Bishop Rating System Research Articles

Comparison of sonographic score and Bishop score in the prediction of successful labor induction in term patients: A prospective observational study

BackgroundThe cervical favorability for IOL is assessed by scoring systems. There are various scoring systems, including the Field system, Lange pelvic scoring system, and Bishop scoring system, which was then modified and termed ‘The modified Bishop scoring system, and it is the most widely used one. This scoring is done based on the assessment of the station of the fetal presenting part, consistency, position, dilatation, and length of the maternal cervix. Owing to its subjective assessment, there is a high chance of inter-observer variability. Therefore, radiological methods such as Trans-vaginal ultrasonogram (TVS) and Trans-abdominal ultrasonogram (TAS) are preferred over manual methods. This study aims to determine the role of assessment of the cervix by Modified Bishop Score and assessment of the cervical parameters by Transvaginal ultrasonogram (TVS) and compare them in predicting the outcome of labour. Material and methodsThis prospective observational study was conducted by the Department of Obstetrics and Gynecology in a tertiary care hospital located at Chengalpattu, Tamil Nadu, in a term singleton pregnancy woman, and the Study period was from January 2023 to July 2023 for six months. In total, one hundred fifty pregnant women were recruited. The study inclusion criteria were singleton pregnant women with intact amniotic membranes and a period of gestation >37 weeks with cephalic presentation. The findings of TVS were blinded to the person who measured cervical parameters for the bishop score. IOL done for both favorable and unfavorable cervix according to the guidelines given by FOGSI-ICOG (2018) for IOL. ResultsReceiver operating characteristic (ROC) curve analysis showed the area under the curve (AUC) for the TVS score was 0.705(95 % CI: 0.616–0.794) against the standard bishop score. TVS Score≥6.5 cm is the best cut-off value to ascertain successful IOL with a sensitivity of 99 % and specificity of 94 % among singleton pregnancy women. ConclusionThis prospective observational study deduced that TVS scoring is a valid alternative tool against the standard bishop score in predicting cervical favorability for IOL among singleton pregnant women with plausible sensitivity and specificity. TVS scoring for assessing cervical favorability acts as an outstanding marker in predicting the IOL with a cut-off value of ≥6.5 cm in singleton pregnant women.

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study

BackgroundThe induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland.MethodsA hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis.ResultsOf a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction.ConclusionThis study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

A prospective randomized study comparing retractor-endoscopic vs. open release of carpal tunnel and cubital tunnel syndromes

ObjectiveTo evaluate the neurological and neurophysiological outcomes of retractor-endoscopic versus open release in carpal tunnel syndrome (rCTS and oCTS, respectively) and cubital tunnel syndrome (rCbTS and oCbTS, respectively) at 3- and 12-month follow-up. MethodsBetween 2013 and 2017, 80 patients were prospectively blindly randomized. McGowan scores were used for preoperative grading and outcomes were assessed using a modified Bishop rating system (BRS). Furthermore, incapacity to work, duration of postoperative pain, hypoesthesia, atrophy, subjective weakness, and a subjective assessment of the operative result were analyzed. The differences in the cohorts were evaluated with t-tests and ANOVAs as parametric tests and Kruskal-Wallis and Mann-Whitney U tests as nonparametric tests. ResultsThe 80 patients underwent retractor-endoscopic or open decompression of the median or ulnar nerve. The rCTS group exhibited significant improvements in neurophysiological data (P = 0.032), shorter periods of postoperative pain (P = 0.03), and less discomfort (P = 0.005), as well as significantly better BRS results after 3 months compared with the oCTS group (P = 0.005). Between the oCbS and rCbTS groups, no significant differences were observed (P > 0.05). Regarding improvements in McGowan scores, no statistically significant differences were observed between the rCTS and oCTS groups after 3 months (P = 0.52) or 12 months (P = 0.86), nor were any observed between the rCbTS and oCbTS groups after 3 months (P = 0.88) or 12 months (P = 0.10). ConclusionSignificantly superior results were obtained at short-term follow-up for rCTS, whereas no superiority was found for rCbTS release. This study concluded that this endoscopic procedure is safe as well as and effective and has the potential to achieve better results in carpal tunnel syndrome compared with conventional methods.

