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Sample records for operative vaginal delivery

  1. Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs. Cesarean Section.

    Science.gov (United States)

    Barbara, Giussy; Pifarotti, Paola; Facchin, Federica; Cortinovis, Ivan; Dridi, Dhohua; Ronchetti, Camilla; Calzolari, Luca; Vercellini, Paolo

    2016-03-01

    Several studies have explored the association between modes of delivery and postpartum female sexual functioning, although with inconsistent findings. To investigate the impact of mode of delivery on female postpartum sexual functioning by comparing spontaneous vaginal delivery, operative vaginal delivery, and cesarean section. One hundred thirty-two primiparous women who had a spontaneous vaginal delivery, 45 who had an operative vaginal delivery, and 92 who underwent a cesarean section were included in the study (N = 269). Postpartum sexual functioning was evaluated 6 months after childbirth using the Female Sexual Function Index. Time to resumption of sexual intercourse, postpartum depression, and current breastfeeding also were assessed 6 months after delivery. Female Sexual Function Index total and domain scores and time to resumption of sexual intercourse at 6 months after childbirth. Women who underwent an operative vaginal delivery had poorer scores on arousal, lubrication, orgasm, and global sexual functioning compared with the cesarean section group and lower orgasm scores compared with the spontaneous vaginal delivery group (P < .05). The mode of delivery did not significantly affect time to resumption of sexual intercourse. Women who were currently breastfeeding had lower lubrication, more pain at intercourse, and longer time to resumption of sexual activity. Operative vaginal delivery might be associated with poorer sexual functioning, but no conclusions can be drawn from this study regarding the impact of pelvic floor trauma (perineal laceration or episiotomy) on sexual functioning because of the high rate of episiotomies. Overall, obstetric algorithms currently in use should be refined to decrease further the risk of operative vaginal delivery. Copyright © 2016. Published by Elsevier Inc.

  2. Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

    LENUS (Irish Health Repository)

    Contag, Stephen A

    2010-06-01

    We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks\\' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

  3. Predictors of shoulder dystocia at the time of operative vaginal delivery.

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    Palatnik, Anna; Grobman, William A; Hellendag, Madeline G; Janetos, Timothy M; Gossett, Dana R; Miller, Emily S

    2016-11-01

    It remains uncertain whether clinical factors known prior to delivery can predict which women are more likely to experience shoulder dystocia in the setting of operative vaginal delivery. We sought to identify whether shoulder dystocia can be accurately predicted among women undergoing an operative vaginal delivery. This was a case-control study of women undergoing a low or outlet operative vaginal delivery from 2005 through 2014 in a single tertiary care center. Cases were defined as women who experienced a shoulder dystocia at the time of operative vaginal delivery. Controls consisted of women without a shoulder dystocia at the time of operative vaginal delivery. Variables previously identified to be associated with shoulder dystocia that could be known prior to delivery were abstracted from the medical records. Bivariable analyses and multivariable logistic regression were used to identify factors independently associated with shoulder dystocia. A receiver operating characteristic curve was created to evaluate the predictive value of the model for shoulder dystocia. Of the 4080 women who met inclusion criteria, shoulder dystocia occurred in 162 (4.0%) women. In bivariable analysis, maternal age, parity, body mass index, diabetes, chorioamnionitis, arrest disorder as an indication for an operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg were significantly associated with shoulder dystocia. In multivariable analysis, parity, diabetes, chorioamnionitis, arrest disorder as an indication for operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg remained independently associated with shoulder dystocia. The area under the curve for the generated receiver operating characteristic curve was 0.73 (95% confidence interval, 0.69-0.77), demonstrating only a modest ability to predict shoulder dystocia before performing an operative vaginal delivery. While risk factors for shoulder dystocia at the time of operative vaginal delivery

  4. Assisted Vaginal Delivery

    Science.gov (United States)

    ... be needed. What are the risks for my baby if I have assisted vaginal delivery? Although the overall rate of injury to the baby as a result of assisted vaginal delivery is low, there still is a risk of ...

  5. Attempted operative vaginal delivery vs repeat cesarean in the second stage among women undergoing a trial of labor after cesarean delivery.

    Science.gov (United States)

    Son, Moeun; Roy, Archana; Grobman, William A

    2017-04-01

    It is not well-characterized whether attempting operative vaginal delivery is a safe and effective alternative among women who undergo a trial of labor after cesarean delivery who are unable to complete second-stage labor with a spontaneous vaginal delivery. The purpose of this study was to compare maternal and neonatal outcomes that are associated with attempted operative vaginal delivery with those that are associated with second-stage repeat cesarean delivery without an operative vaginal delivery attempt among women who undergo a trial of labor after cesarean delivery. This is a retrospective secondary analysis of data from Cesarean Registry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Women who underwent a trial of labor after cesarean delivery who were at least 36 weeks gestation were eligible for analysis if they had a live, singleton, nonanomalous gestation in cephalic presentation and reached second-stage labor (defined as complete cervical dilation) with a fetal station of at least +2. The data for women who had an attempted operative vaginal delivery with either forceps or vacuum were compared with those of women who underwent second stage repeat cesarean delivery without operative vaginal delivery attempt. Outcomes of maternal and neonatal complications were compared between groups with bivariable and multivariable analyses. Of 1230 women whose cases were eligible for analysis, 945 women (76.8%) had an attempted operative vaginal delivery. Of those who underwent attempted operative vaginal delivery, 914 women (96.7%) achieved a vaginal delivery. Women who attempted operative vaginal delivery had a lower mean body mass index (30.4±6.0 vs 31.8±5.9 kg/m(2); P=.001) and gestational age (39.5±1.3 vs 39.8±1.2 weeks; P=.012) at delivery and were more likely to be of non-Hispanic black race (30.0% vs 22.1%; P=.002), to have had a previous vaginal delivery (34.9% vs 20

  6. Operative vaginal delivery and invasive procedures in pregnancy among women living with HIV.

    Science.gov (United States)

    Peters, Helen; Francis, Kate; Harding, Kate; Tookey, Pat A; Thorne, Claire

    2017-03-01

    To describe the use and outcomes of operative delivery and invasive procedures in pregnancy amongst women living with HIV. The National Study of HIV in Pregnancy and Childhood (NSHPC) is a comprehensive population-based surveillance study in the UK and Ireland. The NSHPC has collected data on operative delivery since 2008, and invasive procedures in pregnancy (amniocentesis, cordocentesis, chorionic villus sampling) from 2012. Descriptive analyses were conducted on 278 pregnancies expected to deliver from 1 January 2008 with outcome reported to the NSHPC by 31 March 2016. Among 9372 pregnancies in 2008-2016, there were 9072 livebirths with 251 operative deliveries and 27 invasive procedures in pregnancy reported. Information was available for 3023/3490 vaginal deliveries, and use of forceps or vacuum reported in 251deliveries (8.2%), increasing over calendar time to almost 10% by 2014-16. Forceps were used twice as often as vacuum delivery, and forceps use increased over time. One infant delivered operatively is known to have acquired HIV. From 2012 there were 4063 pregnancies resulting in 3952 livebirths, 83 terminations and 28 stillbirths. 2163/4063 had information on use (or not) of invasive procedures in pregnancy. Amniocentesis was reported in 25/2163 pregnancies, there was one report of chorionic villus sampling and one of cordocentesis. There were no reported transmissions following invasive procedures in pregnancy. This is the largest study to date to report on operative delivery in women living with HIV on combined antiretroviral therapy (cART), and provides an up-to-date picture of invasive procedures during pregnancy in this group. Findings from this comprehensive national study are reassuring but numbers are currently low; on-going monitoring is crucial as obstetric care of women with HIV becomes normalised. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve

    2011-01-01

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  8. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  9. Twin vaginal delivery: innovate or abdicate.

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    Easter, Sarah Rae; Taouk, Laura; Schulkin, Jay; Robinson, Julian N

    2017-02-07

    Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; Pinnovation. Without novel provider-focused strategies, we may relinquish passively the requisite skills for not only our patients but also for future generations of obstetricians.

  10. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had ..... Table 2: Logistic regression of factors influencing vaginal delivery in primigravidae ... times higher risk of emergency caesarean section.

  11. A cohort study of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-02-01

    OBJECTIVE: To evaluate the risk factors and maternal and neonatal morbidity associated with sequential use of instruments (vacuum and forceps) at operative vaginal delivery. STUDY DESIGN: A cohort study of 1360 nulliparous women delivered by a single instrument (vacuum or forceps) or by both instruments, within two university teaching hospitals in Scotland and England. Outcomes were compared for use of sequential instruments versus use of any single instrument. A sub-group analysis compared sequential instruments versus forceps alone. Outcomes of interest included anal sphincter tears, postpartum haemorrhage, urinary retention, urinary incontinence, prolonged hospital admission, neonatal trauma, low Apgar scores, abnormal cord bloods and admission to the neonatal intensive care unit (NICU). RESULTS: Use of sequential instruments at operative vaginal delivery was associated with fetal malpositions, Odds Ratio (OR) 1.8 (95% Confidence Interval (CI) 1.3-2.6), and large neonatal head circumference (>37 cm) (OR 5.0, 95% CI 2.6-9.7) but not with maternal obesity or grade of operator. Sequential use of instruments was associated with greater maternal and neonatal morbidity than single instrument use (anal sphincter tear 17.4% versus 8.4%, adjusted OR 2.1, 95% CI 1.2-3.3; umbilical artery pH <7.10, 13.8% versus 5.0%, adjusted OR 3.3, 95% CI 1.7-6.2). Sequential instrument use had greater morbidity than single instrument use with forceps alone (anal sphincter tear OR 1.8, 95% CI 1.1-2.9; umbilical artery pH <7.10 OR 3.0, 95% CI 1.7-5.5). CONCLUSIONS: The use of sequential instruments significantly increases maternal and neonatal morbidity. Obstetricians need training in the appropriate selection and use of instruments with the aim of completing delivery safely with one instrument.

  12. A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night

    Science.gov (United States)

    Butler, Katherine; Ramphul, Meenakshi; Dunney, Clare; Farren, Maria; McSweeney, Aoife; McNamara, Karen; Murphy, Deirdre J

    2014-01-01

    Objective To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night. Design Prospective cohort study. Setting Urban maternity unit in Ireland with off-site consultant staff at night. Population All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013. Methods Delivery outcomes were compared for women who delivered by day (08:00–19:59) or at night (20:00–07:59). Main outcome measures The main outcomes included postpartum haemorrhage (PPH), anal sphincter tear and neonatal unit admission. Procedural factors included operator grade, sequential use of instruments and caesarean section. Results Of the 597 women who required an OVD, 296 (50%) delivered at night. Choice of instrument, place of delivery, sequential use of instruments and caesarean section did not differ significantly in relation to time of birth. Mid-grade operators performed less OVDs by day than at night, OR 0.60 (95% CI 0.43 to 0.83), and a consultant supervisor was more frequently present by day, OR 2.26 (95% CI 1.05 to 4.83). Shoulder dystocia occurred more commonly by day, OR 2.57 (95% CI 1.05 to 6.28). The incidence of PPH, anal sphincter tears, neonatal unit admission, fetal acidosis and neonatal trauma was similar by day and at night. The mean decision to delivery intervals were 12.0 and 12.6 min, respectively. Conclusions There was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night. PMID:25354825

  13. Instrumental vaginal delivery--back to basics.

    Science.gov (United States)

    Keriakos, R; Sugumar, S; Hilal, N

    2013-11-01

    Assisted vaginal delivery using forceps or a vacuum extractor is an essential part of obstetric practice. Operative vaginal delivery rates in the UK have remained stable between 10% and 15%, yielding safe and satisfactory outcomes for the majority of mothers and their babies. However, there has been an increase in medico-legal cases due to an increasing awareness of the potential morbidity for both the mother and the baby. There are many factors that can play a part in both the maternal and fetal complications resulting from instrumental deliveries. The aim of this educational review is to address these factors and identify measures to reduce them by adherence to the basics and relevant evidence.

  14. After vaginal delivery - in the hospital

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    ... patientinstructions/000629.htm After vaginal delivery - in the hospital To use the sharing features on this page, ... enable JavaScript. Most women will remain in the hospital for 24 hours after delivery. This is important ...

  15. Reoccurrence of retained placenta at vaginal delivery

    DEFF Research Database (Denmark)

    Løkkegaard, Ellen Christine Leth; Bergholt, Thomas; Nikolajsen, Sys

    2013-01-01

    To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery.......To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery....

  16. Reoccurrence of retained placenta at vaginal delivery

    DEFF Research Database (Denmark)

    Nikolajsen, Sys; Løkkegaard, Ellen Christine Leth; Bergholt, Thomas

    2013-01-01

    To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery.......To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery....

  17. OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES IN REFERRED CASES

    Directory of Open Access Journals (Sweden)

    Prameela

    2015-03-01

    Full Text Available INTRODUCTION: Instrumental vaginal deliveries are important procedures. Performed in indicated cases and attending to the well laid criterias will reduce the fetal and maternal morbidity. These assisted instrumental vaginal deliveries help in reducing the caesarean sec tion rate. AIMS AND OBJECTIVES: To determine the incidence and indications of instrumental vaginal deliveries. To know the maternal and fetal outcome in ventouse (vaccum assisted vaginal delivery and forceps deliveries. MATERIAL AND METHOD: This was a retrospective study carried between 01/06/2014 to 31/08/2014 at Cheluvamba Hospital, Mysore Medical College and Research Institute. The hospital records of all the referred patients who had ventouse (vaccum assisted vaginal delivery and forcep s deliveries were obtained and data on age, parity, referral and type of procedure performed, APGAR score and complications were entered into a proforma and analyzed. RESULT: During the period under review there were total of 3385 deliveries, LSCS 843 case s(24.9%, Total instrumental vaginal deliveries 110 cases(3.2%. 33 Ventouse (vaccum assisted vaginal delivery deliveries(0.9%, 57 Low forceps deliveries(1.68% and 20 Outlet forceps deliveries(0.59%.Most common indication for instrumental deliveries be ing fetal distress(62 cases , Prolonged second stage of labour and maternal exhaustion (36 cases.Cut short 2 nd stage of labour - previous LSCS(8cases and Eclampsia(2cases, RHD(1case, Sickle cell anemia with avascular necrosis femur neck(1case.Number of alive babies(103 babies, Perinatal mortality 7cases(0.20%, 8 babies required NICU admission for 3 - 4 days, 1 baby had subdural hematoma, 2 babies had forceps mark. Complications like vaginal tear (4 cases, episiotomy extension (18 cases. CONCLUSION: Ve ntouse and forceps remains appropriate tool in the armamentarium of the modern obstetrician. The major factor which determines the safety of the instrument is the operator rather than the

  18. Pregnancy and Vaginal Delivery after Sacrohysteropexy

    Directory of Open Access Journals (Sweden)

    Deniz Balsak

    2015-01-01

    Full Text Available Pregnancy and birth after a Pelvic Organ Prolapse (POP surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.

  19. Mesenteric venous thrombosis following vaginal delivery

    Directory of Open Access Journals (Sweden)

    Roopa Sachidananda

    2013-01-01

    Full Text Available Acute abdomen following an uneventful vaginal delivery is a rare occurrence. Diagnosis may be delayed due to pregnancy related comorbid conditions such as preeclampsia, hemolysis elevated, liver enzymes, low platelet (HELLP count syndrome, acute fatty liver of pregnancy (AFLP, etc. We describe a 21-year-old woman with pre-eclampsia, HELLP syndrome and AFLP with acute abdomen that was managed successfully in our intensive care unit.

  20. Mucoadhesive and thermogelling systems for vaginal drug delivery.

    Science.gov (United States)

    Caramella, Carla M; Rossi, Silvia; Ferrari, Franca; Bonferoni, Maria Cristina; Sandri, Giuseppina

    2015-09-15

    This review focuses on two formulation approaches, mucoadhesion and thermogelling, intended for prolonging residence time on vaginal mucosa of medical devices or drug delivery systems, thus improving their efficacy. The review, after a brief description of the vaginal environment and, in particular, of the vaginal secretions that strongly affect in vivo performance of vaginal formulations, deals with the above delivery systems. As for mucoadhesive systems, conventional formulations (gels, tablets, suppositories and emulsions) and novel drug delivery systems (micro-, nano-particles) intended for vaginal administration to achieve either local or systemic effect are reviewed. As for thermogelling systems, poly(ethylene oxide-propylene oxide-ethylene oxide) copolymer-based and chitosan-based formulations are discussed as thermogelling systems. The methods employed for functional characterization of both mucoadhesive and thermogelling drug delivery systems are also briefly described.

  1. Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia.

    Science.gov (United States)

    Hehir, Mark P; Rubeo, Zachary; Flood, Karen; Mardy, Anne H; O'Herlihy, Colm; Boylan, Peter C; D'Alton, Mary E

    2017-05-18

    Shoulder dystocia is an obstetric emergency that occurs in 0.2-3% of all cephalic vaginal deliveries. We hypothesized that because of the difficult nature of deliveries complicated by shoulder dystocia, the condition may be associated with anal sphincter injury. We sought to identify risk factors for obstetric anal sphincter injury in women with shoulder dystocia. This retrospective analysis included all cases of shoulder dystocia from 2007 to 2011 at two large tertiary referral centers, in the USA and Ireland. Details of maternal demographics, intrapartum characteristics, and delivery outcomes in cases of shoulder dystocia were analyzed. Univariate and multivariate analyses were used to describe the association between shoulder dystocia and anal sphincter injury. There were 685 cases of shoulder dystocia, and the rate of shoulder dystocia was similar at both institutions. The incidence of anal sphincter injury was 8.8% (60 out of 685). The rate was 14% (45 out of 324) in nulliparas and 4.2% (15 out of 361) in multiparas. Women with sphincter injury were more likely to be nulliparous (75% [45 out of 60] vs 45% [279 out of 625]; p anal sphincter injury is 9%. Risk factors include nulliparity, operative vaginal delivery, and use of internal maneuvers, whereas episiotomy was found to have a protective effect against anal sphincter injury during cases of shoulder dystocia.

  2. Mucus-penetrating nanoparticles for vaginal and gastrointestinal drug delivery

    Science.gov (United States)

    Ensign-Hodges, Laura

    A method that could provide more uniform and longer-lasting drug delivery to mucosal surfaces holds the potential to greatly improve the effectiveness of prophylactic and therapeutic approaches for numerous diseases and conditions, including sexually transmitted infections and inflammatory bowel disease. However, the body's natural defenses, including adhesive, rapidly cleared mucus linings coating nearly all entry points to the body not covered by skin, has limited the effectiveness of drug and gene delivery by nanoscale delivery systems. Here, we investigate the use of muco-inert mucus-penetrating nanoparticles (MPP) for improving vaginal and gastrointestinal drug delivery. Conventional hydrophobic nanoparticles strongly adhere to mucus, facilitating rapid clearance from the body. Here, we demonstrate that mucoadhesive polystyrene nanoparticles (conventional nanoparticles, CP) become mucus-penetrating in human cervicovaginal mucus (CVM) after pretreatment with sufficient concentrations of Pluronic F127. Importantly, the diffusion rate of large MPP did not change in F127 pretreated CVM, implying there is no affect on the native pore structure of CVM. Additionally, there was no increase in inflammatory cytokine release in the vaginal tract of mice after daily application of 1% F127 for one week. Importantly, HSV virus remains adherent in F127-pretreated CVM. Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that hypotonically-induced fluid uptake could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We evaluated hypotonic formulations for delivering water-soluble drugs and for drug delivery with MPP. Hypotonic formulations markedly increased the rate at which drugs and MPP reached the epithelial surface. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that isotonic formulations

  3. Fetal Acidosis from Obstetric Interventions During the First Vaginal Delivery

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    Chi-Feng Su

    2008-12-01

    Conclusion: Oxytocin augmentation and vacuum extraction were significantly related to low cord arterial pH values (pH < 7.20, but there were no adverse effects to the newborns of first vaginal deliveries.

  4. Vaginal delivery versus cesarean section for term breech delivery

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    Babović Ivana

    2010-01-01

    Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

  5. Vaginal delivery simulation in the Obstetrics and Gynaecology clerkship.

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    Nitsche, Joshua; Morris, Dana; Shumard, Kristina; Akoma, Ugochi

    2016-10-01

    Although simulation is now used in other areas of obstetrics and gynaecology, its utility in the training of an uncomplicated vaginal delivery is surprisingly under-explored. Here we describe our experience integrating simulation into the third-year Obstetrics and Gynaecology (OB/GYN) clerkship. In 2013/14, at the start of each 4-week OB/GYN clerkship, each third-year student participated in a 90-minute vaginal delivery simulation session using the Noelle(®) simulator. Upon completion of the clerkship, they were surveyed using a five-point Likert scale questionnaire (1, inferior; 5, superior) to assess self-perceived training adequacy, clinical preparedness and number of deliveries performed during the clerkship. Students who completed the clerkship in 2012/13, before the introduction of the simulation, were also surveyed to serve as a comparison group. Survey scores and number of deliveries performed were compared between the two cohorts of students. The 2013/14 cohort (n = 98) who received simulation training gave their training in vaginal deliveries an average rating of 4.1, versus 2.7 for the 2012/13 cohort that did not receive the simulation (n = 80; p < 0.001). Self-perceived preparedness to perform a vaginal delivery was 4.0 in the 2013/14 cohort, versus 3.0 in the 2012/13 cohort (p < 0.001). There was no difference in the number of deliveries performed between the cohorts. Students that received simulation rated their training adequacy and readiness to perform a vaginal delivery higher than students that did not receive training. Simulation did not increase participation in real-life deliveries. The utility of simulation in the training of an uncomplicated vaginal delivery is under-explored. © 2015 John Wiley & Sons Ltd.

  6. Predictors of vaginal delivery in medically indicated early preterm induction of labor.

    Science.gov (United States)

    Sievert, Rachel A; Kuper, Spencer G; Jauk, Victoria C; Parrish, Melissa; Biggio, Joseph R; Harper, Lorie M

    2017-09-01

    When delivery is indicated prior to 34 weeks, many providers perform a cesarean delivery rather than induce labor based on perceptions of a high failure rate. Given the morbidity of cesarean delivery, an accurate estimate of the success rate and factors associated with success in preterm induction of labor is important in management decisions. We sought to develop a prediction model for successful induction of labor in preterm patients using factors known at the time the decision is made to deliver. A retrospective cohort study of all live singletons undergoing an indicated induction of labor between 23 and 34 0/7 weeks from 2011 through 2015. Pregnancies with major fetal anomalies or no intrapartum fetal monitoring were excluded. Successful induction of labor was defined as vaginal delivery. The cohort was randomly split into a training cohort to develop a prediction model for vaginal delivery and a validation cohort to test the model. Factors significantly associated with vaginal delivery were identified using univariate analyses, and candidate factors were used in the multivariate logistic regression model. Only factors known at the start of the induction of labor were used in the model. Receiver-operating characteristic curves were created to estimate the predictive value of the model. Sensitivity and specificity of the model were assessed. Of 331 patients who underwent induction of labor, 208 (62.8%) delivered vaginally and 123 (37.1%) by cesarean delivery. Of the factors significantly associated with cesarean delivery, the final model included gestational age, simplified Bishop score, suspected intrauterine growth retardation, chronic hypertension, and body mass index. In the training cohort, the model correctly classified 72.3% of subjects with a sensitivity (cesarean delivery predicted/cesarean delivery performed) of 56.7% and a specificity (vaginal delivery predicted/vaginal delivery performed) of 84.1%. When applied to the validation cohort, 73.9% of

  7. Prediction of scar integrity and vaginal birth after caesarean delivery.

    OpenAIRE

    Valentin, Lil

    2013-01-01

    A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: inter-delivery interval (higher risk with short interval), birth weight (higher risk if 4000 g or over), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model that includes clinical variables has bee...

  8. Amnioinfusion among women attempting vaginal birth after cesarean delivery.

    Science.gov (United States)

    Strong, T H; Vega, J S; O'Shaughnessy, M J; Feldman, D B; Koemptgen, J G

    1992-05-01

    Eighteen of 901 women (2%) attempting vaginal birth after cesarean delivery (VBAC) received amnioinfusion. No untoward effects occurred in the subjects or their fetuses. We conclude that, though amnioinfusion in the setting of a VBAC attempt is needed only infrequently, it appears to be a reasonable intrapartum management option. The usual safeguards for a VBAC attempt should be followed.

  9. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts.

    Science.gov (United States)

    Miller, Hugh; Goetzl, Laura; Wing, Deborah A; Powers, Barbara; Rugarn, Olof

    2016-01-01

    To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.

  10. Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery.

    Science.gov (United States)

    Baheti, Vidyasagar H; Wagaskar, Vinayak G; Patwardhan, Sujata K

    2015-10-01

    Bladder rupture following caesarian section is well documented complications. Intraperitoneal bladder rupture following normal vaginal delivery is very rare. Hereby, we present a case report of intraperitoneal bladder rupture presented late following normal vaginal delivery. We report a case of spontaneous intraperitoneal urinary bladder rupture following uneventful outlet forceps delivery in a 22-year-old primi gravid woman with gestational diabetes mellitus and fetal macrosomia who presented with large urinary ascites, anuria and renal failure. Emergent exploratory laparotomy with repair of the intraperitoneal bladder rupture helped to prevent its potential complications. Postpartum patients who undergo episiotomy or perineal repair may land up in unnoticed urinary retention which may rarely terminate in spontaneous urinary bladder rupture. Awareness of its manifestations amongst emergency physician would help to initiate appropriate timely management.

  11. Subserosal hematoma of the sigmoid colon after vaginal delivery

    Science.gov (United States)

    Bacalbașa, N; Bohîlțea, RE; Dumitru, M; Turcan, N; Cîrstoiu, MM

    2017-01-01

    Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case. PMID:28255383

  12. Interdelivery weight gain and risk of cesarean delivery following a prior vaginal delivery.

    Science.gov (United States)

    Dude, Annie M; Lane-Cordova, Abbi D; Grobman, William A

    2017-09-01

    Approximately one third of all deliveries in the United States are via cesarean. Previous research indicates weight gain during pregnancy is associated with an increased risk of cesarean delivery. It remains unclear, however, whether and to what degree weight gain between deliveries (ie, interdelivery weight gain) is associated with cesarean delivery in a subsequent pregnancy following a vaginal delivery. The objective of the study was to determine whether interdelivery weight gain is associated with an increased risk of intrapartum cesarean delivery following a vaginal delivery. This was a case-control study of women who had 2 consecutive singleton births of at least 36 weeks' gestation between 2005 and 2016, with a vaginal delivery in the index pregnancy. Women were excluded if they had a contraindication to a trial of labor (eg, fetal malpresentation or placenta previa) in the subsequent pregnancy. Maternal characteristics and delivery outcomes for both pregnancies were abstracted from the medical record. Maternal weight gain between deliveries was measured as the change in body mass index at delivery. Women who underwent a subsequent cesarean delivery were compared with those who had a repeat vaginal delivery using χ(2) statistics for categorical variables and Student t tests or analysis of variance for continuous variables. Multivariable logistic regression was used to determine whether interdelivery weight gain remained independently associated with intrapartum cesarean delivery after adjusting for potential confounders. Of 10,396 women who met eligibility criteria and had complete data, 218 (2.1%) had a cesarean delivery in the subsequent pregnancy. Interdelivery weight gain was significantly associated with cesarean delivery and remained significant in multivariable analysis for women with a body mass index increase of at least 2 kg/m(2) (adjusted odds ratio, 1.53, 95% confidence interval, 1.03-2.27 for a body mass index increase of 2 kg/m(2) to cesarean

  13. Changes in vaginal breech delivery rates in a single large metropolitan area.

    LENUS (Irish Health Repository)

    Hehir, Mark P

    2012-06-01

    Vaginal breech delivery rates have been accepted widely to be in decline and the Term Breech Trial (TBT) has recommended delivery of a breech-presenting infant by elective cesarean section delivery. Our aim was to examine the rate of vaginal delivery of term breech pregnancies in the 8 years before and after the publication of the TBT.

  14. Moyamoya disease and pregnancy: case reports and criteria for successful vaginal delivery

    OpenAIRE

    2015-01-01

    Key Clinical Message Based on our experience with seven deliveries (five cesarean and two vaginal deliveries) in five women with Moyamoya disease, we discussed the appropriate method of delivery and anesthesia for patients with Moyamoya disease. In certain conditions, women with Moyamoya disease can successfully undergo vaginal delivery.

  15. Diabetes Insipidus after normal vaginal delivery: a case report

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2014-07-01

    Treatment was continuing, when the symptoms of central diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered normal. Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal delivery or when hepatic function returns to normal.

  16. Quality of Life after Cesarean and Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    Seyed Abbas Mousavi

    2013-07-01

    Full Text Available Objective: Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery.Methods: This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum.Results: In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65 ± 12.7 and 72.12 ± 11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group (p<0.05. In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical (R2=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350] and social (R2=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023] domains of QOL and the global QOL score (R2=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]. While multiparas, there was no relationship between QOL and type of delivery.Conclusion: In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery.

  17. Risk factors for cesarean section and instrumental vaginal delivery after successful external cephalic version.

    Science.gov (United States)

    de Hundt, Marcella; Vlemmix, Floortje; Bais, Joke M J; de Groot, Christianne J; Mol, Ben Willem; Kok, Marjolein

    2016-01-01

    Aim of this article is to examine if we could identify factors that predict cesarean section and instrumental vaginal delivery in women who had a successful external cephalic version. We used data from a previous randomized trial among 25 hospitals and their referring midwife practices in the Netherlands. With the data of this trial, we performed a cohort study among women attempting vaginal delivery after successful ECV. We evaluated whether maternal age, gestational age, parity, time interval between ECV and delivery, birth weight, neonatal gender, and induction of labor were predictive for a vaginal delivery on one hand or a CS or instrumental vaginal delivery on the other hand. Unadjusted and adjusted odds ratios were calculated with univariate and multivariate logistic regression analysis. Among 301 women who attempted vaginal delivery after a successful external cephalic version attempt, the cesarean section rate was 13% and the instrumental vaginal delivery rate 6%, resulting in a combined instrumental delivery rate of 19%. Nulliparity increased the risk of cesarean section (OR 2.7 (95% CI 1.2-6.1)) and instrumental delivery (OR 4.2 (95% CI 2.1-8.6)). Maternal age, gestational age at delivery, time interval between external cephalic version and delivery, birth weight and neonatal gender did not contribute to the prediction of failed spontaneous vaginal delivery. In our cohort of 301 women with a successful external cephalic version, nulliparity was the only one of seven factors that predicted the risk for cesarean section and instrumental vaginal delivery.

  18. Perineal trauma after vaginal delivery in healthy pregnant women

    Directory of Open Access Journals (Sweden)

    Larissa Santos Oliveira

    Full Text Available CONTEXT AND OBJECTIVE:Despite all the medical care provided during delivery labor, perineal injury is still prevalent and may lead to diverse pelvic floor disorders. The aim here was to investigate the prevalence of obstetric and anal sphincter injuries (OASIS in healthy pregnant women after vaginal delivery.DESIGN AND SETTING:Cross-sectional study involving 3,034 patients with singletons in a secondary hospital for low-risk cases.METHODS:A standardized questionnaire was prepared and applied to medical files that had been completely filled out (classification of the Royal College of Obstetricians and Gynecologists, RCOG in order to identify OASIS and analyze risk factors associated with mild and severe perineal lacerations.RESULTS:The women's mean age was 25 years; more than half (54.4% were primiparae. Almost 38% of the participants had perineal lacerations; these were severe in 0.9% of the cases. Previous vaginal delivery (odds ratio, OR: 1.64 [1.33-2.04] and forceps delivery (OR: 2.04 [1.39-2.97] were risk factors associated with mild perineal injuries (1st and 2nd OASIS classifications. Only remaining standing for prolonged periods during professional activity (OR: 2.85 [1.34-6.09] was associated with severe perineal injuries.CONCLUSION:The prevalence of severe perineal injuries was concordant with data in the literature. The variable of standing position was considered to be a risk factor for severe perineal injury and should be further investigated.

  19. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi

    2014-03-01

    Conclusion: The results of this study showed in comparison with cesarean delivery, normal vaginal delivery provides better outcomes in terms of breast problems, breast feeding status, duration of labor and duration of maternal hospitalization for both mother and infant. So, adopting careful instructions in management and administration of deliveries will help the prevalence of making decisions for normal vaginal delivery and the recovery of delivery outcomes.

  20. Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery

    NARCIS (Netherlands)

    Mulder, Femke E M; Rengerink, Katrien Oude; van der Post, Joris A M; Hakvoort, Robert A; Roovers, Jan-Paul W R; Oude Rengerink, K

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Postpartum urinary retention (PUR) is a common consequence of bladder dysfunction after vaginal delivery. Patients with covert PUR are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL. Incomplete bladder emptying may predispose to

  1. Spontaneous unscarred fundal rupture after normal vaginal delivery

    Directory of Open Access Journals (Sweden)

    Shreya Thapa

    2014-06-01

    Full Text Available Uterine rupture is one of the most dangerous obstetric situation carrying an increased risk of maternal and perinatal morbidity and mortality, associated with poorly managed labour. The incidence of spontaneous rupture of unscarred uterus is around 1 in 8000 to 1 in 15000 deliveries. We report this unusual case of spontaneous unscarred fundal rupture after normal vaginal delivery. This case under reference developed shock soon after delivery and was explored due to suspected intraperitoneal hemorrhage. This case is being reported to emphasis the need for proper post-delivery monitoring not only to diagnose post-partum hemorrhage but also to suspect uterine rupture as a cause of unexplained shock developing after delivery inspite of all resuscitative measures. Although unexpected in a woman with an unscarred uterus, rupture should be considered as a possible cause of unusual pain or hypotension in the mother. The most effective way to reduce the number of morbidity and mortality would be to prevent unwanted pregnancies by informed and effective use of contraception. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 780-782

  2. [To rescue a vanishing obstetric skill--vaginal breech delivery].

    Science.gov (United States)

    Glezerman, Marek

    2011-02-01

    In 2000, a large randomized controlled trial was published (Term Breech Trial - TBT). The authors concluded that cesarean section (CS) was safer for newborns in breech presentation than vaginal breech delivery (VBD). This conclusion was endorsed by major professional institutions, was adopted almost immediately by the medical community and led to a wholesale abandonment of planned VBD in the western world, including Israel. In past years, serious criticism has been voiced related to the methodology applied in the TBT and numerous studies have contradicted the recommendations. Subsequently, the professional institutions published revised guidelines with the recommendation that pregnant women with breech presentation should, under certain circumstances, be given the choice between CS and VBD. Yet, in most delivery wards, following a decade of abandonment of VBD, the expertise for this technique had almost vanished. An unbearable situation had materialized: CS increases maternal mortality and morbidity when compared to vaginal delivery but most obstetricians are no longer capable of offering women the choice of VBD. Recently, and with the support of the Israel Societies of Obstetrics and Gynecology and Feto-Maternal Medicine, representatives of 17 obstetrical departments convened and decided on urgent steps to revive VBD, including updating the relevant clinical guidelines and informed consent forms and, most importantly, to issue a call to train obstetricians in VBD. In March 2010, a workshop dedicated to breech delivery was conducted at the Beilinson Hospital, with the representatives of most Israeli hospitals and specialists from abroad. Subsequently, and at the same hospital, a week-long program for VBD was conducted at which approximately 30 obstetricians received hands-on training. Time will show if "turning back the tide" will help to progress into a safer future for women with breech presentation and to annually avoid between 1000 and 2000 needless cesarean

  3. The Effect of Cognitive Behavior Therapy on Anxiety Reduction of First Normal Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    R Imanparast

    2014-04-01

    Conclusions: Consequently the cognitive behavior therapy causes to decrease the anxiety with enduring effect at first normal vaginal delivery. Therefore, this treatment is proposed to reduce the anxiety of first delivery women.

  4. Anal endosonographic findings in women after vaginal delivery

    Energy Technology Data Exchange (ETDEWEB)

    Kolodziejczak, Malgorzata [Department of Proctology, Hospital at Solec, Warsaw (Poland); Sudol-Szopinska, Iwona, E-mail: iwsud@ciop.pl [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Stefanski, Robert [Department of Proctology, Hospital at Solec, Warsaw (Poland); Department of Diagnostic Imaging, Second Faculty of Warsaw Medical University, Warsaw (Poland); Panorska, Anna K. [Department of Mathematics and Statistics, University of Nevada, Reno (United States); Gardyszewska, Agnieszka [Second Clinic of Obstetrics and Gynecology, Warsaw (Poland); Krasnodebski, Ireneusz [Department of General and Gastroenterological Surgery and Nutrition, Medical University, Warsaw (Poland)

    2011-04-15

    Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck's classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters' tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma.

  5. Prediction of scar integrity and vaginal birth after caesarean delivery.

    Science.gov (United States)

    Valentin, Lil

    2013-04-01

    A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: inter-delivery interval (higher risk with short interval), birth weight (higher risk if 4000 g or over), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model that includes clinical variables has been published. A thin lower uterine segment at 35-40 weeks, as measured by ultrasound in women with a caesarean hysterotomy scar, increases the risk of uterine rupture or dehiscence. No cut-off for lower uterine segment thickness, however, can be suggested because of study heterogeneity, and because prospective validation is lacking. Large caesarean hysterotomy scar defects in non-pregnant women seen at ultrasound examination increase the risk of uterine rupture or dehiscence in subsequent pregnancy, but the strength of the association is unknown. To sum up, we currently lack a method that can provide a reliable estimate of the risk of uterine rupture or dehiscence during a trial of labour in women with caesarean hysterotomy scar(s).

  6. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model.

    Science.gov (United States)

    Fagerberg, Marie C; Maršál, Karel; Källén, Karin

    2015-05-01

    We aimed to validate a widely used US prediction model for vaginal birth after cesarean (Grobman et al. [8]) and modify it to suit Swedish conditions. Women having experienced one cesarean section and at least one subsequent delivery (n=49,472) in the Swedish Medical Birth Registry 1992-2011 were randomly divided into two data sets. In the development data set, variables associated with successful trial of labor were identified using multiple logistic regression. The predictive ability of the estimates previously published by Grobman et al., and of our modified and new estimates, respectively, was then evaluated using the validation data set. The accuracy of the models for prediction of vaginal birth after cesarean was measured by area under the receiver operating characteristics curve. For maternal age, body mass index, prior vaginal delivery, and prior labor arrest, the odds ratio estimates for vaginal birth after cesarean were similar to those previously published. The prediction accuracy increased when information on indication for the previous cesarean section was added (from area under the receiver operating characteristics curve=0.69-0.71), and increased further when maternal height and delivery unit cesarean section rates were included (area under the receiver operating characteristics curve=0.74). The correlation between the individual predicted vaginal birth after cesarean probability and the observed trial of labor success rate was high in all the respective predicted probability decentiles. Customization of prediction models for vaginal birth after cesarean is of considerable value. Choosing relevant indicators for a Swedish setting made it possible to achieve excellent prediction accuracy for success in trial of labor after cesarean. During the delicate process of counseling about preferred delivery mode after one cesarean section, considering the results of our study may facilitate the choice between a trial of labor or an elective repeat cesarean

  7. A History of Abuse and Operative Delivery

    DEFF Research Database (Denmark)

    Schei, Berit; Lukasse, Mirjam; Ryding, Elsa Lena

    2014-01-01

    OBJECTIVE: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult....... DESIGN: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records....... The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary...

  8. VAGINAL DELIVERY OF GIANT FETUS – SHOULDER DYSTOCIA

    Directory of Open Access Journals (Sweden)

    Jasmina Popović

    2009-04-01

    Full Text Available Shoulder dystocia (SD is defined as unpredictable and urgent obstetric complication that happens when the pelvis of a mother is spread sufficiently to deliver fetal head, but insufficiently to deliver fetal shoulders. It is associated with high percentage of maternal and fetal morbidity. Fetal lethality from hypoxia ranges from 2-16%.We observed the case of vaginal delivery in a multiparous woman in the 39th gestational week. Head delivery was performed by using vacuum extraction. Because of the shoulder dystocia, we applied McRoberts’ maneuver with Resnik’s suprapubic pressure and performed one more episiotomy. Since these maneuvers did not give the expected result, we did the aspiration of the upper respiratory paths of the fetus, after which we performed Hibbard’s cord with simultaneous Kristeler’s maneuver. It led to releasing the shoulders and fetal delivery. On delivery, male fetus was 6000 g/60 cm, estimated with Apgar 1. The urgent reanimation was undertaken. After few hours, the baby was transferred to Pediatric Surgical Clinic for further treatment of present pneumotorax and humerus fracture. After many days, the baby being in normal state, was referred to physical rehabilitation treatment. Today, the baby is without sequelae.SD is one of the most difficult, hardly predictable perilous obstetric complications with high percentage of maternal morbidity and fetal morbidity and mortality. It requires caution, training and skills of obstetric-neonatal team. Liberalization of the use of Caesarian section in managing SD decreases the appearance of injuries in both mother and child. However, regardless of very rapid development of perinatology and the use of modern diagnostic-therapeutic protocols, some questions from classical, practical obstetrics remain unanswered.

  9. The Effect of Cognitive Behavior Therapy on Anxiety Reduction of First Normal Vaginal Delivery

    OpenAIRE

    R Imanparast; H Bermas; S.Danesh; Z Ajoudani

    2014-01-01

    Introduction: Anxiety has an impressive effect on normal vaginal delivery. Since no study has been conducted in this regard, this research is designed to determine the effect of cognitive behavior therapy on the reduction of anxiety at first normal vaginal delivery. Methods: A semi-experimental study was carried out on 40 nulliparous women with six months age of pregnancy and without abortion and infertility background. After the completion of testimonial, the rate of anxiety was evaluated...

  10. Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

    OpenAIRE

    Irene Mora-Hervás; Emília Sánchez; Francisco Carmona

    2015-01-01

    Objectives: To estimate the incidence of perineal trauma in primiparous women with spontaneous vaginal delivery and to identify the factors associated with second-degree lacerations. Materials and Methods: A subset analysis of women with spontaneous vaginal deliveries (n=489) from an institutional review board-approved parent study in healthy, nulliparous, continent pregnant women, attending the public health care system of Catalonia (northeast Spain). Primary outcome measure was perineal ...

  11. Informed Consent for Vaginal Delivery: Is It Time to Revisit the Shared Decision-Making Process?.

    Science.gov (United States)

    Malik, Mokerrum F; Awonuga, Awoniyi O; Iglesia, Cheryl B

    2016-01-01

    Vaginal delivery as we know it today has evolved, with increasing recognition of trauma to the pelvic floor and perineum. Evolutionary adaptation of the human female pelvis to vaginal deliveries brings with it many benefits, but risks still exist. These benefits and risks should be discussed with patients prior to delivery. Currently, no consensus exists on a standard informed consent process prior to normal vaginal delivery. To synopsize the current literature regarding the ethics of informed consent in the setting of obstetric and gynecological practice, and to make the case for informed consent for vaginal delivery prior to labor. Vaginal birth is still viewed as the default method of delivery. The reason for this is not unrelated to the direct connection between the uterus that holds the fetus before labor, and the vagina, for which the term birth canal was given even before modern obstetrics. Although there are known benefits for advocating vaginal births, there are also attendant risks. It is incumbent on obstetricians and midwives to discuss those risk and benefits with their patient prior to labor. Verbal discussion without documentation may no longer be appropriate due to medical advancements and the litigious health care climate. For this reason, we argue for and advocate that a consent process be included as an educational measure and as part of our ethical obligation to provide care.

  12. Misoprostol vaginal insert for induction of labor: a delivery system with accurate dosing and rapid discontinuation.

    Science.gov (United States)

    Stephenson, Megan L; Hawkins, J Seth; Powers, Barbara L; Wing, Deborah A

    2014-01-01

    Labor induction and cervical ripening are widely utilized and new methods are constantly being investigated. Prostaglandins have been shown to be effective labor induction agents and, in particular, were compared with other prostaglandin preparations; vaginal misoprostol used off-label was associated with reduced failure to achieve vaginal delivery. The challenge is to provide this medication with the correct dosing for this indication and with the ability to discontinue the medication if needed, all while ensuring essential maternal and neonatal safety. The misoprostol vaginal insert initiates cervical ripening using a delivery system that controls misoprostol release and can be rapidly removed. This article reviews the development, safety and efficacy of the misoprostol vaginal insert for induction of labor and cervical ripening, and will focus on vaginally administered prostaglandins.

  13. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola

    2017-01-01

    : The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. RESULTS......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

  14. Dislocation of temporo-mandibular joint - an uncommon circumstance of occurrence: vaginal delivery

    Directory of Open Access Journals (Sweden)

    Abderrahim El Bouazzaoui

    2010-06-01

    Full Text Available Dislocation of temporo-mandibular joint (TMJ is an infrequent disease but still almost spectacular. This disease consists of a permanent, to some extent complete disruption of the temporo-mandibular joint. These dislocations often occurs in a context of yawning, and less frequently after a burst of laughing or relatively mild facial trauma (slap, punch on the chin.We report a case of TMJ occurring in an uncommon circumstance : vaginal delivery. A young woman aged 24-years with no special past medical history; primipara was admitted in the Department of Maternity of the University Hospital Hassan II of Fez for an imminent delivery of a twin pregnancy. Obstetrical analgesia was not possible so the parturient cried in a strong manner during labour. Ten minutes after admission, the patient delivered vaginally with episiotomy. She gave birth to twins weighing 2800g and 2400g. During labour, and effort of crying, the patient presented a sudden and immediate loss of function of the temporo-mandibular joint, with difficulty of speaking, the mouth permanently opened, with the chin lowered and thrown forward. The examination found an emptiness of the glenoid fossa of the temporo-mandibular joint in both sides. The diagnosis of dislocation of the TMJ has established. Performance of special radiologic screening to study the TM was technically not possible. A CT scan of facial bones has been achieved so objectifying a bilateral dislocation of TMJ. The reduction of this dislocation was performed in the operating room under sedation

  15. Comparing Quality of Life in Women after Vaginal Delivery and Cesarean Section

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Majzoobi

    2014-10-01

    Full Text Available Background & aim: Postpartum period is accompanied by significant changes in women’s quality of life. These alterations can affect the health of mothers and children. Considering the importance of postnatal quality of life and its different contributing factors, this study aimed to compare women’s quality of life after vaginal delivery and cesarean section. Methods:This retrospective cohort study included a random sample of 2100 women, referring to Hamadan health care centers for congenital hypothyroidism screening or infant vaccination. The participants’ quality of life was examined, using Short Form-36 (SF-36 questionnaire, evaluating five periods of time including one week, two months, four months, six months, and one year after delivery (either vaginal or cesarean delivery. Data were analyzed using t-test. Results: Quality of life was significantly higher in women with vaginal delivery, compared to women with cesarean section in all periods including one week (68.77 vs. 42.44, two months (69.11 vs. 54.76, four months (78.19 vs. 53.02, six months (75.62 vs. 54.94,and one year(78.43 vs. 53.77 after delivery. Conclusion: Considering women’s higher quality of life after vaginal delivery, compared to cesarean section, it seems that vaginal delivery is a safer and less expensive option, which is recommended for all pregnant women.

  16. Risk factors associated with forth-degree laceration during vaginal delivery

    Directory of Open Access Journals (Sweden)

    N. Zafarghandi

    2006-08-01

    Full Text Available Background: To identify the risk factors of fourth-degree laceration during vaginal delivery. Methods: This is a retrospective, case control study. We reviewed 131802 records of vaginal deliveries within 14 years period from 1990 to 2004 in two obstetric center. Cases were 93 vaginal deliveries with fourth-degree laceration and 7 cases were delivered at home, control subjects were 200 vaginal deliveries without third- or fourth-degree lacerations and were identified with the use of random selection. We studied the effects of: maternal age, nationality, parity, gestational age, hour of delivery, birth attendants, episiotomy use and duration of second stage of labor, use of oxytocin, use of forceps or vaccum, Infant birth weight, presentation and postion of fetus, previous severe perineal injury, maternal medical illness and place of delivery. Results: We found 93 cases (%0.07 of documented fourth-degree laceration in 131802 deliveries Conclusion: This study identified several factors associated with fourth-degree laceration. Median episiotomy should be avoided. Nulliparity, fetal macrosomia and OP position are significant risk factors that require caution by birth attendants during delivery

  17. Vaginal Delivery After Dührssen Incisions in a Patient With Bladder Exstrophy and Uterine Prolapse.

    Science.gov (United States)

    Lachica, Ruben; Chan, Yen; Uquillas, Kristen R; Lee, Richard H

    2017-04-01

    Bladder exstrophy is a rare congenital anomaly affecting the lower abdominal wall, pelvis, and genitourinary structures. Pregnant women with bladder exstrophy present a unique challenge to the obstetrician. The patient is a 35-year old pregnant woman with bladder exstrophy, an extensive surgical history, and uterine prolapse with an abnormal, rubbery consistency to her cervix. Prenatally, she was counseled on the potential use of Dührssen incisions to facilitate vaginal delivery. Labor was induced at 36 4/7 weeks of gestation after her pregnancy was complicated by recurrent pyelonephritis. Vaginal delivery was achieved 8 minutes after the creation of Dührssen incisions. The care of pregnant women with bladder exstrophy requires multidisciplinary management and careful delivery planning. Successful vaginal delivery can be attained in these patients.

  18. Vaginitis

    Science.gov (United States)

    ... vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse. Glossary Antibiotics: ... Resources & Publications Committee Opinions Practice Bulletins Patient Education Green Journal Clinical Updates Practice Management Coding Health Info ...

  19. [Impact of the instrumental vaginal delivery on pain perception at two months].

    Science.gov (United States)

    Weslinck, N; De Jonckheere, J; Storme, L; Logier, R; Appel, M; Thomas, D; Rakza, T

    2014-06-01

    Although instrumental vaginal delivery reduces the risk of neonatal mortality, it increases the risk of specific morbidity including prolonged neonatal discomfort. Previous studies suggest that neonatal exposure to acute pain could have long-term effects on the pain response later in life. The aim of the study was to investigate whether instrumental vaginal delivery may alter the response to a noxious stimulus at the age of two months. Newborn infants were enrolled in this prospective observational study after parental consent. A group of children born by instrumental vaginal delivery (group 2) were compared to matched controls born by vaginal delivery (group 1). Pain was assessed in each newborn infant between two and four hours after birth using the scale of pain and discomfort of the newborn baby (EDIN). These children were reassessed for pain response to immunizations (Infanrix(®) and Prevenar(®)) at two months of age using the DAN scale. Thirteen children were enrolled in this study, six in group 1 and seven in group 2. Gestational age, birth weight, Apgar score, and umbilical arterial blood were similar in both groups. The EDIN measured between H2 and H4 was significantly higher in group 2 (median, 4 [IQ, 3] versus 0 [3.25], Pdelivery causes discomfort after birth and increases the pain response to immunization at the age of two months. This study supports the hypothesis that instrumental vaginal delivery may alter pain perception later in life. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  20. Propylene glycol-embodying deformable liposomes as a novel drug delivery carrier for vaginal fibrauretine delivery applications.

    Science.gov (United States)

    Li, Wei-Ze; Hao, Xu-Liang; Zhao, Ning; Han, Wen-Xia; Zhai, Xi-Feng; Zhao, Qian; Wang, Yu-E; Zhou, Yong-Qiang; Cheng, Yu-Chuan; Yue, Yong-Hua; Fu, Li-Na; Zhou, Ji-Lei; Wu, Hong-Yu; Dong, Chun-Jing

    2016-03-28

    The purpose of this work was to develop and characterize the fibrauretine (FN) loaded propylene glycol-embodying deformable liposomes (FDL), and evaluate the pharmacokinetic behavior and safety of FDL for vaginal drug delivery applications. FDL was characterized for structure, particle size, zeta potential, deformability and encapsulation efficiency; the ability of FDL to deliver FN across vagina tissue in vitro and the distribution behavior of FN in rat by vaginal drug delivery were investigated, the safety of FDL to the vagina of rabbits and rats as well as human vaginal epithelial cells (VK2/E6E7) were also evaluated. Results revealed that: (i) the FDL have a closed spherical shape and lamellar structure with a homogeneous size of 185±19nm, and exhibited a negative charge of -53±2.7mV, FDL also have a good flexibility with a deformability of 92±5.6 (%phospholipids/min); (ii) the dissolving capacity of inner water phase and hydrophilicity of phospholipid bilayers of deformable liposomes were increased by the presence of propylene glycol, this may be elucidated by the fluorescent probes both lipophilic Nile red and hydrophilic calcein that were filled up the entire volume of the FDL uniformly, so the FDL with a high entrapment capacity (were calculated as percentages of total drug) for FN was 78±2.14%; (iii) the permeability of FN through vaginal mucosa was obviously improved by propylene glycol-embodying deformable liposomes, no matter whether the FN loaded in liposomes or not, although FN loaded in liposomes caused the highest permeability and drug reservoir in vagina; (iv) the FN mainly aggregated in the vagina and uterus, then the blood, spleen, liver, kidney, heart and lungs for vaginal drug delivery, this indicating vaginal delivery of FDL have a better 'vaginal local targeting effect'; and (v) the results of safety evaluation illustrate that the FDL is non-irritant and well tolerated in vivo, thereby establishing its vaginal drug delivery potential

  1. Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Caissutti, Claudia; Saccone, Gabriele; Zullo, Fabrizio; Quist-Nelson, Johanna; Felder, Laura; Ciardulli, Andrea; Berghella, Vincenzo

    2017-09-01

    To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis. MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017. Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI. Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants). Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a

  2. [Time trend of the rates of cesarean and vaginal delivery according to the source of financing].

    Science.gov (United States)

    Paris, Gisele Ferreira; Monteschio, Lorenna Vlccentine Coutinho; de Oliveira, Rosana Rosseto; Latorre, Maria do Rosário Dias de Oliveira; Pelloso, Sandra Marisa; Mathias, Thais Aidar de Freitas

    2014-12-01

    To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing. This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at pdelivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period. Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.

  3. Vaginitis

    Science.gov (United States)

    ... are the symptoms of a yeast infection? What treatments are available for vaginal yeast infection? Should I use an over-the-counter medication to treat a yeast infection? What is bacterial vaginosis? What are the symptoms of bacterial vaginosis? How ...

  4. Increasing vaginal progesterone gel supplementation after frozen-thawed embryo transfer significantly increases the delivery rate

    DEFF Research Database (Denmark)

    Alsbjerg, Birgit; Polyzos, Nikolaos P; Elbaek, Helle Olesen

    2013-01-01

    The aim of this study was to evaluate the reproductive outcome in patients receiving frozen-thawed embryo transfer before and after doubling of the vaginal progesterone gel supplementation. The study was a retrospective study performed in The Fertility Clinic, Skive Regional Hospital, Denmark....... A total of 346 infertility patients with oligoamenorrhoea undergoing frozen-thawed embryo transfer after priming with oestradiol and vaginal progesterone gel were included. The vaginal progesterone dose was changed from 90 mg (Crinone) once a day to twice a day and the reproductive outcome during the two...... rate (8.7% versus 20.5%, respectively; P=0.002). Doubling of the vaginal progesterone gel supplementation during frozen-thawed embryo transfer cycles decreased the early pregnancy loss rate, resulting in a significantly higher delivery rate. This study evaluated the reproductive outcome of 346 women...

  5. Vaginal delivery of carboplatin-loaded thermosensitive hydrogel to prevent local cervical cancer recurrence in mice.

    Science.gov (United States)

    Wang, Xue; Wang, Jin; Wu, Wenbin; Li, Hongjun

    2016-11-01

    Local tumor recurrence after cervical cancer surgery remains a clinical problem. Vaginal delivery of thermosensitive hydrogel may be suited to reduce tumor relapse rate with more efficacy and safety. A pilot study was carried out to evaluate the efficacy of carboplatin-loaded poloxamer hydrogel to prevent local recurrence of cervical cancer after surgery. In vivo vaginal retention evaluation of 27% poloxamer hydrogel in mice was proven to be a suitable vaginal drug delivery formulation due to its low gelation temperature. A mimic orthotopic cervical/vaginal cancer recurrence model after surgery was established by injecting murine cervical cancer cell line U14 into the vaginal submucosa to simulate the residual tumor cells infiltrated in the surgical site, followed by drug administration 24 h later to interfere with the formation/recurrence of the tumor. By infusing fluorescein sodium-loaded hydrogel into the vagina of mice, a maximized accumulation of fluorescein sodium (Flu) in the vagina was achieved and few signals were observed in other organs. When used in the prevention of the cervical cancer formation/recurrence in mice, the carboplatin-loaded poloxamer hydrogel exhibited great efficacy and systemic safety. In conclusion, thermosensitive hydrogel presents a simple, practical approach for the local drug delivery via vagina against cervical cancer recurrence.

  6. Assisted vaginal deliveries in mothers admitted as public or private patients in Western Australia.

    Directory of Open Access Journals (Sweden)

    Kristjana Einarsdóttir

    Full Text Available BACKGROUND: Mothers delivering as private patients in Australia have a high rate of assisted deliveries, which could lead to adverse infant outcomes in this group of patients. We investigated whether the risk of adverse infant outcomes after assisted deliveries was different for mothers admitted as public or private patients for delivery, when compared with unassisted deliveries. METHODS AND FINDINGS: We included 158,241 vaginal, singleton, term birth admissions in our study where the infant was live born and without birth defects. The study population was identified from statutory birth and hospital data collections held by the Western Australian (WA Department of Health. We estimated odds ratios and confidence intervals using logistic regression models adjusted for a range of maternal demographic, pregnancy and birth characteristics. Interaction was assessed by including interaction terms in the models. Outcomes included low Apgar scores at five minutes (< 7, neonatal resuscitation and special care admission. Mothers delivering as private patients had an increased risk of assisted vaginal delivery compared with public patients (adjusted OR 1.74, 95% CI  =  1.68-1.80. Compared with unassisted vaginal deliveries, assisted deliveries were associated with increased risk of Apgar scores at five minutes below 7 (OR 1.25, 1.08-1.45, neonatal resuscitation (OR  =  1.69, 1.42-2.00 and admission to special care nursery (OR  =  1.64, 1.53-1.76. The increased risk of neonatal resuscitation was higher for mothers admitted as private patients for delivery (OR  =  2.13 than public patients (OR  = 1 .55, p(interaction  =  0.03. CONCLUSIONS: Our results suggested that the high risk of neonatal resuscitation following assisted vaginal deliveries compared to unassisted is higher in private patients than public patients. Whether this phenomenon is due to the twofold higher rate of assisted vaginal deliveries in this group of patients or a

  7. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola;

    2017-01-01

    INTRODUCTION: Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. METHODS......: The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. RESULTS......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

  8. Circulating maternal cortisol levels during vaginal delivery and elective cesarean section.

    Science.gov (United States)

    Stjernholm, Ylva Vladic; Nyberg, Annie; Cardell, Monica; Höybye, Charlotte

    2016-08-01

    Maternal S-cortisol levels increase throughout pregnancy and peak in the third trimester. Even higher levels are seen during the physical stress of delivery. Since analgesia for women in labor has improved, it is possible that maternal stress during labor is reduced. The aim of this study was to compare maternal S-cortisol during vaginal delivery and elective cesarean section. Twenty healthy women with spontaneous vaginal delivery and healthy women (n = 20) undergoing elective cesarean section were included in the study. S-cortisol was measured during three stages of spontaneous vaginal delivery (tvd1, tvd2 and tvd3), as well as before and after elective cesarean section (tcs1 and tcs2). In the vaginal delivery group, mean S-cortisol at tvd1 was 1325 ± 521 nmol/L, at tvd2 1559 ± 591 nmol/L and at tvd3 1368 ± 479 nmol/L. In the cesarean section group, mean S-cortisol at tcs1 was 906 ± 243 nmol/L and at tcs2 831 ± 257 nmol/L. S-cortisol was higher in the vaginal delivery group at the onset of labor as compared to the cesarean section preoperative group (p = 0.006). There were also significant differences between S-cortisol levels postpartum as compared to postoperatively (p cesarean section, indicating higher stress levels. A reduction in the hydrocortisone dose at childbirth in women with adrenal insufficiency should be considered, particularly in women undergoing an elective cesarean section.

  9. Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery

    NARCIS (Netherlands)

    Wijma, J; Potters, AEW; de Wolf, BTHM; Tinga, DJ; Aarnoudse, JG

    Objective To assess the incidence of urinary incontinence in pregnancy and after spontaneous vaginal delivery and its relation with changes in the static and dynamic function of the pelvic floor. Design The second part of a prospective longitudinal study. Setting University Hospital Groningen and

  10. Vaginal delivery for breech presentation should be an option: experience in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Isha Gutgutia

    2014-06-01

    Conclusions: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill and confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 562-565

  11. Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

    Directory of Open Access Journals (Sweden)

    Zaman Shakila

    2010-01-01

    Full Text Available Abstract Background Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. Methods This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. Results The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees and from the patient's perspective was 79 US$ (5278 rupees. The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees and 204 US$ (13678 rupees from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74% of households had a monthly income of less than 149 US$ (10000 rupees. Conclusion The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare.

  12. Maternal and neonatal copeptin levels at cesarean section and vaginal delivery.

    Science.gov (United States)

    Foda, Ashraf A; Abdel Aal, Ibrahim A

    2012-12-01

    The objective of the study was to measure the copeptin levels in maternal serum and umbilical cord serum at cesarean section and vaginal delivery in normotensive pregnancy and pre-eclamptic women. This was a prospective study at Mansoura University Hospital, Egypt. Ninety cases were included. They were divided into six groups: (1) normal pregnancy near term, as a control group, (2) primiparas who had vaginal delivery, (3) primiparas who had vaginal delivery and mild preeclampsia, (4) elective repeat cesarean section, (5) intrapartum cesarean section for indications other than fetal distress, and (6) intrapartum cesarean section for fetal distress. Serum copeptin concentrations were quantified with an enzyme-linked immunosorbent assay (ELISA). Mean, standard deviation, and paired t-test were used to test for significant change in quantitative data. The vaginal delivery groups had higher levels of maternal serum copeptin than the elective cesarean section group (P<0.01). Higher maternal serum copeptin levels were found in cases with pre-eclampsia as compared with the normotensive cases. The maternal copeptin levels during intrapartum cesarean section were higher than that during elective repeat cesarean section. There was a significant correlation between maternal copeptin levels and the duration of the first stage. In the presence of fetal distress, umbilical cord serum copeptin levels were significantly higher than other groups. Vaginal delivery can be very painful and stressful, and is accompanied by a marked increase of maternal serum copeptin. Increased maternal levels of serum copeptin were found in cases with pre-eclampsia as compared with the normotensive cases, and it may be helpful in assessing the disease. Intrauterine fetal distress is a strong stimulus to the release of copeptin into the fetal circulation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. Mucoadhesive cellulosic derivative sponges as drug delivery system for vaginal application.

    Science.gov (United States)

    Furst, Tania; Piette, Marie; Lechanteur, Anna; Evrard, Brigitte; Piel, Géraldine

    2015-09-01

    Vaginal delivery of active drugs has been largely studied for local and systemic applications. It is well known that vagina is a complex route, due to physiological and non-physiological changes. Therefore, in order to achieve a prolonged local effect, these variations have to be considered. The aim of this study was to formulate and to characterize a solid system, called sponges, obtained by lyophilization of cellulosic derivative (HEC 250M) hydrogels. These sponges have to meet particular criteria to be adapted for vaginal application: they have to adhere to the vaginal cavity and to be rehydrated by the small amount of vaginal fluids. Moreover, they have to be easily manipulated and to be stable. Three freezing temperatures have been tested to prepare sponges (-15°C, -25°C, -35°C). By SEM analyzes, it was observed that the pores into the sponges were smaller and numerous as the freezing temperature decreases. However, this temperature did not have any influence on the rehydration speed that was rather influenced by the HEC concentration. Viscosity and mucoadhesive strength of hydrogels and corresponding sponges were also measured. It appeared that these parameters are mainly dependent on the HEC concentration. These mucoadhesive sponges can be considered as potential drug delivery systems intended for vaginal application.

  14. Chitosan in Mucoadhesive Drug Delivery: Focus on Local Vaginal Therapy

    Science.gov (United States)

    Andersen, Toril; Bleher, Stefan; Flaten, Gøril Eide; Tho, Ingunn; Mattsson, Sofia; Škalko-Basnet, Nataša

    2015-01-01

    Mucoadhesive drug therapy destined for localized drug treatment is gaining increasing importance in today’s drug development. Chitosan, due to its known biodegradability, bioadhesiveness and excellent safety profile offers means to improve mucosal drug therapy. We have used chitosan as mucoadhesive polymer to develop liposomes able to ensure prolonged residence time at vaginal site. Two types of mucoadhesive liposomes, namely the chitosan-coated liposomes and chitosan-containing liposomes, where chitosan is both embedded and surface-available, were made of soy phosphatidylcholine with entrapped fluorescence markers of two molecular weights, FITC-dextran 4000 and 20,000, respectively. Both liposomal types were characterized for their size distribution, zeta potential, entrapment efficiency and the in vitro release profile, and compared to plain liposomes. The proof of chitosan being both surface-available as well as embedded into the liposomes in the chitosan-containing liposomes was found. The capability of the surface-available chitosan to interact with the model porcine mucin was confirmed for both chitosan-containing and chitosan-coated liposomes implying potential mucoadhesive behavior. Chitosan-containing liposomes were shown to be superior in respect to the simplicity of preparation, FITC-dextran load, mucoadhesiveness and in vitro release and are expected to ensure prolonged residence time on the vaginal mucosa providing localized sustained release of entrapped model substances. PMID:25574737

  15. Chitosan in Mucoadhesive Drug Delivery: Focus on Local Vaginal Therapy

    Directory of Open Access Journals (Sweden)

    Toril Andersen

    2015-01-01

    Full Text Available Mucoadhesive drug therapy destined for localized drug treatment is gaining increasing importance in today’s drug development. Chitosan, due to its known biodegradability, bioadhesiveness and excellent safety profile offers means to improve mucosal drug therapy. We have used chitosan as mucoadhesive polymer to develop liposomes able to ensure prolonged residence time at vaginal site. Two types of mucoadhesive liposomes, namely the chitosan-coated liposomes and chitosan-containing liposomes, where chitosan is both embedded and surface-available, were made of soy phosphatidylcholine with entrapped fluorescence markers of two molecular weights, FITC-dextran 4000 and 20,000, respectively. Both liposomal types were characterized for their size distribution, zeta potential, entrapment efficiency and the in vitro release profile, and compared to plain liposomes. The proof of chitosan being both surface-available as well as embedded into the liposomes in the chitosan-containing liposomes was found. The capability of the surface-available chitosan to interact with the model porcine mucin was confirmed for both chitosan-containing and chitosan-coated liposomes implying potential mucoadhesive behavior. Chitosan-containing liposomes were shown to be superior in respect to the simplicity of preparation, FITC-dextran load, mucoadhesiveness and in vitro release and are expected to ensure prolonged residence time on the vaginal mucosa providing localized sustained release of entrapped model substances.

  16. A critical appraisal of the misoprostol removable, controlled-release vaginal delivery system of labor induction

    Directory of Open Access Journals (Sweden)

    Patte C

    2015-11-01

    Full Text Available Charlotte Patte,1 Philippe Deruelle1,21Lille University Hospital, Jeanne De Flandre Maternity, 2UPRES EA 4489, Environnement périnatal et santé, Faculté de médecine Henri Warembourg, Université Lille 2, Lille, France Background: Induction of labor is a major issue in pregnancy management. Finding strategies to increase rate and decrease time to vaginal delivery is an important goal, but maternal or neonatal safety must remain the primary objective. Misoprostol is a synthetic analogue of prostaglandin used off label to ripen the cervix and induce labor. The misoprostol vaginal insert (MVI was designed to allow a controlled-release delivery of misoprostol (from 50 to 200 µg with a removal tape. The objective of this review was to make a critical appraisal of this device referring to the literature.Methods: A literature search was performed in the PubMed and Cochrane databases using the keywords “vaginal misoprostol insert”.Results: Several studies compared different doses of MVI (50, 100, 150, and 200 µg with the 10 mg dinoprostone insert. The 100 µg MVI compared with the dinoprostone vaginal insert (DVI showed similar efficacy and no significant differences in cesarean delivery rate. MVI 200 µg compared with DVI showed a reduced time to vaginal delivery and oxytocin need but had an increased risk of uterine hyperstimulation. The rate of hyperstimulation syndrome was two to three times more frequent with the 200 µg MVI than the 100 µg.Conclusion: Current data suggest that the 100 µg MVI would provide the best balance between efficacy and safety. Further studies should be performed to evaluate this dose, especially in high-risk situations needing induction of labor. Keywords: prostaglandins, efficacy, safety, pregnancy 

  17. Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial.

    Science.gov (United States)

    Morais, Ítalo; Lemos, Andréa; Katz, Leila; Melo, Lorena Fernandes Rosendo de; Maciel, Mariano Maia; Amorim, Melania Maria Ramos de

    2016-07-01

    Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111-1131-8433) was conducted in a hospital in Northeastern, Brazil. Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15 ° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature was monitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no

  18. [Trying vaginal delivery in 1000 patients with previous cesarean section in the Antiguo Hospital Civil de Guadalajara].

    Science.gov (United States)

    Guzman Sánchez, A; Alfaro Alfaro, N; Pérez García, J F; Martín de Alba, A

    1998-08-01

    Because of the main justification for practicing a cesarean section is due to a previous cesarean and the rasing rates frequency of this operation, we concluded a descriptive and prospective investigation in order to analize the factibility and security of vaginal delivery after one cesarean section. We include 1000 patients with a past history of one previous cesarean section and with the following main characteristics: normal evaluation of the actual pregnancy and a gestational age of at least 36 weeks of pregnancy, no pelvis stenosis and a normal fetal status. The management were expectant and or with the use of oxitocin, prostaglandin PGEJ, uterionhibition and or amnioinfusion according to medical indication, 679 (67.9%) patients had a vaginal delivery; one ruterine rupture (0.001 x 1000) happened (the place of the rupture were not in the scar of the previous cesarean); two uterine dehicence (0.002 x 1000) of the previous uterine scar; one of this require laparotomy and sture of the dehiscence scar and the other one only require observation. We had two intrapartum fetal dead (0.002 x 1000) on due to the uterine rupture and the other one because of a taquisitolia not corrected by betamimetics. The factibility and security of vaginal delivery after one previous cesarean section is a logical and reasonable strategy in order to decrease the actual high rates of cesarean section. Whenever we try a viginal delivery in a patients with one previous cesarean is imperative to keep in mind that if something is not going well during the attempts we must repeat another cesarean.

  19. The Impact of Healthcare Reform Plan on the Rate of Vaginal Delivery and Cesarean Section in Shiraz (Iran) in 2015.

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    Rooeintan, Faranak; Borzabad, Parviz Aghaei; Yazdanpanah, Abbas

    2016-10-01

    The uncontrolled increase in the rate of cesarean section is one of the most controversial issues, and is a primary challenge among health policy makers. This study was conducted to examine the impact of the Iranian health evolution plan on vaginal delivery rate and cesarean section. This cross-sectional study was carried out in 2014. Maternal health data for 2013 and 2014 were used in this study and changes in vaginal delivery and cesarean section were compared before and after the reform, using t-test and Wilkinson test. According to the findings of this study, 64.7% of deliveries in 2013 were performed using cesarean section while it was 58.6% in 2014 (p= 0.772), of which no significant changes were observed. In addition, the percentage of vaginal delivery in 2013 and 2014 were 35.3% and 41.4% respectively (p= 0.00), so a significant increase was found for vaginal delivery. Healthcare reform has led to an increase in the number of vaginal deliveries in hospitals affiliated to Shiraz University of Medical Sciences (SUMS). Due to the limited number of hospitals adhering to the healthcare reform plan to increase vaginal delivery (using private midwife and implementing painless delivery), the reform for decreasing the cesarean rate was not effective enough.

  20. Spray-dried powders enhance vaginal siRNA delivery by potentially modulating the mucus molecular sieve structure

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    Wu N

    2015-08-01

    Full Text Available Na Wu,1,2,* Xinxin Zhang,2,* Feifei Li,2 Tao Zhang,2 Yong Gan,2 Juan Li1 1School of Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China; 2Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Vaginal small interfering RNA (siRNA delivery provides a promising strategy for the prevention and treatment of vaginal diseases. However, the densely cross-linked mucus layer on the vaginal wall severely restricts nanoparticle-mediated siRNA delivery to the vaginal epithelium. In order to overcome this barrier and enhance vaginal mucus penetration, we prepared spray-dried powders containing siRNA-loaded nanoparticles. Powders with Pluronic F127 (F127, hydroxypropyl methyl cellulose (HPMC, and mannitol as carriers were obtained using an ultrasound-assisted spray-drying technique. Highly dispersed dry powders with diameters of 5–15 µm were produced. These powders showed effective siRNA protection and sustained release. The mucus-penetrating properties of the powders differed depending on their compositions. They exhibited different potential of opening mesh size of molecular sieve in simulated vaginal mucus system. A powder formulation with 0.6% F127 and 0.1% HPMC produced the maximum increase in the pore size of the model gel used to simulate vaginal mucus by rapidly extracting water from the gel and interacting with the gel; the resulting modulation of the molecular sieve effect achieved a 17.8-fold improvement of siRNA delivery in vaginal tract and effective siRNA delivery to the epithelium. This study suggests that powder formulations with optimized compositions have the potential to alter the steric barrier posed by mucus and hold promise for effective vaginal siRNA delivery. Keywords: siRNA delivery, vaginal administration, spray-dried powders, mucus penetration, molecular sieve effect

  1. Alterations in head shape of newborn infants after caesarean section or vaginal delivery.

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    Souza, S W; Ross, J; Milner, R D

    1976-08-01

    Alterations of head shape in preterm, small-for-dates, and term normal infants were studied by measuring occipitofrontal circumference (OFC), biparietal diameter (BPD), and occipitofrontal diameter (OFD) at intervals after birth. In 9 preterm infants born by elective caesarean section ther was a 5-2% reduction in BPD and 2-0% reduction in OFC at the age of 7 days. In 18 term infants born by elective caesarean section these changes were 2-4% and 0% respectively in BPD and OFC. In 25 preterm infants born by vertex vaginal delivery there was a significant fall in OFC of 0-7% at the age of 7 days and of 2-4% in BPD, but no significant change in OFD. In 19 small-for-dates infants born vaginally OFC increased 1-0% and OFD 2-7% at 7 days, but BPD decreased 2-5%. After the first week all three measurements increased in both groups of vaginal deliveries. The results show that shrinkage and biparietal flattening of the skull occur during the first week of life in preterm and term infants born by caesarean section and in preterm infants born vaginally. This fact should be borne in mind when comparing the measurements of an infant's head size with published norms.

  2. A Rare Complication of a Vaginal Breech Delivery

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    H. C. Vergers-Spooren

    2011-01-01

    Full Text Available Rectal lesions without anal sphincter trauma in childbirth are only sporadically described in literature. We describe the case of a 29-year-old primigravida who delivered a child in frank breech presentation. During the second stage of labour a foot presented transanally through a rectal laceration with intact anal sphincters. The laceration was repaired immediately after delivery in theatre. Follow-up visits showed a properly cured laceration and no complaints of incontinence or foul discharge.

  3. Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu’s Arteritis

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    Sean Patrick Clifford MD

    2016-12-01

    Full Text Available Takayasu’s arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu’s arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery.

  4. Acute pseudo-obstruction of the large bowel with caecal perforation following normal vaginal delivery: a case report

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    Seenath Marlon

    2010-04-01

    Full Text Available Abstract Introduction Acute pseudo-obstruction of the large bowel following normal vaginal delivery is an extremely rare complication of normal vaginal delivery. It can be fatal if not recognized early. Only one previous report has been found in the English literature. Case presentation A 36-year old Caucasian, normally fit woman presented with abdominal distension and vomiting five days post-normal vaginal delivery at term. Localised peritonitis in the right iliac fossa developed in the next few days, and caecal perforation was found at laparotomy, without evidence of appendicitis or colitis. Conclusion Although very rare, Ogilvie's syndrome should be considered by obstetricians, general surgeons and general practitioners as a potential cause of vomiting and abdominal pain following normal vaginal delivery. Early recognition and management are essential to minimize the possibility of developing serious complications.

  5. Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture.

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    Persson, Lisa K G; Sakse, Abelone; Langhoff-Roos, Jens; Jangö, Hanna

    2017-06-01

    To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life. This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry. The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses. Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

  6. Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery.

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    Baydock, Sandra A; Flood, Catherine; Schulz, Jane A; MacDonald, Dianna; Esau, Deborah; Jones, Sandra; Hiltz, Craig B

    2009-01-01

    To determine the prevalence of and risk factors for urinary and fecal incontinence four months after vaginal delivery. All patients who had vaginal deliveries at a tertiary care hospital over a three-month period were approached during their postpartum hospital stay regarding participation in the study. Participants underwent a telephone interview at four months after their delivery to determine the presence and type of any incontinence. Of 632 patients, 145 (23%) had stress incontinence, 77 (12%) had urge incontinence, 181 (29%) had any urinary incontinence and 23 (4%) had fecal incontinence. In univariate analysis, stress incontinence was found to be increased in patients>or=30 years of age (26.2%) compared with patientsor=30 years (34.1%) compared to or=30 years (P<0.01) and forceps delivery (P<0.01). There were no identified risk factors for fecal incontinence. Urinary incontinence is common in women at four months post partum. Fecal incontinence is less common. Maternal age and forceps assisted delivery were risk factors for urinary incontinence.

  7. Budi Iman Santoso Assessment (BISA: a model for predicting levator ani injury after vaginal delivery

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    Budi I. Santoso

    2012-05-01

    Full Text Available Background: There have been no attempts or studies to integrate various risk factors that can be utilized to predict levator ani injury caused by vaginal delivery. This study was aimed to establish an index measurement system by using various risk factors for predicting levator ani injury in vaginal delivery.Methods: A prospective cohort was conducted at two hospitals in Jakarta between 2010 and 2011. The subjects were nulipara pregnant women without levator ani injury during pregnancy and vaginal birth. Levator ani injury was evaluated using 4D USG during pregnancy and three months after delivery. The variables studied were age, body mass index, mode of delivery, fetal birth weight, episiotomy, perineum rupture and duration of second stage labor. Prediction model was analyzed using logistic regression analysis.Results: There were 182 recruited subjects of which 124 subjects were eligible and only 104 subjects could be analyzed. Incidence of levator ani injury at three months after delivery was 15.4% (95% CI: 8.6-23%. Two prediction models were obtained. The first consisted of fetal birth weight (OR= 5.36, 95% CI: 1.08-26.59, episiotomy (OR= 5.41, 95% CI: 0.94-31.18, and duration of second stage labor (OR= 15.27, 95% CI: 3.15-73.96. The second model consisted of duration of second stage labor (OR= 9.51, 95% CI: 1.23-68.10 and perineum rupture (OR= 142.70, 95% CI: 14.13-1440.78.Conclusion: Fetal birth weight, episiotomy and duration of second stage labor could predict levator ani injury for model 1; while the variables of prediction for model 2 were duration of second stage labor and perineum rupture. (Med J Indones. 2012;21:102-7Keywords: Levator ani, prediction model

  8. Preparation and characterization of bioadhesive controlled-release gels of cidofovir for vaginal delivery.

    Science.gov (United States)

    Tuğcu-Demiröz, Fatmanur; Acartürk, Füsun; Özkul, Aykut

    2015-01-01

    The aim of this study was to develop mucoadhesive and thermosensitive gels for vaginal delivery that would be able to provide a controlled release of the model drug, cidofovir. The study also monitored the drug's potential antiviral properties. Cidofovir was put into the form of a vaginal gel, using mucoadhesive and thermosensitive polymers such as chitosan, Carbopol 974P, HPMC, and poloxamer 407. The physicopharmaceutical properties and stability of the vaginal gel formulations were evaluated. The gel formulation which was prepared with HPMC K100M exhibited the highest viscosity, as well as maximum adhesiveness, cohesiveness, and mucoadhesion values. The results of antiviral activity studies, which used the bovine herpes virus type 1 virus infection in vitro model using Vero cells, demonstrated the antiherpetic effect of the cidofovir gel containing HPMC K100M, at least under in vitro conditions. The study found that a mucoadhesive vaginal gel containing cidofovir can be a promising and innovative alternative therapeutic system for the treatment of genital herpes simplex virus and human papilloma virus induced infections in women.

  9. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section.

    Science.gov (United States)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola; Kristensen, Kim; Secher, Niels Jørgen

    2017-01-01

    Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. Emergency caesarean section was not associated with childhood asthma. none. not relevant.

  10. The association between intrauterine inflammation and spontaneous vaginal delivery at term: a cross-sectional study.

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    Michiel L Houben

    Full Text Available BACKGROUND: Different factors contribute to the onset of labor at term. In animal models onset of labor is characterized by an inflammatory response. The role of intrauterine inflammation, although implicated in preterm birth, is not yet established in human term labor. We hypothesized that intrauterine inflammation at term is associated with spontaneous onset of labor. METHODS/RESULTS: In two large urban hospitals in the Netherlands, a cross-sectional study of spontaneous onset term vaginal deliveries and elective caesarean sections (CS, without signs of labor, was carried out. Placentas and amniotic fluid samples were collected during labor and/or at delivery. Histological signs of placenta inflammation were determined. Amniotic fluid proinflammatory cytokine concentrations were measured using ELISA. A total of 375 women were included. In term vaginal deliveries, more signs of intrauterine inflammation were found than in elective CS: the prevalence of chorioamnionitis was higher (18 vs 4%, p = 0.02 and amniotic fluid concentration of IL-6 was higher (3.1 vs 0.37 ng/mL, p<0.001. Similar results were obtained for IL-8 (10.93 vs 0.96 ng/mL, p<0.001 and percentage of detectable TNF-alpha (50 vs 4%, p<0.001. CONCLUSIONS: This large cross-sectional study shows that spontaneous term delivery is characterized by histopathological signs of placenta inflammation and increased amniotic fluid proinflammatory cytokines.

  11. Frequency of placenta previa in women with history of previous caesarean and normal vaginal deliveries.

    Science.gov (United States)

    Bashir, Adeela; Jadoon, Humaira Naz; Abbasi, Aziz-un-Nisa

    2012-01-01

    Placenta previa is known to be associated with previous caesarean deliveries, advanced maternal age, increasing parity, smoking, curettage and myomectomy. This study was carried out to compare the frequency of placenta previa, in women with previous caesareans versus those with normal vaginal deliveries. It was one year study conducted at the Department of Obstetrics and Gynaecology Unit B, Ayub Teaching Hospital, Abbottabad. One hundred women were included in the study, 50 in Group A with previous caesarean deliveries, and 50 in Group B with previous normal vaginal deliveries. Frequency of placenta previa in both groups was analysed. Placenta previa was found in one (2%) woman in Group A, and in two women (4%) in Group B. It was not found in para 4 or less in both groups. One woman in Group A and two women in Group B with parity 4 or more had placenta previa (p placenta previa, while with previous 2 scars one had placenta previa (p placenta previa in Group A and both women with placenta previa in Group B were more than 25 years old. Placenta previa was not found in women below 25 years of age. Previous one caesarean section did not increase the frequency of placenta previa. Increasing number of scars, increasing maternal age beyond 25 years and increasing parity beyond 4 were associated with placenta previa.

  12. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery.

    Science.gov (United States)

    Adams, S S; Eberhard-Gran, M; Eskild, A

    2012-09-01

    To assess the association between fear of childbirth and duration of labour. A prospective study of women from 32 weeks of gestation through to delivery. Akershus University Hospital, Norway. A total of 2206 pregnant women with a singleton pregnancy and intended vaginal delivery during the period 2008-10. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ) version A at 32 weeks of gestation, and defined as a W-DEQ sum score ≥ 85. Information on labour duration, use of epidural analgesia and mode of delivery was obtained from the maternal ward electronic birth records. Labour duration in hours: from 3-4 cm cervical dilatation and three uterine contractions per 10 minutes lasting ≥ 1 minute, until delivery of the child. Fear of childbirth (W-DEQ sum score ≥ 85) was present in 7.5% (165) of women. Labour duration was significantly longer in women with fear of childbirth compared with women with no such fear using a linear regression model (crude unstandardized coefficient 1.54; 95% confidence interval 0.87-2.22, corresponding to a difference of 1 hour and 32 minutes). After adjustment for parity, counselling for pregnancy concern, epidural analgesia, labour induction, labour augmentation, emergency caesarean delivery, instrumental vaginal delivery, offspring birthweight and maternal age, the difference attenuated, but remained statistically significant (adjusted unstandardized coefficient 0.78; 95% confidence interval 0.20-1.35, corresponding to a 47-minute difference). Duration of labour was longer in women with fear of childbirth than in women without fear of childbirth. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  13. Posthysterectomy vault prolapse of vaginal walls: Choice of operating procedure

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    Argirović Rajka

    2012-01-01

    Full Text Available Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman’s quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and costeffectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

  14. Martius flap and anterior vaginal wall sling for correction of urethrovaginal fistula (UVF associated with stress urinary incontinence (SUI after vaginal delivery

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    A.M. Abdelbary

    2012-12-01

    Conclusions: Patients with a post-birth trauma in the form of UVF should be examined intra-operatively for the presence of associated SUI following correction of UVF. The use of the Martius flap and anterior vaginal wall sling in treating such patients is safe, efficient and reproducible. An anterior vaginal wall sling should be avoided in distal UVF to avoid recurrence of SUI.

  15. Successful Vaginal Delivery despite a Huge Ovarian Mucinous Cystadenoma Complicating Pregnancy: A Case Report

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    Dipak Mandi

    2013-12-01

    Full Text Available A 22-year-old patient with 9 months of amenorrhea and a huge abdominal swelling was admitted to our institution with an ultrasonography report of a multiloculated cystic space-occupying lesion, almost taking up the whole abdomen (probably of ovarian origin, along with a single live intrauterine fetus. She delivered vaginally a boy baby within 4 hours of admission without any maternal complication, but the baby had features of intrauterine growth restriction along with low birth weight. On the 8th postpartum day, the multiloculated cystic mass, which arose from the right ovary and weighed about 11 kg, was removed via laparotomy. A mucinous cystadenoma with no malignant cells in peritoneal washing was detected in histopathology examination. This report describes a rare case of a successful vaginal delivery despite a huge cystadenoma of the right ovary complicating the pregnancy.

  16. Successful pregnancy "during" pedicled transverse rectus abdominis musculocutaneous flap for breast reconstruction with normal vaginal delivery

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    Siew Cheng Chai

    2015-01-01

    Full Text Available A transverse rectus abdominis myocutaneous (TRAM flap is a popular choice for breast reconstruction. Pregnancies in women following a TRAM flap present concerns regarding both safety and the integrity of the abdominal wall. We report a case of a patient who was pregnant during immediate breast reconstruction with pedicled TRAM flap and had a successful spontaneous vaginal delivery. We also conducted a literature review using PubMed on pregnancy post TRAM flap, type of reconstruction, timing of pregnancy after TRAM flap, complication, and mode of delivery, which are summarised in this report. We concluded that patients may have safe pregnancies and normal deliveries following TRAM flap breast reconstruction regardless of the time frame of pregnancy after the procedure. Therefore, TRAM flaps can continue to be a reconstruction option, even in women of childbearing age.

  17. DO CHANGES IN ANAL SPHINCTER ANATOMY CORRELATE WITH ANAL FUNCTION IN WOMEN WITH A HISTORY OF VAGINAL DELIVERY?

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    Sthela Maria MURAD-REGADAS

    2014-09-01

    Full Text Available Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS, the anterior and posterior internal anal sphincter (IAS, the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal.

  18. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

    OpenAIRE

    Liu, E H C; Sia, A T H

    2004-01-01

    Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women.

  19. Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients.

    Science.gov (United States)

    Rusavy, Zdenek; Karbanova, Jaroslava; Jansova, Magdalena; Kalis, Vladimir

    2016-12-01

    To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery. The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery including mediolateral or lateral episiotomy between April 1, 2010 and March 31, 2012. Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum. Anal incontinence was defined as a St Mark's incontinence score above four and individual anal-incontinence components were analyzed separately; results were compared between the two episiotomy techniques. Questionnaires were returned by 300 and 366 patients who underwent mediolateral and lateral episiotomies, respectively; baseline characteristics were similar. Anal incontinence at 3 months and 6 months was recorded among 21 (7.0%) and 9 (3.0%) patients who underwent mediolateral and 27 (7.4%) and 20 (5.5%) who underwent lateral episiotomy, respectively. The study was underpowered to confirm equivalence between the groups; however, no statistically significant differences were observed in the rates of anal incontinence, flatus, solid or liquid incontinence, and de novo incontinence. Fecal urgency (P=0.017) and de novo fecal urgency (P=0.008) were more prevalent among patients who underwent lateral episiotomies at 6 months. Anal incontinence was comparable between primiparous patients who underwent mediolateral or lateral episiotomy. The association between lateral episiotomy and fecal urgency merits further scientific interest. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. The efficacy of lower uterine segment compression for prevention of early postpartum hemorrhage after vaginal delivery.

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    Chantrapitak, Wanchai; Srijuntuek, Kamol; Wattanaluangarun, Renu

    2011-06-01

    To determine the efficacy and amount of blood loss of the maneuver utilizing lower uterine segment compression (LUSC) for the prevention of early postpartum hemorrhage. The present study enrolled 686 mothers with singleton pregnancy, gestational ages between 28 and 42 weeks, at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok between July 2009 and March 2010. All subjects had no past medical history and delivered by vaginal route. They were divided into two groups, the experimental group and the control group. Mothers in both experimental and control groups were treated with the same methods, oxytocin administration before and after delivery, clamping and cutting umbilical cords within three minutes after birth of the newborns, and placental delivery done by controlled cord traction together with uterine massage at the fundus through the abdominal wall immediately. In addition, in the experimental group, the subjects were assisted by LUSC for 10 minutes. The amount of blood loss was measured and recorded two hours after delivery of the placentas in both experimental and control groups. Among 686 cases, nine cases were excluded from the present study. They were composed of five cases in the control group, with retained placenta, and four cases in the experimental group because of retained placenta, retained placental fragments, severe perineum tear, and vaginal hematoma. Subjects in the experimental group who were additionally assisted by LUSC were found to have lesser incidence of PPH with statistical significance in comparison to those in the control group (2.9% vs. 6.8%; relative risk 0.43, 95% confidence interval 0.21-0.90, p = 0.02). The amount of blood loss reduced by 29.26 ml (289.70 +/- 179.53 mlvs. 260.44 +/- 116.30 ml), p = 0.012). Lower uterine segment compression (LUSC) significantly reduced the rate of PPH and amount of blood loss after vaginal delivery The efficacy of this technique was over the conventional method

  1. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance.

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    Hilde, Gunvor; Stær-Jensen, Jette; Siafarikas, Franziska; Engh, Marie Ellström; Brækken, Ingeborg Hoff; Bø, Kari

    2013-01-01

    We sought to study impact of delivery mode on vaginal resting pressure (VRP) and on pelvic floor muscle (PFM) strength and endurance, and whether these measurements differed in women with and without urinary incontinence. We conducted a cohort study following 277 nulliparous women from midpregnancy to 6 weeks postpartum. Manometer was used for PFM measurements; differences were analyzed by t test (within groups) and analysis of variance (between groups). Only VRP changed significantly (10% reduction, P = .001) after emergency cesarean section. After normal and instrumental vaginal delivery, VRP was reduced by 29% and 30%; PFM strength by 54% and 66%; and endurance by 53% and 65%, respectively. Significant differences for all PFM measures (P VRP and in PFM strength and endurance were found after vaginal delivery. Continent women were stronger than incontinent counterparts. Copyright © 2013 Mosby, Inc. All rights reserved.

  2. Bioinspired bioartifical polymer hybrid composites for propolis vaginal delivery II: formulation and characterization

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    M. Glavas-Dodov

    2014-12-01

    Full Text Available In our previous work Box-Behnken experimental design was applied for formulation optimization of the thermoreversible mucoadhesive in situ vaginal hydrogels with propolis and optimized batches were identified. Optimized batches of bioartificial polymer hybrid composites (chitosan, Lutrol® F-127 and Lutrol® F-68 mixture (CP1, CP2, CP3 were prepared using so-called cold method. Formulation P3 (chitosan free was prepared in order to evaluate the effect of chitosan on the physico-chemical and biopharmaceutical properties of the polymer hybrid composites (gels. The pH values of the gels were 4-4.5. The gelation temperature for all formulations was in a range of 29-33 o C. Total flavonoids content was above 95%. Increase in concentration of Lutrol® F-127 and Lutrol® F-68/Lutrol® F-127 ratio lead to a higher viscosity values and slower gel erosion/dissolution. The presence of chitosan increased gel viscosity and hence slow-down erossion/dissoluiton. Propolis release rate was the highest in P3 which released propolis within 5 h, corresponding to time of complete erosion. The same correlation between erosion process and drug release rate was observed in CP1-CP3, where prolonged propolis release for more than 10 h was achieved. Microbiological quality was in accordance with the requirements of Ph. Eur. 7. All formulations demonstrated adequate stability at 5 ± 3 °C during 6 months. Based on overall results it can be anticipated that bioartificial blended bioinspired polymer hybrid composites for propolis vaginal delivery could represent intelligent delivery systems with physicochemical and biopharmaceutical properties in favor or efficacious and safe therapy of vaginal infections.

  3. Novel vaginal drug delivery system: deformable propylene glycol liposomes-in-hydrogel.

    Science.gov (United States)

    Vanić, Željka; Hurler, Julia; Ferderber, Kristina; Golja Gašparović, Petra; Škalko-Basnet, Nataša; Filipović-Grčić, Jelena

    2014-03-01

    Deformable propylene glycol-containing liposomes (DPGLs) incorporating metronidazole or clotrimazole were prepared and evaluated as an efficient drug delivery system to improve the treatment of vaginal microbial infections. The liposome formulations were optimized based on sufficient trapping efficiencies for both drugs and membrane elasticity as a prerequisite for successful permeability and therapy. An appropriate viscosity for vaginal administration was achieved by incorporating the liposomes into Carbopol hydrogel. DPGLs were able to penetrate through the hydrogel network more rapidly than conventional liposomes. In vitro studies of drug release from the liposomal hydrogel under conditions simulating human treatment confirmed sustained and diffusion-based drug release. Characterization of the rheological and textural properties of the DPGL-containing liposomal hydrogels demonstrated that the incorporation of DPGLs alone had no significant influence on mechanical properties of hydrogels compared to controls. These results support the great potential of DPGL-in-hydrogel as an efficient delivery system for the controlled and sustained release of antimicrobial drugs in the vagina.

  4. Persistent postpartum urinary retention following vaginal delivery: a rare complication in obstetrics practice

    Directory of Open Access Journals (Sweden)

    Amrita Chaurasia

    2013-06-01

    Full Text Available Postpartum urinary retention occurs in 10-15% of women and is likely to be multifactorial in origin. Long labour, epidural analgesia, instrumental delivery, nulliparity, significant vaginal and perineal laceration or a previous history of voiding difficulty are risk factors for altered voiding parameters. Previous literatures have defined two types of urinary retention, first, overt retention and the other covert variety. Overt variety represents the acute retention while covert variety is of subacute in nature. Being subacute in nature, it damages the detrusors slowly. Sometimes the damage is so much so that it may take substantial time to recover or may not recover at all and the patient may have lifelong detrusor hypotonia with persistent urinary retention, requiring lifelong intermittent self-catheterization. This badly affects her personal as well as social wellbeing and also poses her for recurrent urinary tract infection. Here, we report a case of 25 yrs old, 36 weeks primigravida having persistent postpartum urinary retention following vaginal delivery, Who was enough fortunate to have recovery of detrusors. But, still it took 3-4 weeks for complete recovery of the urinary bladder. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 475-477

  5. Prophylactic manual rotation for fetal malposition to reduce operative delivery.

    Science.gov (United States)

    Phipps, Hala; de Vries, Bradley; Hyett, Jon; Osborn, David A

    2014-12-22

    Manual rotation is commonly performed to increase the chances of normal vaginal delivery and is perceived to be safe. Manual rotation has the potential to prevent operative delivery and caesarean section, and reduce obstetric and neonatal complications. To assess the effect of prophylactic manual rotation for women with malposition in labour on mode of delivery, and maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), the Australian and New Zealand Clinical Trials Registry (ANZCTR), ClinicalTrials.gov, Current Controlled Trials and the WHO International Clinical Trials Registry Platform (ICTRP) (all searched 23 February 2014), previous reviews and, references of retrieved studies. Randomised, quasi-randomised or cluster-randomised clinical trials comparing prophylactic manual rotation in labour for fetal malposition versus expectant management, augmentation of labour or operative delivery. We defined prophylactic manual rotation as rotation performed without immediate assisted delivery. Two review authors independently assessed study eligibility and quality, and extracted data. We included only one small pilot study (involving 30 women). The study, which we considered to be at low risk of bias, was conducted in a tertiary referral hospital in Australia, and involved women with cephalic, singleton pregnancies. The primary outcome was operative delivery (instrumental delivery or caesarean section).In the manual rotation group, 13/15 women went on to have an instrumental delivery or caesarean section, whereas in the control group, 12/15 women had an operative delivery. The estimated risk ratio was 1.08 (95% confidence interval 0.79 to 1.49). There were no maternal or fetal mortalities in either groupThere were no clear differences for any of the secondary maternal or neonatal outcomes reported (e.g. perineal trauma, analgesia use duration of labour).In terms of adverse events, there were no

  6. Ultrasound assessment of cervical length in prolonged pregnancy: prediction of spontaneous onset of labor and successful vaginal delivery.

    Science.gov (United States)

    Vankayalapati, P; Sethna, F; Roberts, N; Ngeh, N; Thilaganathan, B; Bhide, A

    2008-03-01

    To evaluate the usefulness of sonographic assessment of cervical length in the prediction of spontaneous onset of labor and of vaginal delivery. Two hundred and six women who attended a dedicated postdates clinic at 41 + 3 weeks of pregnancy and agreed to the assessment of cervical length using transvaginal ultrasound imaging were included in the study. Those who had not delivered at 42 weeks were offered induction of labor. The labor details were recorded prospectively, and the onset of spontaneous labor and mode of delivery were correlated with cervical length data. Women who underwent spontaneous onset of labor (n = 112) had a significantly shorter cervical length (mean (SD) 25.0 (8.3) mm) than had women whose labor was induced (n = 67; mean (SD) 29.7 (8.5) mm). Logistic regression analysis showed that cervical length was an independent predictor of the likelihood of spontaneous labor in nulliparous women, and of vaginal delivery in both nulliparous and parous women. Parity had no independent effect on the onset of spontaneous labor, but was an independent predictor of the likelihood of vaginal delivery. Sonographic assessment of cervical length is a significant independent predictor of the likelihood of the onset of spontaneous labor in nulliparous women, and of successful vaginal delivery in both nulliparous and parous women with prolonged pregnancy. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.

  7. Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes

    Science.gov (United States)

    Nanda, Smiti; Gupta, Anjali; More, Hemant

    2016-01-01

    Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean). Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables. Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p = 0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p = 0.000). Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems. PMID:27631023

  8. Predicting successful intended vaginal delivery after previous caesarean section : external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate

    NARCIS (Netherlands)

    Schoorel, E. N. C.; Melman, S.; van Kuijk, S. M. J.; Grobman, W. A.; Kwee, A.; Mol, B. W. J.; Nijhuis, J. G.; Smits, L. J. M.; Aardenburg, R.; de Boer, K.; Delemarre, F. M. C.; van Dooren, I. M.; Franssen, M. T. M.; Kleiverda, G.; Kaplan, M.; Kuppens, S. M. I.; Lim, F. T. H.; Sikkema, J. M.; Smid-Koopman, E.; Visser, H.; Vrouenraets, F. P. J. M.; Woiski, M.; Hermens, R. P. M. G.; Scheepers, H. C. J.

    2014-01-01

    ObjectiveTo externally validate two models from the USA (entry-to-care [ETC] and close-to-delivery [CTD]) that predict successful intended vaginal birth after caesarean (VBAC) for the Dutch population. DesignA nationwide registration-based cohort study. SettingSeventeen hospitals in the Netherlands.

  9. The preference of Iranian women to have normal vaginal or cesarean deliveries

    Directory of Open Access Journals (Sweden)

    Najmeh Maharlouei

    2013-01-01

    Full Text Available Background: The cesarean section (C-section has higher risk compared to normal vaginal delivery (NVD. The aim of this population-based study was to evaluate the frequency of mothers′ tendency toward the mode of delivery and the factors that can affect this inclination. Materials and Methods: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20 th to 30 th weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother′s preference for the route of delivery. Results: Of 6921 participants, 2197 (31.7% preferred C-section and 4308 (62.2% favored NVD while 416 (6% had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1% participants was zero, and 1261 women (18.2% achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother′s unacceptable level of knowledge regarding complications of C-section, and mother′s and husband′s positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. Conclusion: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.

  10. Vaginal birth - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features ... vaginal delivery. Please keep in mind that every birth is unique, and your labor and delivery may ...

  11. Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women

    DEFF Research Database (Denmark)

    Svare, Jens A; Hansen, Bent B; Lose, Gunnar

    2014-01-01

    INTRODUCTION AND HYPOTHESIS: The objective was to examine the relationship between maternal and perinatal factors and the occurrence of stress (SUI) or mixed (MUI) urinary incontinence (UI) 1 year after the first vaginal delivery in primiparous women. METHODS: Participants in this prospective coh...

  12. Vacuum-assisted vaginal delivery (VAVD)-basics for the risk manager.

    Science.gov (United States)

    Veltman, Larry

    2014-01-01

    The neonatal intensive care unit (NICU) manager calls you about a baby delivered last night now with brain trauma. She understands that it was a difficult delivery with a vacuum. There were "multiple pop-offs" and, after the baby was delivered, the NICU resuscitation team was called. The Apgar scores were 3 and 5. They are requesting risk management to lead a debriefing today. What to ask? How many pop-offs are allowed? What was the interaction between the nurses and physician? Why wasn't the resuscitation team in attendance before the delivery? Was the vacuum placed properly? How many pulls? How long was the vacuum in place? What should be documented, and was the documentation adequate? All of these are appropriate questions for an adequate analysis of an adverse outcome resulting from a vacuum-assisted vaginal delivery (VAVD). This article focuses on the risk management issues of VAVD in order to give the risk manager a better understanding of appropriate use, data-gathering tools, educational opportunities, and assistance in establishing a culture of safety for the entire perinatal team regarding the use of the vacuum device. © 2014 American Society for Healthcare Risk Management of the American Hospital Association.

  13. Optimisation of polyherbal gels for vaginal drug delivery by Box-Behnken statistical design.

    Science.gov (United States)

    Chopra, Shruti; Motwani, Sanjay K; Iqbal, Zeenat; Talegaonkar, Sushma; Ahmad, Farhan J; Khar, Roop K

    2007-08-01

    The present research work aimed at development and optimisation of mucoadhesive polyherbal gels (MPG) for vaginal drug delivery. As the rheological and mucoadhesive properties of the gels correlate well to each other the prepared MPGs were optimised for maximum mucoadhesion using a relationship between the storage modulus (G') and Gel Index (GI), by employing a 3-factor, 3-level Box-Behnken statistical design. Independent variables studied were the polymer concentration (X(1)), honey concentration (X(2)) and aerosil concentration (X(3)). Aerosil has been investigated for the first time to improve the consistency of gels. The dependent variables studied were the elastic modulus, G'(Y(1)), gel index (Y(2)), and maximum detachment force (Y(3)) with applied constraints of 500vaginal drug delivery by optimum mucoadhesion and longer retention.

  14. Mathematical Model for the Secretion of Oxytocin after Vaginal Delivery or Caesarean in Breastfeeding Women

    Directory of Open Access Journals (Sweden)

    Dr. S. Lakshmi

    2014-05-01

    Full Text Available Oxytocin, which is produced in the supraoptic (SON and paraventricular (PVN nuclei of the hypothalamus, is released in to circulation from magnocellular neurons which extend down to the posterior pituitary. In addition, oxytocin is produced and released from parvocellular neurons in the PVN, which project to many areas within the brain such as other parts of the hypothalamus, the amygdala , the striatum, the raphenuclei, the LC, the vagal motor and sensory nuclei, the dorsal horn of the spinal cord as well as the preganglionic sympathetic neurons of the intermediolateral column of the spinal cord . The structure of the nonapeptide oxytocin differs by only two amino acids from that of vasopressin, which is produced in separate neurons of the PVN and SON. Only one oxytocin receptor, i.e. the uterine type of receptor, has been identified. This type of receptor also has been demonstrated in the central nervous system. Oxytocin release into the nervous system during the early postpartum period may strengthen the expression of maternal behaviors and prolong breastfeeding. Comparisons between woman following vaginal delivery (VD versus caesarean section (CS suggest that exposure to oxytocin during labor and in the postpartal period can influence the subsequent function of oxytocin-producing neurons during the lactation period. In the Mathematical model, both the cases are compared by finding the Renewal density and Failure Density functions. Renewal density is higher if we compare the caesarean case with vaginal delivery during the labor and in the early post partum period. In a similar manner, we obtain the bounds of the failure density functions in both the cases. MATHEMATICAL SUBJECT CLASSIFICATION: 60GXX, 60E05.

  15. Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

    Directory of Open Access Journals (Sweden)

    Cantekin Iskender

    Full Text Available PURPOSE: To describe the risk factors and labor characteristics of Clavicular fracture (CF and brachial plexus injury (BPI; and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. METHODS: This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300 was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. RESULTS: During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2% sustained permanent injury, whereas one neonate (4.5% with BPI following shoulder dystocia sustained permanent injury (p = 0.34. CONCLUSION: BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

  16. Chitosan gel containing polymeric nanocapsules: a new formulation for vaginal drug delivery

    Directory of Open Access Journals (Sweden)

    Frank LA

    2014-06-01

    100. The chitosan formulation presented suitable viscosity for vaginal application and acidic pH (approximately 4.5. The tensile stress test showed that both formulations containing polymeric nanocapsules presented higher mucoadhesion when compared with the formulation without nanocapsules. In the washability experiment, no significant differences were found between formulations. Confocal microscopy and fluorescence quantification after extraction from the mucosa showed higher penetration of Nile red when it was nanoencapsulated, particularly in cationic nanocapsules. The formulations developed based on chitosan gel vehicle at 2.5% weight/weight containing polymeric nanocapsules, especially the cationic nanocapsules, demonstrated ­applicability for the vaginal delivery of hydrophobic substances.Keywords: Eudragit® RS 100, Eudragit® S 100, vaginal route, nanotechnology

  17. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus – a systematic review

    Directory of Open Access Journals (Sweden)

    Yang Jin

    2008-08-01

    Full Text Available Abstract Background Caesarean section before labor or before ruptured membranes ("elective caesarean section", or ECS has been introduced as an intervention for preventing mother-to-child transmission (MTCT of hepatitis B virus (HBV. Currently, no evidence that ECS versus vaginal delivery reduces the rate of MTCT of HBV has been generally provided. The aim of this review is to assess, from randomized control trails (RCTs, the efficacy and safety of ECS versus vaginal delivery in preventing mother-to-child HBV transmission. Results We searched Cochrane Pregnancy and Childbirth Group's Trials Register (January, 2008, the Cochrane Central Register of Controlled Trials (the Cochrane Library 2008, issue 1, PubMed (1950 to 2008, EMBASE (1974 to 2008, Chinese Biomedical Literature Database (CBM (1975 to 2008, China National Knowledge Infrastructure (CNKI (1979 to 2008, VIP database (1989 to 2008, as well as reference lists of relevant studies. Finally, four randomized trails involving 789 people were included. Based on meta-analysis, There was strong evidence that ECS versus vaginal delivery could effectively reduce the rate of MTCT of HBV (ECS: 10.5%; vaginal delivery: 28.0%. The difference between the two groups (ECS versus vaginal delivery had statistical significance (RR 0.41, 95% CI 0.28 to 0.60, P Conclusion ECS appears to be effective in preventing MTCT of HBV and no postpartum morbidity (PPM was reported. However, the conclusions of this review must be considered with great caution due to high risk of bias in each included study (graded C.

  18. Comparison of pelvic floor muscle strength in nulliparous women and those with normal vaginal delivery and cesarean section.

    Science.gov (United States)

    Afshari, Poorandokht; Dabagh, Fariba; Iravani, Mina; Abedi, Parvin

    2017-08-01

    Weakness of the pelvic floor is quite common among women, and may occur following childbirth. The aim of this study was to compare pelvic floor muscle strength in women of reproductive age who were nulliparous or who had a cesarean section or normal vaginal delivery. In this cross-sectional study, 341 women including 96 nulliparous women, 73 women with a history of normal vaginal delivery with and without episiotomy, and 172 women with a history of elective or emergency cesarean section were recruited randomly from public health centers in Ahvaz, Iran. Data were collected using a sociodemographic questionnaire and a checklist was used to record weight, height, body mass index, and pelvic floor muscle strength. Pelvic floor muscle strength was measured with the woman in the lithotomy position using a Peritron 9300 V perineometer. Data were analyzed using one-way analysis of variance, the least significant difference test and the chi-squared test. The nulliparous women had the highest mean pelvic muscle strength (55.62 ± 15.86 cm H2O). Women who had vaginal delivery with episiotomy had the lowest pelvic muscle strength (32.71 ± 14 cm H2O). In nulliparous women pelvic floor muscle strength was higher than in women who had normal vaginal delivery with episiotomy (p cesarean section (elective or emergency, p = 0.245). Nulliparous women had the highest pelvic floor muscle strength and there was no significant difference in pelvic floor muscle strength between women with normal vaginal delivery and those with cesarean section.

  19. Neonatal apgar scores and umbilical blood gas changes in vaginal delivery and cesarean: a comparative study

    Directory of Open Access Journals (Sweden)

    SH. Raafati

    2006-07-01

    Full Text Available Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory. Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40, elective C/S under general anesthesia (n=35 and C/S under spinal anesthesia (n=25. Duration of anesthesia and its effect on blood gas and infants apgar were assessed. Results: In the first group (vaginal delivery mean blood gase parameters were; pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05. Conclusion: There

  20. Drivers of Vaginal Drug Delivery System Acceptability from Internet-Based Conjoint Analysis

    Science.gov (United States)

    Primrose, Rachel J.; Zaveri, Toral; Bakke, Alyssa J.; Ziegler, Gregory R.; Moskowitz, Howard R.; Hayes, John E.

    2016-01-01

    Vaginal microbicides potentially empower women to protect themselves from HIV and other sexually transmitted infections (STIs), especially when culture, religion, or social status may prevent them from negotiating condom use. The open literature contains minimal information on factors that drive user acceptability of women’s health products or vaginal drug delivery systems. By understanding what women find to be most important with regard to sensory properties and product functionality, developers can iteratively formulate a more desirable product. Conjoint analysis is a technique widely used in market research to determine what combination of elements influence a consumer’s willingness to try or use a product. We applied conjoint analysis here to better understand what sexually-active woman want in a microbicide, toward our goal of formulating a product that is highly acceptable to women. Both sensory and non-sensory attributes were tested, including shape, color, wait time, partner awareness, messiness/leakage, duration of protection, and functionality. Heterosexually active women between 18 and 35 years of age in the United States (n = 302) completed an anonymous online conjoint survey using IdeaMap software. Attributes (product elements) were systematically presented in various combinations; women rated these combinations of a 9-point willingness-to-try scale. By coupling systematic combinations and regression modeling, we can estimate the unique appeal of each element. In this population, a multifunctional product (i.e., broad spectrum STI protection, coupled with conception) is far more desirable than a microbicide targeted solely for HIV protection; we also found partner awareness and leakage are potentially strong barriers to use. PMID:26999009

  1. Drivers of Vaginal Drug Delivery System Acceptability from Internet-Based Conjoint Analysis.

    Science.gov (United States)

    Primrose, Rachel J; Zaveri, Toral; Bakke, Alyssa J; Ziegler, Gregory R; Moskowitz, Howard R; Hayes, John E

    2016-01-01

    Vaginal microbicides potentially empower women to protect themselves from HIV and other sexually transmitted infections (STIs), especially when culture, religion, or social status may prevent them from negotiating condom use. The open literature contains minimal information on factors that drive user acceptability of women's health products or vaginal drug delivery systems. By understanding what women find to be most important with regard to sensory properties and product functionality, developers can iteratively formulate a more desirable product. Conjoint analysis is a technique widely used in market research to determine what combination of elements influence a consumer's willingness to try or use a product. We applied conjoint analysis here to better understand what sexually-active woman want in a microbicide, toward our goal of formulating a product that is highly acceptable to women. Both sensory and non-sensory attributes were tested, including shape, color, wait time, partner awareness, messiness/leakage, duration of protection, and functionality. Heterosexually active women between 18 and 35 years of age in the United States (n = 302) completed an anonymous online conjoint survey using IdeaMap software. Attributes (product elements) were systematically presented in various combinations; women rated these combinations of a 9-point willingness-to-try scale. By coupling systematic combinations and regression modeling, we can estimate the unique appeal of each element. In this population, a multifunctional product (i.e., broad spectrum STI protection, coupled with conception) is far more desirable than a microbicide targeted solely for HIV protection; we also found partner awareness and leakage are potentially strong barriers to use.

  2. Drivers of Vaginal Drug Delivery System Acceptability from Internet-Based Conjoint Analysis.

    Directory of Open Access Journals (Sweden)

    Rachel J Primrose

    Full Text Available Vaginal microbicides potentially empower women to protect themselves from HIV and other sexually transmitted infections (STIs, especially when culture, religion, or social status may prevent them from negotiating condom use. The open literature contains minimal information on factors that drive user acceptability of women's health products or vaginal drug delivery systems. By understanding what women find to be most important with regard to sensory properties and product functionality, developers can iteratively formulate a more desirable product. Conjoint analysis is a technique widely used in market research to determine what combination of elements influence a consumer's willingness to try or use a product. We applied conjoint analysis here to better understand what sexually-active woman want in a microbicide, toward our goal of formulating a product that is highly acceptable to women. Both sensory and non-sensory attributes were tested, including shape, color, wait time, partner awareness, messiness/leakage, duration of protection, and functionality. Heterosexually active women between 18 and 35 years of age in the United States (n = 302 completed an anonymous online conjoint survey using IdeaMap software. Attributes (product elements were systematically presented in various combinations; women rated these combinations of a 9-point willingness-to-try scale. By coupling systematic combinations and regression modeling, we can estimate the unique appeal of each element. In this population, a multifunctional product (i.e., broad spectrum STI protection, coupled with conception is far more desirable than a microbicide targeted solely for HIV protection; we also found partner awareness and leakage are potentially strong barriers to use.

  3. Optical instrument for measurement of vaginal coating thickness by drug delivery formulations

    Science.gov (United States)

    Henderson, Marcus H.; Peters, Jennifer J.; Walmer, David K.; Couchman, Grace M.; Katz, David F.

    2005-03-01

    An optical device has been developed for imaging the human vaginal epithelial surfaces, and quantitatively measuring distributions of coating thickness of drug delivery formulations—such as gels—applied for prophylaxis, contraception or therapy. The device consists of a rigid endoscope contained within a 27-mm-diam hollow, polished-transparent polycarbonate tube (150mm long) with a hemispherical cap. Illumination is from a xenon arc. The device is inserted into, and remains stationary within the vagina. A custom gearing mechanism moves the endoscope relative to the tube, so that it views epithelial surfaces immediately apposing its outer surface (i.e., 150mm long by 360° azimuthal angle). Thus, with the tube fixed relative to the vagina, the endoscope sites local regions at distinct and measurable locations that span the vaginal epithelium. The returning light path is split between a video camera and photomultiplier. Excitation and emission filters in the light path enable measurement of fluorescence of the sited region. Thus, the instrument captures video images simultaneously with photometric measurement of fluorescence of each video field [˜10mm diameter; formulations are labeled with 0.1%w/w United States Pharmacoepia (USP) injectable sodium fluorescein]. Position, time and fluorescence measurements are continuously displayed (on video) and recorded (to a computer database). The photomultiplier output is digitized to quantify fluorescence of the endoscope field of view. Quantification of the thickness of formulation coating of a surface sited by the device is achieved due to the linear relationship between thickness and fluorescence intensity for biologically relevant thin layers (of the order of 0.5mm). Summary measures of coating have been developed, focusing upon extent, location and uniformity. The device has begun to be applied in human studies of model formulations for prophylaxis against infection with HIV and other sexually transmitted pathogens.

  4. Efficacy and safety of motherwort injection and oxytocin in preventing postpartum hemorrhage after vaginal delivery: a Meta analysis

    Directory of Open Access Journals (Sweden)

    Lin-miao ZENG

    2015-11-01

    Full Text Available Objective To evaluate the clinical efficacy and safety of motherwort injection and oxytocin in preventing postpartum hemorrhage after vaginal delivery. Methods Data of randomly controlled trials (RCTs of motherwort injection and oxytocin in preventing postpartum hemorrhage after vaginal delivery were collected by searching PubMed (1980-2013.9, Wiley Online Library (1990-2013.9, Embase (1990-2013.9, CNKI (1990-2013.9, VIP database (1990-2013.9 and WanFang Data (1990-2013.9. The amount and incidence of postpartum hemorrhage and quantity of blood loss, as well as the incidence of postpartum morbidity were then collected in those puerperal women treated with motherwort injection and oxytocin. The quality of included studies was assessed according to Cochrane Systematic Review, and Meta-analysis was conducted by RevMan 5.1 software. Results A total of 13 studies involving 2186 patients were included. Compared with oxytocin group, motherwort and oxytocin decreased the amount of vaginal bleeding within 2 hours after delivery and 24 hours after delivery. Furthermore, motherwort and oxytocin significantly decreased the incidence of postpartum hemorrhage (RR=0.30, 95%CI 0.19-0.47, P<0.00001. No difference was found between the two groups in the postpartum adverse reaction rate (RR=0.63, 95%CI 0.37-1.05, P=0.08. Conclusions Motherwort injection and oxytocin are effective in preventing postpartum hemorrhage after vaginal delivery, and they can effectively reduce incidence of postpartum hemorrhage and the amount of blood loss without increasing the side effects in patients. DOI: 10.11855/j.issn.0577-7402.2015.10.11

  5. Vaginal birth after cesarean delivery: a group practice's approach to minimizing failed trial of labor.

    Science.gov (United States)

    Stedman; Scudder; Joseph

    1998-07-01

    Objective: Among women attempting a trial of labor (TOL) after a prior abdominal delivery, 60-80% accomplish a vaginal birth after cesarean (VBAC). McMahon and coworkers (N Engl J Med, 1996) have indicated that at a 60% success level for TOL, the remaining 40% incurred enough major complications that the scheduled repeat cesarean section group was less morbid overall. The same authors speculated that a success rate of 80% might be necessary for the TOL group's morbidity to be superior. We sought to review our group's patient selection experience during an interval when successful TOL consistently exceeded 80%.Methods: The study interval ranged from January 1995 through June 1997 and was limited to patients with one previous low transverse cesarean section. Rather than using administrative or charge-related diagnoses, we analyzed a departmental database that included each delivering physician's selection of one of four VBAC categories: successful VBAC, unsuccessful VBAC, patient declined trial of labor, or physician advised against trial of labor. All deliveries were at a single institution and were performed by one of seven obstetricians in a group practice.Results: During the study interval, 332 women provided a history of a single previous cesarean delivery. Of these 332, a total of 173 attempted a TOL and 150 of the 173 (87%) were successful. Fifty-eight of the 332 (18%) declined a trial of labor despite being assessed as excellent candidates, and 101 (30%) were advised against a TOL by their physician. Most common reasons for physicians discouraging labor included malpresentation, fetal macrosomia, and clinically small pelvis. Complications for the 23 of 173 (13%) experiencing a failed TOL included 1 asymptomatic partial separation of a uterine scar and 4 cases of puerperal fever; neither transfusion nor hysterectomy was required.Conclusions: This study demonstrates that in a population of women with one prior cesarean delivery, it is possible for a group

  6. Modeling the Intention to Choose Natural Vaginal Delivery: Using Reasoned Action and Social Cognitive Theories

    Directory of Open Access Journals (Sweden)

    Safieh Kanani

    2015-03-01

    Full Text Available Background: The Behavioral Intention Model is one of the best and most widely models used regarding attitude of behavioral of pregnancy and decrease the rate of cesarean section (CS among pregnant women, except effect of atti-tude and subjective norms on behavioral intention. Two variables of self-efficacy, and outcome expectation, relate to individual’s behavior in an upcoming situation, and both of them are important at the development of behavior. The purpose of the present study was to develop a model to explain women’s inten-tion to choose natural vaginal delivery (NVD. The variables of self-efficacy and outcome expectations, derived from Bandura’s Social Cognitive Theory, and Behavioral Intention Model constructs were used to define the model.Methods: The study was descriptive and cross-sectional in nature and took place in Pars Abad, Iran in 2014. The non-probability sample consisted of 200 pregnant women who voluntarily participated in the study and provided the data. SPSS 21 and MPLUS 6.8 were employed to analyze the data.Results: Self-efficacy, outcome expectations, and attitude toward NVD were associated with intention to choose the NVD.Conclusion: The study findings may play a role in designing educational inter-ventions aimed at influencing the NVD and improving childbirth programs.

  7. Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants.

    Science.gov (United States)

    Shams-Ghahfarokhi, Zahra; Khalajabadi-Farahani, Farideh

    2016-01-01

    Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. A study was conducted among 400 pregnant women aged 18-38 years, with gestational age of 24-40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were "the role of physician" (OR=1.33, pcesarean section" and "individualism" influence CS decision through subjective norm. Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians' role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses.

  8. Fears related to pregnancy and childbirth among primigravidae who requested caesarean versus vaginal delivery in Iran.

    Science.gov (United States)

    Matinnia, Nasrin; Faisal, Ibrahim; Hanafiah Juni, Muhamad; Herjar, Abdul Rahman; Moeini, Babak; Osman, Zubaidah Jamil

    2015-05-01

    Pregnancy- and childbirth-related fears are common psychological concerns and the primary reasons for requesting caesarean section (CS). We aimed to examine the content of maternal fear and the associated demographic factors in a sample of Iranian primigravidae. A randomly selected sample of primigravidae (n = 342) was recruited in four health care centres in Iran. Data were collected using a 30-item questionnaire. Principal components factor analysis was applied to identify the main factors of pregnancy- and childbirth-related fears. All primigravidae reported some degree of fear, 48.2 % presented severe fear, and 62.6 % requested a CS because of childbirth-related fear. Most of the employed primigravidae with higher education level, higher family income, and unplanned pregnancy requested CS. The items constructed to measure maternal fear were subjected to exploratory factor analysis. Six categories were identified, including 'process of labour and childbirth', 'life and well-being of the baby', 'competence and behaviour of maternity ward personnel', 'own capabilities and reactions', 'becoming a parent and family life after delivery' and 'general fear in pregnancy' that cumulatively explained 55.3 % of the variance. The most common factor was 'life and well-being of the baby'. Severe fear was found in 70.6 % of those who chose CS, while 10.9 % of those who chose vaginal delivery reported severe fear. The between-group differences for mean scores and levels of fear were statistically significant. Pregnancy- and childbirth-related fears were frequently experienced by all low-risk primigravidae. Better strategies to address women's psychological needs during pregnancy are necessary.

  9. A study on mode of delivery and conduct of labour in women with vaginal birth after caesarean section in Dhulikhel Hospital.

    Science.gov (United States)

    Tamrakar, S R; Chawla, C D

    2010-06-01

    Vaginal birth after caesarean section is the delivery of a baby through the vagina after a previous cesarean delivery. For this to be conducted safely and responsibly emergency obstetric care must be available. To study the different modes of delivery in Dhulikhel Hospital (DH), evaluate the frequency of attempted and successful vaginal birth after caesarean section and, in the VBAC group, to identify those factors that may influence outcome and safety. The study was a retrospective study of all women who were delivered via different routes and the subgroup who underwent attempted vaginal birth after caesarean section in DH from January 2007 to December 2009. In this study factors associated with the successful VBAC were also analyzed. During the study period a total of 4215 deliveries conducted in DH and a total of 890 lower segment caesarean sections (21.1% of all deliveries) were performed. Of the 890 caesareans performed, 743 were primary and 147 were repeat (69 were repeat elective and 78 were repeat emergency). In this period an additional 33 women with previous lower segment caesarean sections had a successful vaginal delivery. Hence 18.3% (33/180) vaginal birth after caesarean sections was conducted successfully among women with previous caesarean). The results of this study indicate that vaginal birth after caesarean section is a clear feature of obstetric practice in DH. This is possible because of the vigilance in managing these women and the availability in this hospital setting of resources for immediate cesarean section.

  10. Comparative analysis of fecal microflora of healthy full-term Indian infants born with different methods of delivery (vaginal vs cesarean): Acinetobacter sp. prevalence in vaginally born infants

    Indian Academy of Sciences (India)

    Prashant Kumar Pandey; Pankaj Verma; Himanshu Kumar; Ashish Bavdekar; Milind S Patole; Yogesh S Shouche

    2012-12-01

    In this study fecal microflora of human infants born through vaginal delivery (VB) and through cesarean section (CB) were investigated using culture-independent 16S rDNA cloning and sequencing approach. The results obtained clearly revealed that fecal microbiota of VB infants distinctly differ from those in their counterpart CB infants. The intestinal microbiota of infants delivered by cesarean section appears to be more diverse, in terms of bacteria species, than the microbiota of vaginally delivered infants. The most abundant bacterial species present in VB infants were Acinetobacter sp., Bifidobacterium sp. and Staphylococcus sp. However, CB infant’s fecal microbiota was dominated with Citrobacter sp., Escherichia coli and Clostridium difficile. The intestinal microbiota of cesarean section delivered infants in this study was also characterized by an absence of Bifidobacteria species. An interesting finding of our study was recovery of large number of Acinetobacter sp. consisting of Acinetobacter pittii (former Acinetobacter genomic species 3), Acinetobacter junii and Acinetobacter baumannii in the VB infants clone library. Among these, Acinetobacter baumannii is a known nosocomial pathogen and Acinetobacter pittii (genomic species 3) is recently recognized as clinically important taxa within the Acinetobacter calcoaceticus–Acinetobacter baumannii (ACB) complex. Although none of the infants had shown any sign of clinical symptoms of disease, this observation warrants a closer look.

  11. Counseling on vaginal delivery of contraceptive hormones: implications for women's body knowledge and sexual health.

    Science.gov (United States)

    Nappi, Rossella E

    2013-12-01

    Healthcare providers (HCPs) have an important role in helping women select the contraceptive method that best matches their needs and lifestyle. Recent surveys outline the need of women to be informed about all available choices, including the newest methods (particularly those not requiring daily administration), such as vaginal contraception. The most relevant publications on combined contraceptive vaginal ring are revised in the context of counseling as an opportunity to empower women in term of vaginal health and sexual functioning. HCPs should explain the main characteristics of the combined contraceptive vaginal ring including the anatomical and physiological implications that make the vagina an ideal route of hormonal administration and the basic notions about functional modifications of the vagina during reproductive life. Clinical data on the vaginal ring should be summarized with regard to efficacy, tolerability, pharmacokinetics, cycle control and user acceptability, including recent findings on extra-contraceptive benefits (also compared to other hormonal contraceptives) on the vaginal flora and on sexual function. Vaginal contraception offers various benefits and should always be discussed during contraceptive counseling. An open dialogue about vaginal contraception will also help enhance body knowledge and sexual health.

  12. Vaginal dryness

    Science.gov (United States)

    ... Vaginitis due to reduced estrogen; Atrophic vaginitis; Menopause vaginal dryness ... sexual intercourse more comfortable. It also helps decrease vaginal dryness. If estrogen levels drop off, the vaginal tissue ...

  13. The "RESEAU MATER": An efficient infection control for endometritis, but not for urinary tract infection after vaginal delivery.

    Science.gov (United States)

    Ayzac, Louis; Caillat-Vallet, Emmanuelle; Girard, Raphaële; Berland, Michel

    2016-09-01

    "RESEAU MATER" is useful to monitor nosocomial infections in maternity and contributes to the decreasing trend of it, since its implementation. Specifically, this network demonstrates its efficiency in the control of endometritis following vaginal deliveries, but not in the control of urinary tract infections. The aim of this study is to determine whether the difference between the control of endometritis and of urinary tract infection could be explained by an unsuitable regression model or by an unsuitable care policy concerning urinary cares. This study includes (1) the analysis of historic data of the network and (2) the description of French guidelines for maternity cares and available evaluations, concerning endometritis and urinary tract infection prevention. Univariate and multivariate odds ratios (ORs) were calculated for the total study period of 1999-2013, for these infections and their risk factors. The endometritis frequency is decreasing, in association with no significant evolution of associated risk factors, but urinary tract infection frequency is constant, in association with a increasing trend of its risk factors such as intermittent catheterization and epidural analgesia. In French guidelines, all preventive measures against endometritis are clearly broadcasted by all field operators, and repeated audits have reinforced the control of their application. But preventive measures against urinary tract infection seem to be broadcasted exclusively in the circle of infection prevention agencies and not in the obstetrics societies or in the Health Ministry communication. Urinary tract infection prevention requires a clearer public and professional policy in favor of a more efficient urinary cares, with a specific target to maternity.

  14. Vaginal inserts based on chitosan and carboxymethylcellulose complexes for local delivery of chlorhexidine: preparation, characterization and antimicrobial activity.

    Science.gov (United States)

    Bigucci, Federica; Abruzzo, Angela; Vitali, Beatrice; Saladini, Bruno; Cerchiara, Teresa; Gallucci, Maria Caterina; Luppi, Barbara

    2015-01-30

    The aim of this work was to prepare vaginal inserts based on chitosan/carboxymethylcellulose polyelectrolyte complexes for local delivery of chlorhexidine digluconate. Complexes were prepared with different chitosan/carboxymethylcellulose molar ratios at a pH value close to pKa interval of the polymers and were characterized in terms of physico-chemical properties, complexation yield and drug loading. Then complexes were used to prepare inserts as vaginal dosage forms and their physical handling, morphology, water-uptake ability and drug release properties as well as antimicrobial activity toward Candida albicans and Escherichia coli were evaluated. Results confirmed the ionic interaction between chitosan and carboxymethylcellulose and the influence of the charge amount on the complexation yield. Complexes were characterized by high values of drug loading and showed increasing water-uptake ability with the increase of carboxymethylcellulose amount. The selection of appropriate chitosan/carboxymethylcellulose molar ratios allowed to obtain cone-like shaped solid inserts, easy to handle and able to hydrate releasing the drug over time. Finally, the formulated inserts showed antimicrobial activity against common pathogens responsible for vaginal infections.

  15. Sintomas urinários irritativos após parto vaginal ou cesárea Irritative bladder symptoms after vaginal delivery or c-section

    Directory of Open Access Journals (Sweden)

    Kátia Pary Scarpa

    2009-01-01

    Full Text Available OBJETIVO: Avaliar a frequência de Sintomas Urinários Irritativos (SUI três anos após o parto em mulheres previamente entrevistadas no terceiro trimestre da gestação e sua associação com a via de parto exclusiva, a paridade, a idade materna, o peso do RN, a realização da episiotomia e o uso de fórcipe. MÉTODOS: Das 340 mulheres, originalmente avaliadas no terceiro trimestre da gestação, 120 foram localizadas e entrevistadas por telefone, três anos após o parto, entre junho e outubro de 2006. Foi analisada a associação entre SUI e via exclusiva de parto (vaginalou cesáreo, paridade,idade materna, peso do recém-nascido, realização da episiotomia e uso de fórcipe. Os resultados foram avaliados por meio de estatística descritiva, teste Qui quadrado e cálculo da razão de prevalência (p 35 peso do recém-nascido (> 4000g, realização da episiotomia e uso de fórcipe. CONCLUSÃO: A via de parto e a paridade não foram fatores determinantes para a disfunção do trato urinário inferior após o parto, representada pelos sintomas urinários irritativos, tampouco, a idade materna, o peso do RN, a realização da episiotomia e o uso de fórcipe.OBJECTIVE: This study intended to investigate the frequency of irritative bladder symptoms three years after delivery in women previously interviewed in the third trimester of pregnancy and its correlation to mode of delivery, parity, maternal age, birth weight, episiotomy and forceps. METHODS: From 340 women previously evaluated at the third trimester of pregnancy, 120 were interviewed three years after delivery, between June and October 2006. Correlation of postpartum irritative bladder symptoms and mode of delivery (exclusively vaginal or c-section, parity, maternal age, birth weight, episiotomy and forceps was analyzed. Associations between irritative bladder symptoms and obstetric parameters were assessed by the Fisher's exact test and Chi-square (p 35, birth weight (> 4000g

  16. Development of starch based mucoadhesive vaginal drug delivery systems for application in veterinary medicine.

    Science.gov (United States)

    Gök, Mehmet Koray; Özgümüş, Saadet; Demir, Kamber; Cirit, Ümüt; Pabuccuoğlu, Serhat; Cevher, Erdal; Özsoy, Yıldız; Bacınoğlu, Süleyman

    2016-01-20

    The aim of this study was to prepare and evaluate the mucoadhesive, biocompatible and biodegradable progesterone containing vaginal tablets based on modified starch copolymers for the estrus synchronization of ewes. Starch-graft-poly(acrylic acid) copolymers (S-g-PAA) were synthesized and characterized. The vaginal tablets were fabricated with S-g-PAA and their equilibrium swelling degree (Qe) and matrix erosion (ME%) were determined in lactate buffer solution. In vitro, mucoadhesive properties of the tablets were investigated by using ewe vaginal mucosa and in vivo residence time were also investigated. In vitro and in vivo progesterone release profiles from the tablets were compared with two commercial products. Tablet formulation containing wheat starch based grafted copolymer (WS-g-PAA)gc indicated promising results and might be convenient as an alternative product to the commercial products in veterinary medicine.

  17. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Fyfe Elaine M

    2012-10-01

    Full Text Available Abstract Background Increasing rates of postpartum haemorrhage in developed countries over the past two decades are not explained by corresponding changes in risk factors and conjecture has been raised that maternal obesity may be responsible. Few studies investigating risk factors for PPH have included BMI or investigated PPH risk among nulliparous women. The aim of this study was to determine in a cohort of nulliparous women delivering at term whether overweight and obesity are independent risk factors for major postpartum haemorrhage (PPH ≥1000ml after vaginal and caesarean section delivery. Methods The study population was nulliparous singleton pregnancies delivered at term at National Women’s Hospital, Auckland, New Zealand from 2006 to 2009 (N=11,363. Multivariable logistic regression was adjusted for risk factors for major PPH. Results There were 7238 (63.7% women of normal BMI, 2631 (23.2% overweight and 1494 (13.1% obese. Overall, PPH rates were increased in overweight and obese compared with normal-weight women (n=255 [9.7%], n=233 [15.6%], n=524 [7.2%], p Conclusion Nulliparous obese women have a twofold increase in risk of major PPH compared to women with normal BMI regardless of mode of delivery. Higher rates of PPH among obese women are not attributable to their higher rates of caesarean delivery. Obesity is an important high risk factor for PPH, and the risk following vaginal delivery is emphasised. We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women.

  18. Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

    Directory of Open Access Journals (Sweden)

    Fiona Urner

    2014-01-01

    Full Text Available The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH, which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

  19. Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

    Science.gov (United States)

    Zimmermann, Roland

    2014-01-01

    The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity. PMID:24812585

  20. Fatores associados ao parto vaginal em gestantes de alto risco submetidas à indução do parto com misoprostol Factors associated with vaginal delivery in high-risk pregnant women submitted to labor induction with misoprostol

    Directory of Open Access Journals (Sweden)

    Zuleika Studart Sampaio

    2004-02-01

    determine the main factors associated with vaginal delivery in high-risk pregnant women submitted to labor induction with vaginal misoprostol (50 µg. METHODS: this is a secondary analysis of an open nonrandomized clinical trial that included 61 high-risk pregnant women admitted at the "Maternidade-Escola Assis Chateaubriand", Fortaleza (Ceará. All women had singleton pregnancies with alive fetuses, gestational age >37 weeks and Bishop scores 4 and interval induction to delivery 4 (OR = 3.30, 95% CI = 2.15-4.45 were significant independent predictors for vaginal delivery. In the ROC curve for parity and Bishop score, sensitivity of 63.2% and positive predictive value of 100% were found. The area under the ROC curve was 86.8%, significantly higher than 50% (p=0.023. CONCLUSIONS: the most important predictive factors for vaginal delivery after induction with misoprostol were parity and Bishop score. These characteristics should be considered when choosing schemes and doses of misoprostol for cervical ripening and labor induction.

  1. Effect of Training Preparation for Childbirth on Fear of Normal Vaginal Delivery and Choosing the Type of Delivery Among Pregnant Women in Hamadan, Iran: A Randomized Controlled Trial

    Science.gov (United States)

    Masoumi, Seyedeh Zahra; Kazemi, Farideh; Oshvandi, Khodayar; Jalali, Mozhgan; Esmaeili-Vardanjani, Ali; Rafiei, Hossein

    2016-01-01

    Objective: To examine effect of an educational program on pregnant women’s fear of normal vaginal delivery. Fear of natural childbirth during pregnancy may increase the risk of caesarean section. Educational programs may be effective in reducing women fear of natural childbirth. Materials and methods: This randomized controlled trial conducted from September 2012 to January 2013 in Hamadan, Iran. One hundred fifty eligible women were randomly assigned to group "A" (Intervention group, n = 75) or group "B" (Control group, n = 75). Women in group A, participated in an antenatal educations program for physiologic childbirth in 8 two-hour sessions. A self-designed questionnaire was used to examine women's fear of natural childbirth. Data were analyzed with SPSS.16 software. Results: Baseline characteristics of women were similar in both groups. After intervention the mean fear score in group A compared to group B was significantly reduced (51.7 ± 22.4 vs. 58.7 ± 21.7) (p = 0.007). Physiologic delivery was the first choice of type of child birth after training in pregnant women in group A (58.7%). But delivery in physiologic form had lowest rate in group A (8%). Conclusion: Results of present study showed that educational program could be serving as an important tool in reducing women fear from natural childbirth and in choosing of physiologic birth. And for delivery as a physiological, education and counseling of pregnant women, doctors and midwives are required. PMID:28101112

  2. Effect of Training Preparation for Childbirth on Fear of Normal Vaginal Delivery and Choosing the Type of Delivery Among Pregnant Women in Hamadan, Iran: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Seyedeh Zahra Masoumi

    2016-12-01

    Full Text Available Objective: To examine effect of an educational program on pregnant women’s fear of normal vaginal delivery. Fear of natural childbirth during pregnancy may increase the risk of caesarean section. Educational programs may be effective in reducing women fear of natural childbirth.Materials and methods: This randomized controlled trial conducted from September 2012 to January 2013 in Hamadan, Iran. One hundred fifty eligible women were randomly assigned to group "A" (Intervention group, n = 75 or group "B" (Control group, n = 75. Women in group A, participated in an antenatal educations program for physiologic childbirth in 8 two-hour sessions. A self-designed questionnaire was used to examine women's fear of natural childbirth. Data were analyzed with SPSS.16 software.Results: Baseline characteristics of women were similar in both groups. After intervention the mean fear score in group A compared to group B was significantly reduced (51.7 ± 22.4 vs. 58.7 ± 21.7 (p = 0.007. Physiologic delivery was the first choice of type of child birth after training in pregnant women in group A (58.7%. But delivery in physiologic form had lowest rate in group A (8%.Conclusion: Results of present study showed that educational program could be serving as an important tool in reducing women fear from natural childbirth and in choosing of physiologic birth. And for delivery as a physiological, education and counseling of pregnant women, doctors and midwives are required.

  3. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population.

    Science.gov (United States)

    Krauss-Silva, Leticia; Almada-Horta, Antonio; Alves, Mariane B; Camacho, Karla G; Moreira, Maria Elizabeth L; Braga, Alcione

    2014-03-19

    Bacterial vaginosis (BV) increases the risk of spontaneous preterm deliveries (PD) in developed countries. Its prevalence varies with ethnicity, socioeconomic conditions and gestational age. Aerobic vaginitis (AV) has also been implicated with spontaneous PD. The present study aimed to estimate the prevalence of asymptomatic BV, the accuracy of vaginal pH level to predict BV and to estimate the risk of spontaneous PD Vaginal smears of women with vaginal pH > = 4.5 were collected to determine the Nugent score; a sample of those smears was also classified according to a modified Donders' score. Primary outcomes were spontaneous PD vaginal pH= > 4.5 and = > 5.0 to predict BV status was 100% and 82%, correspondingly; the 5.0 cutoff value doubled the specificity, from 41% to 84%. The incidence of 4.5 was 3.8%. The RR of spontaneous PD  =4.5, as compared with those with intermediate state, were 1.24 and 1.86, respectively (Fisher's exact test, p value = 1; 0.52, respectively, both ns). No spontaneous case of PD or abortion was associated with severe or moderate AV. A high prevalence of asymptomatic BV was observed without statistically significant difference between black and white women. The RRs of spontaneous PD < 34 and <37 weeks among women with BV, as compared with those with intermediate state were not statistically significant but were consistent with those found in the literature.

  4. Vaginal Atrophy

    Science.gov (United States)

    Vaginal atrophy Overview Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls due to your body having less estrogen. Vaginal atrophy occurs most often after ...

  5. Vaginal birth after a caesarean section : the development of a Western European population-based prediction model for deliveries at term

    NARCIS (Netherlands)

    Schoorel, E. N. C.; van Kuijk, S. M. J.; Melman, S.; Nijhuis, J. G.; Smits, L. J. M.; Aardenburg, R.; de Boer, K.; Delemarre, F. M. C.; van Dooren, I. M.; Franssen, M. T. M.; Kaplan, M.; Kleiverda, G.; Kuppens, S. M. I.; Kwee, A.; Lim, F. T. H.; Mol, B. W. J.; Roumen, F. J. M. E.; Sikkema, J. M.; Smid-Koopman, E.; Visser, H.; Woiski, M.; Hermens, R. P. M. G.; Scheepers, H. C. J.

    2014-01-01

    ObjectiveTo develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term. DesignRegistration-based retrospective cohort study. SettingFive uni

  6. The influence of the material properties on the biomechanical behavior of the pelvic floor muscles during vaginal delivery.

    Science.gov (United States)

    Parente, M P L; Natal Jorge, R M; Mascarenhas, T; Fernandes, A A; Martins, J A C

    2009-06-19

    In this work, a finite element model intends to represent the effects that the passage of a fetal head can induce on the muscles of the pelvic floor, from a mechanical point of view. The finite element method is a valuable tool, that is contributing to the clarification of the mechanisms behind pelvic floor disorders related to vaginal deliveries, although some care is necessary in order to obtain correct results. The present work shows how the variation of the material parameters, used in the constitutive model, can affect the obtained results from a finite element simulation. The constitutive equation adopted in this work for the pelvic floor muscles is a modified form of the incompressible transversely isotropic hyperelastic model proposed earlier by Humphrey and Yin. Results for the pelvic floor strain and stresses obtained during the passage of the fetus head are presented. The results show the importance of the material parameters and the need for a correct constitutive model.

  7. Predictors for failure of vacuum-assisted vaginal delivery : A case-control study

    NARCIS (Netherlands)

    Verhoeven, Corine J M; Nuij, Chelly; Janssen-Rolf, Christel R M; Schuit, Ewoud; Bais, Joke M J; Oei, S. Guid; Mol, Ben Willem J

    2016-01-01

    Objective To identify potential predictors for failed vacuum-assisted delivery. Study design Retrospective case-control study conducted in two perinatal centers in the Netherlands. Cases were women who underwent a failed vacuum-assisted delivery between 1997 and 2011. A failed vacuum extraction was

  8. Predictors for failure of vacuum-assisted vaginal delivery : A case-control study

    NARCIS (Netherlands)

    Verhoeven, Corine J M; Nuij, Chelly; Janssen-Rolf, Christel R M; Schuit, Ewoud; Bais, Joke M J; Oei, S. Guid; Mol, Ben Willem J

    2016-01-01

    Objective To identify potential predictors for failed vacuum-assisted delivery. Study design Retrospective case-control study conducted in two perinatal centers in the Netherlands. Cases were women who underwent a failed vacuum-assisted delivery between 1997 and 2011. A failed vacuum extraction was

  9. A novel vaginal drug delivery system: anti-HIV bioadhesive film containing abacavir.

    Science.gov (United States)

    Ghosal, Kajal; Ranjan, Alok; Bhowmik, Benoy Brata

    2014-07-01

    Women are very much susceptible for acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs), mainly due to unprotected heterosexual vaginal intercourse and for some other social and economical disadvantages. Our aim was to formulate and optimize vaginal film of abacavir, a potent nucleoside reverse transcriptase inhibitor, for the treatment of AIDS and HIV. Abacavir films were prepared by solvent evaporation method using sodium alginate (Na-alginate) as the main polymer, Hydroxypropyl Methylcellulose E 15 (HPMC E 15) as the copolymer and glycerol as a humectant. Abacavir sulphate (ABC) was used here as a drug. Films were optimized for various physicochemical parameters such as tensile strength, % elongation at break, swelling capacity, drug content (mg/cm(2)), thickness, folding endurance, bioadhesion, pH, moisture content and SEM. Drug polymer interaction was studied by FTIR Spectra. The drug release study was accomplished in dissolution apparatus. In vivo study was also carried out. This newly formed film was one kind of sustain release type and can be considered as a novel drug carrier system for the treatment of AIDS and other STDs. It was suitable for local as well as systemic effect. The films showed good physicochemical property with good aesthetic appeal.

  10. Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women

    Institute of Scientific and Technical Information of China (English)

    Tung Chi Wai; Cheon Willy Cecilia; Tong Wai Mei Anny; Leung Hau Yee

    2015-01-01

    Background:Obstetric anal sphincter injuries (OASIS) can cause an adverse impact on women's physical and mental health.There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps.This study was to determine the incidence and risk factors of OASIS.Methods:This is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong.The control group was selected randomly.Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014.Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.Results:Of 15,446 women delivered,49 had OASIS.The percentage of OASIS increased from 0.3% (2011) to 0.38% (2014).There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotomy (P < 0.01),but it did not increase the OASIS risk (P =0.46).Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery (odds ratio [OR] =8.73,P < 0.01),prolong second stage of labor (OR =1.43,P < 0.01) increased the risk for OASIS.In multivariate regression models,only forceps delivery (OR =6.28,P < 0.01) proved to be independent risk factor.Conclusions:The incidence of OASIS in Chinese women was increased after 2012,but still lower than the reported figures in the literature.Outlet forceps delivery could be a possible associated risk factor.

  11. Maternal Satisfaction about Prenatal and Postnatal Cares in Vaginal and Cesarean Section Delivery at Teaching and Non- teaching Hospitals of Tabriz/ Iran

    Directory of Open Access Journals (Sweden)

    Somayyeh Naghizadeh

    2014-02-01

    Full Text Available Objectives: The main goal of care services is provide and promote mankind's health. Patient satisfaction is recognized as an important parameter for assessing the quality of patient care services. Spatially mothers' satisfaction from delivery is very important because it influence on family and society psychological health. The aim of this study was comparing maternal satisfaction about prenatal and postnatal cares in vaginal and cesarean section delivery at teaching and nonteaching hospitals of Tabriz/ Iran. Materials and Methods: This is a descriptive-comparative study. We selected 454 women who had been hospitalized for delivery in Alzahra, Talegani (teaching and 29Bahman (nonteaching Tabriz/Iran hospitals. For data collection, we used a questionnaire. Spss/ver13, Descriptive statistic, Independent t test, ANOVA and correlation tests were used for data analysis. Results: Findings indicated the highest level of satisfaction in both kind of hospitals was about physical and the lowest one was about informational aspect in women who had vaginal delivery, accordingly these rates about cesarean section was about physical and about informational and emotional aspects in labor. The analysis of data showed significant difference between mothers' satisfaction with all aspects of care in the teaching and non- teaching hospitals (P < 0.001. Conclusion: The results showed that the highest rank from mothers' satisfaction was in the physical and the lowest rank was in informational category. Mothers were satisfied from vaginal delivery in all aspects. Rate of satisfaction in nonteaching were more than teaching hospitals.

  12. Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies

    DEFF Research Database (Denmark)

    Klein, K; Rode, L; Nicolaides, K H;

    2011-01-01

    and placebo groups were similar. Mean gestational age at delivery did not differ significantly between the two groups either in patients with a short cervix (34.3 ± 4.1 vs. 34.5 ± 3.0 weeks, P = 0.87) or in those with a history of preterm delivery or late miscarriage (34.6 ± 4.2 vs. 35.2 ± 2.7 weeks, P = 0...

  13. Preterm delivery and intimacy during pregnancy: interaction between oral, vaginal and intestinal microbiomes

    Directory of Open Access Journals (Sweden)

    Demian Arturo Herrera Morban

    2015-05-01

    Full Text Available Durante el embarazo los microbiomas bucal, vaginal e intestinal de la mujer sufren cambios para adaptarse a las demandas del cuerpo, aumentando la relación y similitud entre ellos. Debido a esto se considera pertinente realizar una revisión literaria con el propósito de determinar la existencia de factores que influyen en un microbioma específico y que posteriormente podrían modificar a los demás. Este es el caso del microbioma bucal que depende de la actividad íntima de la mujer y por consiguiente puede ser un factor que se relacione con el desarrollo de un embarazo pretérmino.

  14. Incidence of uterine torsion during veterinary-assisted dystocia and singleton live births after vaginal delivery inHolstein-Friesian cows at pasture

    Institute of Scientific and Technical Information of China (English)

    Faria N; Simes J

    2015-01-01

    Objective:To determine the incidence of uterine torsion and their association with live births after vaginal delivery at pasture.Methods:A total of 119 veterinary-assisted dystocia, occurred in Holstein-Friesian cows, were accessed between September 2012 and February 2013 from Azores islands (Portugal). The general health status of dam, cause of dystocia, obstetric treatment choice, number and viability of fetus were evaluated.Results:The uterine torsion represented 24.4% (29/119) of total assisted dystocia. The general health status was normal or slowly affected, at delivery time, for 96.6% (28/29) of the cows with uterine torsion. Vaginal delivery after rolling cows, cesarean section or euthanasia were performed in 72.4% (21/29), 24.1% (7/29) and 3.5% (1/29) of dams with uterine torsion, respectively. Singletons were observed in 96.6% (28/29) and 86.7% (78/90) of cows with uterine torsion and remaining dystocia, respectively. After vaginal delivery, the occurrence of singleton live births was more probable to occur in cows with uterine torsion (17/21) than the remaining cows (37/70) of control group (odds ratio=3.79; 95% interval of confidence from 1.16 to 12.41;P<0.05).Conclusions:A high frequency of uterine torsion was observed in Holstein-Friesian cows with normal or slowly affected general health status at delivery time at pasture. The singleton live births prevailed and, in general, their occurrence by vaginal delivery after uterus reposition was most likely to occur in cows with uterine torsion than dams presenting other dystocia.

  15. Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

    Directory of Open Access Journals (Sweden)

    Miriam Raquel Diniz Zanetti

    Full Text Available CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713, respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

  16. 羊水过少经阴道分娩的临床观察%Clinical observation of amniotic fluid had less vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    李丽华; 王金兰

    2012-01-01

      目的:探讨妊娠晚期羊水过少的监测、终止妊娠时机、提高阴道分娩率,有效降低剖宫产率.方法:对216例羊水过少孕妇阴道试产的临床资料进行回顾性分析.结果:羊水过少阴道分娩率为58.33%,其中羊水量150~299 ml阴道分娩率为73.58%,羊水量100~149 ml阴道分娩率为48.84%,羊水量小于100 ml阴道分娩率为25%.结论:动态监测妊娠晚期孕妇羊水量,对羊水过少选择适当时机终止妊娠,提高阴道分娩率,有效降低剖宫产率.%  Objective To investigate trimester amniotic fluid too little monitoring,termination of pregnancy timing,increase vaginal delivery rate,effectively reducing the rate of cesarean section.Methods Clinical data on 216 cases of amniotic fluid too few pregnant women vaginal trial of labor were analyzed retrospectively.Results The amniotic fluid had less vaginal birth rate was 58.33%,73.58%of the vaginal delivery rate of 150~299 ml of amniotic fluid volume,amniotic fluid volume of 100~149 ml of vaginal delivery rate of 48.84%,amniotic fluid volume is less than 100 ml of vaginal delivery was 25%.Conclusion Dynamic monitoring of pregnant women in late pregnancy amniotic fluid volume,oligohydramnios an appropriate time to termination of pregnancy,vaginal delivery rate,effectively reducing the rate of cesarean section.

  17. Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome.

    Science.gov (United States)

    Holmgren, Calla; Scott, James R; Porter, T Flint; Esplin, M Sean; Bardsley, Tyler

    2012-04-01

    To estimate the time from the diagnosis of uterine rupture to delivery that would prevent adverse neonatal sequelae. Cases of uterine rupture from January 1, 2000, to December 31, 2009, were identified in nine hospitals in the Intermountain Health Care system and at the University of Utah. Maternal demographics, labor characteristics, and neonatal outcomes were obtained. Primary adverse outcome was abnormal umbilical artery pH level less than 7.0 or 5-minute Apgar score less than 7. Adverse secondary outcome included fetal or neonatal death and neonatal neurologic injury attributed to uterine rupture. Thirty-six cases of uterine rupture occurred during 11,195 trials of labor after cesarean delivery. Signs of uterine rupture were fetal (n=24), maternal (n=8), or a combination of maternal and fetal (n=3). In one case, uterine rupture was not suspected. Mean time to delivery from the onset of symptoms or signs for the primary adverse outcome group (n=13) was 23.3 (±10.8) minutes compared with 16.0 (±7.7) minutes for those without an adverse outcome (P=.02). No neonate delivered in fewer than 18 minutes had an umbilical pH level below 7.0. Three neonates delivered at more than 30 minutes met criteria for an adverse secondary outcome. The frequency of uterine rupture was 0.32% in patients attempting a trial of labor after cesarean delivery. Neonates delivered within 18 minutes after a suspected uterine rupture had normal umbilical pH levels or 5-minute Apgar scores greater than 7. Poor long-term outcome occurred in three neonates with a decision-to-delivery time longer than 30 minutes. II.

  18. Trends in Rural and Urban Deliveries and Vaginal Births: California 1998-2002

    Science.gov (United States)

    Hughes, Susan; Zweifler, John A.; Garza, Alvaro; Stanich, Matthew A.

    2008-01-01

    Context: Pregnant women in rural areas may give birth in either rural or urban hospitals. Differences in outcomes between rural and urban hospitals may influence patient decision making. Purpose: Trends in rural and urban obstetric deliveries and neonatal and maternal mortality in California were compared to inform policy development and patient…

  19. Vaginal Atrophy

    Science.gov (United States)

    ... Body in Balance › Vaginal Atrophy Fact Sheet Vaginal Atrophy November, 2011 Download PDFs English Espanol Editors JoAnn ... MD Richard J. Santen, MD What is vaginal atrophy? Vaginal atrophy is a condition in which the ...

  20. Fatores prognósticos para o parto transvaginal em pacientes com cesárea anterior Prognostic factors for vaginal delivery after cesarian section

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Santos

    1998-07-01

    prognostic factors for vaginal delivery in pregnant women after previous cesarean section admitted to CAM-IMIP in labor.Patients and Methods: a case-control study was performed, analyzing all deliveries of patients with previous cesarean section admitted to CAM-IMIP between January 1991 and December 1994. Patients who had a cesarean section (n=156 were considered cases while patients with a vaginal birth were the controls (n=338. Inclusion criteria were: gestational age > 36 weeks, previous cesarean section at least 1 year before, alive fetus, spontaneous labor and vertex presentation. Patients with high-risk pregnancies, acute fetal distress and a previous vaginal delivery after cesarean section were excluded. Statistical analysis was performed with in Epi-Info 6.0 and Epi-Soft, using c² test, Fisher's exact test and Student's "t" test. Odds ratio and its 95% confidence interval was calculated and multiple logistic regression analysis was performed for the control of confounding factors. Results: overall rate of cesarean section was 31.6%. Maternal factors significantly associated with vaginal delivery were age 35 years (OR = 0.54, 95% CI = 0.36-0.82, history of vaginal delivery (OR = 1.6, 95% CI = 1.01-2.55 and complications of pregnancy as indication for previous cesarean section (OR = 3.67, 95% CI =1.19-12.02. A significant association with vaginal delivery could not be detected for other variables: interval between previous cesarean section and present delivery, other indications for cesarean section and type of uterine suture. In a multiple logistic regression model the variables that remained associated with vaginal delivery were maternal age and previous vaginal delivery. Conclusions: maternal age below 20 years, previous cesarean section indicated due to gestational complications and previous vaginal delivery were favorably associated with vaginal delivery in patients with prior cesarean section. Risk of repeated cesarean section is increased in pregnant women aged

  1. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population

    Science.gov (United States)

    Maykin, Melanie Mai; Mularz, Amanda J.; Lee, Lydia K.; Valderramos, Stephanie Gaw

    2017-01-01

    Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal–Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (65%). The actual versus predicted success rates were compared. Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). Conclusion When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

  2. Novel Spray Dried Glycerol 2-Phosphate Cross-Linked Chitosan Microparticulate Vaginal Delivery System—Development, Characterization and Cytotoxicity Studies

    Science.gov (United States)

    Szymańska, Emilia; Szekalska, Marta; Czarnomysy, Robert; Lavrič, Zoran; Srčič, Stane; Miltyk, Wojciech; Winnicka, Katarzyna

    2016-01-01

    Chitosan microparticulate delivery systems containing clotrimazole were prepared by a spray drying technique using glycerol 2-phosphate as an ion cross-linker. The impact of a cross-linking ratio on microparticle characteristics was evaluated. Drug-free and drug-loaded unmodified or ion cross-linked chitosan microparticles were examined for the in vitro cytotoxicity in VK2/E6E7 human vaginal epithelial cells. The presence of glycerol 2-phosphate influenced drug loading and encapsulation efficacy in chitosan microparticles. By increasing the cross-linking ratio, the microparticles with lower diameter, moisture content and smoother surface were observed. Mucoadhesive studies displayed that all formulations possessed mucoadhesive properties. The in vitro release profile of clotrimazole was found to alter considerably by changing the glycerol 2-phosphate/chitosan ratio. Results from cytotoxicity studies showed occurrence of apoptotic cells in the presence of chitosan and ion cross-linked chitosan microparticles, followed by a loss of membrane potential suggesting that cell death might go through the mitochondrial apoptotic pathway. PMID:27690062

  3. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population.

    Science.gov (United States)

    Maykin, Melanie Mai; Mularz, Amanda J; Lee, Lydia K; Valderramos, Stephanie Gaw

    2017-01-01

    Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (65%). The actual versus predicted success rates were compared. Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

  4. Formulation and in vitro evaluation of coconut oil-core cationic nanocapsules intended for vaginal delivery of clotrimazole.

    Science.gov (United States)

    Santos, Sara S; Lorenzoni, Alessandra; Pegoraro, Natháli S; Denardi, Laura B; Alves, Sydney H; Schaffazick, Scheila R; Cruz, Letícia

    2014-04-01

    The objective of this work was to propose coconut oil-core nanocapsules prepared from Eudragit(®) RS100, a cationic polymer, and to evaluate their potential for vaginal delivery of clotrimazole in candidiasis. Nanocapsule suspensions loaded with clotrimazole at 1.0 and 3.0mg/mL were prepared by interfacial deposition of Eudragit(®) RS100. The physicochemical characterization showed average diameter lower than 200 nm, low polydispersity index, positive zeta potential (+10.94 to +14.57 mV), acid pH values (5.4-5.7) and encapsulation efficiencies close to 100%. After 60 days of storage at room temperature and protected from light, the nanocapsules were reasonably stable. Photodegradation studies showed that nanoencapsulation improved clotrimazole stability against UV radiation. The in vitro drug release at pH 4.5 was characterized by a prolonged release with no burst effect. The nanocapsules were more active than free clotrimazole against Candida albicans and Candida glabrata strains susceptible and resistant to fluconazole. Hence, clotrimazole-loaded coconut oil-core nanocapsules represent promising alternatives to the treatment of vulvovaginal candidiasis.

  5. Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms.

    Science.gov (United States)

    Fergus, Paul; Hussain, Abir; Al-Jumeily, Dhiya; Huang, De-Shuang; Bouguila, Nizar

    2017-07-06

    Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤ 7.20-acidosis, n = 18; pH > 7.20 and pH machine-learning algorithms are trained, and validated, using binary classifier performance measures. The findings show that deep learning classification achieves sensitivity = 94%, specificity = 91%, Area under the curve = 99%, F-score = 100%, and mean square error = 1%. The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies.

  6. Confidence in performing normal vaginal delivery in the obstetrics clerkship: a randomized trial of two simulators.

    Science.gov (United States)

    Sabourin, Jeanelle N; Van Thournout, Rhonda; Jain, Venu; Demianczuk, Nestor; Flood, Cathy

    2014-07-01

    Objectif : Comparer la confiance des étudiants de médecine en stage clinique, pour ce qui est de l’exécution d’une simulation d’accouchement vaginal normal (AVN), à la suite de leur participation à une session de formation en simulation au moyen de deux modèles différents. Méthodes : Des étudiants de médecine ont été affectés, au hasard, à une session de simulation d’AVN faisant appel à un mannequin obstétrical ou à une session de simulation faisant appel à un modèle de bassin simulant l’accouchement. Des questionnaires ont été utilisés pour évaluer la confiance et la simulation avant et immédiatement après la session, ainsi qu’au cours de la dernière journée de la rotation en obstétrique. Résultats : Cent dix étudiants ont été affectés au hasard à l’un ou l’autre des groupes de simulation. Au début du stage clinique, les deux groupes présentaient des niveaux de confiance et d’exposition à la pratique obstétricale semblables. Seulement 15 étudiants (13,9 %) étaient d’avis qu’ils étaient prêts à tenter un AVN de façon indépendante ou sous une supervision minimale. Cette proportion a connu une hausse considérable en passant à 43 étudiants (39,4 %) immédiatement après la session de simulation. À la fin du stage clinique, 79 des 81 étudiants répondants (97,5 %) étaient confiants de pouvoir tenter un AVN de façon indépendante ou sous une supervision minimale. Aucune différence significative n’a été constatée entre les groupes de simulation à quelque moment que ce soit. Les sessions ont été évaluées comme étant tout aussi utiles et réalistes les unes que les autres; cette constatation est demeurée la même à la fin du stage clinique. Conclusion : La formation faisant appel à la simulation d’un AVN au moyen d’un mannequin obstétrical ou d’un modèle de bassin simulant l’accouchement offre aux étudiants en stage clinique une expérience positive et accroît imm

  7. Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Vaginal Breech Deliveries.

    Science.gov (United States)

    Secter, Michael B; Simpson, Andrea N; Gurau, David; Snelgrove, John W; Hodges, Ryan; Mocarski, Eva; Pittini, Richard; Windrim, Rory; Higgins, Mary

    2015-11-01

    Objectif : De nos jours, dans le domaine de l’obstétrique, il est difficile d’acquérir les compétences cliniques nécessaires à la tenue d’un accouchement vaginal du siège (AVS) en toute sûreté. Des stratégies pédagogiques novatrices sont requises, puisque l’exposition des stagiaires en obstétrique à l’AVS demeure limitée. Cette étude avait pour objectif d’identifier, au moyen de démonstrations filmées par des spécialistes, les compétences verbales et non verbales nécessaires à la prise en charge de l’AVS. Méthodes : Les membres du personnel infirmier de la salle de travail et d’accouchement de trois importants hôpitaux universitaires ont identifié les cliniciens qu’ils considéraient comme étant compétents en matière d’AVS. Les obstétriciens les plus souvent identifiés ont été conviés à participer à l’étude. Les participants ont été filmés alors qu’ils procédaient à un AVS sur un simulateur d’accouchement; à ces occasions, nous leur avons également demandé de nous entretenir de leur évaluation et de leur technique, ainsi que de nous fournir des conseils cliniques issus de leur expérience. Deux membres de l’étude ont passé en revue toutes les vidéos et ont documenté les composantes verbales et non verbales de l’évaluation, les ont groupées en thèmes communs et en ont rédigé une synthèse. Cette synthèse a été transmise à tous les participants et a été analysée par des obstétriciens expérimentés de l’étranger. Résultats : Dix-sept cliniciens ont été identifiés; 12 (70 %) ont consenti à participer à l’étude. Parmi les thèmes identifiés, on trouvait les suivants : évaluation méticuleuse et counseling prégrossesse; rôles de l’équipe multidisciplinaire; nécessité d’une communication attentive et adéquate avec les parents; techniques d’accouchement particulières; et documentation et soins postpartum. Une liste des tâches cliniques a été g

  8. The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

    Science.gov (United States)

    Kwon, Ha Yan; Kwon, Ja-Young; Park, Yong Won

    2016-01-01

    Objective To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section. PMID:27200306

  9. The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines.

    Science.gov (United States)

    Kwon, Ha Yan; Kwon, Ja-Young; Park, Yong Won; Kim, Young-Han

    2016-05-01

    To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

  10. A new vaginal delivery system of amphotericin B: a dispersion of cationic liposomes in a thermosensitive gel.

    Science.gov (United States)

    Kang, June-Woo; Davaa, Enkhzaya; Kim, Ye-Tae; Park, Jeong-Sook

    2010-09-01

    Amphotericin B (AmB) is used in the treatment of fungal infections; however, its clinical use is limited by its toxic side effects. In this study, AmB-loaded cationic liposome gels were formulated with 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE), 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP), and cholesterol (CH) at a molar ratio of DOPE:DOTAP:CH = 4:5:1 in thermosensitive gel composed of poloxamer 407 (P407) and poloxamer 188 (P188). To enhance the solubility of AmB, 6 mol% of distearoyl phosphatidyl ethanolamine-polyethylene glycol was added prior to encapsulation of the drug into liposomes. Scanning electron microscopy was used to observe the AmB encapsulated cationic liposome gels. In vitro release, stability and cytotoxicity of AmB in cationic liposome gels were evaluated. The particle size and zeta potential of AmB-loaded liposomes were in the range of 400-500 nm and 40-60 mV, respectively. The thermosensitive gel at the ratio of P407:P188 = 15:15 (w/w) gelled at 37 degrees C, approximating body temperature. Encapsulation efficiency of AmB was approximately 50-60%, which was influenced by the ratio of AmB to lipid. Moreover, AmB-loaded cationic liposome gels were more stable and less toxic than free AmB. From these results, cationic liposome gel formulations may be useful for vaginal delivery of AmB.

  11. Cesarean delivery rates and obstetric culture - an Italian register-based study.

    Science.gov (United States)

    Plevani, Cristina; Incerti, Maddalena; Del Sorbo, Davide; Pintucci, Armando; Vergani, Patrizia; Merlino, Luca; Locatelli, Anna

    2017-03-01

    Cesarean delivery rates are rising due to multiple factors, including less use of operative vaginal delivery and vaginal birth after cesarean delivery, which often reflect local obstetric practices. Objectives of the study were to analyze the relations between cesarean delivery, these practices, and perinatal outcomes. We included all deliveries in the 72 hospitals of Lombardia, a region in northern Italy, during the year 2013. The delivery certificate was used as data source. Pearson's correlation coefficient and logistic regression were used for statistical analysis. We included 87 896 deliveries. The number of deliveries per hospital ranged from 140 to 6123. The rate of cesarean delivery was 28.3% (range 9.9-86.4%), operative vaginal delivery 4.7% (range 0.2-10.0%), and vaginal birth after cesarean 17.3% (range 0-79.2%). We found a significant inverse correlation between rates of overall cesarean delivery and operative vaginal delivery (r = -0.25, p = 0.04). The correlation between rate of overall cesarean delivery and vaginal birth after cesarean was also inverse and significant (r = -0.57, p cesarean delivery rate and the rates of Apgar score at 5 min cesarean delivery, could reduce the rising cesarean delivery rate. This will require a change in obstetric culture, continuing education of healthcare providers, and leadership. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Vaginal Diseases

    Science.gov (United States)

    Vaginal problems are some of the most common reasons women go to the doctor. They may have ... that affect the vagina include sexually transmitted diseases, vaginal cancer, and vulvar cancer. Treatment of vaginal problems ...

  13. Vaginal Fistula

    Science.gov (United States)

    Vaginal fistula Overview By Mayo Clinic Staff A vaginal fistula is an abnormal opening that connects your vagina to ... or urine to pass through your vagina. Vaginal fistulas can develop as a result of an injury, ...

  14. A comparative review of intra-operative hemodynamic changes in patients undergoing vaginal surgeries using tumescent anaesthesia vs conventional techniques

    Directory of Open Access Journals (Sweden)

    Anu Pathak

    2013-06-01

    Full Text Available Background: The objective was to assess intra-operative hemodynamic changes in patients undergoing vaginal surgeries using tumescent anaesthesia vs conventional techniques. Methods: Study was carried out on 200 patients attending the Obst. & Gynae. Dept. of S.N. Medical College, Agra. According to randomization they were divided into 2 groups: group-a: include 100 patients undergoing vaginal surgery using conventional techniques and group-b: include 100 patients undergoing vaginal surgery using tumescent anaesthesia (25 mol of 2% lignocaine and .5 ml eg. Adrenaline (1:1000 conc. ease and duration of surgery, blood loss, hemodynamic changes during surgery were recorded and comparison drawn and analysed by statistical analysis. Results: In our study, time required for completion of surgery in group-a was 21-35 min as in group-b it was 36-50 min. More number of cases had blood loss 100 ml (90%0. No significant change in mean blood pressure and heart rate between both groups (p>0.05. Conclusion: Tumescent anaesthesia is on safe approach which reduces time of surgery and blood loss during surgery with no significant changes in haemodynamic variables. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 379-382

  15. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity

    DEFF Research Database (Denmark)

    Romero, Roberto; Nicolaides, Kypros; Conde-Agudelo, Agustin;

    2012-01-01

    To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality.......To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality....

  16. A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labor: a cohort study.

    Science.gov (United States)

    Pinton, Anne; Severac, François; Meyer, Nicolas; Akladios, Cherif Y; Gaudineau, Adrien; Favre, Romain; Langer, Bruno; Sananes, Nicolas

    2017-04-01

    The aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor. This was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015. All women with a singleton pregnancy hospitalized with threatened preterm labor between 23 and 34 weeks of gestation were included. Cases of iatrogenic preterm delivery were excluded. A multivariable logistic regression model to estimate the significant predictive parameters of spontaneous preterm delivery was performed. The primary endpoint of our study was a preterm birth before 34 weeks of gestation. A total of 395 women were included in our study. The rate of preterm delivery before 34 weeks was 13%. In univariate analysis every single cervical parameter assessed by the digital examination and all the ultrasound parameters were significantly associated with preterm delivery. The final model included five variables predicting preterm birth: visualization of the membranes at the speculum examination (OR 15.8, 95% CI 2.43-146), ultrasound cervical length (OR 0.82, 95% CI 0.75-0.89), signs of inflammation (OR 6.23, 95% CI 2.07-22.9), gestational age on admission (OR 0.84, 95% CI 0.71-1.0), and presence of vaginal infection (OR 4.28, 95% CI 1.52-12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery. Our study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria.

    Science.gov (United States)

    Garba, Ibrahim; Muhammed, Abubakar Shehu; Muhammad, Zakari; Galadanci, Hadiza Shehu; Ayyuba, Rabiu; Abubakar, Idris Sulaiman

    2016-01-01

    Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism. To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae. The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishop's score were the factors found to be associated with high success rate of IOL (P < 0.001). Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishop's scores were the factors found to be associated with the success of IOL.

  18. Breast Stimulation in Low-Risk Primigravidas at Term: Does It Aid in Spontaneous Onset of Labour and Vaginal Delivery? A Pilot Study

    Directory of Open Access Journals (Sweden)

    Nilanchali Singh

    2014-01-01

    Full Text Available Aims. The aim of the study was to elicit the safety and efficacy of breast stimulation as an intervention to prevent postdatism and as an aid in spontaneous onset of labour. Methods. Primigravidas with cephalic presentation, without any high-risk factor, were recruited between 36 to 38 weeks of gestation. 200 patients were recruited and randomized into two groups (n = 100. Breast stimulation was advised to one group but not to the other group. Bishop’s scoring was done at 38 weeks and repeated at 39 weeks of gestation. Maternal and fetal outcomes were compared in two groups. Result. Bishop’s score changed from 3.12 (±1.01 to 3.9 (±1.08 in control group and from 3.02 (±0.82 to 6.08 (±1.29 in breast stimulation group after one week (P value < 0.0001. The period of gestation at delivery was 39.5 (±2.3 weeks in control group and 39.2 (±2.8 weeks in intervention group (P value: 0.044. There were increased chances of vaginal delivery in intervention group (P value: 0.046. Duration of labor, hyperstimulation, presence of meconium stained liquor, postpartum hemorrhage, and neonatal outcomes were similar in both groups. Conclusion. Breast stimulation in low-risk primigravidas helps in cervical ripening and increases chances of vaginal delivery.

  19. Explore of feasibility of uterine scar vaginal delivery%疤痕子宫阴道分娩的可行性研究

    Institute of Scientific and Technical Information of China (English)

    张妹玉

    2015-01-01

    目的:探讨疤痕子宫再次妊娠经阴道分娩的可行性。方法:回顾性分析再次妊娠的产妇142例,其中70例剖宫产术后再次妊娠产妇作为治疗组(均为第二产次),72例为正常分娩后再次妊娠产妇作为对照组(均为第二产次)。结果:两组产妇经阴道分娩的成功率、婴儿 APORG 评分、术后并发症发生情况,两组间差异无统计学意义(P ﹥0.05)。结论:对剖宫产术后疤痕子宫再次妊娠者加强孕期管理,仔细评估,其中具备阴道分娩条件者应鼓励孕妇阴道试产,在严密观察监护下是可以成功阴道分娩的。%Objective To discuss the scar uterus during pregnancy again the feasibility of vaginal delivery. Method Retrospectively analyze on 142 therapy cases of secondary pregnant women. Among these cases,we regard it as a comparison group for 70 cases of secondary pregnancy women after caesarean section childbirth(all second childbirth),and regard it as another comparison group for 72 cases of sec-ondary pregnancy women after vaginal childbirth(all secondary childbirth). Results These 2 groups had no significant and meaningful difference in terms of success rate of vaginal delivery,baby's APORG audit,and the incidence of complication. Conclusion It needs to strengthen management on pregnancy period,audit carefully and choose appropriate childbirth ways. It needs to encourage pregnant women to vaginal delivery who have this condition,but the delivery period should be observed very closely.

  20. Vaginal delivery - discharge

    Science.gov (United States)

    ... only plain water. Avoid bubble baths or oils. Episiotomy Care Most women heal without problems, although it ... the discomfort and speed the healing of your episiotomy . Other Self-care Try eating smaller meals than ...

  1. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

    Science.gov (United States)

    Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

    2017-01-01

    Introduction Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, ‘Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery’, uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Methods and analysis Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. Ethics and dissemination The University of Utah and Intermountain Healthcare

  2. 阴道分娩产妇会阴裂伤相关因素分析%The analysis of related factors in perineal tear after vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    李晓红; 李绍楠; 刘锦玉; 陈婷

    2010-01-01

    Objective To explore the relevant factors of maternal perineal tear after vaginal delivery. Methods A retrospective analysis of 1 322 cases of maternal perineal tear after a natural vaginal delivery in our hospital was done, and production times, the birth process, maternal age, newborn birth weight, the use of contractions reagent, fetal position, birth attendants work experience and other factors were analyzed. Results Second degree perineal tear in primipara was higher than that of second or more vaginal deliveries ( P < 0. 05 );With the increase in newborn birth weight , the incidence of perineal tear was increased significantly ( P < 0. 005 ); if birth attendants work experience was less than 5 years, the incidence of maternal perineal tear of vaginal delivery was significantly higher ( P < 0. 005 ); urgent production did not increase the incidence of perineal tear, but there was significant difference in the proportion in different degrees of tear (P<0.05 ); maternal age and the use of contractions reagent did not increase the incidence of perineal tear (P > 0. 05 ) . Conclusions Primipara, newborn birth weight, the lack of work experience of birth attendants are the main factors of perineal tear after vaginal delivery. As long as enhancing learning, improving their technical level, prenatal preparation, observing carefully during porduction, detecting unusual circumstances in time, mastering the surgical indications for midwifery strictly, selecting the appropriate mode of delivery could reduce the incidence of perineal tear.%目的 探讨经阴道分娩产妇会阴裂伤的有关因素.方法 回顾分析我院1 322例经阴道自然分娩产妇会阴裂伤情况,并对产次、产程、产妇年龄、胎儿体重、使用宫缩剂、胎方位、接生者工作年限等因素进行分析.结果 初产妇Ⅱ度会阴裂伤发生率高于经产妇(P<0.05);随着胎儿体重的增加会阴裂伤发生率明显增加(P<0.005);

  3. pH and temperature dual-sensitive liposome gel based on novel cleavable mPEG-Hz-CHEMS polymeric vaginal delivery system

    Directory of Open Access Journals (Sweden)

    Chen D

    2012-05-01

    Full Text Available Daquan Chen,1,2 Kaoxiang Sun,1,2 Hongjie Mu,1 Mingtan Tang,3 Rongcai Liang,1,2 Aiping Wang,1,2 Shasha Zhou,1 Haijun Sun,1 Feng Zhao,1 Jianwen Yao,1 Wanhui Liu1,21School of Pharmacy, Yantai University, 2State Key Laboratory of Longacting and Targeting Drug Delivery Systems, Yantai, 3School of Pharmaceutical Sciences, Shandong University, Jinan, People's Republic of ChinaBackground: In this study, a pH and temperature dual-sensitive liposome gel based on a novel cleavable hydrazone-based pH-sensitive methoxy polyethylene glycol 2000-hydrazone-cholesteryl hemisuccinate (mPEG-Hz-CHEMS polymer was used for vaginal administration.Methods: The pH-sensitive, cleavable mPEG-Hz-CHEMS was designed as a modified pH-sensitive liposome that would selectively degrade under locally acidic vaginal conditions. The novel pH-sensitive liposome was engineered to form a thermogel at body temperature and to degrade in an acidic environment.Results: A dual-sensitive liposome gel with a high encapsulation efficiency of arctigenin was formed and improved the solubility of arctigenin characterized by Fourier transform infrared spectroscopy and differential scanning calorimetry. The dual-sensitive liposome gel with a sol-gel transition at body temperature was degraded in a pH-dependent manner, and was stable for a long period of time at neutral and basic pH, but cleavable under acidic conditions (pH 5.0. Arctigenin encapsulated in a dual-sensitive liposome gel was more stable and less toxic than arctigenin loaded into pH-sensitive liposomes. In vitro drug release results indicated that dual-sensitive liposome gels showed constant release of arctigenin over 3 days, but showed sustained release of arctigenin in buffers at pH 7.4 and pH 9.0.Conclusion: This research has shed some light on a pH and temperature dual-sensitive liposome gel using a cleavable mPEG-Hz-CHEMS polymer for vaginal delivery.Keywords: mPEG-Hz-CHEMS polymer, pH-sensitive liposomes, thermosensitive

  4. Study on the influence of the fetus head molding on the biomechanical behavior of the pelvic floor muscles, during vaginal delivery.

    Science.gov (United States)

    Silva, M E T; Oliveira, D A; Roza, T H; Brandão, S; Parente, M P L; Mascarenhas, T; Natal Jorge, R M

    2015-06-25

    Pelvic floor injuries during vaginal delivery are considered a significant risk factor to develop pelvic floor dysfunction. The molding of the fetus head during vaginal delivery facilitates the labor progress, since it adjusts to the birth canal geometry. In this work, a finite element model was used to represent the effects induced by the passage of the fetus head on the pelvic floor. The numerical model used for this simulation included the pelvic floor muscles attached to the bones, and a fetus body. The model of the fetus head included the skin and soft tissues, the skull with sutures and fontanelles, and the brain. The fetus head movements during birth in vertex position were simulated: descent, internal rotation and extension. Two models of the fetus head were compared: a rigid and a deformable one, with the inclusion of the cranial sutures. The influence of the fetus head molding on the pelvic floor muscles was analyzed by evaluating their reaction forces, stretch, and stress and strain fields. Additionally, anatomical indices for the molding of the fetal skull were obtained and compared with clinical data. The passage of the deformable fetus head through the birth canal leads to a reduction of 17.3% on the reaction forces on the pelvic floor muscles when compared to the ones of a rigid head. Furthermore, the fetus head molding implies inferior resistance to rotation resulting in a reduction of 1.86% in muscle stretching. Quantitative evaluation of the fetus head molding showed good agreement with clinical experiments.

  5. Post placental copper-T 380A insertion after normal vaginal delivery and cesarean section and its clinical outcome

    Directory of Open Access Journals (Sweden)

    Jyoti Malik

    2016-07-01

    Conclusions: Although there was high incidence of missing IUCD threads (due to coiling of thread, actual expulsion rate was far lesser. Removal rate due to menorrhagia, pain abdomen and vaginal discharge was low and 6 months continuation rate was considerably good. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2254-2256

  6. Second-stage primary Caesarean deliveries: Are maternal ...

    African Journals Online (AJOL)

    of time given to the second stage of labour has been shown to increase the overall rate of ... operative vaginal delivery, anal sphincter tears, postpartum haemorrhage ... calculated using logistic regression since the outcomes were very rare.

  7. Functional MRI of the pelvic floor: postpartum changes of primiparous women after spontaneous vaginal delivery; Funktionelle Magnetresonanztomographie (MRT) des Beckenbodens: Postpartale Veraenderungen bei Erstgebaerenden nach vaginaler Spontangeburt

    Energy Technology Data Exchange (ETDEWEB)

    Lienemann, A.; Fischer, T.; Reiser, M. [Inst. fuer Klinische Radiologie, Klinikum der Univ. Muenchen (Germany); Anthuber, C. [Klinik und Poliklinik fuer Geburtshilfe und Frauenheilkunde, Klinikum der Univ. Muenchen/Grosshadern (Germany)

    2003-08-01

    Purpose: Detection of morphological and functional changes of the pelvic floor with functional MRI in primiparous women after spontaneous vaginal delivery. Methods and Materials: The study comprises 26 primiparous women after vaginal delivery and a control group of 41 healthy asymptomatic nulliparous volunteers. MRI was performed on a 1.5 T system in supine position with vagina and rectum opacified with Sonogel. The static images consisted of sagittal and axial T{sub 2}-weighted SE sequences and functional images of true FISP sequences in midsagittal and axial planes acquired with the patient at rest, straining and during defecation. Evaluation of morphometric parameters included pelvimetry, thickness of the puborectal muscle and width of the urogenital hiatus as well as position and movement of the pelvic organs relative to the pubococcygeal reference line. Results: The configuration of the bony pelvis did not differ for both groups. The puborectal muscle was significantly thinner in the study group (0.8 cm vs 0.6 cm). The functional images showed no significant differences between both groups at rest but a significantly increased incidence in the descent of the bladder neck, vaginal fornix and anorectal junction in the study group during straining. In addition, the primiparous women had more prominent rectoceles (0.6 cm vs 1.5 cm). Conclusion: Static imaging alone fails to demonstrate relevant pelvic floor changes and a functional method is necessary to evaluate the interactions of the pelvic organs regarding organ descent. Functional MRI of the pelvic floor is an excellent method to reveal the significant changes of the pelvic floor after vaginal birth without exposing the uterus to radiation. (orig.) [German] Ziel: Darstellung von morphologischen und funktionellen Veraenderungen am Beckenboden bei Erstgebaerenden nach spontanvaginaler Entbindung mittels funktioneller MRT. Methodik: Funktionelle MRT des Beckenbodens von 26 Erstgebaerenden nach vaginaler

  8. Development of a vaginal delivery film containing EFdA, a novel anti-HIV nucleoside reverse transcriptase inhibitor.

    Science.gov (United States)

    Zhang, Wei; Parniak, Michael A; Sarafianos, Stefan G; Cost, Marilyn R; Rohan, Lisa C

    2014-01-30

    The aim of this work was to develop a fast-dissolving film formulation containing EFdA for potential use as a topical vaginal microbicide for prevention of HIV sexual transmission. Solid state compatibility approaches were used to screen commonly used polymers for formulation development. Factorial design and desirability function were used to investigate the effect of two variables, the ratio of the polymers and the concentration of selected plasticizer on four mechanical responses including tensile strength, elongation at break, toughness and elastic modulus for optimization of the film formulation. Assessments of EFdA-loaded films included physicochemical characteristics, in vitro cytotoxicity, epithelia integrity, ex vivo permeability and bioactivity test. The optimal placebo film was composed of PVA, HPMC E5 and propylene glycol (7:3:3, w/w), and its mechanical characteristics were comparable to those of VCF(®) film (a commercial vaginal film product). Permeability studies using human ectocervical explants showed that there was no significant difference in cumulative permeated amount of EFdA between EFdA film and free EFdA. The results of in vitro cytotoxicity and bioactivity testing showed that 50% cytotoxic concentration (CC50) was several orders of magnitude higher than 50% effective concentration (EC50) of EFdA. Furthermore, epithelial integrity study showed that EFdA-loaded film had a much lower toxicity to HEC-1A cell monolayers as compared to VCF(®). Therefore, EFdA-loaded vaginal film may be considered as a promising vaginal microbicide for HIV prevention.

  9. Econazole-polycarbophil, a new delivery system for topical therapy: microbiological and clinical results on vaginal candidiasis.

    Science.gov (United States)

    Furneri, P M; Corsello, S; Masellis, G; Salvatori, M; Cammarata, E; Roccasalva, L S; Mangiafico, A; Tempera, G

    2008-06-01

    The aim of this study was to demonstrate that the addition of a bioadhesive polymer to econazole, which increases the duration of the active drug at the site of infection, leads to a greater frequency of negative culture after treatment and probably reduces the recurrence rate of vaginal candidiasis.180 women with vaginal candidiasis were treated with 150 mg vaginal ovules econazole nitrate with (group A) or without (group B) polycarbophil. After 3 days of treatment the negative culture of Candida albicans reached 98.6% in group A and 84.8% in B group, while the overall persistence (C. albicans, C. glabrata, C. krusei, and C. parapsilosis) was 5.6% and 30%, respectively. During a 60-day follow-up, only one case out of 85 (1.2%) in group A reported recurrence while in group B there were 6 out of 63 (9.5%) recurrences. We conclude that, since the women were treated with the same amount of econazole, the better clinical and microbiological results can be attributed to polycarbophil, as confirmed by a significant reduction of recurrences.

  10. pH and temperature dual-sensitive liposome gel based on novel cleavable mPEG-Hz-CHEMS polymeric vaginal delivery system

    Science.gov (United States)

    Chen, Daquan; Sun, Kaoxiang; Mu, Hongjie; Tang, Mingtan; Liang, Rongcai; Wang, Aiping; Zhou, Shasha; Sun, Haijun; Zhao, Feng; Yao, Jianwen; Liu, Wanhui

    2012-01-01

    Background In this study, a pH and temperature dual-sensitive liposome gel based on a novel cleavable hydrazone-based pH-sensitive methoxy polyethylene glycol 2000-hydrazone-cholesteryl hemisuccinate (mPEG-Hz-CHEMS) polymer was used for vaginal administration. Methods The pH-sensitive, cleavable mPEG-Hz-CHEMS was designed as a modified pH-sensitive liposome that would selectively degrade under locally acidic vaginal conditions. The novel pH-sensitive liposome was engineered to form a thermogel at body temperature and to degrade in an acidic environment. Results A dual-sensitive liposome gel with a high encapsulation efficiency of arctigenin was formed and improved the solubility of arctigenin characterized by Fourier transform infrared spectroscopy and differential scanning calorimetry. The dual-sensitive liposome gel with a sol-gel transition at body temperature was degraded in a pH-dependent manner, and was stable for a long period of time at neutral and basic pH, but cleavable under acidic conditions (pH 5.0). Arctigenin encapsulated in a dual-sensitive liposome gel was more stable and less toxic than arctigenin loaded into pH-sensitive liposomes. In vitro drug release results indicated that dual-sensitive liposome gels showed constant release of arctigenin over 3 days, but showed sustained release of arctigenin in buffers at pH 7.4 and pH 9.0. Conclusion This research has shed some light on a pH and temperature dual-sensitive liposome gel using a cleavable mPEG-Hz-CHEMS polymer for vaginal delivery. PMID:22679372

  11. Artificial Abdominal Pressure Delivery in Vaginal Delivery in Clinical Effect Analysis%人工腹压助产在阴道分娩中的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    刘琼英

    2012-01-01

      目的:对应用人工腹压助产技术进行阴道分娩的临床效果进行研究分析.方法:抽取102例阴道分娩并接受助产处理的产妇病例,将其分为A、B 2组,平均每组51例.A组产妇进行胎头吸引助产;B组产妇进行人工腹压助产.结果:B组产妇在助产过程中对阴道产生的损伤程度明显轻于A组;出现产后出血的人数明显少于A组;接受助产对胎儿所产生的损伤明显小于A组;新生儿在围产期的窒息率明显低于A组;新生儿在围产期出现疾病的人数明显少于A组;2组产妇在围产期内均没有出现任何并发症.结论:应用人工腹压助产技术进行阴道分娩的临床效果非常明显.%  Objective:Artificial abdominal pressure midwifery technique for vaginal delivery clinical effect analysis.Methods:Selected 102 cases of vaginal delivery and receiving midwifery processing maternal case, which can be divided into A, B two group, average each of 51 cases. Group A maternal low forceps midwifery;group B maternal artificial abdominal pressure midwifery. Results:The B group in the midwifery process to maternal vaginal resulting injury severity was much lighter than that of A group;the number of occurrence of postpartum hemorrhage was obviously less than group A; receiving midwifery on fetal arising from the injury was significantly less than that in group A;neonates after perinatal asphyxia rate was significantly lower than that in A group;neonates after perinatal disease significantly the number of less than group A; the two groups of women during the perinatal period are not any complications.Conclusions: the application of the artificial abdominal pressure midwifery technique for vaginal delivery of clinical effect is very obvious.

  12. Atrophic vaginitis.

    Science.gov (United States)

    Stika, Catherine S

    2010-01-01

    With the loss of estrogen that occurs with menopause, physiologic and structural changes occur within the vulvovaginal mucosa that lead to a condition commonly called atrophic vaginitis. Although mild genital changes occur in most women, 10-47% of postmenopausal women will develop one or more debilitating symptoms that include vulvovaginal dryness, dyspareunia, vulvar itching or pain, recurrent urinary tract infections, as well as abnormal vaginal discharge. Topical estrogen replacement therapies reverse these mucosal changes and are effective treatments for the symptoms of atrophic vaginitis. Vaginal moisturizers and lubricants also provide symptomatic relief for vaginal dryness and dyspareunia, respectively. © 2010 Wiley Periodicals, Inc.

  13. Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers.

    Science.gov (United States)

    Karanth, Laxminarayan; Kanagasabai, Sachchithanantham; Abas, Adinegara Bl

    2017-08-04

    the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.

  14. A history of abuse and operative delivery--results from a European multi-country cohort study.

    Directory of Open Access Journals (Sweden)

    Berit Schei

    Full Text Available OBJECTIVE: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. DESIGN: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS, or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. RESULTS: Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49, and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24. Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3. Neither physical abuse (in adulthood or childhood <18 years, nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19. CONCLUSION: Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.

  15. Analysis of complications in vaginal deliveries of pregnant women with scarred uteruses%瘢痕子宫阴道分娩的并发症分析

    Institute of Scientific and Technical Information of China (English)

    谭静; 刘丽园; 张立波

    2016-01-01

    Objective To study the complications in vaginal deliveries of pregnant women with scarred uteruses. Methods180 women with pregnancies between 37 to 42 weeks who were in the obstetrical department of Shenzhen Longhua New District Central Hospital from January 2014 to January 2016 were selected, 90 pregnant women with normal uteruses were assigned to control group,90 re-pregnant women with scarred uteruses were assigned to observation group. Both two groups adopted spontaneous vaginal deliveries,the delivery outcomes and postpartum complications of the two groups were compared and analyzed.ResultsThe puerperal endometritis rates, obstetric infection rates, and hospitalization time of the two groups were not obviously different(P>0.05).In the observation group,the bleeding amount within 24 hours after delivery,midwifery proportion,and threatened uterus rupture rate were more or higher than those of the control group, while the differences were not obvious(P>0.05),there were no statistical significances.ConclusionBased on fully grasping of the contraindications and indications by vaginal birth trial,with effective preventions, carefully monitoring, and timely discovery & processing mechanism, the re-pregnant women with scarred uteruses can adopt spontaneous vaginal deliveries.Though some re-pregnant women with scarred uteruses suffered complications,compared with the pregnant women with normal uteruses, the incidence of complications is still within a controllable range.Therefore, we recommend re-pregnant women with scarred uteruses attempting vaginal deliveries,if they meet vaginal delivery conditions and physical conditions.%目的:探讨瘢痕子宫阴道分娩的并发症并进行分析。方法选择2014年1月~2016年1月龙华新区中心医院产科收治的孕周在37~42周孕妇180例,其中对照组90例为非瘢痕子宫妊娠者,观察组90例为瘢痕子宫再次妊娠者,两组孕妇均采用阴道自然分娩,对两组患者的妊娠结

  16. The effect observation of application of delivery ball and acupoint manipulation for reduce vaginal delivery pain%分娩球加穴位推拿对改善阴道分娩疼痛的效果观察

    Institute of Scientific and Technical Information of China (English)

    吕琦玲; 杨西萍; 曾伟; 雷玉妃; 刘锐; 李青; 莫文辉

    2016-01-01

    目的:探讨分娩球配合穴位推拿对缓解阴道分娩疼痛效果.方法:选择2014年6月~2015年6月在我院收治的224例初产单胎头位、排除高危因素的临产产妇为研究对象,随机等分为观察组和对照组,观察组由专业助产士全程陪护,负责指导产妇分娩球的合理使用,中医师指导助产士按摩穴位;对照组按常规处理,两组进行观察比较疼痛情况、产程时间和剖宫产情况.结果:观察组较对照组疼痛明显减轻,产程缩短,降低了剖宫产例数,差异有统计学意义(P<0.05).结论:分娩球加穴位按摩可减轻分娩疼痛,产程缩短,降低剖宫产率.%Objective:To explore the effect of application of delivery ball and acupoint manipulation for reduce vaginal delivery pain. Methods:Selected 224 cases of parturient puerperae who were going to give first birth to single fetuses with normal fatal head position at exception of high risk factors as research objects in our hospital from June 2014 to June 2015 and equally divided them into observation group and control group at random. The observation group was whole-process accompanied and attended by professional midwifes who were responsible for offering guidance of the reasonable usage of delivery ball and instructed by traditional Chinese medicine physicians to give acupoint manipulation for parturient puerperae;the control group was given the normal treat-ment. Then to observe and compare their degree of delivery pain, time of delivery stage and cesarean delivery condition of the two groups. Results:The deliv-ery pain, time of delivery stage and cases of cesarean delivery of observation group was significantly less than the control group. The difference was of statis-tic significance (P<0. 05). Conclusion:The application of delivery ball and acupoint manipulation can effectively reduce the delivery pain, delivery stage time and to reduce the rate of cesarean delivery.

  17. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Bo Sung Yoon

    2014-12-01

    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  18. Vaginal childbirth and pelvic floor disorders

    OpenAIRE

    Memon, Hafsa U.; Handa, Victoria L.

    2013-01-01

    Childbirth is an important event in a woman’s life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal deli...

  19. The Near Future Impaction on Primiparas’Pelvic Floor Function After the Unprotected Vaginal Delivery%初产妇无保护阴道分娩对盆底功能的近期影响

    Institute of Scientific and Technical Information of China (English)

    范承玲; 周宏霞; 张荣善

    2015-01-01

    目的:探讨初产妇无保护阴道分娩对盆底功能的近期影响。方法选择经阴道分娩的初产妇208例为研究对象,无保护阴道分娩无侧切138例为观察组,常规阴道分娩行会阴侧切70例为对照组,于产后42 d返院专人对产妇临床症状及盆底功能进行检测,对比两组分娩方式对盆底功能的近期影响。结果观察组切口疼痛发生率、性生活障碍发生率低于对照组(P0.05)。结论无保护阴道分娩可减少产后盆底功能障碍疾病的发生。%Objective To discuss the near future impaction on primiparas’pelvic floor function after unprotected vaginal delivery. Methods Selected 208 cases of primiparas after vaginal delivery as the research objects,138 cases of unprotected vaginal delivery with no side cut were taken as observation group, 70 cases of normal vaginal delivery with line episiotomy were taken as control group. The puerperas came back to hospital after postpartum 42 day,and were tested the clinical symptoms and pelvic floor function by personnels. Compared the two groups recent impaction on pelvic floor function. Results The incidences of incision pain and sexual dysfunction in observation group was obviously lower than these in control group(P0.05). Conclusion Unprotected vaginal delivery can reduce the incidence of postpartum pelvic floor dysfunction diseases.

  20. 瘢痕子宫足月妊娠孕妇阴道分娩的临床分析%Clinical Analysis of Vaginal Delivery in Scarred Uterus Pregnant Women With Full-term Pregnancy

    Institute of Scientific and Technical Information of China (English)

    王冉

    2016-01-01

    目的:探讨瘢痕子宫再次妊娠行阴道分娩的临床效果及安全性。方法选择我院200例瘢痕子宫孕妇为研究对象,根据分娩方式的不同将剖宫产术后阴道分娩(VBAC)娩出胎儿者作为阴道分娩组,另瘢痕子宫女性再次妊娠剖宫产术分娩(RCS)的孕妇作为剖宫产组,每组各100例。观察两组产妇分娩出血量、分娩成功率、住院时间、术后并发症情况,并对新生儿进行Apgar评分。结果阴道分娩组分娩出血量低于剖宫产组,但是分娩时间长于剖宫产组,差异均有统计学意义(P<0.05);分娩后,阴道分娩组住院时间少于剖宫产组,伤口感染、产后出血发生率低于剖宫产组,差异均有统计学意义(P<0.05);两组新生儿Apgar评分与新生儿窒息率比较,差异均无统计学意义(P>0.05)。结论对于具备阴道分娩条件的瘢痕子宫孕妇,应优先考虑阴道分娩途径分娩,阴道试产过程中严密监护。经阴道分娩是安全可行的。%Objective To explore the clinical effect and safety of vaginal delivery in scarred uterus pregnant women with ful-term pregnancy.Methods 200 cases of pregnant women with scar uterus in our hospital were colected as study objects,according to the different ways of delivery,100 cases of uterine scar again pregnancy vaginal birth after cesarean(VBAC)were selected as the vaginal delivery group,and another 100 cases of uterine scar again pregnancy repeat cesarean section(RCS)were selected as the cesarean section group.The vaginal bleeding,delivery success rate,hospitalization time, postoperative complications of two groups were observed,and the newborns were scored by Apgar scoreing.Results The amount of bleeding of the vaginal delivery group was significantly lower than that in the cesarean section group,but the delivery time was significantly longer than that of the cesarean section group,the differences were statisticaly

  1. Evaluation of polycaprolactone matrices for sustained vaginal delivery of nevirapine in the prevention of heterosexual HIV transmission.

    Science.gov (United States)

    Dang, Nhung; Sivakumaran, Haran; Harrich, David; Shaw, P Nicholas; Coombes, Allan G A

    2014-07-01

    Nevirapine (NVP) was loaded in polycaprolactone (PCL) matrices to produce vaginal inserts with the aim of preventing HIV transmission. NVP dispersions in PCL were prepared, at 10% (w/w) theoretical loading, measured with respect to the PCL content of the matrices, in the form of (1) NVP only, (2) a physical mixture of NVP with polyethylene glycol (PEG) 6000 or (c) a solid dispersion (SD) with PEG produced by co-dissolution in ethanol. Characterisation of SD by differential scanning calorimetry and attenuated total reflectance-Fourier transform infrared spectroscopy suggested transformation of the crystalline structure of NVP to an amorphous form which consequently increased the dissolution rate of drug. A low-loading efficiency of 13% was obtained for NVP-loaded matrices and less than 20% for matrices prepared using physical mixtures of drug and PEG. The loading efficiency was improved significantly to around 40% when a 1:4 NVP-PEG SD was used for matrix production. After 30 days, 40% of the drug content was released from NVP-loaded matrices, 55% from matrices containing 1:4 NVP-PEG physical mixtures and 60% from matrices loaded with 1:4 NVP-PEG SDs. The in vitro anti-viral activity of released NVP was assessed using a luciferase reporter gene assay following the infection of HeLa cells with pseudo-typed HIV-1. NVP released from PCL matrices in simulated vaginal fluid retained over 75% anti-HIV activity compared with the non-formulated NVP control. In conclusion, 1:4 NVP-PEG SDs when loaded in PCL matrices increase drug loading efficiency and improve release behaviour.

  2. Distribution of vaginal flora in the women at six weeks after delivery and the effect of vaginal application of lactobacilli capsule%产后6周妇女阴道菌群分布及应用阴道乳杆菌胶囊的效果

    Institute of Scientific and Technical Information of China (English)

    黄新颜; 陈敏枝; 蒋敏; 刘丹

    2012-01-01

    目的:探讨产后6周妇女阴道菌群分布情况,研究微生物制剂(阴道乳杆菌胶囊)对恢复产后妇女阴道内环境,预防生殖道感染发生的临床意义.方法:收集11 453例产后6周妇女阴道分泌物,采用革兰氏染色法检查,进行Nugent评分,了解产后6周妇女阴道内环境状态及乳酸杆菌和条件致病菌分布情况.结果:11 453例产后6周妇女Nugent评分正常5 216例,临界5 342例,细菌性阴道病535例,阴道假丝酵母菌339例和滴虫21例.11 453例产后6周妇女有6 237例发生阴道炎症,疾病构成比以非特异性阴道炎为主5 342例,特异性阴道炎较为少见.所有产后6周妇女阴道pH值均为5.0以上.在所有涂片中,被认为在维持正常阴道微生态平衡中起关键作用的乳杆菌数量和比例明显不足.300例产后6周阴道分泌物正常妇女阴道内放置乳酸杆菌活菌胶囊,观察1年,结果显示研究组阴道pH明显降低,接近正常女性阴道pH水平(P<0.05);且阴道乳酸杆菌数量明显增多(P<0.05);同时产后3个月、6个月、9个月、12个月阴道炎的发生率均明显低于对照组(P<0.05).结论:产后6周妇女阴道炎症以非特异性阴道炎为主,细菌性阴道病、真菌性阴道炎和滴虫性阴道炎较少见.乳杆菌胶囊作为生态治疗的活菌制剂,既能预防阴道感染,又无不良反应,还可以减少产后妇女阴道炎的复发率,值得临床推广应用.%Objective: To explore the distribution of vaginal flora in the women at six weeks after delivery, research the clinical significance of microbial agent (lactobacilli capsule) in recovering vaginal internal environment and preventing the onset of genital tract infection for the postpartum women. Methods: The vaginal secretion samples of 11453 women at six weeks after delivery were collected, Gram staining was used to examine the samples, Nugent score was conducted, the vaginal internal environment and the distributions of

  3. From Data to Improved Decisions: Operations Research in Healthcare Delivery.

    Science.gov (United States)

    Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

    2017-11-01

    The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

  4. Vaginal Cancer

    Science.gov (United States)

    Vaginal cancer is a rare type of cancer. It is more common in women 60 and older. You are also more likely to get it if you have had a human ... test can find abnormal cells that may be cancer. Vaginal cancer can often be cured in its ...

  5. Vaginal cysts

    Science.gov (United States)

    ... cysts URL of this page: //medlineplus.gov/ency/article/001509.htm Vaginal cysts To use the sharing ... may need a biopsy to rule out vaginal cancer, especially if the mass appears to be solid. If the cyst is located under the bladder or urethra, x-rays may be needed to see if ...

  6. Cesarean section or vaginal delivery at 24 to 28 weeks' gestation: comparison of survival and neonatal and two-year morbidity.

    Science.gov (United States)

    Kitchen, W; Ford, G W; Doyle, L W; Rickards, A L; Lissenden, J V; Pepperell, R J; Duke, J E

    1985-08-01

    A large cohort of consecutive live births with gestational ages assessed antenatally from 24 to 28 weeks from one tertiary center was studied to determine the association between mode of delivery and in-hospital mortality and morbidity and morbidity at two years of age. Between 1 January 1977 and 31 March 1982, 52.8% (172 of 326) of such infants survived their primary hospitalization. Obstetric factors independently associated with improved survival were increasing gestational age (P less than .0001), the absence of maternal hypertension (P = .007), singleton pregnancy (P = .007), and antenatal steroid therapy (P = .018). Although 62.7% (32 of 51) of infants delivered by cesarean section survived compared with 50.9% (140 of 275) of infants delivered vaginally, the increased survival was not statistically significant (X 2 = 1.97). Moreover, the trend favoring cesarean section disappeared after adjustment for confounding obstetric factors. In univariate analyses cesarean births more frequently required ventilatory support and there was a trend toward a lower incidence of cerebroventricular hemorrhage; again, however, when adjusted for extraneous factors these associations disappeared. Of the 172 in-hospital survivors, five died at home unexpectedly; 162 of the remaining 167 were traced; 18 (11.1%) had cerebral palsy and two (1.2%) were deaf. Of the 111 children who were fully assessed, 13.5% had major handicaps, 23.4% were suspect, and 63.1% were free of handicap at two years' corrected age. There was no association between mode of delivery and frequency of handicap. Little evidence was found from mortality or morbidity data to support routine delivery of infants of borderline viability by cesarean section.

  7. 阴道分娩产后出血的相关因素分析%Analysis of the related factors of postpartum hemorrhage via vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    闫爱兰; 王秀艳

    2016-01-01

    目的:分析导致阴道分娩产后出血的相关因素,探讨如何预防产后出血。方法选取住院阴道分娩产妇2417例,分析子痫前期、巨大儿、胎盘早剥、肥胖、胎膜早破、高血压、孕周、孕产妇年龄、孕产次、流产次数、瘢痕子宫分娩、缩宫素引产、米索前列醇促宫颈成熟、产钳助产等与产后出血的相关性。结果产后出血发生率15.22%,子痫前期、巨大儿、胎盘早剥与产后出血显著相关(χ2=26.75、0.16、22.26,均 P <0.01);肥胖、胎膜早破与产后出血相关(χ2=6.53、4.98,均 P <0.05);高血压、孕周、孕产妇年龄、孕产次、流产次数、瘢痕子宫分娩与产后出血无相关性(P >0.05);缩宫素引产、米索前列醇促宫颈成熟、产钳助产与产后出血显著相关(χ2=45.66、21.77、88.06,均 P <0.01)。结论产前通过控制孕产妇及新生儿体质量、预防子痫前期、胎盘早剥、胎膜早破等发生以预防产后出血;产时避免无指征缩宫素引产、米索前列醇促宫颈成熟、产钳助产等以减少产后出血;产后准确估计出血量,积极处理,避免发生严重并发症。%Objective To analyze the relevant factors of vaginal delivery postpartum hemorrhage,and discussion how to prevent postpartum hemorrhage.Methods 2 417 maternal women who hospitalized vaginal delivery were selected.Preeclampsia,macrosomia,placental abruption,obesity,premature rupture of membranes,high blood pressure,gestational age,maternal age,maternal time,the number of abortion,scar uterus vaginal delivery,oxytocin induced labor,misoprostol for cervical mature,forceps midwifery,and the correlation of postpartum hemorrhage were analyzed.Results The incidence rate of postpartum hemorrhage was 15.22%.Pre -eciampsia,macrosomia,placental abruption had significant association with postpartum hemorrhage(χ2 =26.75,0.16,22.26,all P 0

  8. A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery

    Directory of Open Access Journals (Sweden)

    Azar Danesh Shahraki

    2011-01-01

    Conclusions: Restrictive episiotomy results in low maternal complications. Therefore, avoiding routine episiotomy in unnecessary conditions would increase the rate of intact perineal and minor perineal trauma and reduce postpartum delivery pain with no adverse effects neither on maternal nor neonatal morbidities.

  9. A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state

    Directory of Open Access Journals (Sweden)

    Priyanka Chaudhari

    2016-10-01

    Conclusions: Ventouse should be preferred over forceps whenever there is an indication for instrumental delivery (except in fetal distress as it is associated with less maternal trauma and most of the neonatal morbidities were insignificant in comparison with both instruments. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3294-3299

  10. Manufacturing scale-up of electrospun poly(vinyl alcohol) fibers containing tenofovir for vaginal drug delivery.

    Science.gov (United States)

    Krogstad, Emily A; Woodrow, Kim A

    2014-11-20

    Electrospun fibers containing antiretroviral drugs have recently been investigated as a new dosage form for topical microbicides against HIV-1. However, little work has been done to evaluate the scalability of the fiber platform for pharmaceutical production of medical fabrics. Scalability and cost-effectiveness are essential criteria in developing fibers as a practical platform for use as a microbicide and for translation to clinical use. To address this critical gap in the development of fiber-based vaginal dosage forms, we assessed the scale-up potential of drug-eluting fibers delivering tenofovir (TFV), a nucleotide reverse transcriptase inhibitor and lead compound for topical HIV-1 chemoprophylaxis. Here we describe the process of free-surface electrospinning to scale up production of TFV fibers, and evaluate key attributes of the finished products such as fiber morphology, drug crystallinity, and drug loading and release kinetics. Poly(vinyl alcohol) (PVA) containing up to 60 wt% TFV was successfully electrospun into fibers using a nozzle-free production-scale electrospinning instrument. Actual TFV loading in fibers increased with increasing weight percent TFV in solution, and encapsulation efficiency was improved by maintaining TFV solubility and preventing drug sedimentation during batch processing. These results define important solution and processing parameters for scale-up production of TFV drug-eluting fibers by wire electrospinning, which may have significant implications for pharmaceutical manufacturing of fiber-based medical fabrics for clinical use. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Emphysematous vaginitis.

    Science.gov (United States)

    Lima-Silva, Joana; Vieira-Baptista, Pedro; Cavaco-Gomes, João; Maia, Tiago; Beires, Jorge

    2015-04-01

    Emphysematous vaginitis is a rare condition, characterized by the presence of multiple gas-filled cysts in the vaginal and/or exocervical mucosa. Although its etiology is not completely understood, it is self-limited, with a benign clinical course. Vaginal discharge, sometimes bloody, and pruritus are the most common symptoms. Chronic and acute inflammation can be found, and diseases that impair the immune system and pregnancy have been associated with this condition. A 48-year-old postmenopausal woman, with a history of hysterectomy with several comorbidities, presented with a 4-month history of bloody discharge and vulvar pruritus. Examination showed multiple cystic lesions, 1 to 5 mm, occupying the posterior and right lateral vaginal walls. Speculum examination produced crepitus. Vaginal wet mount was normal, except for diminished lactobacilli; results of Trichomonas vaginalis DNA test and vaginal cultures were negative. Lugol's iodine applied to the vagina was taken up by the intact lesions. Biopsy result showed typical features of emphysematous vaginitis. This is an unusual entity, presenting with common gynecological complaints, and both physicians and pathologists should be aware to prevent misdiagnosis and overtreatment.

  12. Clinical analysis of the vaginal delivery outcome and episiotomy%经阴道分娩结局与会阴侧切的临床分析

    Institute of Scientific and Technical Information of China (English)

    陈思; 叶宇齐; 王静; 钟伟萍; 王佩娟

    2016-01-01

    Objective To research the effect of episiotomy on vaginal delivery outcome , to reduce episiotomy rate and promote natural childbirth .Methods 200 cases of episiotomy vaginal delivery women hospitalized in Integrated Hospital of Traditional Chinese and Western medicine of Jiangsu Province from October 2013 to October 2014 were selected as the observation group , while another 200 cases of natural childbirth women hospitalized at the same time were chosen as the control group .Compared the perineal edema , pain, healing, infection, 24 hours bleeding, sexual life, organ prolapse and stress urinary incontinence of the two groups .Results The amount of bleeding of puerpera in control group (343.94 ±69.55)mL was less than that of the observation group (404.75 ±89.87) mL,and the difference was statistically significant (P<0.05).The differences of the second stage of labor (P=0.24) and neonatal Apgar score ( P=0.56 ) between the two groups were not statistically significant .Most puerpera in control group had the I degree perineal laceration (159/200) .The wound pain rating of observation group was significantly higher than that of the control group .The wound edema of the two groups were almost the same , all the puerpera showed clinical manifestations of pelvic floor dysfunction ( PFD) , but the observation group had higher incidence of stress urinary incontinence , vaginal anterior and posterior wall prolapse and uterine prolapse after childbirth .Conclusion The vaginal birth outcomes of non -episiotomy is superior to episiotomy .The low-risk pregnant women are not recommended of vaginal delivery episiotomy .%目的:研究会阴侧切对经阴道分娩结局的影响,有效降低会阴侧切率,促进自然分娩。方法选取2013年10月至2014年10月在江苏省中西医结合医院行会阴侧切经阴道分娩的产妇200例作为观察组,同期经阴道分娩非会阴侧切产妇200例作为对照组,比较两组产妇分娩后的会阴水肿、

  13. Vaginal flatus and the associated risk factors in Iranian women: a main research article.

    Science.gov (United States)

    Veisi, Firoozeh; Rezavand, Negin; Zangeneh, Maryam; Malekkhosravi, Shohreh; Rezaei, Mansour

    2012-01-01

    Objective. The aim of the study was to determine the prevalence of vaginal flatus and some related risk factors in Iranian women. Methods. After conducting a pilot study, a sample size of 1000 subjects of 18 to 80 years was determined; of those 58 were unable to cooperate for various reasons. Age, parity, marital status, birth history, body mass index, and the weight of the largest newborn were collected. After a full gynecologic examination looking for pelvic organ prolapse, patients were asked about vaginal flatus and the frequency and time of occurrence. The results were studied using the chi-square test and independent t-test considering an alpha error of less than 0.05. Results. The prevalence of vaginal flatus was mainly 20% in this study, but embarrassment was observed in 5.7% of these women. 4% in the group were with no history of sexual contact (virgin). Vaginal flatus mostly started after vaginal delivery (45%) or spontaneously (34%); however, it was also reported after cesarean section and other pelvic operations. The most common activity leading to vaginal flatus was intercourse (54%); however, the time which had resulted in more inconvenience for the patients was during physical activities (92%). BMI and age were significantly lower in the patients (P < 0.0001). The grade of prolapse was lower in the patients (P < 0.0001). Conclusion. Low age, low body mass index, and vaginal delivery can affect the incidence of a noisy vagina.

  14. Clinical Application of Gasbag Midwifery in Vaginal Delivery%气囊助产术在阴道分娩的临床应用

    Institute of Scientific and Technical Information of China (English)

    卡比努尔·吐尔干; 许婷; 阿衣努尔

    2014-01-01

    Objective To investigate the clinical ef ect of airbag midwifery in obstetrics in vaginal delivery. Methods Fom January 2013 to January 2014, 60 cases of clinical data. Were randomly divided into two groups, of which 30 cases for the observation group (group A) by gasbag midwifery. 30 cases as control group (group B) normal delivery. Results The first, second stage of labor time of A group was significantly shorter than that of group B, no significant relationship between the third birth process. Conclusion Gasbag midwifery is a simple, safe, ef ective, suitable for modern midwifery, is a method worthy of popularization and application.%目的探讨气囊助产术在产科阴道分娩中的临床应用效果。方法随机选择我院2013年元月~2014年元月60例临床资料。随机分两组,其中30例为观察组(A组)采用气囊助产术。30例为对照组(B组)正常分娩。结果第一、二产程时间A组较B组明显缩短,第三产程无明显关系。结论气囊助产术是一种简便、安全、有效、适宜的现代助产技术,是一种值得推广应用的方法。

  15. 瘢痕子宫再次妊娠阴道分娩25例临床分析%Clinical analysis of 25 scarred uterus re-pregnancy by vaginal delivery cases

    Institute of Scientific and Technical Information of China (English)

    谢文燕; 付秀虹; 崔利娜; 白爱红

    2015-01-01

    ObjectiveTo investigate feasibility and safety of scarred uterus re-pregnancy by vaginal delivery.MethodsThere were 25 pregnant women with scarred uterus re-pregnancy by vaginal delivery as observation group, and another 30 pregnant women with non-scarred uterus re-pregnancy by vaginal delivery at the same period as control group. All patients had natural labor, and their labor time, intrapartum bleeding volume, neonatal Apgar score, neonatal weight, episiotomy rate, and hospital stay were compared.ResultsThe differences of labor time, intrapartum bleeding volume, neonatal Apgar score, and hospital stay between the two groups had no statistical significance (P>0.05). The observation group had lower neonatal weight and higher episiotomy rate than the control group, and their difference had statistical significance (P0.05);观察组的新生儿体重低于对照组,会阴侧切率高于对照组,差异有统计学意义(P<0.05)。结论在严密监护,具备随时抢救、手术的条件下,符合阴道试产条件的瘢痕子宫孕妇可行阴道分娩。

  16. Development, optimization and evaluation of polymeric electrospun nanofiber: A tool for local delivery of fluconazole for management of vaginal candidiasis.

