This study was a small-scale, "quasirandomized," controlled trial carried out to determine the effectiveness and safety of cervical cerclage performed using the McDonald technique in patients with symptomatic placenta previa. Outcomes were compared in 18 women undergoing cerclage and 19 control women. Criteria for admission to the study included painless vaginal bleeding, a gestational age of 20 to 34 weeks, and sonographic confirmation of the diagnosis. Gross congenital anomalies, other complications, type 1 placenta previa more than 2 cm from the internal os, and a cervical length less than 3 cm, noted on speculum examination 24 hours after bleeding stopped, were criteria for exclusion.Patients were placed on bedrest, sedated if bleeding was present, and given steroids weekly from 28 to 34 weeks gestation. Blood was transfused as needed. The McDonald stitch was placed under antibiotic prophylaxis and tocolysis that began 1 hour before cerclage and continued for 48 hours postoperatively. If placenta previa was characterized as "minor," patients were discharged 3 days after cerclage. Pregnancies were terminated at 37 weeks gestation.All but one of the end points recorded differed significantly between the cerclage and control groups, the exception being the amount of blood transfused. Cerclage patients had fewer major hemorrhagic episodes and fewer episodes associated with blood clots or signs of hypovolemia. In none of 10 patients with minor placenta previa who had cerclage and subsequent normal-term vaginal delivery was the placenta felt on pelvic examination after removal of the stitch. Pregnancies were prolonged by a mean of 53 days in the cerclage group and 19 days in control women. The respective mean gestational ages at delivery were 37 and 31 weeks. Mean birth weights were substantially greater in the cerclage group (2549 g vs 1568 g). Eight of the 19 control pregnancies ended in perinatal death, but there were no such deaths in the 18 cerclage cases.These promising results deserve a large randomized, controlled trial that would distinguish between the effect of cerclage in women with minor and major placenta previa.

We describe the contents of the IFCIR and present post-natal data to suggest potential benefit to fetal therapy among pregnancies considered for possible intervention and support proposals for additional work.

Delayed cord clamping at birth increases neonatal mean venous hematocrit within a physiologic range. Neither significant differences nor harmful effects were observed among groups. Furthermore, this intervention seems to reduce the rate of neonatal anemia. This practice has been shown to be safe and should be implemented to increase neonatal iron storage at birth.

Absence of nasal bone by first trimester ultrasound was significantly associated with Down syndrome. When a proper view of the fetal face was obtained, the nasal bone was visible in more than 99% of karyotypically normal fetuses.

Objective To evaluate the effect of early versus delayed feeding after caesarean section on the woman's satisfaction.Design Randomised, controlled trial.Setting Tertiary care hospital.Population Healthy pregnant women were enrolled for the study during antenatal care visits.Methods Uncomplicated singleton pregnancies undergoing a planned or intrapartum caesarean section performed under regional anaesthesia were randomly assigned to either (1) a 'delayed feeding' group who started oral fluids 4 hours after surgery with diet introduced at 24 hours; or (2) an 'early feeding' group who were offered a regular diet within the first 8 hours.Main outcome measures Primary outcome was the woman's satisfaction measured with a visual analogue scale (VAS) before their hospital discharge. The secondary outcomes were: pain, anorexia, abdominal distension, persistent nausea and/or vomiting, time to the first bowel movement and passage of flatus.Results Two hundred women were recruited, with 103 randomised to delayed feeding and 97 to early feeding. The woman's satisfaction (mean VAS ± SD) was similar in both groups; 73 ± 17 mm in the delayed feeding group and 77 ± 13 mm in the early feeding group (P = 0.12). A statistically significant difference was observed in mean postoperative pain: 29 ± 13 mm in the delayed feeding group versus 24 ± 11 mm in the early feeding group (P = 0.008). No other significant differences in postoperative variables were recorded, and there were no major postoperative complications observed in either group.Conclusion Early feeding after uncomplicated caesarean in low-risk women is equivalent in terms of the woman's satisfaction and the reduced perceived pain.

No abstract

Objective

Objective: To describe the contribution of 3-dimensional computed tomography (3D-CT) in the prenatal diagnosis of skeletal dysplasias (SD) in a cohort of patients with inconclusive diagnosis by ultrasound (US). Methods: Between May 2007 and February 2010, six pregnant women with suspected fetal SD on US examination but with no specific diagnosis were studied with 3D-CT. The images were evaluated by a multidisciplinary team who proposed a likely diagnosis. Further postnatal workup included clinical and radiological evaluation in all cases. Prenatal and postnatal diagnoses were compared. Results: The use of 3D-CT provided a precise diagnosis confirmed postnatally in 5/6 patients. These included osteogenesis imperfecta type II (n = 2), osteogenesis imperfecta type III (n = 1), chondrodysplasia punctata (n = 1) and thanatophoric dysplasia type I (n = 1). A precise diagnosis could not be made in 1 case – either pre- or postnatally. Conclusion: Prenatal 3D-CT contributed to the diagnosis of the specific fetal SD in the majority of these cases. 3D-CT may have a complementary role to US where fetal SD is suspected, but no specific diagnosis can be made using US alone. Further studies on clinical performance and risk-benefit analysis are needed.