A novel method for assessing the condition of the cervix before labor induction: Cervical length/thickness ratio

Background/Aim: Due to the increasing cesarean rates globally, new methods for supporting vaginal delivery and induction of successful vaginal delivery are still being developed. We aimed to obtain an easy-to-use method that can predict the effectiveness of cervical ripening agents before labor induction. So, we presented the effects on labor by measuring the thickness of the cervix and the cervical length/thickness ratio ultrasonographically. Methods: In this prospective cohort study, we evaluated 183 pregnant between 37 and 41 weeks of gestational age and will apply vaginal delivery induction. Before oxytocin induction, we applied 10 mg dinoprostone vaginally to women whose cervix was stiff. We started labor induction with oxytocin when regular uterine contractions or dilatation occurred. We used the Bishop Scoring System for favorable cervix defining. Then, we compared the groups with successful and unsuccessful cervical ripening regarding cervical length and thickness parameters. Results: The mean cervical thickness of the pregnant women with successful cervical ripening was 34.5 (7.5) mm before treatment, while the mean values of the unsuccessful group were 29.2 (9.1) mm (P &lt; 0.001). The cervical length did not differ between the two groups (31.6 [8.2] vs. 32.5 [6.8], P = 0.44), while the cervical length/thickness ratio was lower in the group with successful ripening (0.9 [0.38–2], P &lt; 0.001). Cervical length/thickness ratio was the highest predictor of the favorable cervix with dinoprostone. Each 1 unit decrease in the length/thickness ratio of the cervix increases the preparation of the cervix for induction by 0.25 times (P = 0.04). A successful response to dinoprostone can be obtained if the cervical length/thickness ratio is &lt;1.06 mm (P &lt; 0.001). Conclusion: In conclusion, assessing the cervix’s condition before labor induction by measuring the cervical length/thickness ratio may be a good predictor of cervical ripening activity.

Intraneural or extraneural ganglion cysts as a cause of cubital tunnel syndrome: A retrospective observational study.

PurposeCubital tunnel syndrome caused by ganglion cysts has rarely been reported. The purpose of this study was to evaluate the surgical treatment outcomes of a patient diagnosed with cubital tunnel syndrome caused by intraneural or extraneural cysts and to summarize our experience.MethodIn total, 34 patients were evaluated retrospectively from January 2011 to January 2020 with a follow-up of more than 24 months. Preoperative data, such as demographic data, clinical symptoms, physical examination findings, and laboratory tests, were all recorded and pre-operative and post-operative data were compared. The function was evaluated by the modified Bishop scoring system and the McGowan grade at the last follow-up.ResultsImprovement of interosseous muscle strength, the Visual Analog Scale (VAS), 2-point discrimination (2-PD), electromyogram (EMG) result, Wartenberg sign, claw hand, and weakness could be clearly observed in all patients. Extraneural cysts were completely removed and the pedicles of the cysts were ligated. Intraneural cysts were incised and drained, and part of their cyst walls were removed using a microsurgical technique. All patients underwent anterior subcutaneous transposition (AST). At the last follow-up, McGowan's (0-IIa) grade increased from seven patients (20.6%) preoperatively to 27 patients (79.4%); the excellent and good rate according to the modified Bishop scoring system was 82.4% (28 patients), and all patients had no symptoms of recurrence after surgery.ConclusionThe treatment of cubital tunnel syndrome caused by intraneural or extraneural cysts achieved good long-term results through extraneural cyst resection or intraneural cyst incision and drainage combined with subcutaneous transposition. Early diagnosis and surgical treatment are essential for the patient's postoperative recovery.

Ultrasound-Assisted Precise In Situ Decompression for Cubital Tunnel Syndrome.

