mother, fetus or operator. This review highlights the validated uses of ultrasound in obstetrics, such as pregnancy dating, screening for aneuploidy, diagnosis of fetal abnormality, placental localization, diagnosis of chorionicity in multiple pregnancy, assessment of fetal growth and well-being and fetal therapy. Knowledge of the evidence base for the role of ultrasound will result in effective and appropriately timed interventions in pathological pregnancies.     

Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS: Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). RESULTS: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals' data, only 13% of pregnancies with a serious fetal disorder detected were continued. CONCLUSIONS: All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive more attention in future studies.     

Impact of prenatal care with reduced frequency of visits in a residency teaching program.

OBJECTIVE: To determine if decreasing the number of prenatal visits for routine obstetric patients affects pregnancy outcome. STUDY DESIGN: A historical control study was designed to include 734 deliveries from January 1 to December 31, 1991, in women who had prenatal care per American College of Obstetricians and Gynecologists Committee Opinion no. 79, January 1990, guidelines for uncomplicated obstetric care. A prospective study cohort of women with 711 deliveries from January 1 to December 31, 1994, underwent prenatal care with modified guidelines to include: first visit at 6-12 weeks to confirm dating and obtain initial laboratory data, second visit at 16-20 weeks to obtain maternal serum alpha-fetoprotein screening, third visit at 24-28 weeks for 28-week laboratory data, fourth visit at 32 weeks, fifth visit at 36 weeks, sixth visit at 38 weeks, seventh visit at 40 weeks and weekly thereafter. Pregnancy outcomes included estimated fetal weight, gestational age at delivery, preeclampsia, Apgar score at one and five minutes and delivery mode. Neonatal outcomes, including stillbirth rate, preterm delivery rate, intraventricular hemorrhage rate, bronchopulmonary dysplasia and neonatal mortality, were evaluated. RESULTS: There were no statistically significant differences in perinatal or neonatal outcomes with decreased prenatal visits from an average of 12 per pregnancy to 8. CONCLUSION: Prenatal visits can be decreased in a teaching hospital in women with uncomplicated pregnancies from the standard number, 12-14 visits, to an average of 7 or 8 per patient without adverse perinatal outcomes.     

The quality of antenatal care in Turkey and the role of ultrasonography in the antenatal care system

OBJECTIVE: The aim of this study was to determine the quality of antenatal care and the role of routine obstetric ultrasonography (US) in Turkey's antenatal care program. MATERIALS AND METHOD: Two surveys consisting of 11 questions were conducted on 295 patients without pregnancy associated risk in 1995 and on 208 patients in 2000, during the first 24 h after delivery. The results of the two surveys were compared. A P value of <0.05 was used to denote statistical significance. RESULTS: When the results of the two surveys were compared, we found that in 2000, patients had started their antenatal visits earlier in pregnancy than those in 1995 and basic laboratory tests, such as complete blood count, urinalysis, and diabetes screening had been performed on an increased number of patients receiving antenatal care outside our clinic. Ultrasonographic examination was performed on all of the patients during their antenatal visits in 2000, while only 76.6% of the cases were examined by US in 1995. The number of ultrasound examinations per antenatal visit had significantly increased (0.47 in 1995 versus 0.6 in 2000, [Odds ratio: 1.277, 95% confidence interval: 1.12-1.44]). Data from 2000 has shown that 8.7% (5/57) of the patients who received antenatal care outside our clinic (Group 1) had been examined using US at least 10 times. However, 17.5% of these patients had not undergone a complete blood count (CBC) or urinalysis and blood pressure had not been measured at all in 5.2% of cases. CONCLUSION: Despite some differences, we believe that the situation in Turkey is similar to that in the rest of the world. The expectations women have of ultrasound examination are much higher than can be realised in reality. In Turkey, it appears that many physicians, especially those based in large cities, rely on highly technical procedures like ultrasonography and neglect the basics of antenatal care (blood pressure measurements, complete blood counts, urinalysis, diabetes screening etc.).     

