Cervical Score Research Articles

Expression of concern: “Induction of labor with three different techniques at 41 weeks of gestation or spontaneous follow-up until 42 weeks in women with definitely unfavorable cervical scores” [EJOG 120(2) (2005) 164–169]

Expression of concern: “Induction of labor with three different techniques at 41 weeks of gestation or spontaneous follow-up until 42 weeks in women with definitely unfavorable cervical scores” [EJOG 120(2) (2005) 164–169]

Manipal Cervical Scoring System by Transvaginal Ultrasound Versus Bishop Score in Predicting Successful Labour Induction

Manipal Cervical Scoring System by Transvaginal Ultrasound Versus Bishop Score in Predicting Successful Labour Induction

Effect of "nape seven needles" on expression of hypoxia inducible factor-1α and Notch1 in cervical intervertebral disc degeneration rats

To observe the effect of "nape seven needles" on the expressions of hypoxia inducible factor-1α (HIF-1α) and Notch1 in cervical intervertebral disc of cervical disc degeneration (CDD) rats, so as to reveal its underlying mecha-nisms in improving CDD. SD male rats were randomly divided into normal, model, non-acupoint and nape seven needles groups, with 10 rats in each group. Staticdynamic imbalance method was used to establish CDD model. Rats in the nape se-ven needles group were treated with acupuncture at "Fengfu"(GV16), and bilateral "Fengchi"(GB20), "Wangu"(GB12) and "Tianzhu"(BL10), and rats in the non-acupoint group received acupuncture at the sham acupoints at the caudal tip and armpit, both for 20 min, 6 days a week for 4 weeks. After intervention, tilted plane test and spiral CT were used to assess the neck movement function and cervical degeneration degree of rats; immunohistochemistry was used to observe the protein expression levels of HIF-1α and Notch1 in cervical discs tissue; Western blot and real-time quantitative PCR were used to detect the protein and mRNA expression levels of HIF-1α and Notch1 in cervical discs tissue, respectively. After modeling, the cervical curvature was straightened, with narrowed intervertebral space, rough and hardened articular surface, osteophytes, and blurred articular space and articular process, which was relatively milder in the nape seven needles group. Compared with the normal group, the angle of tilted plane was significantly reduced (P<0.05), while cervical scores, HIF-1α mRNA expression level in cervical intervertebral disc tissue were significantly increased (P<0.05) in the model group. Compared with the model and the non-acupoint groups, cervical scores were significantly reduced (P<0.05), while the angle of tilted plane, HIF-1α and Notch1 positive expressions, HIF-1α mRNA expression level, Notch1 protein and mRNA expression levels in cervical intervertebral disc tissue were significantly increased (P<0.05) in the nape seven needles group. Acupuncture of "nape seven needles" can reduce the degree of cervical degeneration in rats, which was possibly associated with its effects in up-regulating the expressions of HIF-1α and Notch1 in cervical intervertebral disc tissue, promoting the proliferation and recovery of endogenous cells in nucleus pulposus.

Comparative study Of TVS cervical score and Bishop score in prediction of successful labour induction

BackgroundIn today's obstetric practice, induction of labour is a common procedure. Before the imaging era, the favourability of the cervix was assessed by manual examination scored as the Bishop Score. However, subjectivity and high inter- and intra-observer variability are limitations of this approach. This necessitates the implementation of an objective method of assessment. We used transvaginal sonography (TVS) as an objective method of assessment of cervix by TVS cervical score comprising of five different parameters; cervical length, funnelling at the internal os, distance from the presenting part to the external os, and cervix position. This study aims to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical score in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour.MethodologyThis observational prospective study included 100 pregnant women admitted for labour induction at a single tertiary care centre. The TVS examination which consisted of five parameters was performed after the clinical Bishop scoring. The TVS scores were compared with the Bishop scores for all patients. Labour induction was done within one hour of examination and the outcome of the induction was recorded.ResultsThe mean age was 25.87 years [SD = 4.35]. Labour induction was successful in 74% of patients. At cut-off Scores of ≥ 4, TVS cervical Score performed better than Bishop Score (Sensitivity 93.24 vs. 67.57%, Specificity 73.08 vs. 65.38%). ROC analysis indicated that Area Under Curve (AUC) was more for TVS Score (0.91, 95% CI 0.84–0.97), compared to Bishop Score.ConclusionTransvaginal ultrasonography is an objective method of cervical assessment. We conclude from our study that the use of TVS score which consists of five different parameters in cervical assessment provides a better prediction of successful labour induction than the Bishop score, and so can prevent various complications associated with induction failure.

