Objective.

To evaluate whether pelvic measurements have any association with operative vaginal deliveries and the duration of the second stage of the delivery. Study design. A retrospective study of pregnant women at an increased risk of fetal-pelvic disproportion during 2000-2008 in North-Carelian Central Hospital. The mode of the vaginal delivery was chosen to represent the reference standard. The target condition was spontaneous vaginal delivery. Patients were divided into subgroups according to the size of the fetus and also by the parity to evaluate the variability reflecting differences in patient groups. Receiver operating characteristic (ROC) curves were established.

Results.

A total of 226 participants with fetal cephalic presentation delivered vaginally; of these, 184 women delivered spontaneously, and 42 women required operative vaginal delivery with vacuum extraction. There were no clinically or statistically significant differences between the size of the maternal pelvic outlet and the different modes of delivery types within these subgroups. With respect to the pelvic inlet and outlet, the areas under the curve in ROC were 0.566 with the P value of 0.18 and 95% confidence interval (CI) of 0.465-0.667 and 0.573 (95% CI: 0.484-0.622; P = 0.14).

Conclusions.

The maternal bony pelvic dimensions exhibited virtually no correlation with the need for operative vaginal deliveries.

Objectives.

To develop fundal height (FH) growth curve from normal singleton pregnancy based on last menstrual period (LMP) and/or ultrasound dating for women in the northern part of Thailand. Methods. A retrospective time-series study was conducted at four hospitals in the upper northern part of Thailand between January 2009 and March 2011. FH from 20 to 40 weeks was measured in centimeters. The FH growth curve was presented as smoothed function of the 10th, 50th, and 90th percentiles, which were derived from a regression model fitted by a multilevel model for continuous data.

Results.

FH growth curve was derived from 7,523 measurements of 1,038 women. Gestational age was calculated from LMP in 648 women and ultrasound in 390 women. The FH increased from 19.1 cm at 20 weeks to 35.4 cm at 40 weeks. The maximum increase of 1.0 cm/wk was observed between 20 and 32 weeks, declining to 0.7 cm/wk between 33 and 36 weeks and 0.3 cm/wk between 37 and 40 weeks. A quadratic regression equation was FH (cm) = -19.7882 + 2.438157 GA (wk) - 0.0262178 GA(2) (wk) (R-squared = 0.85).

Conclusions.

A demographically specific FH growth curve may be an appropriate tool for monitoring and screening abnormal intrauterine growth.

Because of the growing importance of infectious disease prevention in the individual patient and the larger community, it is vital that Fellows of the American College of Obstetricians and Gynecologists be prepared to navigate the practical and ethical challenges that come with vaccination. Health care professionals have an ethical obligation to keep their patients' best interests in mind by following evidence-based guidelines to encourage patients to be vaccinated and to be vaccinated themselves. College Fellows should counsel their patients about vaccination in an evidence-based manner that allows patients to make an informed decision about the use of these agents in their health care. The Centers for Disease Control and Prevention reports that no evi-dence exists of risk to the fetus from vaccinating pregnant women with noninfectious virus or bacterial vaccines or toxoids. Mandatory vaccination of health care professionals may be an ethically justified strategy in cases in which the harm to patients and the general population is believed to outweigh the autonomy of individual physicians.

: Pregnant women traditionally have been assigned priority in the allocation of prevention and treatment resources during outbreaks of influenza because of their increased risk of morbidity and mortality. The Committee on Ethics of the American College of Obstetricians and Gynecologists explores ethical justifications for assigning priority for prevention and treatment resources to pregnant women during an influenza pandemic, makes recommendations to incorporate ethical issues in pandemic influenza planning concerning pregnant women, and calls for pandemic preparedness efforts to include clinical research specifically designed to address safety and efficacy of treatment interventions or prevention strategies used by pregnant women.

: Müllerian agenesis occurs in 1 out of every 4,000-10,000 females. The most common presentation of müllerian agenesis is congenital absence of the vagina, uterus, or both, which also is referred to as müllerian aplasia, Mayer-Rokitansky-Küster-Hauser syndrome, or vaginal agenesis. Satisfactory vaginal creation usually can be managed nonsurgically with successive vaginal dilation; however, there are a variety of surgical options for creation of a neovagina. Regardless of the treatment option selected, patients should be thoroughly counseled and prepared psychologically before the initiation of any treatment. Evaluation for associated congenital renal anomalies or other anomalies is also important. Although exact gynecologic screening recommendations are evolving, all women with a neovagina should undergo routine gynecologic care; however, vaginal cytologic screening is not indicated.

Fetal growth restriction, also known as intrauterine growth restriction, is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. An additional challenge is the difficulty in differentiating between the fetus that is constitutionally small and fulfilling its growth potential and the small fetus that is not fulfilling its growth potential because of an underlying pathologic condition. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery.