Cervical Dilatation Research Articles

Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes.

Friedman's standards, developed almost 50 years ago, may no longer align with the needs of today's obstetric population and current pregnancy management practices. This study aims to analyze contemporary labor patterns and estimate labor duration in China, focusing on first-stage labor data from Chinese parturients with a spontaneous onset of labor. This retrospective observational study utilized data from electronic medical records of a tertiary hospital in Changsha, Hunan. Out of a total of 2,689 parturients, exclusions were made for multiple gestations, preterm, post-term, or stillbirth, cesarean delivery, non-vertex presentation, and neonatal intensive care unit admission. Average labor curves were constructed by parity using repeated-measure analysis, and labor duration was estimated through interval-censored regression, stratified by cervical dilation at admission. We performed an analysis to assess the impact of oxytocin augmentation and amniotomy on labor progression and conducted a sensitivity analysis using women with complicated outcomes. Nulliparous women take over 180 minutes for cervical dilation from 3 to 4 cm, and the duration from 5 to 6 cm exceeds 145 minutes. Multiparous women experience shorter labor durations than nulliparous. Labor acceleration is observed after 5 cm in nulliparous, but no distinct inflection point is evident in the average labor curve. In the second stage of labor, the 95th percentile for nulliparous, with and without epidural analgesia, is 142 minutes and 127 minutes, respectively. These findings provide valuable insights for the reassessment of labor and delivery processes in contemporary obstetric populations, including current Chinese obstetric practice.

Influence of Female Genital Mutilation on Women Sexual Function in Egypt

Abstract Background Although Female genital mutilation (FGM) is internationally recognized as a violation of human rights with Short term and long term complications include death due to shock, painful menstruation, dyspareunia, cysts and keloid formation. Aim of the Work aimed to assess the effect of FGM on Women reproductive and sexual function. Subjects and Method This is a cross sectional hospital based study included 800 married or previously married females, between (18 - 40) year old who are apparently healthy. They were recruited from Outpatient clinic of Gynecology and Obstetrics in Etay Elbaroud general hospital, Behaira Governate, Egypt and classified into case group who were circumcised and control non circumcised group. They were subjected to detailed history including history of sexual function and local genital examination after informed consent was taken. During labor; a partogram was used to assess the progess of labor and occurrence of complicated delivery. Partogram is a graph reporting labor events against time which includes cervical dilatation, fetal heart rate, state of membrane and liquor. Results among case group age of FGM ranged from 9-13 with mean value 10.27±0.98 and majority of cases had type I. There was statistically significant difference between the two studied groups regarding regularity of menses and dysmenorrhea. 66% of cases had short term complication and pain was the most common (52%). Assisted mode delivery was higher in cases group with 220(55%) and normal was higher in control group with 244(61%). There was statistical significant difference between two studied groups regarding sexual desire, arousal, orgasm, satisfaction, and pain while there was no statistical significant difference regarding lubrication. Conclusions and Recommendations FGM still being a community problem in Egypt esecially in rural area which running in certain families. The most common type in Egypt is type I and common complication is pain following FGM. Sexual function is affected in all cases experienced FGM especially with type III. Assisted delivery was more common in cases had passed FGM before. It is recommended to raise community awareness about complications and hazard of FGM on sexual function as well as reproductive life.

Evaluation of Efficacy and Cost-effectiveness of Outpatient Resection of Endometrial Pathologies in a University Hospital in the UK

ABSTRACT Objective: The objective of the study was to evaluate the efficacy of outpatient MyoSure procedures and their cost-effectiveness. Design: A retrospective analysis of patients who had outpatient MyoSure procedures from November 2019 to November 2020. Subjects and Methods: Data were collected retrospectively from electronic patient records (hysteroscopy reports, clinic notes, clinic letters, and histopathology results) from November 2019 to November 2020 and analyzed using Microsoft Excel and SPSS software. Results: Fifty-eight outpatient MyoSure procedures were performed from November 2019 to November 2020. The mean age was 53.13 years (22–81 years) and the mean body mass index was 29.65 kg/m2 (18–51 kg/m2). We found that our service has a success rate of 93.1% (54/58), a completion rate of 92.59% (50/58), and a discharge rate of 82.75% (48/58). The complete resection rate for polyps was 100% and for fibroids, it was 76.47%. When compared to the same procedure performed under general or regional anesthesia in a day surgery setting, an outpatient MyoSure procedure saves around 1117 GBP per procedure, for the Trust. We have compared data for the first 6 months to the following 6-month period. There were significant improvements in the success rate, completion rate, and discharge rate, also accompanied by a reduced complication rate. This is likely due to improved operators’ experience in performing the procedure, and also the increased use of local anesthetic injection and cervical dilatation. Conclusions: Outpatient MyoSure procedures are feasible, efficacious, safe, acceptable, and cost-effective. The use of local anesthetic and cervical dilation has been associated with improved success rates.

