Dilatation Of Cervix Research Articles

An investigation into the effect of evening primrose in dilatation of cervix and pain during and after hysterosalpingography.

Hysterosalpingography is one of the essential diagnostic methods for examining women who have difficulty becoming pregnant. This procedure is somehow invasive and is associated with numerous complications such as allergic sensitivity, pain, abdominal cramps and shock. Therefore, this study aimed to investigate the effect of evening primrose on cervical length and pain during and after hysterosalpingography. In this double-blind clinical trial, 66 candidates for hysterosalpingography were randomly divided into two groups. A group received 1000 mg of evening primrose orally for two days prior to hysterosalpingography, while the control group received a placebo drug similar in size to evening primrose three days prior to hysterosalpingography. The pain level was recorded based on the Visual Analogue Scale (VAS), during tenaculum placement but also immediately and four hours after hysterosalpingography. Finally, the data were analyzed using SPSS (version 20). There was a significant difference between the two groups in terms of pain during insertion of speculum and injection of the contrast medium (p <0.05). Less pain was reported in the evening primrose group compared to placebo. There was no significant difference between the two groups in terms of the length and diameter of the cervix (p <0.05). Given the fact that it is a medicinal plant with no complications and can reduce pain during speculum insertion and during contrast medium injection, evening primrose seems to be a good drug for managing pain during hysterosalpingography.

Combined Rupture of Vaginal Vault and Unscarred Uterus and Neonatal Death Following Induction of Labor with Misoprostol

Introduction: Rupture of unscarred uterus (primary uterine rupture) is a rare peripartum complication often associated with catastrophic maternal and neonatal outcomes. Case presentation: A 27-year-old primigravid lady, previously healthy, at 40 weeks + 2 days presented to a midwife’s clinic for routine antenatal consultation. She was advised to have induction of labor. This was initiated with 2 tablets of Misoprostol (400 mcg) vaginally. Twelve hours later, and after remaining at full cervical dilation for 4 hours, she was referred to our maternity service for alleged failure to descend. On arrival, she was apprehensive, exhausted but hemodynamically stable. Pelvic exam disclosed a fully dilated cervix with the vertex at S + 1 and a caput reaching the introitus. No fetal heart rate could be elicited by the CTG monitor and this was verified by a bedside ultrasonography. Operative vaginal delivery was performed due to maternal exhaustion. This was complicated by transient shoulder dystocia. Manual revision of the birth canal and the uterine cavity disclosed a suspicion of left vaginal vault gapping together with a left fundal uterine rupture. Consequently, the patient was rushed to the operating room for an urgent exploratory laparotomy. The rupture sites were identified and repaired while a large broad ligament hematoma on the same side was explored and hemostasis secured with ipsilateral uterine artery ligation of the fundal and cervical branches. The postoperative course was smooth and the patient left the hospital on the 5th day postpartum. Conclusion: Cases of unscarred uterine rupture are limited. One of the most frequent risk factor is the injudicious use of Misoprostol for labor induction. Sudden arrest of progress of labor or failure to descend might mask uterine rupture. We recommend that all birth attendants be familiar with the guidelines issued by FIGO, ACOG and other societies for the safe use of these potent uterotonics.

558: Short cervical length in low risk women: how many will become dilated before 24 weeks?