Knowledge and attitudes of healthcare professionals working in a training and research hospital on early diagnosis of cervical cancer (a Somalia example): cross-sectional study

BackgroundDespite the early diagnosis and treatment of cervical cancer, it is still a significant public health problem in Somalia. This study was conducted to evaluate the knowledge and attitudes of healthcare professionals towards the early diagnosis of cervical cancer.MethodsThis study was conducted in Mogadishu, the capital of Somalia, between December 2020 and February 2021. The cross-sectional study consisted of a total of 280 healthcare professionals. The study data was collected using a questionnaire consisting of 38 questions evaluating the knowledge and attitudes of all healthcare professionals towards the early diagnosis of cervical cancer, an additional 15 questions for women only, and a total of 43 questions.Results22.1% of the participants received cervical cancer training during vocational education and training. Cervical cancer education after graduation is 16.8%, and the rate of providing education to patients is only 29.6%. The rate of female healthcare professionals having a Pap smear test is 2%. The participants' cervical cancer total knowledge score was 16.5 ± 6.69, and the success rate was 63.46. The highest success rate in knowledge subgroup questions was HPV questions with 69.6. A statistically significant difference was found between the participants' profession, training on the subject during their vocational education, and total knowledge scores (p < 0.001). When the knowledge question subscales were compared, a significant difference was found between participants' gender and HPV questions subscale score (p = 0.028). A statistically significant difference was found between the participants' professions, receiving training on the subject during vocational training, and all subscales (p < 0.05). A statistically significant difference was found between the participants' income status and risk factors questions scores (p = 0.026).ConclusionThis study shows that the knowledge and training of healthcare professionals working in a training and research hospital in Somalia for early cervical cancer diagnosis are not sufficient. In addition, it reveals that female healthcare professionals have almost no Pap smears. Therefore, studies and training should be planned to train all healthcare professionals, especially female healthcare professionals, and overcome all possible obstacles to the acceptance of the screening tests by women.

Efficacy and Safety Analysis of Phloroglucinol in Combination with Oxytocin for the Induction of Labor in Women with Term Premature Rupture of Membranes (PROM).

Objective The purpose of this study was to investigate the efficacy and safety of phloroglucinol in combination with oxytocin in the induction of labor in women who had experienced term premature rupture of membranes (PROM). Methods Data from 100 women who experienced PROM between December 2020 and December 2021 were retrospectively evaluated in this study. The puerperae were categorized into observation and control groups based on their uterine contraction regimens. The observation group consisted of 53 participants that had been treated with phloroglucinol in combination with oxytocin, and the control group consisted of 47 participants that had been treated with oxytocin alone. It was observed and compared in terms of the Bishop score before and after the administration of the puerpera to see which group had the best index. A study was performed after the drug was administered to examine its effects on the duration of labor (including the first, second, and third stages of labor), the mode of delivery (including natural vaginal delivery and cesarean section), the incidence of adverse pregnancy outcomes (fetal distress and neonatal asphyxia), successful labor induction, and complication rates. Results Patients in the observation group had a significantly higher Bishop score after administration than those in the control group (P < 0.05), although there was no difference between the two groups before administration. In comparison to the control group, the observation group had a significantly higher efficacy rate for drug administration (P < 0.05), as well as a significantly lower occurrence of the first stage of labor (P < 0.05), a higher rate of vaginal natural delivery and successful induction of labor (P < 0.05), and a significantly lower incidence of adverse pregnancy outcomes and complications (P < 0.05). Conclusion In conclusion, the use of phloroglucinol in combination with intravenous oxytocin in the process of promoting cervical ripening and induction of labor for women with PROM who are at term was investigated. This study could help women speed up cervical dilation, improve the cervical Bishop scores, shorten the total labour process, improve the effective rate of vaginal delivery, and be very safe, making it a good candidate for clinical promotion and application.