Comparing transcervical balloon with osmotic dilators for cervical preparation prior to procedural abortion: A noninferiority randomized trial

ObjectivesThis study aimed to compare cervical preparation with transcervical balloon to osmotic dilators for second-trimester procedural abortions. Study designWe performed an unblinded, randomized, noninferiority trial of people undergoing second-trimester procedural abortion at 18 + 0 to 23 + 6 weeks' gestation. We randomized participants to either overnight osmotic dilators (Dilapan-S) or transcervical balloon (Foley). Both groups received overnight mifepristone and preprocedural misoprostol. We powered the study on mean difference in procedure duration, a noninferiority limit of 5 minutes. We compared preprocedure cervical dilation and the need for additional dilation and, using a 100-point visual analog scale, measured physician satisfaction and ease of procedure, and participant pain and satisfaction. ResultsWe recruited 32 participants at a single academic center. Although procedure time (minutes) was similar (balloon: 22.6 ± 8.9 vs Dilapan-S: 22.4 ± 12.8, p = 0.96), noninferiority was not met (mean difference, 0.2 minutes; 95% CI, −7.8 to 8.2). Cervical dilation >2 cm was more likely after Dilapan-S (100% vs 62.5%, p = 0.02). Placement was well tolerated with similar time (minutes) for insertion (balloon: 4.8 ± 1.0, Dilapan-S: 5.1 ± 2.3, p = 0.64) and maximum pain (median) with insertion (balloon 39 [5–78], Dilapan-S: 39 [0–100], p = 0.92). Pain immediately postinsertion was higher for Dilapan-S (33 [0–100] vs 18 [0–50], p = 0.046) and similar for maximum pain overnight, participant satisfaction, and likelihood to recommend. Complications were minor and similar between groups (p = 0.60). ConclusionWhile significantly more people with transcervical balloon required mechanical dilation, the difference in operative time was clinically negligible. The transcervical balloon was well tolerated and acceptable by participants. ImplicationsClinicians experienced in mechanical dilation may consider a transcervical balloon as a lower-cost tool for second-trimester abortion cervical preparation. Clinical Trial RegistrationClinicalTrials.gov: NCT05099991

Comparison of Efficacy of Vaginal Misoprostol Versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation Before Operative Hysteroscopy: A Randomized Controlled Study

(Abstracted from Gynecol Minim Invasive Ther 12(2023) 225–229) Standard procedure for treatment of uterine lesions includes operative hysteroscopy using the resectoscope. Cervical dilation is necessary before the procedure to prevent complications such as cervical laceration and uterine perforation.

The Effectiveness of Routine Cerclage in In Vitro Fertilization (IVF) Twins.