ObjectiveTo explore the effect of locating the ulnar nerve compression sites and guiding the small incision so as to decompress the ulnar nerve in situ on the elbow by high‐frequency ultrasound before operation.MethodsA retrospective analysis was conducted on 56 patients who underwent ultrasound‐assisted in situ decompression for cubital tunnel syndrome from May 2018 to August 2019. The patients' average age was 51.13 ± 7.35 years, mean duration of symptoms was 6.51 ± 1.96 months, and mean postoperative follow‐up was 6.07 ± 0.82 months. Nine patients had Dellon's stage mild, 39 had stage moderate, and eight had stage severe. Ultrasound and electromyography were completed in all patients before operation. The presence of ulnar nerve compressive lesion, the specific location, and the reason and extent of compression were determined by ultrasound. A small incision in situ surgery was given to decompress the ulnar nerve according to the pre‐defined compressive sites.ResultsAll patients underwent in situ decompression. The compression sites around the elbow were as follows: two in the arcade of Struthers, one in the medial intermuscular septum, four in the anconeus epitrochlearis muscle, five beside the cyst of the proximal flexor carpi ulnaris (FCU), and the remaining 44 cases were all from the compression between Osborne's ligament to the two heads of the FCU. The compression localizations diagnosed by ultrasound were confirmed by operations. Preoperative ultrasound confirmed no ulnar nerve subluxation in all cases. The postoperative outcomes were satisfactory. There was no recurrence or aggravation of symptoms in this group of patients according to the modified Bishop scoring system; results showed that 43 cases were excellent, 10 were good, and three were fair.ConclusionsHigh‐frequency ultrasound can accurately and comprehensively evaluate the ulnar nerve compression and the surrounding tissues, thus providing significant guidance for the precise minimally invasive treatment of ulnar nerve compression.

Can We Use the Bishop Score as a Prediction Tool for the Mode of Delivery in Primiparous Women at Term Before the Onset of Labor?

The Bishop score serves as an evaluation system performed by digital vaginal examination (DVE) to determine cervical ripening. The scoring system includes cervical dilatation, position, effacement and consistency of the cervix and fetal head station1. Nowadays, the Bishop score is frequently used as an important parameter for the prediction of successful induction of labor. Objective: Our objective was to demonstrate the role of the Bishop scoring system in prediction of the mode of delivery in primiparous women at term before the onset of labor. Method: We included in this study unselected primiparous women at term, after 37 weeks of gestation, who presented to the Prenatal Diagnostic Unit (PDU) of the University Emergency County Hospital of Craiova. We excluded from the study multiparous patients, pregnancies with a planned Caesarean section delivery (CD), non-cephalic presentations and multiple pregnancies, twin pregnancies and those with detected fetal anomalies. The protocol included weekly DVEs until delivery for all patients, to determine the evolution of the Bishop score at term and in the week before delivery, and potential correlations with delivery outcome. To reduce clinical bias, the DVEs were performed by three experienced obstetricians involved in the research. Results: Statistical analysis yielded a 4 to 6 Bishop score in all weekly examinations. At 37 weeks of gestation, the majority of primiparous women had a Bishop score of 4, with no significant differences between the primiparous who delivered vaginally and the ones where Caesarean section was necessary. During the following weekly evaluations, we noted a slight turn to a Bishop score of 6 for most of them, without any significant differences between the two groups. However, at 41 weeks of gestation, there was a significant higher Bishop score in the group of primiparous women who delivered vaginally. Conclusion: In our study, the use of the Bishop score failed as a prediction tool for the mode of delivery in primiparous women at term before the onset of labor, at a gestational age less than 40 weeks. Therefore, Bishop score should not be used to counsel regarding the probability of an uncomplicated vaginal delivery (VD) before the onset of labor.

Sonoelastography for the comparative assessment of cervical maturation after different approaches to cervical preparation ahead of labor induction