Predicting Mechanical Failure Following Cervical Deformity Surgery: A Composite Score Integrating Age-Adjusted Cervical Alignment Targets.

Retrospective cohort study. Investigate a composite score to evaluate the relationship between alignment proportionality and risk of distal junctional kyphosis (DJK). 84 patients with minimum 1year follow-up were included (age = 61.1 ± 10.3years, 64.3% women). The Cervical Score was constructed using offsets from age-adjusted normative values for sagittal vertical axis (SVA), T1 Slope (TS), and TS minus cervical lordosis (CL). Individual points were assigned based on offset with age-adjusted alignment targets and summed to generate the Cervical Score. Rates of mechanical failure (DJK revision or severe DJK [DJK> 20° and ΔDJK> 10°]) were assessed overall and based on Cervical Score. Logistical regressions assessed associations between early radiographic alignment and 1-year failure rate. Mechanical failure rate was 21.4% (N = 18), 10.7% requiring revision. By multivariate logistical regression: 3-month T1S (OR: .935), TS-CL (OR:0.882), and SVA (OR:1.015) were independent predictors of 1-year failure (all P < .05). Cervical Score ranged (-6 to 6), 37.8% of patients between -1 and 1, and 50.0% with 2 or higher. DJK patients had significantly higher Cervical Score (4.1 ± 1.3 vs .6 ± 2.2, P < .001). Patients with a score ≥3 were significantly more likely to develop a failure (71.4%) with OR of 38.55 (95%CI [7.73; 192.26]) and Nagelkerke r2 .524 (P < .001). This study developed a composite alignment score predictive of mechanical failures in CD surgery. A score ≥3 at 3months following surgery was associated with a marked increase in failure rate. The Cervical Score can be used to analyze sagittal alignment and help define realignment objectives to reduce mechanical failure.

Maternal and Fetal Outcomes in Active versus Expectant Management of prelabor rupture of membrane

Aim: To assess the effects of planned early birth (active treatment within 24hrs) compared to expectant management (without active treatment within 24hrs) for women at term with Prelabor Rupture of Membrane (PROM) on maternal and fetal outcomes.&#x0D; Methods: This is an observational comparative study carried out in all the pregnant women who present in maternity ward of Shree Birendra Hospital with PROM at 37-41 weeks of gestation with vertex presentation during the study period between 13 April 2020 to 13 April 2021.They were randomly placed into (A) active treatment group and (B) expectant treatment group. Group (A) was induced with 25mcg of PGE1 (Misoprostol) depending on cervical score, whereas group (B) was expectantly managed for 24 hrs. PROM to delivery interval, maternal and fetal outcomes were then evaluated in both the groups.&#x0D; Results: 79.5% of group A and 71.8% in group B delivered through vaginal route. 20.5% patients in group A and 28.2% patients in group B underwent Cesarean section. The average PROM to delivery interval was 15.6 hours in group A, as compared to 16.8 hours in group B. Only 2 babies in group B had an Apgar score of less than 7 at five minutes. Subsequently, in both the groups, two babies required NICU admission for respiratory distress syndrome with no neonatal mortality in both the groups.&#x0D; Conclusion: Expectant management up to 24 hours can be safely offered to a woman with term PROM.

Kuntai Capsule Combined With Letrozole on Gonadal Hormone Levels and Ovarian Function in Patients With PCOS: A Systematic Review and Meta-Analysis.