The incidence of twin pregnancies is on the rise worldwide due to assisted reproductive technologies. Cervical dilatation is a frequent complication and can be considered a cause of premature births in twin pregnancies. In vitro fertilization (IVF) twins are more prone to preterm delivery. Routine cervical cerclage with normal cervical length is not recommended in twins, but studies were not done on IVF twins. So, this study aims to evaluate the effectiveness of routine transvaginal cerclage in twin IVF pregnancies with normal cervical length on maternofetal outcome. A retrospective case-control study was conducted at a maternity hospital in eastern Indiafrom January 2016 to December 2019 with over 21800 deliveries. Two groups were taken, cases were those IVF twins with normal cervical length in whom cervical cerclage was done as they have referred to our hospital from the IVF centers for cerclage and in control no-cervical cerclage as they are referred from other IVF centers where cerclage was not a routine protocol. We have excluded cerclage done for history, ultrasound indicated, uterine anomalies, and monochorionic twins. Fifteen participants were recruited in both cases and controls. In our study 2 (6.66%), 4 (13%), and 26 (86%) were IVF twins delivered at a gestational age of <28 weeks, 28-32 weeks, and 32-37 weeks, respectively. The mean age of participants, mean gestation age at delivery, and birth weight in cases and control were 35.27 ± 5.98 years (min: 23; max: 45), 32.40 ± 5.54 years (min: 25; max: 44); 34 weeks 2 days ± 3.28 (min: 31; max: 37), 33 weeks 5days ± 1.66 (min: 25; max: 37); 1961.33 ± 340 gram, 1899.33 ± 437.48 gram, respectively with no statistical significant difference (p = 0.186, p = 1, p = 0.668, respectively) Conclusion: Routine transvaginal cerclage is not effective in twin IVF pregnancies with normal cervical length for preventing preterm births. IVF twin women usually present at a late age and their birth weight are also low.

KNOWLEDGE, ATTITUDE AND PRACTICES OF DOCTORS AND NURSING STAFF OF WHO INTRAPARTUM CARE GUIDELINES

This cross-sectional study, conducted over a year in a tertiary care center in Delhi, aimed to assess knowledge and adherence to WHO intrapartum care guidelines among 200 doctors and 200 nurses. The study utilized self-administered questionnaires and focused group discussions to identify knowledge gaps and application constraints. Results indicated that doctors exhibited better knowledge of the guidelines than nurses, with more experienced professionals scoring higher. Specifically, questions regarding the duration of the latent phase and cervical dilation posed difficulties, especially for nurses. Only 36% of doctors and 16% of nurses correctly answered knowledge-based questions. Furthermore, doctors demonstrated superior practical application of the guidelines, particularly in areas like fundal pressure and episiotomy in primigravida. The study highlighted a significant association between higher education, experience, and better outcome. The findings underscore the necessity for continuous training and practice to enhance adherence to WHO guidelines, ultimately aiming to improve maternal and neonatal outcomes. Enhanced training and monitoring are recommended to bridge the identified gaps and ensure evidence-based intrapartum care practices are universally applied.

Ambulation During Neuraxial Analgesia in Obese Patients: A Pilot Study

Objective: Obese patients are known to have prolonged labors and an increased risk of cesarean delivery in comparison to their normal weight counterparts. Movement has previously been shown to have beneficial effects on the labor process; however, neuraxial analgesia is often recommended in obese women and in common practice limits mobility. The benefits of continuing to ambulate during neuraxial analgesia are not known. As prior studies have postulated a soft tissue dystocia as a potential etiology for prolonged labor among obese patients, ambulation and encouraged movement throughout the labor process may be of particular benefit for these patients. The purpose of this study was to evaluate the feasibility of ambulation with neuraxial analgesia in nulliparous obese patients admitted for labor. Study Design: This is a pilot study conducted at a single tertiary care center. Patients with a BMI of &gt;=35 were approached if they were nulliparous, term, and planned vaginal trial of labor. Patients were excluded if there were contraindications to ambulation, including magnesium administration. Participants were identified at &gt;=34 weeks estimated gestational age through clinic templates and induction of labor schedules, and were approached either in person or with a standard phone consent. Combined spinal-epidural analgesia was initiated per our institution’s policy, with the exception that during the latter portion of the study the test dose was eliminated in order to decrease the immediate motor block from this dose. Following epidural catheter placement, serial blood pressure measurements and motor assessments were completed to ensure safety including a straight leg test and a step stool test. Patients who passed these assessments were enrolled in the trial. Patients were encouraged to ambulate for 20 minutes of every hour while maintained on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Results: 105 patients were identified for consent for the trial, of whom 20 were ineligible for the study, 20 were not approached, and 40 declined study participation, leaving 25 patients who were consented. Of those 25, 14 completed the study. Reasons for not completing the study included ineligible by motor assessment, BMI less than 35 at time of delivery admission, preterm delivery, withdrawal, complete dilation at time of epidural without time to ambulate, magnesium administration during labor. A total of 14 participants were enrolled in the pilot trial, of which 11 were able to ambulate. The average BMI of participants was 43 kg/m2. Patients received epidural analgesia at a median cervical dilation of 4 cm and the average time from initiation of epidural analgesia to delivery was 15.4 hours. 65% of patients enrolled had a cesarean delivery. Of the 5 patients with a vaginal delivery, there was 1 shoulder dystocia. The median time spent ambulating was 58.5 minutes, with a range of 20-230 minutes. No patients fell during the trial. While one patient developed a spinal headache, it was not thought to be related to ambulation. Conclusions: A pilot trial of ambulation during neuraxial analgesia demonstrated no safety concerns among an obese nulliparous population. This pilot study was underpowered and is not designed to determine if there is an effect of ambulation with neuraxial analgesia on mode of delivery. Strengths of this study were interdisciplinary collaboration and biologic plausibility of decreased cesarean delivery through ambulation. Limitations included a low enrollment rate and the COVID pandemic, which halted the study as well as limited patients from being able to ambulate in the hallways. A larger study is needed to assess the efficacy of this intervention.

