Cardiotocography combined with ST analysis versus cardiotocography combined with fetal blood sampling in deliveries with abnormal CTG: a randomized trial.

Purpose: The aim was to investigate if intrapartum monitoring with cardiotocography (CTG) in combination with ST analysis (STAN) results in an improved perinatal outcome.

Methods: We performed a two-center randomized trial. 1013 women with term fetuses in cephalic presentation entered the trial.

Lactate versus pH levels in fetal scalp blood during labor--using the Lactate Scout System.

Objective: To assess if lactate measured with the Scout Lactate System is a reliable alternative to pH in intrapartum monitoring of the fetus.

Methods: A prospective study analyzing (1) the correlation between scalp lactate measured by the Scout Lactate System and the Automatic Blood Laboratory (ABL), (2) the correlation between lactate and pH measured in scalp blood and (3) the correlation between fetal scalp lactate and umbilical cord SBE. The sensitivity/specificity and positive/negative predictive values of lactate in predicting low pH were analyzed and expressed as Receiver Operating Curves (ROC).

Anal incontinence in women with recurrent obstetric anal sphincter rupture: a case control study.

Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR.

Methods: Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St.

The effect of chorionicity and twin-to-twin delivery time interval on short-term outcome of the second twin.

Objectives: To investigate the effect of chorionicity and twin-to-twin delivery time interval on short-term outcome in the second twin as well as to investigate the predictors of adverse outcome in both twins.

Methods: Data included vaginally delivered twins (≥36 weeks) from Copenhagen University Hospitals (2001-2009). The association between delivery interval and adverse outcome parameters was compared for monochorionic (MC) and dichorionic (DC) twins by multiple linear regression.

Cervical dilation at the time of cesarean section for dystocia -- effect on subsequent trial of labor.

Objective: To investigate the effect of cervical dilation at the time of cesarean section due to dystocia and success in a subsequent pregnancy of attempted vaginal delivery.

Design: Retrospective study.

Setting: University hospital in Copenhagen capital area.

Maternal and perinatal complications by day of gestation after spontaneous labor at 40-42 weeks of gestation.

Objective: To evaluate pregnancy outcome after spontaneous labor by day of gestation between 40(+0) and 41(+6) weeks of gestation.

Design: Evaluation of prospectively collected labor ward data.

Setting: University Hospital, Denmark.

Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis.

Objective: The aim of the present study was (1) to evaluate the relationship between umbilical cord arterial blood lactate and pH, standard base excess (SBE), and actual base excess (ABE) at delivery and (2) to suggest a cut-off level of umbilical cord arterial blood lactate in predicting fetal asphyxia using ROC-curves, where an ABE value less than -12 was used as "gold standard" for significant intrapartum asphyxia.

Study Design: This is a descriptive study of umbilical cord arterial blood samples from 2554 singleton deliveries. The deliveries took place at the Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Copenhagen, Denmark where umbilical cord blood sampling and blood gas analysis is part of the routine assessment of all newborns.

Peripartum hysterectomy in Denmark 1995-2004.

Background: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery.

Methods: Peripartum hysterectomy was defined as a hysterectomy after birth until 1 month after delivery using the codes for hysterectomy from the NOMESCO classification (1995).

Can the reproducibility of fetal heart rate baseline estimation be improved?

Objective: To evaluate the reproducibility of fetal heart rate (FHR) baseline estimation according to an objective and detailed definition presented in this article, by comparison with the FIGO guidelines' definition.

Study Design: Three hundred consecutively acquired FHR tracings, 150 from antepartum high-risk pregnancies and 150 from unselected intrapartum cases, were presented to nine experienced clinicians included in three different groups, for an estimation of the FHR baseline. The first group consisted of clinicians using the proposed definition, without previous training in its use.

Fetal and maternal transcutaneous PCO2 levels during labour and the influence of epidural analgesia.

The Departments of Obstetrics and Gynaecology of the Hvidovre University of Copenhagen and the Free University of Amsterdam collaborated in a study on the relationship of maternal and fetal acid-base state in the intrapartum period. Transcutaneous PCO2 levels of mother (tcPCO2m) and fetus (tcPCO2f) were continuously recorded in 52 patients during labour. TcPCO2f and tcPCO2m correlated significantly (r = 0.

Induction of labour by balloon catheter with extra-amniotic saline infusion (BCEAS): a randomised comparison with PGE2 vaginal pessaries.