BackgroundThe efficacy of Kuntai capsule combined with letrozole (LE) in improving ovarian function of polycystic ovary syndrome (PCOS) has been evaluated before, but there is still a lack of evidence-based support for the regulation of sex hormone levels. In recent years, new randomized clinical trials (RCTs) have been reported on the effect of combined therapy on regulating sex hormone levels.ObjectiveWe aimed to systematically evaluate the efficacy of Kuntai capsule combined with LE in the treatment of PCOS.MethodsA search across the China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang database, PubMed, Web of Science, The Cochrane Library, and Embase was conducted on Kuntai capsule combined with LE in the treatment of PCOS. The time of the self-built database was up to April 30, 2021. RCTs of LE in the control group and LE combined with Kuntai capsule in the experimental group were selected. RevMan5.3 software was used for data analysis.ResultsA total of 17 studies were gathered, which included 1,684 patients. The meta-analysis results showed that the total effective rate of the combined group was 93.36% and that of the LE group was 78.15%. The improvement in the ovulation rate, pregnancy rate, number of mature follicles, endometrial thickness, cervical mucus score, and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) in the combined group was consistent with the results of a previous meta-analysis and was better than that in the LE group (p < 0.05). In addition, the combination group was better than the LE group in regulating the levels of estradiol (E2) and testosterone (T) (p < 0.05). There were no adverse drug reactions in the two groups during treatment.ConclusionAs a type of pure traditional Chinese medicine preparation, Kuntai capsule combined with LE had a better effect than LE alone in the treatment of PCOS, with advantages mainly reflected in enhancing ovarian function and regulating the levels of sex hormones in vivo, among others, but the value of combined therapy still needs to be verified by more high-quality RCTs.

Effective evaluation of labor induction by modifier double balloon Foley catheter at 108 Military Central Hospital

Objective: To evaluate the efficacy of labor induction by modifier double balloon Foley catheter (MDB) in pregnant women with the indication of vaginal delivery. Subject and method: Longitudinal prospective study on 82 pregnant women at Obtetricts Department of 108 Military Central Hospital from June 2020 to September 2021 with criteria: Pregnancy age was older than or equal to 37 weeks, singleton, vertex presentation, their cervical Bishop score &lt; 6, cervix is unfavorable to detach the amnio membranes, intact membranes, to designate termination of pregnancy by vaginal delivery and consent to participate in the study. Labor induction was conducted by double balloon Foley modifier catheter. Result: With success criteria is defined as Bishop score after labor induction larger or equal 7, the success rate with MDB was 86.6%, the increase of Bishop scores averaged 5.63 points with p&lt;0.001. 7.32% tiny fever was connected to Foley catheters. The cesarean section rate after induction was 14.6%. The vaginal birth rate after the succession of labor induction using combined MDBs was 88.7%. There was not any complication for the women and the newborn babies. Conclusion: Our findings suggest that MDB using labor induction was feasible and high effective procedure as well as without compromising maternal or fetal safety.

Effect of Wenshentiaojing Decoction on Hormone Level and Follicular Number in Patients with Menstrual Disorder of Polycystic Ovary Syndrome.