Impact of first-trimester mechanical cervical dilatation during curettage on maternal and neonatal outcomes: A retrospective comparative study

ObjectiveEarlier studies have indicated a potential link between dilatation and curettage (D&C) and subsequent preterm delivery, possibly attributed to cervical damage. This study examines outcomes in pregnancies subsequent to first-trimester curettage with and without cervical dilatation. MethodsA retrospective cohort study was conducted on women who conceived after undergoing curettage due to a first trimester pregnancy loss. Maternal and neonatal outcomes of the subsequent pregnancy were compared between two groups: women who underwent cervical dilatation before their curettage and those who had curettage without dilatation. The primary outcome assessed was the rate of preterm delivery at the subsequent pregnancy, and secondary outcomes included other adverse maternal and neonatal outcomes. Univariate analysis was performed, followed by multiple logistic regression models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsAmong the 1087 women meeting the inclusion criteria during the study period, 852 (78.4 %) underwent first-trimester curettage with cervical dilatation, while 235 (21.6 %) opted for curettage only. No significant maternal or neonatal different outcomes were noted between the study groups, including preterm delivery (5.5 % vs. 3.5 %, p = 0.16), fertility treatments, placental complications, and mode of delivery. However, deliveries following D&C were associated with higher rates of small for gestational age neonates (7.6 % vs. 3.8 %, p = 0.04). Multivariate analysis revealed that cervical dilation before curettage was not significantly linked to preterm delivery [adjusted odds ratio 0.64 (0.33–1.26), p = 0.20]. ConclusionThe use of cervical dilatation during a curettage procedure for first trimester pregnancy loss, does not confer additional risk of preterm delivery. Further studies are needed to reinforce and validate these results.

Oxytocin vs oral misoprostol for PROM induction in nulliparas with unfavorable cervix: a randomized trial

BackgroundInduction of labor (IOL) is recommended following prelabor rupture of membranes (PROM). The optimal method for IOL and need for cervical ripening in those with PROM and an unfavorable cervical examination is unclear. ObjectiveTo determine if oxytocin or oral misoprostol results in a shorter time to delivery among nulliparous patients with an unfavorable cervical examination and PROM diagnosis and to evaluate patient satisfaction with both methods. Study DesignThis is a randomized clinical trial conducted at an urban tertiary care center from 2019 to 2023. Subjects were nulliparas ≥36 weeks with an unfavorable starting cervical exam (≤2 cm and Bishop <8). The primary outcome was time from IOL to delivery in hours compared between oxytocin vs oral misoprostol. Secondary outcomes included suspected intraamniotic infection, cesarean delivery, composite maternal and neonatal morbidity, and patient satisfaction (assessed by Birth Satisfaction Scale-Revised). Sub-group analyses for those with BMI ≥ 30 kg/m2 and cervical dilation ≥1 cm were performed. We required 148 subjects to have 80% power to detect a 2-hour difference in time to delivery. The study was stopped early by the data safety monitoring board due to feasibility concerns in recruiting desired sample size. ResultsA total of 108 subjects were randomized: 56 oxytocin; 52 oral miso. The median gestational age at induction was 39.5 weeks; the mean starting cervical dilation was 1.1 cm. There was no statistical difference in time to delivery between groups overall: 14.9 hours oxytocin vs 18.1 hours oral misoprostol (P=.06). In sub-group analyses, there was a 5 hours shorter time to delivery with oxytocin for those with a BMI ≥ 30 kg/m2 (16.6 hours oxytocin vs 21.8 hours oral misoprostol, P .04) and 4.5 hours shorter time to delivery with oxytocin for those with cervix ≥1 cm (12.9 hours oxytocin vs 17.3 hours oral misoprostol, P .04). There were no differences in intraamniotic infection, cesarean delivery, maternal or neonatal morbidity between the groups. Patient satisfaction was higher for those receiving oxytocin compared to misoprostol (29.0 vs 26.3, P=.03). ConclusionAmong nulliparas with PROM and an unfavorable cervix, there was no difference in overall time to delivery between oxytocin and oral misoprostol. This result should be interpreted with caution given early study discontinuation and inadequate power. However, a shorter time to delivery with oxytocin was noted in obese patients and those with cervical dilation of at least 1 cm. Furthermore, patient satisfaction was higher in the oxytocin group, and there was no increased risk of neonatal or maternal morbidity with oxytocin.

