Cervical Softening Research Articles

The biomechanical evolution of the uterus and cervix and fetal growth in human pregnancy

The coordinated biomechanical performance of maternal tissues facilitates healthy pregnancy. Quantifying uterine and cervical biomechanical function has been challenging due to minimal data on the anatomy’s shape, size, and material properties across gestation. Addressing this challenge, this study quantifies structural features of human pregnancy by assessing maternal reproductive tissues and estimated fetal weight in 47 low-risk pregnancies at four gestation times. Uterocervical size and estimated fetal weight were measured via ultrasound, and cervical stiffness was measured via mechanical aspiration. Patient-specific uterocervical solid models were built for each time point, and uterocervical dimensions and cervical stiffness rate changes were assessed between time points. We found that uterine growth rates are time- and direction-dependent, with cervical softening occurring fastest in early gestation and cervical shortening fastest in late gestation. In conclusion, this work enables computational modeling platforms (i.e., digital twins) to explore the structural performance of the uterus and cervix in pregnancy.

Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy

Cervical softening and dilation are critical for the successful term delivery of a fetus, with premature changes associated with preterm birth. Traditional clinical measures like transvaginal ultrasound and Bishop scores fall short in predicting preterm births and elucidating the cervix’s complex microstructural changes. Here, we introduce a magnetic resonance diffusion basis spectrum imaging (DBSI) technique for non-invasive, comprehensive imaging of cervical cellularity, collagen, and muscle fibers. This method is validated through ex vivo DBSI and histological analyses of specimens from total hysterectomies. Subsequently, retrospective in vivo DBSI analysis at 32 weeks of gestation in ten term deliveries and seven preterm deliveries with inflammation-related conditions shows distinct microstructural differences between the groups, alongside significant correlations with delivery timing. These results highlight DBSI’s potential to improve understanding of premature cervical remodeling and aid in the evaluation of therapeutic interventions for at-risk pregnancies. Future studies will further assess DBSI’s clinical applicability.

Assessing the effectiveness of membrane sweeping combined with cervical massage for term pre-induction cervical ripening: A single experimental study

Massage of the cervical region entails applying light pressure to the cervix to trigger the uterine contractions. Membrane sweeping, often called cervical sweeping or membrane stripping, releases hormones that may start labor by removing the amniotic sac from the uterine wall. Although membrane sweeping is helpful in several clinical trials, no studies have examined how effective cervical massage is when combined with membrane sweeping.This research compared the effectiveness of membrane sweeping and cervical massage as cervical ripening techniques in post-dated pregnancies before labor induction in specialized clinics. A total of 150 low-risk singleton pregnancies with a Modified Bishop Score (MBS) of fewer than five at 38 weeks of gestation were included. The experimental group received membrane sweeping with cervical massage, and the control group, which just received membrane sweeping, was randomly allocated to the participants. 48 hours after the intervention, changes in the MBS were used to gauge cervical favorability. Neonatal morbidity, membrane rupture, intrapartum and postpartum infections, and other complications were assessed.The mean ages and MBS of the primigravidae in the two research groups at induction were similar. After the intervention, the trial group's mean MBS was significantly higher than the control groups. Because of this, primigravidae observed a substantial change in the MBS after the operation. The experimental group's adverse effects and neonatal morbidity were comparable, except cardiotocographic abnormalities were observed more often in the control group.In some cases, when membrane sweeping cannot be conducted because of a closed cervical os, cervical massage combined with membrane sweeping appears successful and secure. A significant choice for obstetric care, this technique may aid cervical softening in post-dated pregnancies.

94 Fully quantitative operator-independent numeric cervical softening device: Cervical softening rate associated with mode of delivery

94 Fully quantitative operator-independent numeric cervical softening device: Cervical softening rate associated with mode of delivery

Quantification of Cervical Elasticity During Pregnancy Based on Transvaginal Ultrasound Imaging and Stress Measurement.

To overcome these limitations, we develop a quantitative cervical elastography system by adding a stress sensor to a clinically used transvaginal ultrasound imaging system. We record the cervical deformation in B-mode images and measure the probe-surface stress through the sensor. Then we quantify the strain using a customized algorithm and estimate the cervical Young's modulus through stress-strain linear regression. In phantom experiments, we demonstrate the system's high accuracy (alignment with the quasi-static compression method, p-value = 0.369 > 0.05), robustness (alignment between 60°- and 90°-contact measurements, p-value = 0.638 > 0.05), repeatability (consistency of single sonographers' measurements, coefficient of variation < 0.06), and reproducibility (alignment between two sonographers' measurements, Pearson correlation coefficient = 0.981). Applying it to pregnant participants, we observe significant cervical softening (p-value < 0.001): Young's modulus decreases 3.95% weekly and its geometric mean value during the first (11 to 13 weeks), second, and third trimesters are 13.07 kPa, 7.59 kPa, and 4.40 kPa, respectively. The proposed system is accurate, robust, and safe, and enables longitudinal and inter-examiner comparisons. The system applies to different ultrasound machines with minor software updates, which allows for studies of cervical softening patterns in pregnancy for larger populations, facilitating insights into conditions such as preterm birth.

Practical Effect of Cervical Softening Decoction Combined with Delivery Ball Approach in Promoting Vaginal Delivery in Primiparous Women

In Traditional Chinese Medicine, Cervical Softening Decoction is derived from a modified “Wan Bing Hui Chun” formulation and consists of natural herbal ingredients such as Angelica sinensis, Ligusticum chuanxiong, Leonurus heterophyllus, and Cortex Daphnes. The decoction regulates Qi, promotes blood circulation, and facilitates fetus descent. Genkwanin is an active compound in L. heterophyllus and previous studies identified this compound in ethanolic extracts from rat uterine smooth muscle cell membrane fractions. To further understand the pharmacological activities of Cervical Softening Decoction, we examined genkwanin effects on isolated rat uterine contractions and protein expression in rat tissue with postpartum hemorrhage complicated by multiple organ dysfunction syndrome (MODS). We also explored the practical effects of Cervical Softening Decoction combined with a birthing ball approach on promoting natural delivery in primiparous women. First, an isolated rat uterine smooth muscle contraction model was generated and three groups established: oxytocin group (0.002 U/mL), conventional genkwanin dose group (3 μg/mL), and high genkwanin dose group (6.0 μg/mL). Changes in uterine smooth muscle contraction and relaxation amplitudes were recorded before and after administration. Second, 50 rats were used to establish the following groups: (1) control group, (2) postpartum hemorrhage with MODS model group (MODS group), and (3) a postpartum hemorrhage with MODS treated with genkwanin group (genkwanin group). Western blotting was used to detect and compare tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 protein expression levels in lung tissue from groups. Finally, 84 primiparous women admitted to our hospital between January 2020 and December 2021 were selected and divided into two groups based on their obstetric interventions. The control group (n = 42) received routine obstetric intervention, while the observation group (n = 42) received Cervical Softening Decoction and delivery ball interventions. Delivery conditions were compared across groups. In basic studies, genkwanin doses significantly increased contraction and relaxation values in isolated rat uterine smooth muscle (P &lt;0.05). Moreover, the genkwanin contractile effects at conventional and high doses were comparable with oxytocin. TNF-α and IL-6 protein expression in MODS group lung tissue was significantly higher when compared with the control group, while expression in the genkwanin group was significantly reduced when compared with the MODS group (P &lt;0.05). In clinical studies, the observation group showed significantly higher natural delivery rates and Labor Agentry Scale (LAS) scores when compared with the control group. In contrast, cesarean section rates, first and second stage labor duration, total labor duration, and Facial Pain Scale (FPS) scores were significantly lower in the observation group when compared with the control group (P &lt;0.05). In basic studies, genkwanin elicited significant contraction effects on isolated rat uterine smooth muscle and effectively inhibited inflammatory responses in rats with postpartum hemorrhage complicated by MODS. In clinical studies, combined Cervical Softening Decoction and delivery ball generated promising practical effects in promoting vaginal delivery in primiparous women. The intervention significantly increased the probability of a natural delivery, shortened labor duration, relieved maternal pain, and enhanced maternal control during delivery.

Assessment of cervical softening and the prediction of preterm birth (STIPP): protocol for a prospective cohort study

IntroductionPreterm birth (PTB) is among the leading causes of perinatal and childhood morbidity and mortality. Therefore, accurate identification of pregnant women at high risk of PTB is key to enable...