Detection of small-for-gestational-age fetuses by ultrasound screening in a high risk population: a randomized controlled study.

OBJECTIVE: To assess the value of fetal weight estimation during routine third trimester ultrasound examinations for the identification of small-for-gestational-age (SGA) fetuses, to promote active pregnancy management and so reduce perinatal morbidity. DESIGN: A prospective controlled randomized study. SETTING: Outpatient clinic at the Department of Obstetrics, Herlev University Hospital, Denmark. SUBJECTS: One thousand pregnant women considered at risk were selected consecutively from April 1985 to September 1987 and randomized to either a revealed-results group or a withheld-results group. INTERVENTION: All the women had an early ultrasound examination for estimation of gestational age. Both groups had routine ultrasound estimates of fetal weight after 28 weeks and then every third week until delivery. The results were available for clinical use only in the revealed group. MAIN OUTCOME MEASURES: Number of interventions during pregnancy (admission to hospital, elective delivery), emergency intervention during labour, and fetal outcome. RESULTS: Revealing the results of ultrasound estimates of fetal weight for gestational age during the third trimester resulted in statistically significantly increased diagnosis of SGA fetuses, of elective deliveries based on this diagnosis, and of healthy preterm babies admitted to the neonatal care unit, but no detectable overall improvement in weight for gestational age at birth, or in neonatal morbidity or mortality. CONCLUSION: This method of screening improved the diagnosis of SGA fetuses, but this was not followed by improved fetal outcome.     

Screening for congenital heart disease prenatally. Results of a 2 1/2-year study in the South East Thames Region.

OBJECTIVE: To assess the efficacy of four chamber view examination, during routine obstetric scanning, in the prenatal detection of fetuses with congenital heart disease. DESIGN: Prospective observational study. SETTING: Ten obstetric ultrasound units in the South East Thames Region. SUBJECTS: All pregnant women attending for routine obstetric ultrasound examination. INTERVENTION: Ultrasonographers performing routine ultrasound examinations were taught to obtain, and correctly interpret, the four chamber view of the fetal heart. When this view could not be achieved adequately, an attempt was made to identify a reason for failure and, if possible, to arrange a repeat scan. All suspected abnormalities were referred to a specialized unit. MAIN OUTCOME MEASURES: Numbers of true abnormalities detected or overlooked, and the number in whom abnormality was suspected incorrectly. RESULTS: Over a 2.5-year period, 69% of the known number of cardiac lesions associated with an abnormality of the four chamber view were detected prenatally during the routine obstetric scan, 10% were identified as a result of referal for other high-risk factors and 21% were overlooked. The overall positive predictive value in the 10 obstetric units was 36%. CONCLUSIONS: Prenatal screening for some forms of major congenital heart disease is possible by including examination of the four chamber view of the fetal heart in routine obstetric scans. However, there are important limiting factors that will influence the success of abnormality detection and must be taken into account if screening is to be effective nationwide.     

Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial

OBJECTIVES: To assess the efficacy of an ultrasound scan at the first antenatal visit. DESIGN: Randomised clinical trial. SETTING: Women's and Children's tertiary level hospital, Adelaide, Australia. POPULATION: Six hundred and forty-eight women attending for their first antenatal visit at less than 17 weeks of gestation who had no previous ultrasound scan in the pregnancy, who were expected to give birth at the hospital, and for whom there was no indication for an ultrasound at their first visit. METHODS: Eligible consenting women were enrolled by telephone randomisation into either the ultrasound at first visit group, who had an ultrasound at the time of their first antenatal visit, or the control group in whom no ultrasound assessment was done at their first antenatal visit. Both groups of women completed a questionnaire at the end of the first visit on their feelings towards the pregnancy and anxiety levels. Data were collected on details of any ultrasound assessments, including the 18 to 20 weeks morphology scan, and pregnancy outcome. All primary analyses were on an intention-to-treat basis. MAIN OUTCOME MEASURES: The number of women who needed adjustment in dates of 10 days or more on the basis of their 18 to 20 weeks ultrasound morphology scan, who were booked for their morphology scan at sub-optimal gestations, who had a repeat of their maternal serum screening test, or who felt worried about their pregnancy at the end of the first antenatal visit. RESULTS: Fewer women (9%) in the ultrasound at first visit group needed adjustment of their expected date of delivery as a result of the 18 to 20 week ultrasound, compared with 18% of women in the control group (RR 0.52, 95% CI 0.34-0.79; P = 0.002). The number of women who had the 18 to 20 week ultrasound assessment timed suboptimally was similar to that in the control group (16% vs. 21%), as was the number of women who had a repeat blood sample taken for maternal serum screening (6% vs. 6%). Fewer women in the ultrasound at first visit group reported feeling worried about their pregnancy (RR 0.80, 95% CI 0.65-0.99; P = 0.04) or not feeling relaxed about their pregnancy (RR 0.73, 95% CI 0.56-0.96; P = 0.02), compared with women in the control group. CONCLUSIONS: A routine ultrasound assessment for dating offered to women at the first antenatal visit provides more precise estimates of gestational age and reduces the need to adjust the estimate of the date of delivery in mid-gestation. Women who had an ultrasound at the first visit reported more positive feelings about their pregnancy, compared with women in the control group at that time.     

One-stage ultrasound screening in pregnancy. An evaluation

A one-stage ultrasound screening program was evaluated, using a pregnancy/perinatal database containing information from 2766 pregnancies and deliveries. Among women who did not have a second-trimester ultrasound examination, labor was induced for presumed post-term pregnancy in 4.0% versus 1.6% of pregnancies in the screening group (p = 0.007). In the group with second-trimester ultrasound scanning other than screening, the frequency was 3.2%. Of women with spontaneous labor or who were induced for presumed post-term pregnancy, 3.8% in a screening group and 8.0% in a group with other second-trimester ultrasound examination were post-term according to BPD measurements (p = 0.0003). In the screening group, 6.2% of liveborn singletons were small for gestational age (less than the 10th percentile) compared with 8.5% in the non-screening group (p less than 0.05). A subset of 365 screened women with optimal menstrual history had spontaneous labor or were induced for presumed post-term pregnancy. According to menstrual history and ultrasound examination, 7.4% and 3.8% of these were post-term, respectively (p = 0.04). It is concluded that the main value of screening lies in a more accurate dating of pregnancy, even when menstrual history is optimal, with a lower incidence of induced labor for believed post-term pregnancies. In addition, there may be an improvement in the obstetric management of pregnancy, reflected in our study as a lower incidence of small for gestational age infants.     

A Home Obstetric Service With Expert Consultation and Back-Up

ABSTRACT: The medical literature comparing home and hospital obstetric outcomes is reviewed. A home obstetric service with hospital and obstetrician back-up is described, including screening, care during pregnancy and delivery and management of complications. Of 495 women who were accepted for home delivery, 77 miscarried or moved, 49 changed to hospital delivery, 19 had premature labor, and 61 were transferred to the hospital during labor. Maternal and perinatal mortality and morbidity are described. In this well-selected low risk population, careful prenatal and intrapartum care resulted in outcomes which are comparable to those of hospital programs.     

Booking Ultrasound Examinations Performed by Obstetric Senior House Officers - Time to Reevaluate?