The Partograph: A Practical Guide for Preventing Prolonged Labour

Background: The partograph, a graphic recording of labour and features in the mother and foetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and foetus in labour. Objectives: The study aimed to evaluate effect of using partograph on the management and outcome of labour. Materials and Methods: It was a prospective cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh over one (1) year from January 2017 to December 2017. A total 280 patients were enrolled in this study. Plotting on the partograph was started at cervical dilation of 4 cm on alert line. Results: The mean age of the participants was 23.4 ±4 years and mean gestational age was 38.3 ±1.74 weeks and 45% were primigravida. The mean Apgar score of the newborn after 5 minutes was 9.3 ±0.7. The mean duration for delivery on active labour was 4.3 ±2.5 hours in primigravida and 3.4 ±2.3 hours in multipara.Conclusion: The proper use of partographs and the application of the right decision at the right time can be achieved the best for maternal and neonatal outcomes. KYAMC Journal Volume: 14, No: 04, January 2024: 215-219.

(015) DEVELOPMENT OF A VAGINAL DILATOR DEVICE AND A HOME INSEMINATION DEVICE FOR CIS- AND TRANSGENDER PEOPLE, BASED ON THE ACTUAL ANATOMY OF THE PELVIS

Abstract Introduction Individuals undergoing vaginoplasty with canal creation must undertake life-long self-dilation and douching to maintain canal patency and hygiene. Commercially available dilators and douches are designed for cisgender anatomy, and are either straight, or, have an abrupt upward curve at the tip, inconsistent with neovaginal canal anatomy, which lacks the elasticity of a cisgender woman’s vagina, making it sensitive to dilator shape, and douche nozzle length. In addition, many LGBTQ+ individuals with a uterus seek pregnancy without a male sexual partner, but few devices exist for this population. Objective We assessed the vaginal canal shape in transgender and cisgender women and sought to: 1) Design a vaginal dilator which reflects pelvic and canal anatomy. 2) Create a novel dilator that combines dilation, douching, and depth measurement functions. 3) To create a vaginal dilator that can be irrigated with semen by trans men and by cis women seeking pregnancy without a male sexual partner Methods A floppy radio-opaque catheter was placed into the neovaginal canal from the introitus to the vault apex of 12 transgender women who underwent vaginoplasty with neovaginal canal creation. C-Arm fluoroscopy delineated canal curvature based on the catheter. In addition, gynaecologic texts were reviewed and both current and historical surgical instruments were examined to ascertain the shape of a cisgender woman’s vaginal canal. Based on these findings, a novel dilator was designed using ink-drawings, whereupon a CAD-file was designed and 3-D printed. A sex-toy company made our initial prototypes. Results A smooth “S-shape” was found in the vaginal canal of both cis- and transgender women, consistent with the shape of modern and historical cervical dilators. In cisgender women, the vaginal vault, which is elastic, is located much closer to the introitus than that of transgender women, whose canal is inelastic and fixed. The cervix is typically located on the anterior surface of the canal, and, located between 0.5 to 4cm proximal to the posterior fornix. Our vaginal dilators (Figure 1a) (five, each 8-12 cm circumference) and reflect the smooth S-shaped curvature observed, with depth markings, and, side-wall grooves to allow air and liquid to pass with insertion and withdrawal. The dilator is also hollow with holes at the distal end and can be fitted with a douche-bulb. Our insemination device (Figure 1b-c) is only 9 cm. circumference, is similar in shape but is shorter, is hollow to accommodates a 10cc syringe (for introduction of semen), and has a recessed anterior wall, 0.5-4cm from the tip (where the cervix normally resides) for up to 6cc of semen to pool and bathe the cervix with sperm for conception. Conclusions The design improvements shown should make dilation and douching more comfortable, and should improve hygiene and decrease the incidence of granulation tissue. Our inseminator offers a private, at-home means of achieving fertilization for both cisgender and transgender individuals. (U.S. Patent 11638808; Neovaginal and vaginal health devices) Disclosure No.