Comparison of the efficacy of Lecirelin and hCG for ovulation induction in mares

Ovulating agents are very useful drugs in equine breeding, hCG being the first intention molecule, whereas GnRH agonists are especially interesting for any mare immunized against hCG, like repeat breeders and embryo donor mares. In Europe, no long acting GnRH agonist is available in veterinary practice. Saline solutions of buserelin or triptorelin, which is only available for human treatments in Europe are commonly used for equine ovulation induction (Dordas-Perpinya et al. Reprod. Dom. Anim. 2020; 55:374-383). An alternative, Lecirelin which is licensed in cattle and rabbits, has been evaluated in donkeys (Carluccio et al. Therio. 2007;68:914-919). The aim of our study was to compare the efficacy of lecirelin with hCG in horses. Forty mares underwent ovulation induction on four consecutive cycles, two cycles with hCG and two cycles with lecirelin, including one spontaneous estrus and one following chemical luteolysis. Mares were examined on a daily basis to check ovarian follicles diameter, uterine edema, and cervical softening. Once they presented a preovulatory follicle over 35 mm, and uterine edema (>=2) (Mc Kinnon. Equine diagnostic ultrasonography. 1998; 79-102) and a soft cervix, they were randomly injected with saline solution containing 200 µg of Lecirelin or 1500 IU of hCG intravenously. After induction, they were scanned every 12 hours until ovulation. Mares were inseminatedwith a mix of fresh semen of two fertile stallions 20 hours after induction on the spontaneous cycles. Pregnancy diagnosis was performed at day 12 and day 14. As each mare is her own control, statistical analysis was performed by χ², Fisher's test and Student's test for matched data. Follicle size at injection did not differ significantly between the two induction treatments (p>0,05), with or without distinction of spontaneous and induced cycles. Rates of ovulation in the 24-48 hours post-injection did not significantly differ between lecirelin (71%) and hCG (83%) on estrus following chemical luteolysis (p>0,05) or spontaneous estrus (43% for lecirelin and 68% for hCG) (p>0,05). We observed significantly more spontaneous ovulations occurring within the first 24 hours after induction with hCG (27% on spontaneous estrus, and 15% after chemical luteolysis) than with lecirelin (5% on spontaneous estrus, 7% after chemical luteolysis) (p < 0,05). Pregnancy rates were not significantly different following induction by lecirelin (67%) or hCG (57%) (p>0,05). These results highlight the usefulness of saline solution of lecirelin licensed in Europe for bovine and rabbit for induction and synchronization of ovulation for mares with control cycles. Lecirelin may be particularly suitable for embryo donor mares with a reduced hCG response.

Use of prostaglandin E1 analog (misoprostol) to aid cervical dilation in birth induction (a case report)

The cervix is a barrier between the environment and the uterus, composed of longitudinal folds that continue along the uterine folds. Cervical dilation is associated with increased synthesis of prostaglandin E2 (PGE2). Dilatation may fail due to congenital malformations or adhesions of the cervix caused, for example, by previous dystocia or by failure of any mechanisms that regulate cervical relaxation including a reduction in collagen and glycosaminoglycans and an increase in water content and metalloproteinases. Labor induction often requires the ripening of the cervix mechanically or pharmacologically. Oxytocin success may be reduced if the cervix is not favorable or responsive. Misoprostol, a synthetic prostaglandin E1 analog, is widely used in reproduction in cases of oviduct obstruction. It also promotes cervical softening by the dissolution of extracellular collagen. A 17-year-old mixed-breed mare from a private farm in the Middle East presented with abdominal discomfort and signs of imminent delivery, 10th months after embryo transfer. A slight thickening of the uterus-placental junction (7.12mm) was observed during transrectal ultrasound evaluation, but there was no placental detachment. On transabdominal imaging, the absence of a fetal heartbeat, fetal movements, and torsion of the umbilical cord were observed. Imaging evaluations were performed with an ultrasound machine DCS - MyLab™25 GOLD, 5Hzfrequency. Hematological analysis of the mare showed results within normal ranges. Flunixin Meglumine (10mL i.v., Finadyne, 50mg/mL, MSD) was administered before the abortion procedure. After confirmation of fetal death and dystocia in the mare, the cervix dilation process began with a local application of 1mg of misoprostol 200mcg diluted in lubricating gel and mechanical massage. Then, intravenous oxytocin (Syntocin, 10UI/mL, Illium) was started gradually every 5 minutes (5IU, 5IU, 10IU, 10IU). Mild sedation and analgesia was achieved with detomidine (0.6mL i.v., Dormiun V, 10mg/mL, Agener Uniao) and butorphanol (1mL i.v., Torbugesic, 14,58mg/mL, Zoetis). The mare showed signs of delivery before the mechanical rupture of the allantochorion. The position of the fetus (head back and right shoulder flexion) was corrected transvaginally by mechanical maneuver. After removing the fetus, 5 mg of dinoprost (i.m., Lutalyse, 6.71mg/mL, Zoetis) was administered to aid uterine contractility and clearance. The placenta did not have macroscopic changes. The fetus showed an absence of the right posterior limb's first, second, and third phalanges. During fetal necropsy, no other changes were observed. Uterine lavage was performed 24h and 48h after the procedure, using Ringer Lactate Solution (LRS), with 10% iodine (20mL/5L LRS) followed by 20IU oxytocin every eight hours for two consecutive days.

Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

Background: To compare the effects of Dilapan-S versus phloroglucinol on cervical dilation in hysteroscopic polyp resection. Methods: This prospective, observational study enrolled non-menopausal patients with endometrial polyps who underwent operative hysteroscopy for transcervical polyp resection between October 2021 and October 2022. The patients were given Dilapan-S or phloroglucinol for cervical dilation. The primary outcome was cervical dilation time; secondary outcomes included cervical softening and adverse events. Non-inferiority was prespecified with a margin of 6 seconds. Results: Among 105 included patients, 55 were given phloroglucinol and 50 Dilapan-S. There were no significant differences in age, body mass index (BMI), history of vaginal delivery, hysteroscopic electrotomy, and cervical conization between the two groups (all p &gt; 0.05). The cervical dilation time in the Dilapan-S group was shorter than in the phloroglucinol group (41.74 ± 8.68 s vs. 62.04 ± 9.55 s, non-inferiority p &lt; 0.001). Also, more patients achieved highly effective cervical softening in the Dilapan-S group compared to the phloroglucinol group (44/50 vs. 1/55, p &lt; 0.001). There were 4 cases of diarrhea (p = 0.103), 12 cases of vaginal bleeding (p &lt; 0.001), and 4 cases of abdominal pain in the Dilapan-S group (p = 0.103), and none in the phloroglucinol group. There were also 5 cases of intraoperative water leakage in the phloroglucinol group and 8 cases in the Dilapan-S group (p = 0.283). Conclusions: Dilapan-S is found to be equally effective for cervical dilation as phloroglucinol; however, it is associated with a higher incidence of diarrhea, vaginal bleeding, and abdominal pain complications.

Clinical Effect of Phloroglucinol for Injection in Promoting Cervical Softening

Clinical Effect of Phloroglucinol for Injection in Promoting Cervical Softening

The swelling behavior of the mouse cervix: Changing kinetics with osmolarity and the role of hyaluronan in pregnancy

The cervical remodeling process during pregnancy is characterized by progressive compositional and structural changes in the tissues extra-cellular matrix (ECM). Appropriately timed remodeling is critical for healthy gestation and prevention of premature cervical softening leading to preterm birth (PTB). Modification of the ECM glycosaminoglycans (GAGs) content with advancing pregnancy, especially the non-sulfated GAG hyaluronan (HA), is a fundamental change associated with cervical remodeling. While GAGs have numerous physiological roles, the mechanical consequence of evolving GAG content on cervical structure-function behavior remains an open question. Additionally, an understanding of cervical swelling properties, postulated to be regulated in part by GAGs, is required for the appropriate definition of a reference configuration for mechanical tests and to enhance biological understanding. To investigate cervical swelling, osmotic loading tests are conducted on isolated wild type mouse cervices throughout pregnancy. These tests are performed in various osmolarity solutions to assess the influence of the media on swelling kinetics. A genetically altered strain of mice with depletion of cervical HA is also tested to elucidate the contribution of HA to tissue swelling. Results show ex vivo cervical swelling is significant with volume changes ranging from 20 to 100% after 3h of free swelling. The swelling kinetics depend highly on osmolarity of the media and is altered with advancing pregnancy. The contribution of HA to swelling is only significant in hypo-osmotic solution when HA cervical content is high at the end of pregnancy. In summary, it is critical to account for swelling deformation mechanisms after excision in mechanical experiments. Statement of significanceThe cervical extracellular matrix (ECM) undergoes drastic changes to fulfill the functional change of the cervix during pregnancy. Inappropriate timing for this transformation can result in preterm birth, a severe clinical challenge. One of the fundamental changes of the cervical ECM is the significant modification of the glycosaminoglycan content, especially hyaluronan (HA), which is thought to contribute significantly to the swelling and mechanical properties of the cervix. This study aims to measure the swelling kinetics of cervical tissue during pregnancy and to investigate the role of HA in these swelling tendencies. Results show the significant swelling of cervical tissue, which evolves as pregnancy progresses, highlighting a key material property feature of the remodeled cervix. Using a mouse strain with a cervical HA depletion, this work shows HA contributes to the swelling trends of late-term cervical tissue, in a hypo-osmotic solution.

