Dilatation Of Cervix Research Articles

Effective Epidural Analgesia during Labor: A Feasible Method to Decrease Unnecessary Cesarean Deliveries in Thailand

Thailand has reported a high rate of cesarean delivery (45%–55%), prompting global concern about an increase in cesarean delivery rates. Fear of labor pains is one of the most common reasons pregnant women opt for cesarean delivery. Labor pain is associated with cervix dilation and fetal descent into the birth canal, which is exacerbated by ischemic pain caused by uterine contraction. Modern medical and non-medical techniques have demonstrated efficacy in reducing pain and ensuring safety during labor and delivery. Neuraxial labor analgesia is a highly effective medical pain relief method but has no effect on the rate of cesarean or assisted vaginal delivery. Medication administration for pain relief during labor, using a combination of a local anesthetic and an opioid, was observed to be transmitted across the placenta to the fetus, but had no significant effects on fetal outcomes in mothers who chose epidural analgesia. There are several techniques for administering neuraxial labor analgesia that can be customized for each pregnant woman. To achieve the most wonderful feasible labor and delivery experience, effective epidural labor analgesia is a crucial technique for reducing anxiety and suffering about labor pain. It is safe, widely used world-wide, and effective. Implementing a policy to increase public and medical providers awareness and acceptance of labor pain relief, as well as establishing a safe obstetric anesthesia service provided by obstetric anesthesiologists, could improve maternal and neonatal safety while significantly lowering the rate of unnecessary cesarean deliveries.

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

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

Reproductive Performance of Estrus Pattern in Bachaur Cows of Bihar

Background: The Bachaur is a medium sized draft purpose breed mostly present in Madhubani, Darbhanga and Sitamarhi districts of Bihar and presently the breed is at the verge of extinction. Since no data is presently available regarding the estrus pattern in these cows therefore, present study was designed to document the oestrus intensity, estrus cycle length, estrus behaviour and duration of estrus in these animals. Methods: The total of nine healthy breeding Bachaur cows aged 3 to 5 years were maintained under identical managemental conditions.The estrous cycles of nine animals was synchronized using Cloprostenol Sodium @ 500 mg I/M (Pragma®, Intas, India) in cycling Bachaur cows. Estrus was detected in the morning and evening for external signs of estrus, estrus behavior, intensity of estrus, estrus duration and estrous cycle length. Result: In the present study, mounting or mounted by other animals was observed in more than 70% and sniffing, tried to lick and Flehmen’s reaction was observed in about 66.67% of treated cows. The other parameters like bellowing, restlessness, milk yield reduction, frequent micturition and Flehmen’s reaction were recorded in 44.44%, 55.56%, 44.44%, 55.56% and 66.67%, of animals, respectively. The most appreciable physical sign of estrus recorded was intense swelling of vulva (in 88.89%) however hyperaemia of vulva, copious estrual mucous discharge, pronounced tonicity of uterus, completely dilated os cervix and presence of large palpable follicle on the ovary was observed in 44.44%, 55.56%, 66.67%, 77.78% and 66.67%, of cows respectively.

Effects of Fetal Position on the Loading of the Fetal Brain During the Onset of the Second Stage of Labor.

During vaginal delivery, the delivery requires the fetal head to mold to accommodate the geometric constraints of the birth canal. Excessive molding can produce brain injuries and long-term sequelae. Understanding the loading of the fetal brain during the second stage of labor (fully dilated cervix, active pushing, and expulsion of fetus) could thus help predict the safety of the newborn during vaginal delivery. To this end, this study proposes a finite element model of the fetal head and maternal canal environment that is capable of predicting the stresses experienced by the fetal brain at the onset of the second phase of labor. Both fetal and maternal models were adapted from existing studies to represent the geometry of full-term pregnancy. Two fetal positions were compared: left-occiput-anterior and left-occiput-posterior. The results demonstrate that left-occiput-anterior position reduces the maternal tissue deformation, at the cost of higher stress in the fetal brain. In both cases, stress is concentrated underneath the sutures, though the location varies depending on the presentation. In summary, this study provides a patient-specific simulation platform for the study of vaginal delivery and its effect on both the fetal brain and maternal anatomy. Finally, it is suggested that such an approach has the potential to be used by obstetricians to support their decision-making processes through the simulation of various delivery scenarios.

Oestrogen and progesterone concentrations in intrapartum cows with insufficient cervix dilation

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

Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol.

According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO. This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination. The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections. https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).

Cesarean Sectional as a Treatment of Dystocia Caused by Uterine Torsion in Mehsana Buffalo

A case of dystocia due to post-cervical right side uterine torsion with the history of colic and straining since (days) in a pluriparous Mehsana buffalo was presented at the clinics of Veterinary Gynaecology and Obstetrics of Veterinary College, Sardarkrushinagar, Dantiwada, Gujarat, India. Maternal dystocia due to of uterine torsion was diagnosed by history, a clinical sign, per rectal and per vaginal examinations. At first we used modified Schaffer’s method for management of uterine torsion in buffalo. After the three rolls torsion was detorted successfully, but due to insufficient dilated cervix the fetus could not be delivered. Further, the buffalo was treated therapeutically using intravenous administration of 10ml-Dexamethasone®, 75IU-Oxytocin®, 1litre-Normal saline, 1litre-Ringer lactate, 100ml-Calcium borogluconate and 10ml-Valethamate bromide (Epidosin®) was given intramuscularly for treating incomplete cervical dilation(ICD). However, the buffalo could not responded to treatment, therefore finally the caesarean section was performed and a dead male fetus was delivered. Buffalo was post-medicated with various fluids, analgesic, antibiotic and antihistamine parentally apart from intra-uterine pessaries which resulted to recovery of affected Mehsana buffalo within some days.

Evaluation of the effect of Nigella sativa oil on the outcome of missed abortion in women: A randomized double-blind clinical trial.

Due to the concern about the side effects of chemical drugs and their ineffectiveness, the use of natural compounds as alternatives or complementary therapies has received increasing attention. The purpose of this study was to investigate the effect of Nigella sativa oil on the outcome of missed abortion. In this double-blind clinical trial, 70 nulliparous pregnant women referred to Hajar Hospital and Imam Ali clinics of Shahrekord and had missed abortion before the 12-week gestational age were selected and randomly divided into two interventions and control groups. The intervention group received 5 gof Nigella sativa oil alone daily for up to 3 days and the control group received a placebo. In case of nonresponse, 3 days after the last dose of medication or placebo, 800 μgof misoprostol (vaginal) were used. Data were analyzed by SPSS software. The chi-square test, Fisher's exact test, independent t-test and paired t-test were used for analytical statistics. According to the results, 18 cases (51.4%) in the intervention group and seven cases (20%) in the control group showed complete evacuation of uterine contents which had a significant difference (p < 0.05). The frequency of vagina physical examination and type of hemorrhage did not show any significant difference between the two groups before and after the intervention. After the intervention, human chorionic gonadotropin (HCG) was significantly decreased in the intervention group but did not change in the control group (p < 0.05). The frequency of adverse events in the intervention group was three (8.6%) and in the control group was one (2.9%) which had no significant difference. Nigella sativa improves the outcome of missed abortion by reducing HCG and facilitating cervix dilatation and delivery of uterine contents.

Diagnosis and Management of Ringwomb in Sheep: Challenges and Approaches

Small ruminants, including sheep and goats, constitute a major part of the livestock population in different countries of the world. About 15-32% of sheep dystocia are due to incomplete dilation of the cervix which is often called ringwomb. This disorder typically occurs during the lambing process, prompting farmers to possibly seek veterinary assistance due to delayed labor. Different causes, such as calcium and phosphorus deficiency, uterine inertia, and fetal inability to enter the cervical canal, could all lead to incomplete dilation of the cervix. In the meantime, many cases of ringwomb occur as idiopathic. Some factors, such as genetics, nutrition, and imbalance of estrogen to progesterone concentration may also contribute to incomplete dilation of the cervix. In practice, it is important to differentiate the ringwomb with similar conditions such as false dilation of the cervix, early dilation syndrome, and vaginal prolapse associated with ringwomb. In this review, the definition of ringwomb in sheep, an exploration of the structure of the sheep’s cervix, the normal process of cervix dilation during lambing, etiology and symptoms of ringwomb, differential diagnosis, and different treatments are discussed. Keywords: Cervix, Collagen, Dystocia, Sheep, Ringwomb

Analgesia efficacy of lidocaine transfused by a novel disposable injectable cervical dilator during intrauterine device removal procedure: A randomized clinical trial

ObjectiveThe majority of intrauterine devices (IUDs) inserted in China are tailless, requiring intrauterine manipulations for removal and causing pain. This study aimed to investigate the analgesic efficacy of lidocaine injection into a novel disposable injectable cervical dilator for IUD removal procedures. Study designA double-blinded, placebo-controlled, randomized clinical trial was conducted with women aged 18–65 years old requesting outpatient IUD removal. The study randomly assigned participants to either lidocaine (injecting 5 ml of 2% lidocaine into the injectable cervical dilator) or placebo (injecting 5 ml of normal saline into the device) group. All participants received a standardized paracervical block. The primary outcome was pain reported during IUD removal on a 100 mm Visual Analog Scale (VAS). Intention-to-treat were conducted to evaluate the analgesic effectiveness of injecting lidocaine into the injectable cervical dilators. ResultsWe enrolled seventy-four eligible participants (37 in lidocaine group and 37 in placebo group). The results showed that the median intraoperative VAS score in the lidocaine group was lower than the placebo group (30.0 mm [IQR 20.0–46.0, n = 37] vs 46.0 mm [IQR 30.0–55.0, n = 37], p = 0.01. In subgroup analyses, among participants with IUD removal and without uterine manipulation and additional procedures, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (15.0 mm [IQR 10.0–27.5, n = 8] vs 20.0 mm [IQR 20.0–40.0, n = 6]), p = 0.28). Among participants with an IUD removal necessitating intrauterine manipulations and without additional procedures, showing lower intraoperative VAS scores in lidocaine group (25.0 mm [IQR 15.0–40.5, n = 17]) compared to placebo group (46.0 mm [IQR 38.5–50.0, n = 23]), p < 0.01. Among participants with additional procedures in addition to IUD removal, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (41.0 mm [IQR 32.5–57.5, n = 12] vs 45.0 mm [IQR 22.5–69.0, n = 8]), p = 0.97). ConclusionsInjecting lidocaine into the novel disposable injectable cervical dilator for cervix dilation can significantly reduce pain during an IUD removal, particularly in patients necessitating intrauterine manipulations during IUD removal. ImplicationsWhen we have to perform intrauterine manipulations to remove an IUD, surgical pain and narrow cervical canal undoubtedly affect the implementation of the procedure. Injecting lidocaine into the injectable cervical dilator can achieve local anesthesia while dilating the cervix, and might reduce the choice of general anesthesia for IUD removal.

Effect of misoprostol before hysteroscopic polypectomy on Dilatation of the cervix and time of the procedure

Introduction: Using misoprostol (analog prostaglandins E1, PGE1) prior to hysteroscopic intervention to induce ripening of cervix was implemented in gynecological problems management as submucosal myoma, endometrial polyps.1,2 Aim of study: The aim was to assess the effect of using misoprostol on easy dilatation of the cervix and on reducing the time needed for dilatation of cervix and the overall time needed for the procedure Patients and methods: An observational cross sectional study was performed on women who were complaining from vaginal bleeding and diagnosed to have an endometrial polyp either received misoprostol or not prior to hysteroscopic myomectomy and were subjected to hysteroscopic polypectomy under general anesthesia. Results: the time needed for cervical dilatation was more in the control group who did not receive misoprostol (P value &gt;0.001). Conclusion: The use of a regimen of 400 mcg vaginal misoprostol administered 6 hours before hysteroscopic polypectomy is a simple, safe and effective method of cervical priming to facilitate the procedure with less total operative time , less time needed for cervical dilatation and less complications (as cervical lacerations or false passage).

