Fetal Loss in

AP Syndrome

Placental Spiral ArteriesNarrowing

Intimal thickeningAcute Atherosclerosis

Fibrinoid Necrosis

Normal:Dilated Lumen

Fenestrated EndotheliumAbsent muscularis

Definition: ‘Complete 360 degree spiral course of umbilical vessels around Wharton jelly’

UCI = Total coils / length of cordStudied by USGNo coiling: 5-6% - Hypocoil: UCI <10th Centile – Hypercoil: UCI: >90th Centile

UCI: indicator of AN / PN Outcome

Hypocoil predicts PIH – IUGR – Fetal Distress (FH Deceleration) – Low apgar – Meconium stain – Chorioamnionitis – Fetal Death

Pointed out by Edmonds 1954 & Lacro 1987Revisited by Strong et al 1994

Meta analysis: IUD – Meconium stain – PIH – IUGR - Operative intervention -De Laat et al 2005 Performed alongside Doppler in 2nd Trimester: ‘Best single factor to predict SFD babies’

Sensitivity 79% - Specificity 86% - Pos Pred Value 72% - Neg Pred value 90% - J ultrasound 2001

Revision of Distance betweenBlades

Improvement in Locking System

Soft Blades with Rubber coating

Fabrication with Lighter Polymers

• Forceps Blades coated with soft Rubber• RCT: 96 Deliveries ( 51 Soft forceps / 45

Traditional forceps )• Severe Facial Abrasions: 1.9% vs 4.1%• Minimal Marking: 34% vs 61%• Conclusion: better but needs improvement

- Roshan DF et al Int J ObG March 2005

Computer enhanced Isometric Strength

Testing Unit

Leslie KL et al: Original ResearchObG 2005

FINDINGS:*Useful tool for Forceps Training*On simulation most candidates used force above preferred range of>45 lbs without Visual Feed back*Improved on Acquisition Trial*Force exerted while Sitting wasMore than while Standing *Males used more Force than females

John Hopkins Team

Least Forceful way to deliver Baby withShoulder Dystocia

3D Bony Pelvis – Flexible legs – Fetal Mannequin – Mock Uterus withPneumatic Pump – Force sensing Glovesto measure Traction Force – ComputerBased data acquisition system

- Allen et al Am J ObG Jan 2005

Comparison of Rubin’s, Wood screw & Mc Robert’s

Least Force:R: 6.5 WS: 8.5 McR: 16 lbsStretch of Brachial plexus:R:2.9 WS: 6.9 McR: 7.3 cmExtra space under S Pubis:R & WS: 2cm McR: 1 cm

Rubin’s Technique whereAnterior shoulder is rotated& Fetal spine comesAnterior is the Best!

Incidence in USA:16% (Adult 30%)3-fold Increase in 20 yearsWeight Gain recommended during Pregnancy: 11.5 – 16 Kg IOM-US10 – 12.5 Kg WHOExcess Weight Gain associated with Obesity in child at 3 yearsStudy of 770 mothers byGilman of Harvard Medical School & 1,90,000 families by Sharma of CDC, Atlanta

CLOSURE OF PERITONEUMAt Caesarean Section

Cohort study of 173 casesClosure Vs Non closure:Adhesions: 52% vs 73%

Dense Adhesions: 30% vs 45%Conclusion:

Closure protects 5-fold against allAdhesions & 3-fold against dense

AdhesionsPractice of Non closure must be

Questioned?Lyell et al Original Research-

J ObG 2005

RCT: Absorbable Staples for closure of Uterine incision at LSCSStaples made of Copolymer (Polylactic+Polyglycolic acid)

Reduces Op time/Trauma/Blood loss/PO MorbidityAcceptable alternative

Hoskins et al Surg Ob Gyn 1991

US National Academy of SciencesDeveloped Guidelines for ResearchOn Embryonic Stem cells in April ‘05In the section entitled ‘Inter Species Mixing”Authors concluded that there are valid reasons for creating Chimeras – Living entities composed of both Human & Animal cells!

French surgeonsDubernard & Devauchelle

French Girl whose Face was mutilated by Dog bite

Finding Recipients easy!But finding dead donors difficult!

Involves challenging intricateSurgery & Immune suppressing drugs

Raises many Ethical issues

How would you like to live with Another person’s Face?

Katie Holmes

Bought an Ultrasound MachineTo have a peek at his Baby!

Am U/S Society has raisedObjections & Questions the Wisdom of untrained personsPlaying with special equipment!