It has been well established that short cervical length (CL) is associated with an increased risk of spontaneous preterm birth (SPTB). In women without a history of SPTB and a short CL found incidentally on ultrasound, previous studies have shown that cerclage is not associated with improved outcomes. Women with a dilated cervix, however, may benefit from cerclage. It is not well understood which women with a short CL will ultimately become dilated. We sought to determine what proportion of women with a short CL without a history of SPTB will ultimately be dilated at <24 weeks and thus be cerclage candidates. This was a retrospective cohort study of women with singleton pregnancies with short CL (≤25mm) between 16-22 weeks’ gestational age (GA) diagnosed at a single maternal-fetal medicine ultrasound unit between 2011 and May 2018. We included women without a history of SPTB. We routinely perform ultrasounds on women at 16 and 20 weeks GA and image the cervix in all women transabdominally. If the CL was suspected to be short, transvaginal imaging was performed. We routinely follow women with a short CL with serial CL’s, and speculum exams for those with a CL <10mm. We examined the progression of women based on the CL measurement and GA at diagnosis. The primary outcome was cervical dilation or spontaneous delivery <24 weeks. Chi square and logistic regression analysis was used. A total 163 women were included, of whom 27 (16.6%) were ultimately dilated and 4 (2.5%) had pregnancy loss by 24 weeks. The median GA at diagnosis of short CL was 19 5/7 (range 15-22) weeks. Women with a CL ≤15 were more likely to have dilation or pregnancy loss prior to 24 weeks than women whose CL was 16-25mm (42.5% vs. 11.9%, <0.001). GA at diagnosis was not associated with risk of progression. After controlling for differences in baseline characteristics including GA at short CL diagnosis, in vitro fertilization, and history of cervical cone biopsy or loop electrosurgical excision procedure, CL ≤15mm was independently associated with almost a 4-fold increase in odds of dilation or loss (aOR 3.72, 95% CI 1.52-9.09). In women with a short CL without a history of SPTB, the risk of dilation or pregnancy loss <24 weeks is significant, approaching 50% for women with a CL ≤15mm. This supports the practice of serial CL measurements in women found to have a short cervix, especially with a CL ≤15mm, in order to identify those who may become dilated and potentially benefit from an exam-indicated cerclage.

Labour outcomes in caseload midwifery and standard care: a register-based cohort study

BackgroundResearch on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care.MethodsA historical register-based cohort study was carried out using routinely collected data about all singleton births 2013–2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses.ResultsCompared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06–1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13–1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03–1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84–1.28).Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11–2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital.For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06–1.29).ConclusionsFor most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures.

Introduction Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

P06.01: Prediction of the outcome of labour in induced prolonged pregnancy by transvaginal ultrasonographic measurement of cervical length

Induction of labour is an intervention to artificially initiate uterine contraction leading to progressive dilatation and effacement of cervix and birth of the baby. The traditional method of predicting a successful vaginal delivery in induced labour is based on Bishop Score. This is subjective and had shown a poor predictive value of Bishop Score for the outcome of induction. The objective of this study was to correlate the preinduction cervical length measured by transvaginal ultrasonography (TVS) with the mode of delivery. This study was conducted in Department of Obstetrics and Gynecology for one year. One hundred pregnant women with prolonged pregnancy planned for induction of labour were included. Cervical length was measured by TVS prior to induction of labour. The primary outcome was the mode of delivery. The mean age was 23.84±4.56 years. Among 100 patients, 53% had vaginal delivery and 47% had Caesarean section. Primigravida were 63 and 37 were multigravida. On the basis of cervical length, the patients were divided into two groups. One group with cervical length ≤25mm and the other group with cervical length >25mm.There were 54 patients with cervical length ≤25mm and 46 patients with cervical length >25mm. There was a significant correlation between cervical length and mode of delivery with p<0.001.Those who had cervical length ≤25mm, 77.7% had vaginal delivery and 22.3% had Caesarean section. Among those who had cervical length >25mm, 23.9% had vaginal delivery and 76.1% had Caesarean section. There was also significant association of parity with cervical length. Comparing multigravida with primigravida with cervical length ≤25mm, 82.7% versus 72% had vaginal delivery. Similarly comparing multigravida with primigravida with cervical length >25mm, 37.5% versus 21% had vaginal delivery. Cervical length measured by transvaginal ultrasound can predict the outcome of induced labour in prolonged pregnancy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Clinical multicenter study of carboprost methylate suppository for cervical ripening prior to diagnostic hysteroscopy