Aim To compare the efficacy of different approaches to cervical preparation to labor induction using the ultrasound cervical elastography. Materials and methods This prospective open-label study included 200 pregnant women aged between 23 and 38 years eligible for labor pre-induction. Patients were divided into four groups (n = 50 per group). In Group I, four osmotic Dilapan-S cervical dilators combined with two doses of oral mifepristone (200 mg each) 24 h apart were used. The dilators were inserted for up to 12 h. In Group II, only the Dipalan-S dilators were used. In Group III, a Foley catheter was positioned intracervically for 12 h. In Group IV, we used two doses of intracervical prostaglandin E2 gel (0.5 mg each) 6 h apart. Cervical maturation was assessed using the Bishop scoring system and the ultrasound cervicometry with the color mapping and calculation of SR ratio. At baseline, all participants were also divided into three subgroups depending on the Bishop score before the pre-induction. Subgroup А (n = 66) included patients with the Bishop score between 0‒2 points, subgroup B (n = 69) between 3–4 points, and subgroup С (n = 65) between 4–6 points. Results Our study showed that the efficacy of Dilapan-S combined with mifepristone for cervical preparation to labor induction was higher than Dilapan-S, Foley catheter and intracervical prostaglandin E2 gel. In this group, the Bishop score after the pre-induction was the highest (11.4 (0.21) points versus 10.2 (0.2), 9.4 (0.3) и 9.67 (0.25) in Groups II, III and IV respectively (p < .05 for all). The lowest SR values were also observed among the patients receiving the combination of Dilapan-S and mifepristone: 1.23 (0.04) versus 1.63 (0.07), 1.7 (0.08) and 1.83 (0.1) in Groups II, III and IV respectively (p < .05 for all). The sonoelastographic SR values in subgroups B and C were statistically lower compared with subgroup A across all groups studied. Ultrasound elastography of the cervix allowed to perform a more objective assessment of cervical maturation compared with the Bishop scoring. Conclusion Dilapan-S combined with mifepristone had higher efficacy for cervical preparation to labor induction compared with other approaches investigated.

V-Y Lengthening Technique of the Flexor-Pronator Mass for Anterior Submuscular Transposition of the Ulnar Nerve in Severe Cubital Tunnel Syndrome: A Long-Term Follow-Up Study.

This study aimed to retrospectively analyze the clinical results of anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique in patients with severe cubital tunnel syndrome (CTS). From January 2007 to May 2015, 36 patients with grade III CTS based on McGowan's classification were enrolled. All patients were treated with anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique. To evaluate clinical outcomes, all patients underwent preoperative and final follow-up assessments of disabilities of the arm, shoulder, and hand scores, nerve conduction velocity, 2-point discrimination, and pinch and grip strength. Overall functional outcomes were evaluated after a mean follow-up of 53 months using the Modified Bishop rating system. We analyzed the statistical correlation of patients' duration of symptom and age with clinical results. At the final follow-up, the average disabilities of the arm, shoulder, and hand, nerve conduction velocity, 2-point discrimination, and grip and pinch strengths significantly improved in all patients. At least a 1-McGowan grade improvement was achieved in 34 extremities (94.4%). According to the modified Bishop scores, 30 patients (83.3%) achieved good or excellent outcomes and 2 extremities (5.5%) had poor outcomes. There was a significant negative correlation between prolonged symptom duration and the Modified Bishop score at the final follow-up, but age did not affect the functional outcome. In McGowan grade III severe CTS, anterior submuscular transposition of the ulnar nerve using a flexor-pronator V-Y lengthening technique leads to satisfactory outcomes. Longer symptom duration is associated with poorer results, and the outcome is not correlated with age. Therefore, active surgical treatment should be considered regardless of age before severe disease occurs.

Subcutaneous versus submuscular ulnar nerve transposition in cubital tunnel syndrome

Introduction There are different surgical procedures for treatment of cubital tunnel syndrome (CubTS), which can be divided into two types, decompression and transposition procedures. Decompressive procedures include simple decompression with or without medial epicondylectomy without mobilizing the nerve. The transposition procedures mobilize the nerve anteriorly for more protection by subcutaneous, intramuscular, and submuscular methods, depending on the position in which the ulnar nerve is placed. Patients and methods A total of 24 patients with moderate CubTS (according to Dellon’s grading system) between March 2011 and April 2013 were classified according to age and sex into anterior subcutaneous transposition and anterior submuscular transposition groups. The two groups were prospectively followed up for 2 weeks, 6 months, and 12 months postoperatively, and outcome was assessed using the Bishop rating system. Results A total of 24 patients with moderate CubTS were used in this study to compare the operative technique (incision length and operative time), postoperative care (postoperative pain and complications), and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Final results present that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication, and better outcome compared with the submuscular transposition. Conclusion Subcutaneous ulnar nerve transposition in the treatment of CubTS, as compared with the submuscular approach, is an easier surgical technique with less operative time and postoperative pain, earlier postoperative mobilization, and better postoperative outcome.