Chloroorganic (DDT) and organophosphate (malathion) insecticides impair the motor function of the bovine cervix

Dichlorodiphenyltrichloroethane (DDT) is a representative organochlorine insecticide and a known endocrine disruptor. Malathion is an organophosphate insecticide and a next-generation pesticide. Previously, it was shown that oxytocin (OT) and prostaglandins (PGs) are involved in the mechanism of the adverse effect of DDT on bovine myometrial contractions. However, disruption of myometrial contractions without disruption of cervical activity may not be sufficient to cause preterm delivery. Hence, the aim of this study was to determine the effects of insecticides on the function of the bovine cervix at preovulation period. Bovine cervical cells or strips were treated with DDT or malathion (0.1–100 ng/ml), and neither DDT nor malathion (each at a dose of 100 ng/ml) affected the viability of cervical cells. Malathion (0.1–10 ng/ml) and the high doses of DDT (10 ng/ml) decreased the force of cervical contractions, in contrast to a low dose of DDT (0.1 ng/ml). Both insecticides also decreased the mRNA expression of the OT receptor and the level of the second messenger (inositol triphosphate, IP3). Moreover, DDT decreased the amount of other second messengers (diacylglycerol, DAG), while malathion decreased the amount of gap junction protein (GAP). Only malathion increased PGE2 and decreased PGF2α secretion, while neither insecticide had an effect on both prostaglandins synthesis. Both DDT and malathion impaired cervical contractions, secretory function and cellular signalling. It is also possible that malathion-mediated induction of locally produced PGE2 can be followed by cervical softening. Admittedly it was shown that DDT and malathion can evoke failures in the regulation of motor function of cervix during oestrus cycle, while their harmful effect on gestation can be also not excluded.

Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest.

Misoprostol is a synthetic E1 prostaglandin commonly used to induce abortion in the United States and elsewhere. There is limited literature on the cardiovascular adverse effects of misoprostol, and, to the best of our knowledge, very few such events have been reported. We describe the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and experienced a cardiac arrest due to coronary vasospasm. She was successfully resuscitated and echocardiography showed features consistent with Takotsubo cardiomyopathy. Coronary angiography revealed coronary artery spasm which responded to nitroglycerin. Our case adds to the limited literature on this life-threatening adverse event of misoprostol.LEARNING POINTSMisoprostol is frequently used obstetrics and gynaecology and routinely for the medical termination of pregnancy.Misoprostol can result in cardiac arrest due to coronary vasospasm.Coronary vasospasm induced by misoprostol can be relieved with intra-arterial nitroglycerin.