Objective To explore the curative effect of Wenshentiaojing Decoction on the treatment of menstrual disorder caused by PCOS. Methods Patients with menstrual disorders caused by PCOS admitted to our department from January 2020 to January 2021 were selected as the research objects and were divided into a control group and observation group according to the random number table method. The control group was treated with Western medicine, and the observation group was treated with Wenshentiaojing Decoction on the basis of Western medicine. The clinical efficacy of the two groups was compared. Before and after treatment, sex hormones (LH, FSH, LH/FSH, and testosterone (T)), ovarian volume, endometrial thickness, cervical mucus score, follicular number, menstrual conditions (menstrual duration, menstrual cycle, and menstrual volume), and other indicators in both groups were recorded. Results After treatment, the total effective rate of the observation group (91.1% (41/45)) was higher than that of the control group (77.8% (35/45)), and the difference was statistically significant (P < 0.05). After treatment, the LH, LH/FSH, and T levels in the observation group were lower than those in the control group, while the FSH level was higher than that in the control group (P < 0.05). After treatment, the ovarian volume, endometrial thickness, cervical mucus score, and follicle number in the observation group were higher than those in the control group (P < 0.05). After treatment, the menstrual duration and menstrual volume in the observation group were longer than those in the conventional group, and the menstrual cycle was shorter than that in the conventional group (P < 0.05). Conclusion For patients with menstrual disorders caused by PCOS, the treatment effect of Wenshentiaojing Decoction assisted with Western medicine is better, which can effectively improve the level of sex hormones, cervical mucus, and menstrual conditions, increase the ovarian volume, endometrial thickness, and follicle number, and improve the treatment effect, with fewer adverse reactions, which is worthy of further promotion and application.

Оцінка рівня нестабільності ушкоджень, класифікованих за AOSpine Subaxial Cervical Spine Injury Classification System

Актуальність. При визначенні спрямованості та обсягу хірургічного лікування у хворих із травматичним ушкодженням шийного відділу на субаксіальному рівні основними є такі критерії: характер і ступінь ушкодження остеолігаментозного апарату шийного відділу хребта, що визначає рівень нестабільності; ступінь компресії структур хребетного каналу; стан сагітального профілю. Метою цієї роботи є оцінка ступеня нестабільності різних типів ушкоджень шийного відділу хребта, класифікованих відповідно до AOSpine Subaxial Cervical Spine Injury Classification System. Матеріали та методи. Проведено ретроспективний аналіз даних спондилограм, комп’ютерних і магнітно-резонансних томограм 168 пацієнтів із травматичним ушкодженням шийного відділу хребта на субаксіальному рівні, які перебували на стаціонарному лікуванні у відділенні патології спинного мозку ДУ «Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України» в період з 2008 по 2018 р. Виконувалася кількісна оцінка ступеня нестабільності із застосуванням Cervical Spine Injury Severity Score і визначення типу ушкодження згідно з AOSpine Subaxial Cervical Spine Injury Classification System. Результати. Виявлено, що медіана показника нестабільності прогресивно наростає зі збільшенням ступеня тяжкості типу ушкодження. Найбільш широкий діапазон значень показника рівня нестабільності відзначається при компресійному типі ушкоджень: від 6 балів (95% довірчий інтервал (ДІ) 4,76–6,84) при типі А1 до 11 балів (95% ДІ 9,48–11,81) при А4. Для типів А2 і А3 зареєстровано 7 балів (95% ДІ 6,68–7,53) і 8 балів (95% ДІ 7,97–9,01) відповідно. Флексійно-екстензійні ушкодження характеризуються меншим діапазоном значень. Медіана прогресивно зростає від типу В1 — 13 балів (95% ДІ 12,4–13,92) до B3 — 15,5 бала (95% ДІ 14,5–16,35). Показник для В2 займає проміжне значення і становить 15 (95% ДІ 13,59–15,52). Максимальні значення при згинально-розгинальних ушкодженнях — 18 балів, зареєстровані як при типі В2, так і В3. Тип С демонструє найбільший рівень нестабільності — 17 балів (95% ДІ 16,58–17,86) та досить широкий діапазон розрахованих значень — від 13 до 20 балів. Висновки. Загальною тенденцією є збільшення рівня нестабільності в низці підтипів від А1 до С, проте навіть ушкодження типу А1 за певних умов виявляються досить нестабільними і вимагають хірургічного втручання. На противагу класичним уявленням ушкодження типу А досить часто супроводжуються ураженням фасеткових суглобів, що також необхідно враховувати при визначенні індивідуальної тактики терапії постраждалих.