Objective: A new method for induction of labour--balloon catheter with extra-amniotic saline infusion (BCEAS)--is evaluated in randomised comparison with prostaglandin E2 (PGE2) in vaginal pessaries.

Study Group: One-hundred and nine pregnant women with unfavourable cervices.

Major Outcome Measures: The efficiency of inducing vaginal delivery and the level of 'disadvantages following induction of labour' (DisFIL scorings).

Prediction of mode of delivery and 'DisFIL score' following induction of labor by local PGE2.

The objective of the study was to evaluate pre-induction risk factors for (i) assisted vaginal delivery (forceps or vacuum extraction), (ii) caesarean section, (iii) failed induction followed by caesarean section, and from these to evaluate a score of the 'Disadvantages Following Induction of Labour' (the DisFIL score). The study was a case-control study applied on a prospective cohort of 336 pregnant women induced by local PGE2. Assisted vaginal delivery was associated with primiparity (OR (odds ratio) = 10.

[T/QRS-ratio and cardiotocographic changes in the second stage of labor--related to fetal condition at delivery].

The T/QRS ratio of the foetal electrocardiogram (ECG) was recorded from 92 women in labour. Recordings to within 30 min of delivery from 55 women were available for analysis. There was a weak but statistically significant correlation between increasing mean T/QRS ratio and increasing pH/standard base excess (SBE) in the umbilical artery of the 55 foetuses (Spearman, respectively r = 0.

Fetal transcutaneous PCO2 measurements during labour.

The departments of Obstetrics and Gynaecology of the Universities of Bonn and Copenhagen and the Free University of Amsterdam cooperated in the European Community Concerted Action Project 'New methods for Perinatal Surveillance'. In 95 patients fetal transcutaneous PCO2 (tcPCO2) recording (measuring temperature 41 degrees C) during labour was evaluated regarding its clinical applicability. During the first stage of labour fetal tcPCO2 was rather stable at a level of 7.

Predictive value of pelvic scores for induction of labor by local PGE2.

The predictive value of pelvic scores, parity, age and gestational age for induction of labor by local prostaglandin-E2 (PGE2) was examined in 336 women attempting induction of labor by intracervical or vaginal PGE2. The patient characteristics were correlated to: (1) vaginal delivery within 48 h, (2) the period from induction to onset of labor (latency period), and (3) the duration of labor. The Bishop score (P < 0.

Induction of labor by prostaglandin E2: intracervical gel or vaginal pessaries?

To investigate the best route of prostaglandin medication for induction of labor, 125 pregnant women with unfavorable cervices (Bishop scores less than or equal to 6) were randomized to induction of labor with either PGE2 (0.5 mg) in a viscous intracervical gel once daily or PGE2 pessaries (2.5 mg) 1-2 a day.

The current status of intrapartum continuous fetal tissue pH measurements.

Continuous tissue pH monitoring during labor has now been possible for 15 years. Tissue pH is measured in the intercellular fluid, and the value differs in some cases from the blood pH value because of local capillary flow and local metabolism. The fetal scalp seems to be an area where tissue pH and capillary blood pH values are very close, but in acute acidosis there may be a time lag of 10-15 min before tissue pH is equilibrated.

[Cardiotocographic monitoring of deliveries. A prospective comparative study of 2 types of electrodes].

The number of electrodes employed, the frequency of reapplication, the technical quality of monitoring and the complications of use of spiral electrodes and Copeland electrodes for cardiotocographic monitoring of deliveries are assessed in a prospective randomized investigation. The number of electrodes employed and the frequency of reapplications were significantly lower employing Copeland electrodes. Similarly, the electrode signal was significantly better as assessed by the percentage of the duration of monitoring in which the cardiotocogram did not register during the second stage of labour on account of poor electrode signals.

Normal range of fetal transcutaneous carbon dioxide tension during labour.

Fetal transcutaneous carbon dioxide tension (tc-PCO2) was monitored during 122 deliveries, using an electrode temperature of 44 degrees C in 80 cases and of 41 degrees C in 42 cases. Significant correlations between tc-PCO2 and umbilical artery blood PCO2 were found using both electrode temperatures, but the regression lines indicated a larger and more inconstant CO2-contribution from skin metabolism when the low electrode temperature was used. Normal range of tc-PCO2 was calculated at 41 degrees C and 44 degrees C electrode temperatures.