984 Novel measures of cervical deformation properties on transvaginal ultrasound and prediction of time to delivery

To examine deformation characteristics of the cervix during transvaginal ultrasound (TVUS), as a surrogate for cervical softening, in relation to time to delivery. Prospective cohort study of patients undergoing longitudinal cervical imaging. We assessed TVUS exams from 20 weeks to within 1 week of delivery. B-mode video captured standard cervical length (CL) views including the cervical canal, and internal and external os under pressure and release cycles. Cervical deformation characteristics were: CL length stretch ratio defined as CL at the highest pressure divided by CL at the lowest pressure (as the cervix becomes softer it elongates more with pressure), and Anterior-posterior cervical thickness ratio defined as thickness of the anterior layer of cervix divided by thickness of the posterior layer (as the cervix softens, pressure on anterior layer is not transmitted effectively to the posterior layer and it is less compressed) (Fig. 1). These measures were compared between time windows to assess progression of cervical softness as pregnancy progressed in term(T) and spontaneous preterm (PT) births. 160 patients were included; 114 T and 46 PT births. In both T and PT births, the CL stretch ratio significantly increased 1-2 weeks before delivery compared to 3-4 weeks. The anterior-posterior thickness ratio also significantly decreased 1-2 weeks before delivery in T birth. Measures at all time points from 3 to 20 weeks before delivery did not significantly differ, suggesting that cervical softening occurs proximal to delivery in both T and PT births (Fig 2). Measures in T and PT births were similar distant from delivery (3-20 weeks) and proximal to delivery (within 2 weeks), suggesting that cervical ripening patterns are similar, but occur earlier in PT births. We report novel measures of cervical deformation properties easily obtained by TVUS that change 1-2 weeks before delivery. These measures warrant further investigation for clinical application to detect timing of both T and PT deliveries.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

USING OF MISOPROSTOL VAGINALLY PRIOR TO INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION FOLLOWING PREVIOUS INSERTION FAILURE: RANDOMIZED CLINICAL TRIAL

Background: Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Objective: To investigate the possible effect of vaginal administration of misoprostol to insertion of IUCDs in women with previous IUCD insertion failure. Subjects and methods: This study was done at Obstetrics and Gynecology Department of at El-Hussien hospital. It is a double blind randomized clinical trial. The study included 100 patients with previous failed attempt of IUD insertion, divided into two equal groups: Group I received misoprostol prior to IUD insertion and group II received placebo to IUD insertion. Results: There was high significant difference between the two groups regarding the degree of cervical softening and its effect on the success rate of IUCD insertion in each group. Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous cesarean delivery.

USING OF MISOPROSTOL VAGINALLY PRIOR TO INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION FOLLOWING PREVIOUS INSERTION FAILURE: RANDOMIZED CLINICAL TRIAL

Background: Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Objective: To investigate the possible effect of vaginal administration of misoprostol to insertion of IUCDs in women with previous IUCD insertion failure. Subjects and methods: This study was done at Obstetrics and Gynecology Department of at El-Hussien hospital. It is a double blind randomized clinical trial. The study included 100 patients with previous failed attempt of IUD insertion, divided into two equal groups: Group I received misoprostol prior to IUD insertion and group II received placebo to IUD insertion. Results: There was high significant difference between the two groups regarding the degree of cervical softening and its effect on the success rate of IUCD insertion in each group. Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous cesarean delivery.

Effect of Crocus sativus (Saffron) on Cervical Ripening and Progress of Labor in Primiparous Term Women: A Randomized Double-Blind Placebo-Controlled Trial

Background: Saffron is a perennial plant native to Iran which has been traditionally prescribed to facilitate labor. We aimed to investigate the effect of Crocus sativus (Saffron) on cervical ripening and progress of labor in a sample of primiparous term Iranian women. Materials and Methods: This randomized double-blinded study, was conducted on 60 primiparous women whose gestational age was 40 weeks or longer and who had referred to Hazrat Zahra Marzieh hospital in Isfahan, Iran. Inclusion criteria were: singleton pregnancy, cephalic presentation of the fetus, lack of uterine contractions, intact amniotic sac and having a low-risk pregnancy. The intervention (n=30), and control groups (n=30) respectively received one saffron capsule (250 mg, the content of total flavonoid in each saffron capsule was calculated 0.13-0.18 mg), and one placebo capsule for 3 consecutive nights. Bishop scores of the samples were recorded before and after the intervention. Results: The mean Bishop score before inclusion in the study did not show significant difference between two groups (P>0.05). However, on third day of study, this score in saffron group was higher than the placebo (Saffron: 3.93±1.10 vs. placebo: 2.52±1.57) (P=0.001). Further, the mean Bishop score in saffron group was higher on third day of study compared to before their inclusion in the study (before: 2.42±1.19 vs after: 3.93±1.10) (P=0.001). But the placebo group did not show a significant difference before and after inclusion in the study (P=0.16). The average length of first and second stages of labor in saffron group was shorter than in the placebo (P>0.05). Conclusion: It seemsconsumption of oral saffron capsules, affects cervical softening and ripening, and progress of labor.