Modified simple decompression of ulnar nerve in the treatment of cubital tunnel syndrome: Report of a series of cases.

Ulnar compressive neuropathy is the second most common nerve compression in the upper extremity. Although numerous operative procedures have been defined for the treatment of cubital tunnel syndrome (CuTS), the best operative intervention remains controversial. The aim of this study is to discuss the efficacy of a modified simple decompression (MSD) of the ulnar nerve in the treatment of CuTS. Each patient was preoperatively examined, and the following data were recorded: initial complaint, duration of symptoms, and presence of Tinel's sign around the elbow, results of provocation by the elbow flexion test, and results of electrodiagnostic studies. Patients' preoperative clinical manifestations were determined based on Dellon's staging system and Bishop scores. Pre- and post-operative motor conduction velocity (MCV) of the ulnar nerve were also recorded. Under the regional anesthesia, 4 cm long curved skin incision, above and below the elbow, was made posterior to the medial epicondyle of the humerus and the ulnar nerve was seen. The nerve was released proximally as it passed through the medial intermuscular septum. The cubital tunnel retinaculum and flexor carpi ulnaris aponeurosis were then cut distally. Only the compressive fascial bands are released. Then, the cubital tunnel reticulum was sutured to subcutaneous tissue loosely to prevent subluxation of the ulnar nerve. A total of 15 patients were operated. Postoperative electrophysiological study assessed at 3 months following surgery in 8 patients. In 7 of these patients (86%), the mean value of MCV had improved from 38.9 ± 12.0 m/s to 48.1 ± 11.9 m/s (P < 0.05). According to Bishop scoring system, 13 patients (86.7%) were clinically graded as excellent, 1 patient (6.7%) was graded as good, and only 1 patient (6.7%) was graded as fair. MSD is a technically simple, safe, and effective method without annoying complications.

Ulnar nerve entrapment at the elbow. A surgical series and a systematic review of the literature

Chronic compression of the ulnar nerve at the elbow is the second most common entrapment neuropathy. Various surgical options have been described. Timing of surgery is also debated. In this study we report the long-term results of a consecutive surgical series of anterior subcutaneous transpositions and review the pertinent literature. Sixty consecutive patients underwent anterior subcutaneous transposition at our Institution to treat ulnar nerve compression at the elbow. McGowan scale was used in the neurological exam before surgery. Bishop rating system was used to assess outcome. Seventy-eight% of patients scored good-excellent. None of the patients worsened. No complications and no recurrences were reported. Young age and good pre-operative neurological status (McGowan grade 1) were predictive of favorable outcome both at univariate and at multivariate analysis. No differences in outcome were observed between patients with intermediate (McGowan grade 2) and severe (McGowan grade 3) neuropathy. Thirty-four studies assessing outcome of different surgical techniques were reviewed. Anterior subcutaneous transposition had the lowest recurrence rate with an excellent effectiveness and safety profile. The favorable predictive role for outcome of preoperative neurological status was confirmed. The good long-term clinical results of the present series and the results of literature analysis confirm the value of anterior subcutaneous transposition of the ulnar nerve at the elbow. This technique has a particular effectiveness in most severe compressions, where outcomes are comparable with intermediate neuropathy cases. Moreover, our results suggest an aggressive attitude towards ulnar nerve compression at the elbow, particularly in younger patients.