Exploring the Ayurvedic Practice of Potaki Taila Pichu for Labor Facilitation among Rural Women in Northern Indi

Introduction: Childbirth is a profound experience in a woman's life, emphasizing the importance of promoting natural birthing processes to minimize discomfort and medical intervention. Ayurveda, an ancient holistic medical system, advocates for safe motherhood through herbal interventions like Potaki (Basella alba) Taila Pichu, which aims to alleviate imbalances in Apana Vayu and facilitate smooth labor. Methods: This study evaluated the efficacy of Potaki Taila Pichu in promoting easier labor by assessing its impact on cervical dilation and effacement. Sixty pregnant women meeting inclusion criteria were randomly assigned to a trial or control group. Various parameters, including cervical dilation, uterine contractions, and labor duration, were measured and compared between the two groups. Results: The trial group showed significant increases in cervical dilation and effacement compared to the control group, indicating the potential of Potaki Taila Pichu in facilitating labor progression. The intervention did not disrupt the natural rhythm of labor, as evidenced by consistent uterine contraction duration between groups. Moreover, the trial group experienced a significantly shorter latent phase of labor, suggesting accelerated onset of active labor. Discussion: These findings suggest that Potaki Taila Pichu may offer a safe and effective means of promoting smoother labor experiences while minimizing the need for medical interventions. Integrating traditional herbal remedies into modern obstetric care aligns with efforts to enhance maternal and neonatal outcomes. Conclusion: Herbal interventions like Potaki Taila Pichu hold promise in optimizing childbirth experiences by promoting natural labor progression. Further research is needed to validate these findings and explore long-term effects on maternal and neonatal health.

Nomogram-based risk assessment for emergency cervical cerclage failure in patients with cervical insufficiency

BackgroundCervical insufficiency can lead to preterm birth and neonatal mortality. Emergency cervical cerclage is a surgical intervention aimed at preventing preterm birth in patients with cervical insufficiency. However, some patients may experience cerclage failure. This study aimed to identify the risk factors associated with cerclage failure and develop a predictive nomogram model for patients with cervical insufficiency undergoing emergency cervical cerclage. MethodsData of 200 patients who underwent emergency cervical cerclage for cervical insufficiency were retrospectively analyzed. Patients were categorized into successful and failed groups based on their ability to take the infant home. Univariate and multivariate logistic regression analyses were performed to identify risk factors for cerclage failure. A nomogram model was developed based on multivariate logistic regression results, and its performance was assessed using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). ResultsUnivariate logistic regression analysis identified 11 potential risk factors for cerclage failure, including the presence of polycystic ovary syndrome (PCOS), vaginitis, cervical dilation, preoperative C-reactive protein, routine vaginal lavage after cervical cerclage, delivery, gestational age, extended days, chorioamnionitis, intrauterine infection, cervical laceration, and premature rupture of membranes. Multivariate logistic regression analysis revealed that PCOS, cervical dilation after cervical cerclage were independent risk factors for cerclage failure while routine vaginal lavage was a protective factor against failure. The nomogram predictive model demonstrated an area under the curve value of 0.975, indicating excellent discriminatory ability. The calibration plot showed good consistency between the nomogram predictions and actual observations. DCA demonstrated the strong clinical applicability of the nomogram. ConclusionsThis study successfully identified risk factors associated with emergency cervical cerclage failure in patients with cervical insufficiency and developed a predictive nomogram model. This model can assist clinicians in making informed decisions and accurately predicting the risk of cerclage failure in these patients.