A Case Report on Monochorionic Diamniotic Twin Gestation with Rh Negative Pregnancy

The terms "monochorionic" and "diamniotic" refer to multiple gestations with just one placental disk (or chorion) and two separate amniotic cavities, respectively. Each fetus in a monochorionic diamniotic twin pregnancy has its own amniotic sac in addition to the common placenta. PPROM is the rupture of membranes before the onset of labor and before 37 weeks of gestation. We present a case of a 33-week-old primigravida female with monochorionic diamniotic twin gestation, Rh negative pregnancy, and PPROM who presented to the labour room with a fully dilated cervix, an emergency lower segment caesarean section was performed with prolonged second stage labour, and twins were delivered.

Effects of maternal posture and cognitive-behavioral interventions on labor outcomes in primigravidas with abnormal fetal head position: a randomized controlled clinical trial

Objective Fetal head malposition can result in neonatal and maternal complications. Fetal head malposition occurs frequently in labor. Appropriate and timely managements are required. Maternal posture and cognitive-behavioral interventions could improve labor outcomes in primigravidas with fetal head malposition. Methods A randomized controlled clinical trial was performed between January and December 2022 (Chinese Clinical Trial Registry, ChiCTR2100049359). Eligible primigravidas were randomly assigned into four groups. Group A received traditional perinatal care. Group B, C, and D received posture management, posture management with music therapy, and posture management with video education, respectively, in addition to traditional perinatal care. The maternal postures referred to place pregnant women in certain positions (lateral, lateral-prone, hands and knees, open knee-chest) to change the anatomical structure of pelvis, thus, to facilitate the fetal downward movement and birth. Maternal and neonatal outcomes were recorded and compared. Results A total of 136 primigravidas were included, with 34, 35, 34, and 33 women in group A, B, C, and D, respectively. The incidences of cesarean section were lower in groups B, C, and D than that in group A (5.7%, 2.9%, and 3.0% versus 20.6%, p < 0.05). The fetal position correction rates at the time of full dilation of cervix were higher in groups B, C, and D than that in group A (66.7%, 63.6%, 68.8% versus 27.6%, p < 0.05). Primigravidas in groups B, C, and D had better experiences and a lower anxiety level than those in group A (p < 0.001). The four groups had no statistically significant differences in the total labor duration, operative vaginal delivery, umbilical artery blood pH, and neonatal Apgar scores. Conclusion Fetal head malposition could happen in primigravidas. Maternal posture management and cognitive-behavioral interventions during labor could improve labor outcomes in primigravidas with fetal head malposition.

Preoperative promestriene for hysteroscopy: a randomized clinical trial.

Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

Outcomes of Ultrasound or Physical Examination-Indicated Cerclage according to the Degree of Cervical Dilation.