Objective: To evaluate the effectiveness of carboprost methylate suppository for cervical ripening before diagnostic hysteroscopy in premenopausal women. Methods: From July 2014 to July 2015, 1 614 women who were undergone diagnostic hysteroscopy in 12 hospitals were randomly assigned into study group (n=1 209) and control group (n=405) . The cases in study group were given 1 mg carboprost methylate suppository in vagina before hysteroscopy, the cases in control group were given 1 mg placebo. The extent of cervical ripening, the time of dilated cervix, pain scoring, incidence of drug side reactions after 24, 48, 72 hours, satisfaction degree of operators and patients, the time of hysteroscopy, incidence of complications between the two groups were observed and compared. Results: (1) Mean cervical widths in the study and control groups were 6.11±1.11 and 5.95±1.11, and showed a significant difference (P=0.034) ; the percentage of women requiring cervical dilatation in study group was lower than the percentage in control group significantly [28.3% (342/1 209) versus 34.6% (140/405) , P=0.020]. (2) The time of dilated cervix in study group was shorter than the time in control group significantly [ (34±25) versus (52±49) s, P=0.028] for the patients whose mean cervical widths≤4. (3) There was no significant difference in pain scores between the two groups (P>0.05) . (4) The incidence of side reactions 24, 48, 72 hours after operation were no significant difference between the two groups (P>0.05) . (5) The satisfaction degree of operators and patients, the time of hysteroscopy, incidence of complications between the two groups were no singnifcant difference between the two groups (all P>0.05) . Conclusion: Application of carboprost methylate suppository by vagina before hysteroscopy is an effective and safe method of cervical ripening.

Does rescue cerclage work?

Rescue cervical cerclage (RCC), also known as emergency cerclage, has long been the subject of controversy. Its use in women who have a dilated cervix has been ambivalent. RCC is often considered as a salvage measure for pregnancies which are at a high risk of severe preterm delivery (PTD) or mid-trimester miscarriage. This study aims to examine and assess the efficacy of RCC and its ability to prolong pregnancy until neonatal viability is achieved. The current data suggest that RCC is associated with a longer latency period frequently resulting in better pregnancy outcomes (Namouz S, Porat S, Okun N, Windrim R, Farine D. Emergency cerclage: literature review. Obstet Gynecol Surv. 2013;68:379-88). This is supported by the Royal College of Obstetricians and Gynaecologists (RCOG) which states that the insertion of a rescue cerclage may delay delivery by a further 5 weeks on average as compared with expectant management or bed rest alone (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). It further states that it may be associated with a two-fold reduction in the possibility of delivery before 34 weeks of gestation (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). Our study reveals that the average insertion to delivery interval at our centre was 71.2 days with a live birth rate of 92.5%. A total of 89.1% of women delivered beyond 24 weeks of gestation.

Risk factors for Korean women to develop an isthmocele after a cesarean section

BackgroundThe increase in number of cesarean section (CS) operations has resulted in an increase in cases of isthmocele development. The objective of this study is to determine the risk factors for isthmocele development after CS.MethodsIsthmocele measurements were taken for 404 women with a history of at least one low transverse CS. The following potential risk factors were investigated: patient’s age at CS, cause of CS, weeks of gestation at CS, premature rupture of membrane (PROM), phase of labor, type suture (single/double layer), operation time, uterine flexion (anteversion/retroversion), and blood transfusion during operation. A transvaginal ultrasound was carried out to examine the isthmocele in the uterus after CS, including the shape of the isthmocele, residual myometrial thickness, depth and width of isthmocele, cervical thickness, location of the isthmocele, and clinical characteristics.ResultsIn our study population, the isthmocele had a prevalence of 73.8%. Most isthmocele had a triangular (65.4%) or semicircular shape (10.4%). The presence of an isthmocele was significantly associated with repeat CS, premature rupture of membrane (PROM), short operation time, and extent of cervix dilatation at CS. The risk of isthmocele was low in women who had placenta previa totalis (PPT), twin, a long operation time, or a transfusion during the operation.ConclusionsIn our study, isthmocele development was significantly associated with repeat CS, PROM, a short operation time, and the extent of cervix dilatation at CS. Therefore, PROM prevention and a more careful uterine closure are needed to reduce the risk of developing an isthmocele after CS.

PIH3 - Efficacy and Safety of Atosiban in Pregnant Women Under Threat of Preterm Labor: Systematic Review

To assess the efficacy and safety of atosiban in pregnant women under threat of preterm birth. A systematic review was carried out, inclusion criteria were adult pregnant women diagnosed with preterm labor threat with the following characteristics: regular uterine contractions lasting at least 30 seconds, contraction frequency greater than 4 every 30 minutes, cervix dilatation from 1 to 3 cm, gestational age from 24 to 33 weeks and normal fetal heart rate (110 – 160 bpm). Atosiban was set as intervention and the comparators were nifedipin, indomethacin, terbutaline, fenoterol and placebo. Assessed outcomes were: Gestational age at birth, delay in the timing of birth, neonatal mortality, neonatal respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, rate of maternal adverse events, rate of neonatal complications. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The comparison measurements found on studies were extracted in order to perform a network meta-analysis. Results were expressed through forest plots. 11 studies were included in network meta-analysis, all of them were randomized controlled clinical trials. The results showed that atosiban has the greater probability of being the most effective alternative on the following outcomes: delay in the timing of birth (0.81), neonatal mortality (0.85) and rate of maternal adverse events (0.99). Atosiban showed similar efficacy for delaying labor in women with preterm labor threat with comparators. However, it showed a greater safety profile with respect to maternal adverse events and a similar level compared to nifedipine for neonatal complications.