Oxytocin Versus Dinoprostone For Labor Induction in Multiparous Women with Unfavorable Cervix

OBJECTIVE: Dinoprostone is a drug of choice in our daily practice for the induction of labor. The aim of our study; to compare the use of oxytocin with dinoprostone (PGE2- Propess©) used in term multiparous pregnant women to ripen the cervix.STUDY DESIGN: A total of 507 patients were included in the study. Group A, consisted of 262 women with term multiparous pregnancy Bishop score ≤6 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (Propess© -prostaglandin E2). Group B, consisted of 245 cases of pregnancy with Bishop score ≤6 underwent induction of labor with iv oxytocin and was matched for the patient's age and parity. The following data were recorded: age, gestational age, body mass index, the time from the drug administration to the vaginal labor, delivery mode, indications of induction, cesarean indication, birth weight, Apgar score, and need of neonatal intensive care unit. RESULTS: The primary outcome of the in group B interval from induction to vaginal delivery was similar between the two groups. In group A, 41 patients and in group B, 23 patients had a cesarean section. Cesarean section rate was lower in the oxytocin group (cesarean rate 15.6% versus 9.3%, p&lt;0.05). CONCLUSION: It appears; Dinoprostone ovule increases the cesarean rate in terms, multiparous cases with inappropriate cervical score and does not shorten the duration of delivery. Therefore, the use of oxytocin for cervical ripening in multiparous women may be a more appropriate option.

Evaluation of factors that predict the success rate of trial of labor after the cesarean section

BackgroundFor most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC).MethodsAll patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model.ResultsA total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power.ConclusionThe TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability.

Labour Induction Methods: An Overview

Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 &amp; PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy. Prostaglandins PGE1 &amp; PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.

Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain

BackgroundRecent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme.MethodsIn this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period.ResultsThe mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172).ConclusionsFuture prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.

Loop Electrosurgical Excision Procedure in a Low-Resource Setting: Feasibility of Selective See-and-Treat Approach

To assess the correlation between cervical smear, colposcopic findings and loop electrosurgical excision procedure (LEEP) histopathology and thereby assess the feasibility of performing LEEP bypassing cervical biopsy in selected cases. This is a retrospective study of patients who underwent LEEP at our institution from 2014 to 2018. We traditionally follow a three-step approach for detection and treatment of pre-invasive lesions of cervix—(1) pap smear, (2) colposcopy of abnormal pap smear cases and directed biopsy, and (3) treatment of abnormal biopsies with LEEP. LEEP was performed for cervical intraepithelial neoplasia (CIN) 2, CIN3, persistent CIN1 cases. Swede score ≥ 6 or major lesion on International Federation for Cervical Pathology and Colposcopy (IFCPC) scoring on colposcopy was considered to be suggestive of high-grade lesion. Of the 123 patients who underwent LEEP, 80 patients had high-grade squamous intraepithelial lesion (HSIL) on cervical smear and swede score ≥ 6 on colposcopy. Seventy-seven (96.3%) of these patients had high-grade lesion on final histopathology. Avoiding cervical biopsy and proceeding with LEEP in these patients would reduce an additional procedure in 77 patients with overtreatment of only 3 patients (2.4%). Overtreatment rate was 3.2% when IFCPC scoring was used instead of Swede score. LEEP may be considered in patients with high-grade lesions on both colposcopy and cervical smear, bypassing cervical biopsy, thereby reducing the number of procedures performed. This reduces the financial burden for the individual and the healthcare facilities, also decreasing the anxiety and apprehension associated with multiple hospital visits and procedures.