Pregnancy outcomes of individuals receiving cervical cerclage when the cervix is dilated are not well known. We sought to examine preterm birth rates after ultrasound or physical examination-indicated cerclage placement according to the degree of cervical dilation. This was a retrospective cohort study of individuals with singleton pregnancies undergoing ultrasound or physical examination-indicated cerclage before 240/7 weeks of gestation from 2004 to 2018. Individuals were categorized based on the degree of cervical dilation at the time of cerclage. Our primary outcome was preterm delivery at less than 37 weeks of gestation. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95% CI), controlling for predefined covariates. Of 147 individuals undergoing ultrasound or physical examination-indicated cerclage, 90/147 (61%) had a closed or 0.5 cm dilated cervix at the time of cerclage placement, 45/147 (31%) had a cervical dilation of 1 to 2.5 cm, and 12/147 (8%) had a cervical dilation of 3 to 4 cm at the time of placement. Individuals with a cervical dilation of 1 to 2.5 cm compared with those who had a closed cervix did not have increased odds of preterm delivery (58 vs. 42%; aOR: 1.95; 95% CI: 0.93-4.07). However, individuals with a cervical dilation of 3 to 4 cm compared with individuals who had a closed cervix had significantly increased odds of preterm delivery (75 vs. 42%; aOR: 4.33; 95% CI: 1.05-17.77). The rate of preterm birth increases with increasing cervical dilation at the time of cerclage placement. However, individuals who have a cerclage placed when the cervix is 1 to 2.5 cm can achieve an outcome that is not significantly different from those who had a cerclage placed when the cervix is closed. · Time from cerclage placement to delivery decreases as cervical dilation increases.. · Individuals 1 to 2.5 cm dilated at the time of cerclage can achieve a favorable outcome.. · A cervical dilation of ≥3 cm at cerclage placement was associated with extreme prematurity..

Unlocking physiological transformations in riverine buffaloes following uterine torsion correction

This study aimed to examine the physiological alterations in riverine buffaloes with incompletely dilated cervix after the uterine torsion correction and the main objective was to understand the hormonal changes that lead to complete cervical dilatation following detorsion, facilitating per-vaginal birth. Torsion characteristics in buffaloes (n=24) were examined, and detorsion was performed using Sharma’s Modified Schaffer’s approach. Blood samples were collected pre-detorsion, post-detorsion, and at parturition. The average cervical dilation rate was 1.22±0.16 cm/h, and detorsion-to-parturition duration averaged 17.38±1.44 h. There were no significant differences between haematological and biochemical parameters at three-time intervals except serum calcium. Progesterone levelsdecreased progressively (1.43±0.01 ng/mL, 1.37±0.01 ng/mL, 1.34±0.01 ng/mL), while estradiol levels increased significantly (65.86±2.05 pg/mL, 77.08±2.05 pg/mL, 91.8±2.55 pg/mL) from pre-detorsion to post-detorsion and parturition. The levels of cortisol were significantly higher pre-detorsion (24.3±2.07 ng/mL) and post-detorsion (27.1±2.5 ng/mL) than at parturition (18.31±1.76 ng/mL). In conclusion, elevated estradiol levels, coupled with reduced progesterone, post-detorsion, trigger complete cervical dilatation, facilitating per-vaginal birth. This study sheds light on the hormonal dynamics driving the birthing process in buffaloes after uterine torsion correction.

Perinatal outcomes in patients undergoing repeat cerclage: A retrospective case series study.

This study aimed to describe the pregnancy outcomes of a case series of patients with probable cerclage failure who received repeat cerclage (RC) with potential indications. We retrospectively collected a case series of 55 singleton pregnancies with RC from 2019 to 2022 in Shanghai, China. All included women provided written informed consent, and the study was approved by the ethics committees of the two hospitals. We compared pregnancy outcomes between pregnancies with RC for different indications. Among the case series, nine patients underwent RC for the indication of protruding membranes below the previous suture loop (group A), and the other 46 patients for painless cervix dilation (group B). Gestational age at delivery was shorter in group B than in group A (30.7 vs 37.6 weeks, P = 0.009). Rates of preterm birth <32 weeks (63.0% vs 22.2%, P = 0.033) and < 37 weeks (76.1% vs 33.3%, P = 0.002) were significantly higher in group B than in group A. Of the 46 patients who underwent RC for painless cervical dilation, 28 had cervical dilation of 1 to 2 cm (group C) and the other 18 had cervical dilation of 3 to 6 cm (group D). The gestational age at delivery was shorter in group D than in group C (27.4 vs 31.5 weeks, P = 0.037). However, rates of preterm birth <32 or <37 weeks were similar between the groups. RC may constitute a rescue strategy for patients with probable cerclage failure. Protrusion of membranes below the cerclage loop or cervical dilation <3 cm may be an indicator of better pregnancy outcome.