Cervical Characterization with Tactile-Ultrasound Probe.

Background:Premature cervical softening and shortening may be considered an early mechanical failure that predisposes to preterm birth. Preliminary clinical studies demonstrate that cervical elastography may be able to quantify this phenomenon and predict spontaneous preterm delivery.Objective:To explore a new approach for cervix elasticity and length measurements with tactile-ultrasound probe.Methods:Cervix probe has tactile array and ultrasound transducer designed to apply controllable load to cervix and acquire stress-strain data for calculation of cervical elasticity (Young’s modulus) and cervical length for four cervix sectors. Average values, standard deviations, intraclass correlation coefficients and the 95% limits of agreement (Bland-Altman plots) were estimated.Results:Ten non-pregnant and ten pregnant women were examined with the probe. The study with non-pregnant women demonstrated a reliable acquisition of the tactile signals. The ultrasound signals had a prolonged appearance; identification of the internal os of the cervix in these signals was not reliable. The study with pregnant women with the gestational age of 25.4 ± 2.3 weeks demonstrated reliable data acquisition with real-time visualization of the ultrasound signals. Average values for cervical elasticity and standard deviations of 19.7 ± 15.4 kPa and length of 30.7 ± 6.6 mm were calculated based on two measurements per 4 sectors. Measurement repeatability calculated as intraclass correlation coefficients between two measurements at the same cervix sector on pregnant women was found to be 0.97 for cervical elasticity and 0.93 for the cervical length. The 95% limits of agreement of 1) cervical elasticity were from −22.4% to +14.9%, and 2) cervical length from −13.3% to +16.5%.Conclusions:This study demonstrated clinically acceptable measurement performance and reproducibility. The availability of stress-strain data allowed the computation of cervical elasticity and length. This approach has the potential to provide cervical markers to predict spontaneous preterm delivery.

Failed diagnostic hysteroscopy: Analysis of 62 cases

ObjectiveThe aim of the presented study is to improve the office hysteroscopy success rate identifying some of the factors associated to an unsuccessful procedure. Moreover it would highlight the importance of an adequate patients follow up after office hysteroscopy failure enlightening the uterine pathologies missed at the first attempt. StudydesignThis is a retrospective observational study. The Authors reviewed the medical records related to 516 office hysteroscopies performed from January 2016 to November 2018, extrapolating the data from the failed hysteroscopies occurred during this period. After the procedure failure all patients were offered to repeat the hysteroscopy under regional anesthesia in order to identify and treat uterine pathologies. Those patients, who declined to repeat the procedure, received an appropriate follow up. Each failure case is correlated with patient clinical characteristics, indications to hysteroscopy, risk factors presence, hysteroscopy patient compliance, pathology result and patient follow up. ResultsThe presented study shows an office hysteroscopy failure rate of about 12 %. Severe pain due to cervical stenosis, previous uterine surgery, postmenopausal status and marked uterine ventrifixation/retroflexion, represent the main reason why the procedure was not completed in an office setting. The uterine cavity was subsequently examined in only 26 (42 %) out of 62 patients who reported hysteroscopy failure, mostly repeating the procedure under regional anesthesia (24 cases) or performing vaginal hysterectomy for associated benign gynaecological pathology (2 cases). Endometrial malign pathology (endometrioid carcinoma) was diagnosed in 2 cases of them (7.7 %). Moreover the endometrial cavity remained so far unexplored in 36 (58 %) out of 62 patients, due to the patient refuse to repeat the hysteroscopy under anesthesia. Discussion and conclusionResults of the present study suggest that office hysteroscopy should be sussessful at the first attempt due to the patients’ refuse, in majority of cases, to repeat the procedure after a failure. To not repeat the hysteroscopy may lead to lose or delay important diagnosis, such as that of endometrial cancer. In this context, to counsel all patients prior the procedure may singnificanly help to identify those who may benefit of pharmacological cervical softening, local anesthetic injection or small caliber hysteroscopes usage, increasing the procedure success rate.