Validation of a translated version of the modified Japanese Orthopedic Association (mJOA) cervical myelopathy score in an Arabic speaking population

Introduction: Degenerative Cervical Myelopathy (DCM) is a growing disorder. Standardization of its assessment tools is an integral part of its management. The modified Japanese orthopedic association (mJOA) score is one of the most commonly used tools. Currently, there is no available Arabic translated version of any cervical myelopathy functional score. This study aimed to translate, culturally adapt, and measure the psychometric properties of an Arabic translated version of the mJOA. Methods: After translation of the score using the standard forward-backward translation procedure, a validation study including 100 patients was carried out from June 2019 to June 2020. The following psychometric properties were measured: feasibility, reliability, internal consistency, validity, minimal clinically important difference (MCID), ceiling, and floor effect. Results: No problems were encountered during the process of translation and cross-cultural adaptation of the score. The mJOA-AR was found to be a feasible score. It showed high inter-observer reliability (r = 0.833, P < 0.001), test-retest reliability (r = 0.987, P < 0.001) and good internal consistency using Cronbach’s alpha (0.777) and Pearson interclass correlation coefficient (r = 0.717). The score showed good convergent and divergent construct validity correlating it to the Arabic validated version of the neck disability index (NDI). The mJOA-AR had an MCID of 1.506. Both the ceiling and floor effects of the total score and the first and second domains were within the acceptable range, while the third and fourth domains had a high ceiling effect (30% and 39%, respectively). Discussion: Our translated version of the mJOA score was found to be a feasible score with acceptable psychometric properties. This score can be utilized as a good outcome measure tool in Arabic-speaking countries.

Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey

BackgroundMeasuring quality indicators (QI’s) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI’s, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed.MethodsTo quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice.ResultsThe survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI’s (13,9%) did not reach the cut-off of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI’s that were not considered as relevant by the specialists and 3 additional 3 QI’s that we were considered to be superfluous, we obtained an optimized QI list.ConclusionAs QI’s gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI’s for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI’s that can be used in future studies, audits and benchmarking.

Analysis of the factors affecting the duration of the latent period from the moment of prelabor rupture of membranes to the onset of labor

Introduction. Premature rupture of membranes during full-term pregnancy represents an increased risk of septic complications for both the mother and the fetus due to the prolongation of the latency period, the period from the discharge of amniotic fluid till the onset of labor.&#x0D; Purpose of the study: to assess the factors affecting the duration of the latent period (from the moment of discharge of amniotic fluid to the development of labor) during full-term pregnancy.&#x0D; Materials and methods. A prospective analysis of the labor of 136 patients with premature rupture of membranes and full-term pregnancy (37-42 weeks) of low and moderate risk groups, without contraindications for vaginal birth was carried out. Patients with Bishops cervical score less than or equal to 7 points made up the main group (70 pregnant women). Patients with mature cervix were included in the comparison group (66 cases). The analysis of the duration of the latent period was carried out with the use of correlation and regression analysis.&#x0D; Results. The time from the moment of discharge of amniotic fluid to the onset of regular labor in the group with a cervix 7 Bishop points was 7.82 4.53 hours, while in the group with a cervix 8 Bishop points it was 4.4 3.23 hours (T = 5.02; p 0.001). The most significant effect on the duration of the latency period was the assessment of the cervix according to Bishop scale (r = 0.48; p 0.001), the gestational age was in the second place (r = 0.23; p = 0.08). In patients who didnt take mifepristone, the main factors influencing the duration of the latency interval were fetal weight (r = 0.31; p = 0.004) and gestational age (r = 0.29; p = 0.008); the increase in these parameters led to the decrease in the latency interval. Women who received 200 mg mifepristone in labour had a significant positive correlation with maternal age (r = 0.36; p = 0.04), negative with maternal weight (r = 0.42; p = 0.01) and cervical Bishop score (r = 0.48; p = 0.004). Women in labor with the longest latency interval, who received mifepristone in a daily dosage of 400 mg, have an inverse correlation for the gestational age (r = 0.39; p = 0.09), connection with the degree of cervical maturity, age, constitutional features, gestational age was not revealed.&#x0D; Conclusion. The main predictors of the duration of the latency period of premature rupture of membranes at full-term pregnancy were the degree of cervical maturity according to Bishop scale, gestational age and fetal weight at birth.