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INTRODUCTION: Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS: A cross-sectional survey of low-risk, nulliparous pregnant women (N=416) and healthcare providers (N=168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS: Few women (85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women’s reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women’s right to choose (RCT). CONCLUSIONS FOR PRACTICE: Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.

Generally there is a tendency to underrate the value of uterine height in the diagnosis of intrauterine growth retardation (IUGR). This fact is probably due to the lack of standard normal values for this measurement. In a group of 298 healthy pregnant women, the 10th, 50th, and 90th percentile were calculated by week of amenorrhea. Uterine height was measured with a nonelastic measuring tape, from the symphysis pubis to the fundus uteri. With the use of these standard values the predictive value of the method was established. Of 44 neonates with low birth weight for gestational age, 38 had a uterine height below the 10th percentile (sensitivity 86%). Six cases of IUGR were not diagnosed by this method. Of 95 neonates with adequate birth weight, 85 had uterine values above the 10th percentile (specificity 90%). Ten (10%) of these were predicted as low birth weight but were born with adequate weight. The uterine height measurement is shown to be a very good method for detecting IUGR. It can be used as a screening test to detect impairment in fetal growth and to make early referral of those pregnancies.