Results of endoscopically-assisted cubital tunnel release without using any specific instrument

BackgroundWe aimed to report the clinical and electrophysiological results of patients who were treated with an endoscopically assisted in situ release technique for cubital tunnel syndrome and to show safety and efficacy of this procedure. Materials and methodsTwenty nine patients were included into the study. 13 patients (44.8%) were female, 16 patients (55.2%) were male. The mean age was 44.4 years (range; 22–66 years). Mean follow up period was 16.0 months (range; 7–42 months). We used Dellon classification for preoperative staging, and modified Bishop rating system for the evaluation of postoperative clinical results. Dynamometric and electromyographic measurements were obtained preoperatively and at final control. ResultsPreoperative Dellon's classification revealed 3 patients grade 1, 14 grade 2, and 12 grade 3. Modified Bishop score was very good for 21 patients (72.4%), good for 4 patients (13.8%), fair for 3 patient (10.3%), and poor for 1 patient (3.4%). At final control; the mean proportion of grip power and pinch strength of the affected hand to the contralateral normal hand was improved, and also nerve conduction velocity were improved in all patients. As complication, hematoma formation developed in two cases. ConclusionOur study showed that endoscopically assisted decompression technique without using any special instruments can be performed successfully with a low complication rate. It is a safe and effective method in the treatment of cubital tunnel syndrome. Level of evidenceLevel IV, Therapeutic study

Surgical outcome for severe cubital tunnel syndrome in patients aged >70years: a mean follow-up of 4.5years.

Surgical outcomes for cubital tunnel syndrome have been reported to be satisfactory, but could be compromised by advanced age and severe nerve compression. We aim to evaluate the prognosis of severe cubital tunnel syndrome in patients aged >70years. This retrospective study included 25 patients (26 extremities, all McGowan grade III, age >70years); 21 underwent subcutaneous transposition and 5 in situ decompression. Postoperative follow-up lasted >2years. Demographic data, clinical symptoms, physical examination findings, and the Disabilities of the Shoulder, Arm, and Hand Questionnaire were evaluated preoperatively and at final follow-up. Pain and weakness were evaluated using the visual analog scale and overall functional recovery using the modified Bishop's Score and McGowan Grade. Significant improvements were seen in both sensory and motor function. VAS pain and weakness, 2-PD, key-pinch strength, grip strength, first dorsal interosseous muscle strength, the Wartenberg sign, and claw hand all improved significantly. DASH scores improved from an average of 45.2 points preoperatively to 15.9 points postoperatively. According to the modified Bishop scoring system, 10 extremities were graded excellent; 12, good; 2, fair; and 2, poor. Improvement of at least one McGowan Grade was seen in 18 cases, but only 2 extremities recovered to normal. For patients aged >70years with severe cubital tunnel syndrome, surgical treatment is effective, but complete recovery is unlikely, and the recovery process is long.

Bishop scoring: Perceived benefits of using in labour induction by Turkish midwives.

It is not always possible to achieve a successful induction. Bishop scoring system is an efficient method used in determining whether the induction will be effective or not. The aim of this study was to train midwives on the benefits and use of the Bishop scoring system and to minimize the unnecessary use of induction. This study was conducted as pretest-posttest quasi-experimental design. This study was conducted in a maternity hospital in Erzurum between 01 February and 31 July 2012. In the study, the midwives received training on the use of the Bishop scoring system, and changes in their knowledge levels and application during practice of induction were then evaluated. While only 20% of midwives were using the Bishop score before the training, 56.7% started to use this tool after the training. Comparing the examinations performed on pregnant women by the midwives in the pre-induction period before and after the training, the mean of the Bishop score changed from 7.26 to 9.68 after the training. It was determined that the training could increase the knowledge levels of midwives regarding the Bishop scoring system and their attention paid to the Bishop scoring system in the practice of induction.

Ulnar nerve deep branch compression by a ganglion: A review of nine cases

Background and aimUlnar nerve compression is common at the elbow, but less common at the wrist. The purposes of this study were to report a series of nine patients with pure ulnar nerve deep branch compression by a ganglion and to evaluate the outcome following a surgical treatment. MethodsA retrospective study was conducted with nine patients from 2000 to 2011. The patients included four male and five female patients. The mean duration of symptoms before surgery was 16 months (range, 5–32 months). Different degrees of muscular atrophy and weakness of the interossei and adductor pollicis muscles were present without sensory loss in the hand. Ganglion excision and decompression of Guyon's canal were performed in all patients. We evaluated postoperative results of this uncommon nerve lesion based on the modified Bishop's scoring system. ResultsThe ganglion compressing the deep branch originated from the pisohamate joint in eight cases and from the midpalmar space in one case. At the mean follow-up of 23 months (range, 17–31 months), strength improvement of the grip and tip pinch was achieved in all patients. In comparison, grip strength improved from a mean of 63% of the unaffected side preoperatively to 88% of the unaffected side postoperatively. Tip pinch strength improved from a mean of 61% to 87%. According to the modified Bishop's scoring system, six patients (67%) obtained excellent results, two (22%) had good results, and only one (11%) had a fair result. ConclusionsA ganglion causing ulnar nerve deep branch compression is rare. Early surgical treatment can result in satisfactory functional recovery.