Study on the influence of the supine adjustment on the posterior position of the fetal occipital position in the parturient with epidural analgesia

Objective To investigate the effect of supine regulating on maternal fetal occiput posterior position during the delivery after epidural analgesia. Methods Totally600 cases of parturient with intravaginal posterior occipital position with 3cm voluntary labor analgesia were selected,who were born in Dalian maternity hospital from October 2015 to October 2016.The (Visual Analogue Scale/Score)VAS pain score at 15min after epidural labor analgesia was as effective as less than 3 points. They were randomly divided into the control group and the observation group by random number table method, with 300 cases in each group.The control group monitored parturient respiration, pulse, blood pressure, heart rate and fetal heart rate according to routine treatment.The control group monitored parturient respiration, pulse, blood pressure, heart rate and fetal heart rate according to routine treatment.In the observation group, except for routine treatment according to the labor process, after the opening of 5cm, the pregnant women were instructed to take the lateral prone position, so that the maternal side and the fetal side of the spinal column should be the same side. To observe the difference between the two groups in the rate of spontaneous vaginal delivery, delivery rate, cesarean section rate, fetal cardioversion rate, time of birth process and neonatal Apgar score. Results Totally 283 cases delivery through vagina and 17 cases of cesarean section in observation group, while 257 cases of vaginal delivery and 43 cases of cesarean section in the control group.The successful rate of fetal position transfer in the observation group was 74.6% (211/283) which was significantly higher than 45.9% (118/257) of the control group (χ2=62.782, P<0.01), natural labor rate was also 87.3% (262/300) which increased significantly according to 64.7% (194/300) (χ2=42.251, P<0.01),the rate of midwifery (7.0%, 21/300) and cesarean section (5.7%, 17/300) were significantly lower than 21.0% (63/300)and 14.3% (43/300) of the control group (χ2=24.419, 12.519,P<0.01), the second stage of labor was (1.60±0.56) h which was significantly shortened than (2.19±0.53) h also(t=-12.589,P<0.01).In the observation group, the ratio of the posterior occipital position to the occipital transverse position after the opening of 8-10 cm and the complete dilation of the cervical were 7.4% (21/283) and 13.1% (37/283), which were also significantly increased than 3.4% (9/264), 6.8% (18/264) of the control group (χ2=4.240, 5.911, P<0.05). Conclusions Supine adjustment after the cervix dilatation larger than 5cm is more conducive to fetal rotation and to avoid the adverse complications, reduce the rate of vaginal delivery and cesarean section rate, improve the rate of natural childbirth, shorten delivery time, improve the quality of delivery. Key words: Labor analgesia; Supine adjustment; Posterior occipital position

Factors associated with cesarean sections in a high complexity university hospital in southern Brazil.

Objective To identify the factors associated with cesarean sections in a high complexity university hospital in southern Brazil. Methods Cross-sectional study carried out at the Obstetric Hospital Unit of the Hospital de Clínicas de Porto Alegre. Data were gathered from questionnaires carried out with 361 puerperal women and maternal and neonatal records, from February to April 2013. For the analysis, Prevalence Ratio through Univariate Poisson Regression was used. Results The prevalence of cesarean sections was 31%. The category of hospitalization, cervix dilation and its characteristics, fetal presentation, and uterine dynamics, at the time of admission, were statistically related to cesarean sections; not having a previous cesarean section and night shift (from midnight to 6AM) were protective factors. Conclusions The prevalence of cesarean sections is above the rate recommended by the World Health Organization, but it is similar to rates found in other university hospitals, thus pointing out the need for the proposition of actions aimed at improving this indicator.

