Objective To compare the efficacy and safety of 50 mg of sublingual misoprostol with 25 mg of vaginal misoprostol administered for labour induction at term.Design Double-blinded, randomised controlled trial.Setting University Hospital, Kaunas, Lithuania.Sample A total of 140 women at term with indications for labour induction.Methods Women were randomised to receive either 50 mg of sublingual misoprostol with vaginal placebo (n = 70) or sublingual placebo with 25 mg of vaginal misoprostol (n = 70) every 4 hours (maximum six doses).Main outcome measures The number of women delivering vaginally within 24 hours of labour induction.Results Fifty-eight women (83%) in the sublingual misoprostol group and 53 (76%) in the vaginal misoprostol group delivered vaginally within 24 hours [relative risk (RR) 1.1, 95% confidential interval (CI) 0.9-1.3]. However, the induction to vaginal delivery time was significantly shorter in the sublingual group (15.0 ± 3.7 hours) compared with the vaginal group (16.7 ± 4.1 hours, P = 0.03). The incidence of tachysystole was more than three-fold higher in the sublingual than in the vaginal group (14 versus 4.3%; RR 3.3, 95% CI 0.9-11.6), but this was not statistically significant. There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between the two groups.Conclusion A 50 mg of sublingual misoprostol 4 hourly for labour induction at term seems to have similar efficacy as 25 mg of vaginal misoprostol. Further studies on safety with larger numbers of women need to be conducted before routine sublingual misoprostol use in this setting.

Reflection of fetal heart electrical activity is present in registered abdominal ECG signals. However this signal component has noticeably less energy than concurrent signals, especially maternal ECG. Therefore traditionally recommended independent component analysis, fails to separate these two ECG signals. Multistage principal component analysis (PCA) is proposed for step-by-step extraction of abdominal ECG signal components. Truncated representation and subsequent subtraction of cardio cycles of maternal ECG are the first steps. The energy of fetal ECG component then becomes comparable or even exceeds energy of other components in the remaining signal. Second stage PCA concentrates energy of the sought signal in one principal component assuring its maximal amplitude regardless to the orientation of the fetus in multilead recordings. Third stage PCA is performed on signal excerpts representing detected fetal heart beats in aim to perform their truncated representation reconstructing their shape for further analysis. The algorithm was tested with PhysioNet Challenge 2013 signals and signals recorded in the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences. Results of our method in PhysioNet Challenge 2013 on open data set were: average score: 341.503 bpm(2) and 32.81 ms.

MCA-PSV is a significant Doppler index valid for the prediction of moderate and severe fetal anemia.

No abstract

Santrauka. Dvynių transfuzijos sindromas (DTS) komplikuoja apie 15 proc. monochorioninių, diamnioninių dvynių atvejų ir yra susijęs su didele vaisių žūties bei sergamumo rizika. Šį sindromą sukelia pakitusi kraujo srovė per placentos kraujagyslių anastomozes tarp vaisiaus donoro ir vaisiaus recipiento. DTS sunkumo laipsnis skirstomas pagal Quintero klasifikaciją. Veiksmingiausias DTS gydymas – placentos kraujagyslių anastomozių koaguliacija lazeriu atliekama pradinėse ligos stadijose. Pristatome pirmą sėkmingą DTS gydymo atvejį Lietuvoje.