Obstetric factors and neonatal outcomes of depressed skull fractures in newborns

PurposeTo determine the obstetric factors affecting the development of depressed skull fracture in neonates.Materials and methodsThis was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed.ResultsThere were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography.ConclusionsThere was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases.

Evaluation of the Effects of Epidural Labour Analgesia on Mode of Delivery in 250 Bedded District Hospital, Bagerhat, Bangladesh

Background: Labor pain is intensely severe, often leading to hyperventilation and hormonal releases that can harm the fetus by reducing oxygen supply and causing metabolic acidosis. Effective pain management during childbirth is crucial for both physical and mental health. Various pharmacologic and non-pharmacologic methods are available, with epidural analgesia being a prominent choice. It is widely used in high-income countries, provides substantial pain relief, and benefits uterine contractions and placental perfusion. Epidural analgesia has potential side effects and controversies, such as delayed labor and higher intervention rates. Aim of the Study: The study aimed to examine the impact of epidural analgesia on the mode of delivery. Methods: This observational study, conducted from July 2021 to June 2022 at the Department of Gynecology and Obstetrics in a 250-bed District Hospital in Bagerhat, Bangladesh, included 50 participants divided into two groups of 25 each: Group A (with epidural analgesia) and Group B (without epidural analgesia). Approved by the Ethical Committee, the study included women aged 18-35 years, 37-41 weeks gestation, in labor with regular contractions, at least 4 cm cervical dilatation, and a regular fetal heart rate pattern. Excluded were women with medical or obstetrical complications, uterine scars, or spinal deformities. Data were collected via interviews, observations, and clinical examinations. Result: In this study of 50 participants (25 per group), most women were under 30 years old, with mean ages of 22.4±4.5 and 22.9±5.2 years in groups A and B, respectively. Gestational ages ranged from 37 to 40 weeks, and BMIs were 18.5-24.9 kg/m². Both groups had similar parity distributions. Normal vaginal births occurred in 84% (Group A) and 88% (Group B), with LSCS rates at 4%. Group A had 60% male neonates with average birth weights of 2.86±0.27 kg, and Group B had 56% males with weights of 2.88±0.26 kg. APGAR scores were high in both groups. Conclusion: Epidural labor analgesia is safe and does not increase instrumental deliveries or affect neonatal outcomes, making it a viable pain management option. Obstetric care providers can use this information to counsel women.

Analyzing the Expectant Management of Redefined Active Phase of Labor (WHO 2018 Guidelines) in Nulliparous Women: A Randomized Control Trial

BACKGROUND:The World Health Organization (WHO) in their 2018 guidelines favored a noninterventional approach toward the labor process. The active phase of labor will be initiated when the cervix is 5 cm dilated and during obsoleted use of a 1 cm/hour cervical dilation rate as a diagnostic test for abnormal birth outcomes.OBJECTIVES:The aim of the study is to compare an active interventional labor management approach to a noninterventional labor management approach in nulliparous parturient women in terms of need of intervention, mode of birth, and maternofetal outcome.METHODOLOGY:This randomized control study was conducted at a rural tertiary care hospital for a period of 1.5 years. Nulliparous low-risk pregnant women presenting in latent labor were randomly allocated into two groups on the basis of cervical dilation and labor intervention. WHO 2014 guidelines with partograph were followed in group 1, and 2018 WHO guidelines with labor care guide were followed in group 2.RESULT:Both the groups were comparable with age, parity, and Bishop score at the time of admission. The incidence rates of intervention in the active first stage of labor in group 1 and group 2 were 31% and 10% with an odds ratio of 0.192 (95% confidence interval [CI] [0.079, 0.466]), and the rates of lower segment cesarean section in both the groups were 17.6% and 5.8%, respectively. The odds ratio with 95% CI for postpartum hemorrhage and neonatal intensive care unit admission in group 1 compared with group 2 was 0.313 [0.061, 1.610] and 1.057 [0.143, 7.832], respectively.CONCLUSION:This study showed that the shifting of the active first-stage threshold by 1 cm and letting labor progress at its natural pace significantly reduced the need for intervention and affected the fetal and maternal outcome positively.