Fascia wrapping technique: a modified method for the treatment of cubital tunnel syndrome.

Variations of the anterior transposition of the ulnar nerve for cubital tunnel syndrome include subcutaneous, submuscular, intramuscular, and subfascial methods. We introduce a modification of subfascial transposition, which is designed to facilitate nerve gliding by wrapping the nerve with fascia. Twenty patients with wrapping surgery following the diagnosis of cubital tunnel syndrome were reviewed retrospectively. Preoperative electrodiagnostic studies were performed in all patients and all of them were rechecked postoperatively. The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05). Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. The surgical treatment methods for cubital tunnel syndrome have their own advantages and disadvantages, and the preferred method differs depending on the surgeon. The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition. This method could be an alternative option to treat cubital tunnel syndrome.

Surgical interventions for treating distal humeral fractures in adults

Distal humeral fractures in adults are relatively uncommon injuries that require surgical intervention in most cases. There is a lack of consensus regarding the best management of distal humeral fractures in adults, including the role of conservative treatment, appropriate surgical approach, fixation strategies, the role of total elbow arthroplasty and handling of nerves such as the ulnar nerve. To assess the effects (benefits and harms) of surgical interventions for distal humeral fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2012 Issue 4), MEDLINE (1946 to April Week 4 2012), EMBASE (1980 to 2012 Week 17), Current Controlled Trials (1st May 2012), the WHO International Clinical Trials Registry Platform (1st May 2012) and the bibliographies of trial reports and relevant articles. All randomised and quasi-randomised controlled trials pertinent to the management of distal humeral fractures in adults were included. Two review authors independently performed study selection, assessed of risk of bias and extracted data. Pooling of data was impossible due to study heterogeneity. Three small randomised controlled trials, with a total of 109 participants with Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) type C distal humeral fractures, were included. Overall, the quality of the available evidence is limited. As well as the small sample sizes and detection bias from the lack of blinding of subjective outcomes, the methods and results of all three trials were incompletely reported.One trial, involving 42 participants, compared open reduction-internal fixation (ORIF) with total elbow arthroplasty (TEA) in patients aged over 65 years. Of the 40 participants followed up for two years, five allocated ORIF underwent intraoperative conversion to TEA. These participants were crossed-over to the TEA group in the analyses. The reported Mayo Elbow Performance Score (MEPS) results were consistently better in the TEA group at follow-up after 6, 12, and 24 months, whereas the Disability of the Arm, Shoulder, Hand (DASH) scores showed short term (after 6 months), but not longer term (after 12 and 24 months), superiority in the TEA group. The reoperation rate, complication rate and elbow range of motion results showed no statistically significant differences between the two groups. While an intention-to-treat analysis of treatment failure, where the five cross-over participants are placed in their original allocated group, is in favour of TEA, the result did not reach statistical significance (9/21 versus 3/21; RR 3.00, 95% CI 0.94 to 9.55).The second trial, involving 38 patients but reporting results for 35, compared perpendicular versus parallel double plate fixation strategies. There was a consistent finding of a lack of significant differences between the two treatment groups in terms of MEPS, re-operation for complications (3/17 versus 3/18; RR 1.06, 95% CI 0.25 to 4.54), complications and elbow joint range of motion.The third trial, which included 29 patients with preoperative ulnar nerve compression symptoms, compared anterior subfascial transposition with in situ decompression of the ulnar nerve. Although results for complete recovery of ulnar nerve function (12/15 versus 8/14; RR 1.4, 95% CI 0.83 to 2.35) and grades based on the Bishop rating system tended to favour the transposition group, none of the differences were statistically significant. Overall, this review found there is either no or insufficient evidence from randomised or quasi-randomised controlled trials to determine whether surgery is, and which surgical interventions are, the most appropriate for the management of different types of distal humerus fractures. Well designed and reported large and multi-centre randomised controlled trials testing current interventions, such as pre-contoured and locking plating systems, are needed.