A Clinical Study on Labour Analgesia in Full Term Primigravida Patients

Background: Labour is defined as the progressive dilatation of cervix with co-ordinate uterine contractions that effect in and expulsion of the products of conception. Experience has shown that providing pain relief to the mother allays fear, anxiety and provides a more favourable environment for improved obstetric outcome. Aims and Objectives: To compare the effects of programmed labour protocol with epidural analgesia and traditional method of labour. Materials & Methods: This study is a prospective, randomized controlled study conducted in the department of Obstetrics & Gynaecology at Teerthanker Mahaveer Medical College & Research Centre Moradabad. 90 pregnant women in active labour were enrolled in the study. They were allocated to three groups after randomization . Group-A- 30 pregnant women received epidural analgesia. Group-B - 30 pregnant women received programmed labour protocol. Group-C- 30 pregnant women with traditional labour management. Results: There was excellent relief of pain in group A patient compared to other methods with shortening of duration of labour. Conclusion: Labour analgesia is a simple, effective method for painless and safe delivery and thus can reduce the number of caesarean section

Corrigendum to "Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study".

[This corrects the article DOI: 10.1155/2017/9413717.].

Histopathological Evaluation of Benign Proliferative Breast Lesions

Introduction :Placental Neoplasms are classified in to two categories based on their origin: Trophoblastic and non trophoblastic. Non trophoblastic tumors are common and benign ones include chorioangioma and teratoma. Chorioangioma of placenta is the commonest benign tumor of the placenta. It consists of a benign angioma arising from the chorionic tissue. It has been found to be associated with many serious complications such as nonimmune hydrops, congenital abnormalities, hemolytic anemia, polyhydramnios, IUGR, and IUFD.&nbsp;Methods:&nbsp;A 21 years old pregnant female 2nd gravida with 32 weeks of gestation presented to Ob/Gy department at L.G. Hospital with complaints of abdominal distension for 2 weeks associated with lower abdominal pain for 2 days. She had a history of one full term normal delivery without significant peripartum events. General examination was unremarkable. P/A was grossly enlarged with Fundal height more than gestational age, fetal heart rate was 144 /min. Per vaginal examination revealed 2 cm dilated and early effaced cervix with intact membrane. USG revealed a single live fetus with 32 weeks of gestation and without structural malformations and hydrops AFI of 42 cm hyperechoic mass of 8.5 *6.5cm on placental surface, near cord insertion with hypervascularity, separate from placental tissue suggestive of placental chorioangioma. Estimated fetal weight was 1.6kg. After a course of dexamethasone, therapeutic amniocentesis was done; She developed gross polyhydramnios after 4 days of amniocentesis followed by spontaneous preterm normal labor and delivered 1.7kg live baby without peripartum complications. Histopathological analysis of the mass revealed proliferation of capillary sized vascular channels with endothelial cells, hemorrhagic and focal area of calcifications. The neonate was admitted to NICU and was discharged after a week without complications.&nbsp;&nbsp;Conclusion :This case illustrates the prompt and accurate diagnosis of placental chorioangioma can help apply timely interventions improving patient outcome.

Prédiction de l’entrée en travail sous 24 heures en cas de rupture des membranes à terme

ObjectivesTo identify predictive criteria for a positive expectation in the context of rupture of membranes after 37 WG. MethodsSingle-center retrospective study including ROM≥37 WG. The primary outcome was labour onset within 24hours. We compared predictive factors for occurrence of spontaneous labour and described obstetrical and neonatal outcomes according to initial Bishop score<6 or ≥6. ResultsFrom January 2013 to December 2014, 520 patients were included. The predictive factors in case of unfavorable cervix were clinical leakage (P<0.001) and a cervical dilatation≥2cm (P<0.001) according to multivariate analysis. When the expectancy failed, there was a higher rate of cesarean section (24.3% vs. 9.6% P<0.001) but no more proven maternal-fetal infection. In case of Bishop≥6, we identified no predictive factor for labour onset but Apgar<7 at 5minutes (18.7% vs. 3.2% P=0.01) and admission to neonatal unit (18.8% vs. 3.2% P=0.04) were more frequent without majoration of maternal-fetal infection. ConclusionThe favorable expectation was the outcome for 70.8% of ROM at term. Clinical leakage and dilated cervix appeared as the main predictors in case of Bishop<6. Majoration of low Apgar score and admission to neonatal unit could be increased when no labour onset occurred despite Bishop≥6.