“RAIL BIOPSY” A Novel and Useful Technique for Hysteroscopic Endometrial Target Biopsy

Endometrial biopsy (EB) is one of the most common gynecologic procedures. Office-based EB has replaced procedures involving general/loco-regional anesthesia and cervical dilatation performed in the operating room [1-3]. The Grasp Biopsy seems to be the most appropriate EB technique for reproductive-aged women [1,2,4]. Recently, the Visual D&C performed with hysteroscopic tissue removal devices has shown to be a valid alternative [5]. However, it is often difficult to obtain an adequate specimens in peri/post-menopausal women with hypo/atrophic endometrium [2]. Our aim is to show a novel hysteroscopic EB technique called "Rail Biopsy" which requires widespread and cheap instruments. A step-by-step explanation of surgical techinque with narrated video footage. Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero-Universitaria di Bologna" Bologna, Italy. We performed the "Rail Biopsy" technique with a 5.0 mm Continuous Flow Operative Hysteroscope with a 30° Lens and a 5Fr operative channel. We identify the endometrial target area (ETA), and we create a first track cutting through the endometrium in a caudo-cranial direction using cold scissors. We repeat the procedure, creating a second parallel track, thus completing our "rail" and isolating a wide ETA. Then, in the caudo-cranial direction, we cut through the stromal layer beneath the ETA. With a 5Fr cold grasping forceps, we clench the cranial edge of the ETA, and we remove it from the uterine cavity. A high-quality specimen, even in the case of hypo/atrophic endometrium or focal sessile lesions, can be obtained with this technique. The crucial aspect of the "Rail Biopsy" indeed is cutting through the stromal tissue while the endometrium is minimally touched, avoiding thermal damage deriving from electrosurgery. The instruments required are widespread and cheap. Moreover, this technique can be performed on any wall of the uterus, under vision, and, in the majority of patients, in an office-setting without cervical dilatation or general/loco-regional anesthesia, making it an attractive alternative to hysteroscopy performed in the operating room setting. Further studies comparing "Rail Biopsy" to other EB techniques are needed. We showed a novel approach for hysteroscopic EB that may be particularly useful in patients with hypo/atrophic endometrium, easy to learn and with low costs. VIDEO ABSTRACT.

Oestrogen and progesterone concentrations in intrapartum cows with insufficient cervix dilation

AbstractThe cervix is an important organ that has to dilate sufficiently at delivery to allow the foetus to transition to extrauterine life. Insufficient dilatation of the cervix (IDC) is a frequent cause of dystocia in cattle. The mechanisms underlying cervical opening and the pathogenesis of IDC are still widely unclear. Systematic studies on the relationship between IDC and steroid hormones have been limited and have yielded inconsistent findings. This study aimed to measure oestrogen and progesterone (P4) concentrations in intrapartum cows presented with dystocia due to IDC and in a comparison (C) group of cows with eutocic delivery. Before any obstetrical procedures, and right after the initial evaluation, blood samples were taken from IDC and C animals. Concentrations of P4, oestradiol‐17β (E2), free total oestrogens (FTE) and conjugated total oestrogens (CTE) were measured by established radioimmunoassays. Concentrations of P4 (p = .538), FTE (p = .065) and CTE (p = .605) were not statistically different between C and IDC groups. However, E2 levels in group C were significantly lower when compared to those in the IDC group (p = .013), which is inconsistent with the function of oestrogens in cervical dilatation. The correlation analysis demonstrated significant positive correlations between the pairs P4 versus FTE, P4 versus E2 and FTE versus E2 in group C and between the pair FTE versus E2 in group IDC. In conclusion, the results suggest that local activities of steroids relevant to the aetiology of IDC are not reflected by concentrations in the systemic circulation or that other factors are clearly more important.

A national survey of clinicians’ opinions of rotational vaginal births

IntroductionMalposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland’s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. ObjectiveTo gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. Material and methodsA survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. Results252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland’s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. ConclusionThere is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.