Reverse Breech Extraction versus Vaginal Push before Uterine Incision during Cesarean Section with Fully Dilated Cervix and Impacted Fetal Head

Purpose: To compare between the two commonly used methods to deliver the fetus in emergency cesarean section with fully dilated cervix and impacted fetal head; vaginal push up of the fetal head and reverse breech extraction regarding safety and efficacy. Methods: A retrospective observational study was conducted 152 women underwent emergency CS with fully dilated cervix and impacted fetal head were divided into two groups; Group 1, vaginal push (n = 96) and Group 2, reverse breech delivery (n = 56). Data variables were collected and analyzed to evaluate whether either method is more safe regarding maternal and fetal outcomes. Results: There was a significant higher percentage of extension of uterine incision in group 1 (p = 0.002). Also, there were significant higher mean values of operative time and operative blood loss in group 1 (p = 0.008 and 0.015; respectively). On the other hand, there was a significantly shorter uterotomy to delivery time in group 1 (p &lt; 0.001). There was a significantly higher mean value of APGAR score at one minute in group 1 (p = 0.043) but no significant difference between the two groups regarding APGAR score at five minutes, atonic PPH, postoperative blood transfusion and hospital stay. Conclusion: Vaginal push technique was associated with significantly higher intraoperative maternal morbidity but postoperative maternal morbidity and fetal outcomes were comparable between both groups. Push method (after uterine incision) is still the preferable method and larger studies are required to assess the fetal safety with reverse breech extraction.

EP14.23: Cervical cerclage in women with short or dilated cervix before fetoscopic laser surgery for twin–twin transfusion syndrome

EP14.23: Cervical cerclage in women with short or dilated cervix before fetoscopic laser surgery for twin–twin transfusion syndrome

Auricular Acupressure Effectively Reduces Labor Anxiety in Primigravidae by Increasing β-Endorphin Levels

Highlights: 1. Auricular acupressure at the Shenmen point is effective in reducing anxiety.2. Auricular acupressure is more practical than body acupressure since it does not interfere with expectant mothers' mobilization.3. As a non-pharmacological method, auricular acupressure is cost-effective, efficient, and effective in overcoming maternal anxiety during labor Abstract Anxiety is a common psychological symptom in expectant mothers, particularly among primigravidae during labor. There is a link between excessive anxiety and prolonged labor. One of the options to manage anxiety is the use of non-pharmacological methods. Numerous studies have investigated the effectiveness of auricular acupressure to treat anxiety, but few have examined its effect on anxiety biomarkers. Thus, the objective of this study was to analyze the effect of auricular acupressure targeting the Shenmen point on the levels of β-endorphins and anxiety among primigravidae during the first stage of labor. This experimental study used a pretest-posttest control group design. The research subjects were primigravidae in the first stage of labor at the independent midwife practice of Yefi Marliandiani in Surabaya, Indonesia. Among 40 primigravidae, 34 individuals met the inclusion criteria and were then equally divided into treatment and control groups using a simple randomization. The treatment group received auricular acupressure at the Shenmen point every 30 minutes for a duration of 5 minutes, while the control group practiced deep breathing relaxation. The anxiety levels were assessed using the Hamilton Anxiety Rating Scale. The β-endorphin levels were measured by drawing 3 cc of venous blood before (4 cm cervix dilation) and after (9–10 cm cervix dilation) treatment. The obtained data were analyzed using paired- and independent-samples t-tests. A decrease in the mean anxiety level was observed in the treatment group (18.59±7.52) relative to the control group (19.76±7.11), albeit not significant (p=0.64). Simultaneously, the average β-endorphin levels of the treatment group (355.4±224.7) increased compared to the control group (225.1±127.5), with a significant difference observed between the two groups (p=0.04). In conclusion, while both auricular acupressure at the Shenmen point and deep breathing relaxation are effective in reducing anxiety, the former is more prominent in its ability to increase β-endorphin levels.