EDITORIAL COMMENT: We accepted this paper for publication to warn obstetrics hospital administrators that although it is commendable to train house officers to perform ultrasonography, these medical practitioners should not perform the duties of a trained ultrasonographer for the reasons presented. This series considered only the errors in assessment of gestational age. There is considerable literature to indicate that with the detailed 18–20 week scan the need for an expert is far greater.
Summary: We evaluated the proficiency of obstetrics senior house officers, not formally trained in ultrasonography, in assessing fetal viability, the number of fetuses and gestational age. Of 366 women who had an ultrasound examination at the first antenatal visit, 7 (2.1%) had nonviable pregnancies and 7 pairs of twins were correctly identified. Of these women, 329 had a detailed anomaly scan at 18–20 weeks. No anomalies were detected at either scan. Of the booking scans performed by the senior house officers, 89.4% correctly assessed the gestational age of the pregnancy when compared to the anomaly scan (±1 week). One in 10 of the scans performed by the senior house officers was inaccurate. This is important particularly when being used for risk assessment in serum screening for Down syndrome. At present the early ultrasound scan should be performed by more formally trained personnel.     

Postdates pregnancy in an indigent population: the financial burden

OBJECTIVE: The objective of this study was to determine the comparative financial burden of twice-weekly fetal testing from 41 weeks of gestation until delivery, as compared with early dating ultrasound evaluation in an indigent population. STUDY DESIGN: All women who were seen for antepartum testing for postdating pregnancy at Lyndon Baines Johnson Hospital were enrolled. Patient age, parity, gestational age at initiation of prenatal care, the number of prenatal visits, gestational age at first ultrasound scan, and the number of biophysical profiles that were performed before delivery were recorded. The labor and delivery database was searched for all deliveries at >41 weeks of gestation. The charge for a single ultrasound scan at <20 weeks of gestation was compared with twice-weekly testing in the population as a whole with the use of three strategies (no dating ultrasound scans and biophysical profiles until delivery, routine dating ultrasound scan and routine induction at 41 weeks of gestation, and current practice at our institution). RESULTS: One hundred twenty-seven subjects with postdated pregnancy were enrolled (mean age, 25.2 years; median parity, 0 [range, 0-6]). The mean gestational age at the initiation of prenatal care was 21.2 +/- 10.5 weeks. Forty-seven women (38.0%) initiated care at <20 weeks. The mean number of biophysical profiles performed before delivery was 1.5 +/- 1.34; the mean gestational age at delivery was 42.1 +/- 0.87 weeks (spontaneous labor, 39.6%; induced labor, 40.4%). The charge for a biophysical profile is $492.90 US dollars and $551.00 US dollars for a 20-week ultrasound scan; there is no difference in the charge for induced or spontaneous labor. During the 4-month study period, 1638 patients were delivered at our hospital; 341 patients were delivered at >41 weeks of gestation. The estimated financial burden of antenatal testing of 341 patients from 41 weeks to delivery was calculated to be $252,118 US dollars, compared with $902,538 US dollars for a single ultrasound scan at 20 weeks for the entire population of 1638 patients. The estimated financial burden of current practice (10% of patients with no prenatal care, 38% of patients with examination at <20 weeks who were eligible for dating ultrasound scanning, and 37% of patients with examination for postdate testing) was $402,457 US dollars. CONCLUSION: Patients who were seen for postdate antepartum testing in an indigent population lack early initiation of prenatal care and early ultrasound scans. Because on average only 1.5 biophysical profiles are performed per patient before delivery, routine early ultrasound scanning and routine induction at 41 weeks of gestation would add considerable financial burden to the system.     

Characteristics of physicians with obstetric malpractice claims experience

This study compared the demographic and practice characteristics of physicians with and without obstetric malpractice experience. The sample consisted of 387 family physicians and 204 obstetricians in Washington state who were insured for obstetrics by a major malpractice carrier between January 1982 and June 1988. Fifty-three physicians (9%) had an obstetric malpractice claim during the study period. The approximate overall rate of obstetric malpractice claims was low: 0.32 per 1000 deliveries. The higher the total delivery volume (exposure), the greater the chance of having malpractice experience. Although physicians with practices of over 200 deliveries per year were more likely to have had malpractice experience, their risk of malpractice experience per delivery was lower than that of providers doing fewer than 200 deliveries per year. Our work suggests that insurers might consider basing obstetric malpractice premiums on numbers of deliveries rather than specialty.     