Role of Intravenous Hyoscine Butylbromide Injection on the Duration and Progress of First Stage of Labour in Primigavidae

Background: Labour is a physiologic process that results in expulsion of the products of conception outside the uterus throughout 3 stages. It is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Hyoscine butylbromide (HBB) belongs to the parasympatholytic group of drugs and is a semisynthetic derivative of scopolamine. It is a quaternary ammonium derivative, which exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary, and genitourinary tracts. Methods: A case control study conducted on 150 women coming to Al Azhar University Maternity Hospital.Patients who meet the inclusion criteria were asked to participate in the study and a verbal consent was obtained from each patient. Patients were divided into three equal groups (A, B, C). A single dose of the drug (placebo or HBB 20mg or HBB 40 mg) was injected intravenously slowly to groups A, B, C respectively. Labouring mothers were monitored in bed. Vaginal examination was conducted every two hours. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labour until a fully dilated cervix was observed Results: showed significant difference between the three groups regarding the progress of labour. There was a significant decrease in the duration of the active phase of first stage of labour in study groups who received hyoscine butylbromide compared to placebo group. The decrease in the duration of active phase of first stage of labour was not related to the drug dose. There was no significant difference between the three groups regarding the second stage duration. There were no significant adverse effects of hyoscine butylbromide on either mothers or neonates. Conclusion: Hyoscine butylbromide helps to decrease the duration of active phase of labour in primigravdae with no side effects on either the mother or the neonate. This decrease is not related to the dose of the drug. Hyoscine butylbromide (HBB) belongs to the parasympatholytic group of drugs and is a semisynthetic derivative of scopolamine. It is a quaternary ammoniu m derivative, which exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary, and genitourinary tracts. Role of intravenous hyoscine butylbromide injection on the duration and progress of first stage of labour in primigavidae

EP24.24: Cervical ectopic pregnancy: a case report

A cervical pregnancy is an ectopic pregnancy that has implanted in the uterine endocervix. Cervical ectopic pregnancy (CEP) is extremely rare with an incidence of 1:1,000 to 1: 16,000 pregnancies. The etiology of ECP is unknown but risk factors include: Cervical dilatation, cervical curettage, c-section and pregnancies resulting from assisted reproductive technology, occurring in 0.1 % of in vitro fertilisation. The patient was a 35 y.o. gravida: 2, para:1 with a previous c-section who comes to our unit with a B-hCG test: 4.540 IU/L at 6.1 weeks of pregnancy and pelvic pain. A transvaginal ultrasound was performed. After 48 hours B-hCG test was 9.120 IU/L and patient presented with vaginal spotting, another transvaginal ultrasound was performed. A single dose of methotrexate was given to the patient. After 3 days patient begins reported bleeding and was prepared for dilatation of cervix along with removal of embryonic tissue and sac, her private physician reports no complication. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Left oblique laparotomy for caesarean section in a cow due to dystocia

Caesarean Section is a surgical procedure in which an incision is given through the abdominal wall and uterus in order to deliver fetus. It is also known as C-section is one of the most challenging surgical procedures in case of dystocia to save fetus live. A 6 years old HF cross breed cow, weighing 300 kg was admitted to the Teaching Veterinary Hospital (TVH), Chittagong Veterinary and Animal Sciences University (CVASU) with a history of prolonged labour pain. At first all the physical examination was done. Blood sample was collected to know different parameters of serum and blood. As Per vaginal examination revealed incomplete dilation of cervix. Then, it was decided and performed caesarean section using left oblique laparotomy and a live female fetus was delivered. Post operative care was taken for 10 days. The cow recovered successfully without any complications. The cow was followed for next one year. 70 days after surgery, she came to heat and after insemination pregnancy was confirmed at 35 days post AI. The cow had successful pregnancy which was confirmed by rectal palpation at 35 days. Caesarean section through left flank oblique laparotomy is an effective method of resolving dystocia to save cow with fetus.Asian J. Med. Biol. Res. June 2017, 3(2): 282-289

Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural

We present a rare case of a large infarcted submucous fibroid removed manually after a normal vaginal delivery. This patient was known to have a large postero-fundal hybrid predominantly intramural...