Induction of labor using double balloon cervical device in women with previous cesarean section: Experience and review

Induction of labour remains one of the most challenging interventions in current obstetrics. Different pharmaceuticals have been used for cervical ripening such as prostaglandins; however they can lead to a number of potential inconvenient risks namely uterine tachysystole and pathological fetal cardiotocography (CTG). In cases of women with previous caesarean births, using prostaglandins would pose even higher risks such as uterine rupture and perinatal mortality. A mechanical method of cervical ripening could represent an alternative for these women. We report the use of the extra-amniotic double balloon cervical device (Cook’s device) for ripening of unfavourable cervix in seventeen women attempting vaginal birth after cesarean section (VBAC). Using Bishop scoring system to assess cervical dilatetion, position, consistency, fetal station and effacement, the unfavourable cervix is the cervix that scores less than 6. We review the relevant literature discussing this method of induction focusing on its effectiveness, simplicity, safety and efficacy, low cost and any associated serious side effects. Conclusion: Success was estimated to be over 50% with no serious life threatening maternal or fetal complications. We considered the process satisfactory and practical. We recommend larger studies to assess safety and efficacy of Cook’s device in vaginal birth after caesarean section before embarking on routine elective caesarean delivery. Objectives: To estimate success rate for vaginal delivery after previous caesarean section using cervical double balloon device (Cook’s device). Design: Three-year observational study. Setting: Maternity unit in district general hospital, UK. Population: Women who had one previous lower segment caesarean section and unfavourable cervix identified as having Bishop Score less than 6. Methods: Data were obtained from the birth registry over 3 years from January 2008 until December 2010. Main outcome: Measure successful vaginal delivery. Results: Out of 25 cases that had induction of labour with history of one previous lower segment caesarean section, 17 patients did fit in the inclusion criteria and were studied. 53% had a successful vaginal delivery while 47% had to have cesarean section either due to failure to progress or pathological cardiotocography. 82% required to have syntocinon infusion for augmentation as per local unit protocol. All newborn babies were in good condition and did not require admission to neonatal intensive care unit.

Endoscopy-Assisted Cubital Tunnel Release Under Carbon Dioxide Insufflation and Anterior Transposition

The optimal treatment for cubital tunnel syndrome is widely debated. The purpose of this study is to describe the technique of an endoscopic-assisted ulnar nerve decompression using carbon dioxide insufflation in association with subcutaneous anterior transposition and to assess the success or failure of the method of treatment. In all, 8 male and 4 female patients with an average age of 42 years (range, 25-56) who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome were recruited in the retrospective study. Between August 2008 and June 2009, they were operated on using a 0-degree lens endoscope. Preoperatively, they were classified according to the Dellon scale, and the Bishop rating system was used to evaluate the postoperative outcomes. Preoperatively, 5 patients were rated as mild, another 5 as moderate, and the remaining 2 as severe. The average length of the incision was 15 ± 3 mm, the mean length of the ulnar nerve decompression was 18 ± 2 cm, and the whole duration of surgery (skin to skin) lasted 30 ± 5 minutes. The endoscopic-assisted cubital tunnel release under carbon dioxide insufflation and subcutaneous anterior transposition surgeries in all patients were performed with no difficulty. All the patients had improvement in symptoms of cubital tunnel syndrome and 10 of 12 patients scored excellent according to the modified Bishop Rating System at a minimum of 1 year after surgery. Endoscopy-assisted cubital tunnel release under carbon dioxide insufflation demonstrated similar results compared with conventional open surgeries, besides, it may avoid problems such as long incision, painful scarring, and have additional advantages of providing an extended endoscopic view, which is safe and mini-invasive with favorable results in a 12-month follow-up.