Von der Geburtshilfe zur Geburtsmedizin

Obstetrics is one of the oldest medical disciplines. Already in ancient Egyptian illustrations, pictures of births are shown. During the Renaissance Period, the ancient knowledge about obstetrics was revived and the first significant obstetric manual “The Rose Garden” was published. Up to the nineteenth century antenatal examinations mostly took place at the time of delivery. In the early twentieth century obstetric departments were established to reduce maternal and infant mortality. This development also changed the work of midwives. The presence at the actual birth is nowadays only a small part of their professional activities. The focus is on supporting, monitoring and screening pregnant women. Furthermore, the work includes intrapartum monitoring, manual assistance during vaginal delivery, assistance during operative vaginal deliveries and specialized intensive care in high risk pregnancies, as well as postoperative care of patients. Finally, the holistic care continues into treatment and counseling after discharge from hospital. The risk profile of pregnant women and sonographic as well as laboratory investigation options have significantly changed in the last decades mainly due to the increasing age of expectant mothers and the use of reproductive technologies. This has led to a paradigm shift of the period of intensive screening into the first two trimesters of pregnancy. These developments are illustrated by analysis of epidemiological data and evaluation of data from the diagnosis-related groups (DRG) system.     

Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity

OBJECTIVE: This study describes the frequency, pregnancy complications and outcomes of non-trichorionic triplet pregnancies. DESIGN: A retrospective observational study. SETTING: Two tertiary level referral centres of Obstetrics and Prenatal Medicine, Germany. POPULATION: All women booked to receive targeted ultrasound screening between January 1998 and June 2003. The mixed low and high risk population included 36,430 women with ultrasound examinations between 11 and 24 weeks of gestation. Of those with available outcome, 176 were triplet pregnancies with three viable fetuses. METHODS: Analysis of ultrasound data and perinatal outcome in triplet gestations who had first and second trimester targeted ultrasound examination. Pregnancies with monochorionic or dichorionic placentation were identified and pregnancy outcome was compared to trichorionic triplets. MAIN OUTCOME MEASURES: Intrauterine fetal death, fetal growth restriction (FGR), mean discordance and survival rate in non-trichorionic versus trichorionic triplets. RESULTS: Triplets were trichorionic in 81.8% and had a monochorionic or dichorionic placentation in the remaining 18.2%. The rate of monochorionicity and dichorionicity was significantly higher after spontaneous conception than after assisted reproductive technologies (44.8%vs 12.9%, P < 0.001). In non-reduced monochorionic and dichorionic triplets compared with non-reduced trichorionic triplets, there was a higher rate of intrauterine fetal death (8.8%vs 1.5%, P < 0.01), FGR (33.3%vs 25.5%), mean discordance (20.5%vs 12.7%, P < 0.01), discordance >30% (26.3%vs 2.9%, P < 0.01) and delivery <32 weeks of gestations (47.4%vs 32.2%). There was a lower survival rate in non-trichorionic triplets (84.2%) than in trichorionic ones (91.7%). CONCLUSION: Triplet pregnancies with a monochorionic or dichorionic placentation are at significantly higher risk of adverse pregnancy outcome compared with trichorionic pregnancies. First trimester evaluation of chorionicity is strongly emphasised.     

Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination

BACKGROUND: Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination. AIM: To assess the obstetric outcome when the interval between the estimated date of delivery by last menstrual period and the estimated date of delivery by second trimester ultrasound exceeds 14 days. MATERIALS AND METHODS: Population-based prospective cohort study. Included were all women (n = 16 302) with a singleton pregnancy, in one Norwegian county from 1989 to 1999, with a reliable menstrual history and whose second trimester ultrasound examination was conclusive with a 35-60-mm biparietal diameter. RESULTS: Adverse outcome was defined as preterm birth (< 37 weeks), perinatal death, low birthweight (< 2500 g) and small-for-gestational age (< 2 standard deviation). The risk for perinatal death (odds ratio = 2.3), preterm birth (odds ratio = 1.7), low birth weight (odds ratio = 1.5), and small-for-gestational age (odds ratio = 1.5) was highly significantly increased in deliveries where the discrepancy between the two terms was more than 14 days. The increased risk is not explained by differences in parity, maternal age, smoking, fetal malformations, or use of oral contraceptives before pregnancy. CONCLUSION: Fetuses that are smaller than expected at the mid-second trimester ultrasound corresponding to a discrepancy of more than 14 days have an increased risk for adverse obstetric outcome.     

Ultrasound assessment of uterine myomas in pregnancy

OBJECTIVE: Visualisation of myomas in pregnancy and evaluation of their dimension, localisation and echogenic structure are essential to establish the proper diagnosis and further therapeutic management. DESIGN: Our goal was to define a diagnostic value of ultrasound examinations for uterine myomas assessment during pregnancy. MATERIALS AND METHODS: The study group included 53 women with uterine myomas which were visualised in ultrasound examination before pregnancy or during first and second trimester. RESULTS: During third trimester the presence of uterine myomas were observed in 40 cases what is 75.5% of all examined women. The difference of 6.1 mm in the mean values of measured diameters was obtained in comparison of ultrasound examination and intraoperative evaluation (7.6% of mean value diameter). It was found a statistically significant correlation between ultrasonic and intraoperative myomas diameters evaluation (p < 0.01). CONCLUSIONS: 1. The accuracy of ultrasonic measurements completes the knowledge about presence and size of uterine myomas what is of great importance to establish proper diagnosis and mode of delivery. 2. Difficulties in ultrasound visualisation of myomas situated on the posterior uterine wall were noticed during third trimester. Limited role of ultrasound examination was observed in assessment of uterine myomas during third trimester.     

THIRD-TRIMESTER ULTRASOUND FOR NURSE-MIDWIVES

Obstetric ultrasound has become well integrated into management of pregnancy, labor, and delivery. An increasing number of nurse-midwives have expanded their roles to include the use of this technology. This article reviews the basic principles of ultrasound physics, the content of ultrasound examinations, and the performance of basic scans. The uses of limited scans for third-trimester antepartum assessment and intrapartum management are reviewed. Issues surrounding the use of obstetric ultrasound, including limited scans, routine ultrasound screening, and necessary education, are discussed. Information on incorporating the use of ultrasound procedures into nurse-midwifery practice is included.     

Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques

OBJECTIVE: This study was undertaken to compare surgical techniques for the primary repair of obstetric anal sphincter lacerations. STUDY DESIGN: Patients with complete third- or fourth-degree lacerations were recruited and randomly assigned to either an end-to-end or overlapping repair. Data collection included demographic data, obstetric history, and intrapartum events. Postpartum, women completed incontinence questionnaires and underwent physical and ultrasound examinations. To detect a 36% difference between groups with an alpha = .05 and beta = .20, 30 patients were required. Data were analyzed with Student t test and chi2 analysis. RESULTS: Forty-one women were randomly assigned; 23 to an end-to-end and 18 to an overlapping repair. Twenty-seven percent of women underwent episiotomy and 61% operative vaginal delivery. Follow-up was limited to 26 of 41 patients. On physical examination, 3 patients had a separated anal sphincter. On ultrasound, overall 85% of patients had intact sphincters, with no difference between groups (all P > .05). Forty-two percent of women complained of anorectal symptoms with no differences between groups (all P > .28). CONCLUSION: We found no difference in anal incontinence symptoms, physical examination, or translabial ultrasonography findings between the 2 groups. Incontinence symptoms were common in both groups.