    Science.gov (United States)

    Sharma, Rahul; Garg, Tarun; Goyal, Amit K; Rath, Goutam

    2016-01-01

    The present study is designed to explore the localized delivery of fluconazole using mucoadhesive polymeric nanofibers. Drug-loaded polymeric nanofibers were fabricated by the electrospinning method using polyvinyl alcohol (PVA) as the polymeric constituent. The prepared nanofibers were found to be uniform, non-beaded and non-woven, with the diameter of the fibers ranging from 150 to 180 nm. Further drug release studies indicate a sustained release of fluconazole over a period of 6 h. The results of studies on anti-microbial activity indicated that drug-loaded polymeric nanofibers exhibit superior anti-microbial activity against Candida albicans, when compared to the plain drug.

  17. Vaginal wind: A literature review.

    Science.gov (United States)

    Neels, Hedwig; Mortiers, Xavier; de Graaf, Sybrich; Tjalma, Wiebren A A; De Wachter, Stefan; Vermandel, Alexandra

    2017-07-01

    In the medical literature, there is little known about vaginal wind, though from clinical expertise, it turns out to be a consistent and underreported problem. The aim of this review was to collect the available literature about the different aspects of vaginal wind. A systematic literature search was conducted using three databases until December 2015. The search strategy was built using relevant synonyms of vaginal wind. Study characteristics were extracted. Risk of bias, the quality of the relevant studies and the level of evidence was judged. Eleven studies met the inclusion criteria. Vaginal wind occurs on random movements and during or after coitus. The prevalence ranges from one to 69%. The pathophysiology is unclear and the incidence unknown. Known risk factors are vaginal delivery and urinary incontinence. Provoking factors are coitus, digital stimulation, cunnilingus and exercising. Female sexual function is decreased. The sexual function of male partners with vaginal wind is not influenced. Overall vaginal wind leads to a decrease in the quality of live and can have cause social isolation. The treatment is related to the cause and mainly not successful. Tampons can be used for treatment as well as prevention. Vaginal wind is an underestimated health issue with a severe impact on sexual functioning. Adequate research is needed regarding the influence of sexual activity, weight, age, parity, the underlying pathophysiological mechanisms, prevention and treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Vaginal cancer

    Science.gov (United States)

    Hacker NF. Vulvar and vaginal cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 40. Jhingran ...

  19. Clindamycin Vaginal

    Science.gov (United States)

    ... be used to treat vaginal irritation caused by yeast infections or by sexually transmitted diseases such as ... the lining of all or part of the intestine is swollen, irritated, or has sores) or severe ...

  20. Vaginal Bleeding

    Science.gov (United States)

    Menstruation, or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods, is very heavy, or lasts much ...

  1. Sulfonate-modified phenylboronic acid-rich nanoparticles as a novel mucoadhesive drug delivery system for vaginal administration of protein therapeutics: improved stability, mucin-dependent release and effective intravaginal placement

    Directory of Open Access Journals (Sweden)

    Li CY

    2016-11-01

    Full Text Available ChunYan Li,1 ZhiGang Huang,2 ZheShuo Liu,1 LiQian Ci,3 ZhePeng Liu,3 Yu Liu,2 XueYing Yan,1 WeiYue Lu2 1School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, 2Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, 3School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China Abstract: Effective interaction between mucoadhesive drug delivery systems and mucin is the basis of effective local placement of drugs to play its therapeutic role after mucosal administration including vaginal use, which especially requires prolonged drug presence for the treatment of gynecological infectious diseases. Our previous report on phenylboronic acid-rich nanoparticles (PBNPs demonstrated their strong interaction with mucin and mucin-sensitive release profiles of the model protein therapeutics interferon (IFN in vitro, but their poor stability and obvious tendency to aggregate over time severely limited future application. In this study, sulfonate-modified PBNPs (PBNP-S were designed as a stable mucoadhesive drug delivery system where the negative charges conferred by sulfonate groups prevented aggregation of nanoparticles and the phenylboronic acid groups ensured effective interaction with mucin over a wide pH range. Results suggested that PBNP-S were of spherical morphology with narrow size distribution (123.5 nm, polydispersity index 0.050, good stability over a wide pH range and 3-month storage and considerable in vitro mucoadhesion capability at vaginal pH as shown by mucin adsorption determination. IFN could be loaded to PBNP-S by physical adsorption with high encapsulation efficiency and released in a mucin-dependent manner in vitro. In vivo near-infrared fluorescent whole animal imaging and quantitative vaginal lavage followed by enzyme-linked immunosorbent assay (ELISA assay of

  2. Cesarean section without clinical indication versus vaginal delivery as a paradigmatic model in the discourse of medical setting decisions.

    Science.gov (United States)

    Demontis, Roberto; Pisu, Salvatore; Pintor, Michela; D'aloja, Ernesto

    2011-12-01

    Natural childbirth has ceased to be considered the gold standard in the delivery room. For this reason cesarean section on demand is increasing. Many obstetricians justify this phenomenon on evidence-based obstetrical practice. However, other pieces of evidence demonstrate that the data are often a product of the social milieu, and as stated by Wendland, "technology magically wards off the unpredictability and danger of birth". In a recent paper, Kalish pointed out several problems with cesarean deliveries in the absence of medical indications regarding issues of good clinical practice, autonomy, and informed consent. From the late 1990s, the medical community began to speak in favor of women's autonomy in childbirth decisions thus supporting the maternal choice and request for a cesarean section. Starting from these new considerations, it is of primary importance to understand whether emphasizing patient's autonomy is the best, or the only, way to helping the medical decisional process. This general approach may be helpful in all the other cases in which patient's autonomy and physician's responsibility appear to be intertwined in an apparent conflicting manner. We fear that the rhetoric of autonomous choice represents a fundamental shift from medicine-based beneficence toward a perilous relationship founded mainly on patient's wishes, representing a dangerous slippery slope where the physician could be reduced to the role of a functionary delegated to execute patient's claims and demands.

  3. Vaginal Microbiota.

    Science.gov (United States)

    Mendling, Werner

    2016-01-01

    The knowledge about the normal and abnormal vaginal microbiome has changed over the last years. Culturing techniques are not suitable any more for determination of a normal or abnormal vaginal microbiota. Non culture-based modern technologies revealed a complex and dynamic system mainly dominated by lactobacilli.The normal and the abnormal vaginal microbiota are complex ecosystems of more than 200 bacterial species influenced by genes, ethnic background and environmental and behavioral factors. Several species of lactobacilli per individuum dominate the healthy vagina. They support a defense system together with antibacterial substances, cytokines, defensins and others against dysbiosis, infections and care for an normal pregnancy without preterm birth.The numbers of Lactobacillus (L.) iners increase in the case of dysbiosis.Bacterial vaginosis (BV) - associated bacteria (BVAB), Atopobium vaginae and Clostridiales and one or two of four Gardnerella vaginalis - strains develop in different mixtures and numbers polymicrobial biofilms on the vaginal epithelium, which are not dissolved by antibiotic therapies according to guidelines and, thus, provoke recurrences.Aerobic vaginitis seems to be an immunological disorder of the vagina with influence on the microbiota, which is here dominated by aerobic bacteria (Streptococcus agalactiae, Escherichia coli). Their role in AV is unknown.Vaginal or oral application of lactobacilli is obviously able to improve therapeutic results of BV and dysbiosis.

  4. Project configured supply networks: Governance of delivery and failures in operations

    DEFF Research Database (Denmark)

    Koch, Christian

    2008-01-01

    of delivery types; parts, components and subsystems. The project configuration and orchestrated governance forms are not always successful, and failures emerge. The paper aims at studying governance forms in delivery networks using operational failures as litmus. Operation management approaches is used...

  5. Effect of labouring in water on analgesia of vaginal delivery%水中待产对提高阴道分娩产妇镇痛效果的评价

    Institute of Scientific and Technical Information of China (English)

    黄佩贤; 卢淮武; 林宝华; 魏雪群; 黄淑婷; 刘颖琳; 张建平

    2012-01-01

    Objective To examine the effect of labouring in water on analgesia of vaginal delivery.Methods From June 2009 to February 2011,38 women who had volunteered to deliver in water in the obstetrical department were set as the observation group,another 70 women who chose vaginal delivery were named as the control group in the corresponding period.The items of labor pain,satisfaction with the birth experience,length of labor and neonatal outcomes were compared.Results The pain level of the observation group after labouring in water decreased compared with that before immersion in water.The delivery course was not influenced with a high rate of vaginal delivery.Conclusions Labouring in water can alleviate delivery pain,increase rate of vaginal delivery with no influence on delivery course and outcome of mothers and infants.It is a safe and effective analgesia method which should be widely applied.%目的 探讨水中待产对阴道分娩的镇痛效果.方法 选择2009年6月至2011年2月产科住院、自愿行水中待产且符合条件的产妇38例为观察组(水中待产组),以同期、一般情况及产科条件相近、选择阴道分娩的产妇70例为对照组(传统分娩组).比较2组产妇疼痛情况、产程、阴道分娩率及满意度等.结果 观察组产妇入水后疼痛级别较入水前明显降低,且不影响产程进展,阴道分娩率高.结论 水中待产可有效缓解分娩疼痛,提高阴道分娩率,对产程无影响,对母婴无不良影响,适用范围广,是值得推广应用的一种安全有效的分娩镇痛方法.

  6. Distúrbios evacuatórios em primigestas após parto normal: estudo clínico Evacuatory disorders in primigravidae after vaginal delivery: clinical study

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Prolungatti Cesar

    2011-06-01

    Full Text Available Introdução: Os distúrbios evacuatórios são descritos na literatura relacionados ao parto normal e episiotomia. Objetivo: Estudar a incidência de distúrbios evacuatórios em primíparas submetidas à episiotomia, durante o parto normal. Métodos: Estudo prospectivo em 32 pacientes primíparas, submetidas à episotomia durante parto vaginal. Para realização do estudo as pacientes reSponderam os questionários com o score de constipação de Agachan e score de incontinência de Jorge e Wexner, em relação ao período pré-gestacional e 90 dias após o parto. Resultados: Não foram encontradas diferenças estatisticamente significantes quando comparados os resultados dos questionários aplicados, em relação ao período pré-gestacional e 90 dias pós-parto. Conclusões: Não observamos alterações da constipação e continência fecal em primigestas após parto normal com episiotomia.Introduction: Evacuatories disturbances are described in the literature related to vaginal delivery and episiotomy. Objective: To study the incidence of evacuatories disturbances in primiparous undergoing episiotomy during vaginal delivery. Methods: Prospective study in 32 primiparous patients submitted to episotomy during vaginal delivery. For the study the patients answered in relation to the period before pregnancy and 90 days postpartum questionnaires with the score of Agachan constipation and incontinence score of Jorge and Wexner. Results: No statistically significant differences were found when comparing the results from the questionnaires in relation to the period before pregnancy and 90 days postpartum. Conclusions: Episiotomy in vaginal delivery in primiparous women with no prior history of intestinal symptoms, caused no disorders of anal continence postpartum in the pacients of this study.

  7. 人工腹压在足月阴道分娩助产中的应用分析%Application of artificial abdominal pressure in midwifery of full-term vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    刘梦晓

    2015-01-01

    目的:讨论人工腹压对足月孕妇阴道分娩助产的应用效果.方法:选取2011年6月至2013年4月在我院行阴道分娩的产妇100例,随机将其分为对照组和实验组各50例,对照组接受胎头吸引助产,实验组接受人工腹压助产.结果:实验组分娩后阴道损伤程度明显轻于对照组;产后出血人数明显少于对照组;产后胎儿窒息情况明显优于对照组.结论:应用人工腹压对足月阴道分娩产妇进行助产可有助于减少产妇阴道损伤,减少胎儿损伤情况的发生,值得在临床中进一步推广.%Objective: To discuss the application effect of artificial abdominal pressure on full-term pregnant women with vaginal delivery. Methods: 100 cases of maternal underwent vaginal delivery during June 2011 to April 2013 in our hospital were randomly selected and divided into a control group and an experimental group with 50 cases in each group. The control group received forceps midwifery and the experimental group received artificial abdominal pressure midwifery. Results:The degree of vaginal injury in experimental group after delivery were significantly lighter than that of the control group; the number of postpartum hemorrhage in the experimental group was significantly less than that of the control group; postpartum fetal asphyxia in the experimental group was significantly better than that of the control group. Conclusion: The application of artificial abdominal pressure in midwifery of full-term vaginal delivery can help to reduce maternal vaginal injury and reduce the occurrence of fetal damage. It is worthy of further promotion in clinical practice.

  8. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest......, pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC...... was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities....

  9. 常规会阴切开与过度医疗%Routine Use of Episiotomy during Vaginal Delivery and Overtreatment

    Institute of Scientific and Technical Information of China (English)

    郭培奋; 孔欣; 王彩霞

    2013-01-01

    This paper explores the alteration of the episiotomy rate during spontaneous vaginal delivery in China and abroad. Beside the medical reasons for episiotomy, social, medical and maternal factors together cause episiotomy to be used routinely in lots of China hospitals, it is supposed to be over medical treatment. According to our success in reducing the rate of episiotomy from 81% before 2010 to 37% in recent two years for primipara, we put forward effort to take countermeas-ures through these three aspects. Special effort of medical humanistic spirit among obstetrician and hospital managements should be emphasized in restricting the abuse of episiotomy in China.%本文总结了国内外阴道分娩过程中会阴切开率的变迁.受社会、医方及产妇等因素影响,我国会阴切开已逐渐成为产时常规手术,大量不必要的会阴切开以及手术造成的伤害,就形成了过度医疗,即预防性手术过度使用.围绕社会、医方及产妇因素三个方面,笔者提出了相应降低会阴切开率的对策,特别强调产科医务人员的人文素养、专科理论与技能和医院管理在控制会阴切开过程中的作用.

  10. Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.

    Science.gov (United States)

    Vayssière, Christophe; Beucher, Gael; Dupuis, Olivier; Feraud, Olivia; Simon-Toulza, Caroline; Sentilhes, Loïc; Meunier, Emmanuelle; Parant, Olivier; Schmitz, Thomas; Riethmuller, Didier; Baud, Olivier; Galley-Raulin, Fabienne; Diemunsch, Pierre; Pierre, Fabrice; Schaal, Jean-Patrick; Fournié, Alain; Oury, Jean François

    2011-11-01

    Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). The use of low-concentration epidural infusions of bupivacaine potentiated by morphinomimetics reduces the number of operative interventions compared with larger doses (Level A). Placement of an epidural before 3-cm dilatation does not increase the number of operative vaginal deliveries (Level A). Posterior positions of the fetus result in more operative vaginal deliveries (Level B). Manual rotation of the fetus from a posterior position to an anterior position may reduce the number of operative deliveries (Level C). Walking during labour is not associated with a reduction in the number of operative vaginal deliveries (Level A). Continuous support of the parturient by a midwife or partner/family member during labour reduces the number of operative vaginal deliveries (Level A). Under epidural analgesia, delayed pushing (2h after full dilatation) reduces the number of difficult operative vaginal deliveries (Level A). Ultrasound is recommended if there is any clinical doubt about the presentation of the fetus (Level B). The available scientific data are insufficient to contra-indicate attempted midoperative delivery (professional consensus). The duration of the operative intervention is slightly shorter with forceps than with a vacuum extractor (Level C). Nonetheless, the urgency of operative delivery is not a reason to choose one instrument over another (professional consensus). The cup-shaped vacuum extractor seems to be the instrument of choice for

  11. 剖宫产与经阴道分娩对产妇盆底功能的影响%Cesarean Section and Vaginal Delivery Impact on Maternal Pelvic Floor Function

    Institute of Scientific and Technical Information of China (English)

    刘芳华

    2014-01-01

    ObjectiveTo study the effect of cesarean section and vaginal delivery on maternal pelvic floor function.Methods Select 120 cases of lying in women in our hospital received, with different modes of delivery wil be divided into the observation group and the control group, the control group using vaginal delivery, cesarean section was used in the observation group, two groups were compared with POP and pelvic floor muscle condition.Results The patients in the observation group the vaginal and uterine prolapse, pelvic floor muscle tension score were significantly better than the control group (P<0.05).Conclusion Compared with vaginal delivery, cesarean section can effectively reduce the effect of postpartum pelvic floor function on postpartum rehabilitation, but to promote the recovery of pelvic floor function has better effect, so there is no need to be selected as the main part according to mode of delivery.%目的:探讨剖宫产与经阴道分娩对产妇盆底功能的影响。方法选取我院接收的120例产妇,以分娩方式的不同将其分为观察组和对照组,对照组采用经阴道分娩,观察组采用剖宫产,比较两组产妇的POP及盆底肌力情况。结果观察组患者阴道及子宫脱垂情况、产后盆底肌张力评分均明显优于对照组(P<0.05)。结论相较于阴道分娩,剖宫产可有效的减少产后对盆底功能的影响,但产后康复对促进盆底功能恢复有较好的效果,因而无需将其作为选择分娩方式的主要依据。

  12. 瘢痕子宫阴道分娩可行性与安全性临床分析%Clinical analysis of feasibility and safety of scarred uterus vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    杜佩英; 吴静璇

    2015-01-01

    ObjectiveTo investigate the feasibility and safety of scarred uterus vaginal delivery, in order to provide further clinical guide.MethodsThere were 98 scarred uterus re-pregnant puerpera choosing vaginal delivery as observation group, and another 98 puerpera without scarred uterus as control group. Vaginal delivery situation, complications of puerpera and newborn of the two groups were compared and analyzed.ResultsThere were no statistically significant differences of vaginal trial production success rate, labor time, and hospital stay between the two groups (P>0.05). Compared with the control group, the observation group had no statistically significant differences of postpartum hemorrhage volume, impending of rupture of uterus, and neonatal Apgar score (P>0.05).ConclusionVaginal trial production under corresponding conditions has high safety and feasibility for scarred uterus re-pregnancy. This method can effectively reduce cesarean section rate, and it is worthy of clinical reference.%目的:探讨瘢痕子宫阴道分娩的可行性与安全性,进一步指导临床。方法98例瘢痕子宫再次妊娠选择阴道分娩产妇作为观察组,同期随机选取98例非瘢痕子宫选择阴道分娩的产妇作为对照组,对比分析两组产妇阴道分娩情况及产妇、新生儿并发症情况。结果观察组阴道试产成功率、产程时间、住院时间与对照组相比,差异无统计学意义(P>0.05),观察组产后出血量、先兆子宫破裂及新生儿Apgar评分与对照组相比,差异无统计学意义(P>0.05)。结论瘢痕子宫再次妊娠在符合试产条件下行阴道试产具有较高的安全性与可行性,可以有效降低剖宫产率,值得临床借鉴。

  13. 产前盆底肌功能锻炼对阴道分娩结局的影响%Effect of functional exercise of prenatal pelvic floor muscles on vaginal delivery outcome.

    Institute of Scientific and Technical Information of China (English)

    万忠艳

    2011-01-01

    Objective To investigate the effect of functional exercise ofprcnatal pelvic floor muscles on vaginal delivery outcome. Methods Pregnant women who voluntarily accepted functional exercise of prenatal pelvic floor muscles were selected as the study group (n=58). Pregnant women who didn't take part in functional exercise were selected as the control group (n=64). Before all women dehvering, tension of pelvic floor muscles were detected.Some information including the sage of labor and vaginal delivery were evaluated in two groups. Results There were significant differences between the study group and the control group, as to the tension of pelvic floor muscles (P<0.05), the time length of the active labor, second stage of labor and all stage of labor (P<O.0 l). The volume of vaginal bleeding and the rate of episiotomy or vaginal midwifery in the study group were lower than those in the control group (P<0.05). Conclusion Functional exercise ofprenaal pelvic floor muscles has a positive effect on vaginal delivery outcome, which may enhance the tension of pelvic floor muscles and shorten all stage of labor.%目的 探讨产前进行盆底肌功能锻炼对阴道分娩结局的影响.方法 选择自愿接受盆底肌功能锻炼的孕妇58例作为实验组,未进行功能锻炼的孕妇64例作为对照组.两组孕妇分娩前行盆底肌肉肌张力检测,并记录分娩产程时间和阴道分娩情况.结果 实验组孕妇盆底肌肉肌张力强于对照组(P<0.05),活跃期、第二产程和总产程时间均短于对照组(P<0.01);阴道助产率、会阴侧切率和阴道出血量均低于对照组(P<0.05).结论 孕妇产前进行盆底肌锻炼能够增强盆底肌张力、缩短产程,并且对于改善阴道分娩结局有积极的作用.

  14. Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method.

    Science.gov (United States)

    Favero, Giovanni; Miglino, Giovanni; Köhler, Christhardt; Pfiffer, Tatiana; Silva e Silva, Alexandre; Ribeiro, Altamiro; Le, Xin; Anton, Cristina; Baracat, Edmund Chada; Carvalho, Jesus Paula

    2015-01-01

    To evaluate the operative and oncologic outcomes of an innovative technique for organ morcellation in patients scheduled for laparoscopic treatment of uterine malignancies. Endoscopy is currently considered the standard of care for the operative treatment of endometrial cancer; however, the use of minimal invasive surgery (MIS) is restricted in patients with a bulky uterus or narrow vagina. Conventional unprotected intraperitoneal uterine fragmentation is indeed contraindicated in these cases. Consequently, oncologically safe methods to render these patients eligible for MIS are urgently needed. Prospective study of women with histologically proven endometrial cancer in which uterus removal was a realistic concern owing to both organ size and proportionality. The patients underwent laparoscopic staging, including retroperitoneal lymphadenectomy, total hysterectomy, and bilateral salpingo-oophorectomy, followed by vaginal morcellation of the uterus inside a protective pouch (LapSac). In our series of 30 cases, we achieved successful completion in all patients, without conversion to laparotomy. No surgery-related casualty or intraoperative morbidity was observed. The mean organ size was 246 g (range, 148-420 g), and the average additional operative time related to vaginal morcellation was 16 minutes (range, 9-28 minutes). Proper histopathological staging according to 2009 FIGO staging guidelines could be performed in all specimens. Two patients (6%) presented with significant postoperative complications, 1 each with vesicovaginal fistula and vaginal vault dehiscence. Fourteen patients (46%) needed adjuvant therapy. After a median follow-up of 20 months (range, 6-38 months), the 12-month and 24-month overall survival was 100% and 73.4% (95% confidence interval, 51%-96%), respectively. Four patients with positive lymph nodes died of distant metastasis. No case of pelvic or local relapse was observed. Vaginal morcellation following oncologic principles is a feasible

  15. Application of Kiwi OmniCup system in assisted vaginal delivery%Kiwi Omni 胎头吸引器在阴道助产分娩中的应用

    Institute of Scientific and Technical Information of China (English)

    王青青; 白小艺; 侯红瑛

    2016-01-01

    目的:评估 Kiwi Omni 胎头吸引器在阴道助产分娩中的安全性及有效性。方法收集规律产检且通过阴道助产分娩的45例孕妇作为研究对象,其中使用 Kiwi Omni 胎头吸引器的16例为观察组,使用产钳的29例为对照组。对比观察组与对照组的产妇阴道裂伤率、会阴侧切率、新生儿出生后阿普加评分、新生儿脐动脉血气分析及新生儿头皮下血肿、颅内出血等情况,评估不同阴道助产分娩方式的安全性。结果观察组产妇中阴道裂伤1例(6%)、会阴侧切6例(32%),对照组产妇中出现阴道裂伤10例(34%)、会阴侧切23例(88%),观察组产妇的阴道裂伤率及会阴侧切率均低于对照组(P 均<0.05)。观察组新生儿中出现头皮下血肿4例(25%),对照组新生儿中仅1例(3%)出现头皮下血肿,2组比较差异有统计学意义(P <0.05)。2组新生儿的阿普加评分、脐动脉血气分析、转科率及住院时间比较差异均无统计学意义(P 均>0.05)。结论Kiwi Omni 胎头吸引器在阴道助产分娩中可以降低产妇软产道损伤,不增加新生儿窒息率及新生儿转科率。%Objective To evaluate the safety and efficacy of the Kiwi OmniCup system in assisted vaginal delivery.Methods Forty five pregnant women who received prenatal examination and underwent vagi-nal delivery were recruited in this study.Sixteen subjects utilizing the Kiwi OmniCup system were assigned into the observation group and 29 using obstetrics forceps were allocated into the control group.Vaginal laceration rate,lateral episiotomy rate,the Apgar score after birth,neonate umbilical cord artery blood gas analysis,neo-nate subscalp hematoma and neonate intracranial hemotoma were statistically compared between the observation and control groups.The safety of different modes of vaginal delivery was evaluated.Results In the observa-tion group,1 case (6%)had vaginal

  16. ISSUES IN DELIVERY OPERATIONS – CAN VARIABLE PAY SCHEMES REALLY WORK?

    Directory of Open Access Journals (Sweden)

    Katija Vojvodić

    2016-12-01

    Full Text Available Ongoing changes in business objectives increasingly result in implementation of different business strategies striving to improve the workers’ performance. In that context, variable pay schemes have been utilised to increase employees’ motivation and productivity. Unlike the sales and warehouse sector, a number of issues emerge with respect to the variable pay schemes in delivery operations. The paper aims to examine issues and challenges associated with the introduction of variable pay schemes in the field of delivery operations. In this paper, we illustrate and analyse a case study from delivery operations of the FMCG sector in the market of Bosnia and Herzegovina. In this sense, the paper addresses the following research questions: What is the intended purpose of variable pay schemes? Which variables affect delivery operations? Why delivery performance should be carefully monitored? Which external factors influence delivery driver productivity? Can variable pay schemes attract, motivate or retain employees? Can variable pay schemes really work in delivery operations? The discussion presented in the paper has important practical implications related to workforce management and may be useful to managers and other subjects involved in designing pay and reward structures.

  17. Resultados neonatais no parto vaginal espontâneo comparados aos dos partos com fórcipe de Simpson-Braun em primíparas Neonatal outcome of spontaneous deliveries as compared to Simpson-Braun forceps deliveries in nulliparous women

    Directory of Open Access Journals (Sweden)

    Belmiro Gonçalves Pereira

    2004-02-01

    Full Text Available OBJETIVO: comparar os resultados neonatais dos partos vaginais espontâneos ou assistidos com fórcipe de Simpson-Braun em nulíparas. MÉTODO: em estudo de corte retrospectivo foram avaliados dois grupos de primíparas atendidas no Centro Obstétrico do CAISM/UNICAMP, que tiveram parto vaginal sob analgesia epidural. O grupo fórcipe foi formado por 119 pacientes que tiveram parto a fórcipe de Simpson-Braun, e o grupo normal por 114 casos de parto vaginal espontâneo. Foram estudadas as variáveis neonatais imediatas como o estado do líquido amniótico e os índices de Apgar, assim como a evolução neonatal nos primeiros dias de vida. Para análise estatística foram utilizados os testes c², exato de Fisher e t de Student para comparação de médias e considerada significativa a diferença correspondente a pPURPOSE: to compare maternal and neonatal outcomes between spontaneous vaginal and Simpson-Braun forceps deliveries in nulliparous women. METHOD: a retrospective study including two groups of nulliparous women, who had vaginal delivery under peridural anesthesia in the obstetric unit of the CAISM-UNICAMP: the forceps group included 119 women who had Simpson-Braun forceps delivery, and the normal group included 114 women who delivered spontaneously. Neonatal outcomes, such as Apgar score and the evolution in the first days of life, were studied. Data were compared in both groups and, for statistical analysis, c² test, Fisher exact, and Student t tests were used. The differences were considered significant when p<0.05. RESULTS: the indications for Simpson-Braun forceps delivery were maternal-fetal relief (90 cases and abbreviation of the expulsive period (29 cases. In the forceps group there were 8 cases (6.7% of vaginal injuries; a similar result was observed in the normal group. The number of hospitalization days for the parturient and the newborns was identical, 2.4 days. The newborns in the two groups had similar Apgar scores

  18. Does occiput posterior position in the second stage of labour increase the operative delivery rate?

    Science.gov (United States)

    Carseldine, Wendy J; Phipps, Hala; Zawada, Shannon F; Campbell, Neil T; Ludlow, Joanne P; Krishnan, Surya Y; De Vries, Bradley S

    2013-06-01

    To assess the impact of occipito-posterior position in the second stage of labour on operative delivery. Double-blinded prospective cohort study of ultrasound determined occiput-posterior position during the second stage of labour compared with occiput-anterior position. The primary outcome was operative (caesarean section, forceps or vacuum) delivery. A total of 68% (13/19) women in the occiput-posterior group, and 27% (39/141) in the occiput-anterior group had an operative delivery (unadjusted: P labour is strongly associated with operative delivery. There is potential to explore interventions such as manual rotation. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  19. Greener manufacturing and operations: from design to delivery and back

    National Research Council Canada - National Science Library

    Sarkis, Joseph

    2001-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Joseph Sarkis, Clark University Graduate School of Management, USA 11 15 part 1. 1 : Operations Strategy and Policy...

  20. Elective cesarean delivery for term breech

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens

    2003-01-01

    OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information...... was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage...... and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women...

  1. Genital burns and vaginal delivery.

    Science.gov (United States)

    Pant, R; Manandhar, V; Wittgenstein, F; Fortney, J A; Fukushima, C

    1995-07-01

    Obstetric complications may result from burn scarring in the genital area. Women in developing countries typically squat around cooking fires, and burns are common. This recent case in Nepal describes obstructed labor in a young woman whose genital area had extensive scarring from a cooking fire injury. Proper antenatal assessment by health care providers can reduce the risk to mothers and infants of the consequences of a birth canal damaged or obstructed by burn scarring.

  2. A remotely operated drug delivery system with dose control

    KAUST Repository

    Yi, Ying

    2017-05-08

    “On demand” implantable drug delivery systems can provide optimized treatments, due to their ability to provide targeted, flexible and precise dose release. However, two important issues that need to be carefully considered in a mature device include an effective actuation stimulus and a controllable dose release mechanism. This work focuses on remotely powering an implantable drug delivery system and providing a high degree of control over the released dose. This is accomplished by integration of a resonance-based wireless power transfer system, a constant voltage control circuit and an electrolytic pump. Upon the activation of the wireless power transfer system, the electrolytic actuator is remotely powered by a constant voltage regardless of movements of the device within an effective range of translation and rotation. This in turn contributes to a predictable dose release rate and greater flexibility in the positioning of external powering source. We have conducted proof-of-concept drug delivery studies using the liquid drug in reservoir approach and the solid drug in reservoir approach, respectively. Our experimental results demonstrate that the range of flow rate is mainly determined by the voltage controlled with a Zener diode and the resistance of the implantable device. The latter can be adjusted by connecting different resistors, providing control over the flow rate to meet different clinical needs. The flow rate can be maintained at a constant level within the effective movement range. When using a solid drug substitute with a low solubility, solvent blue 38, the dose release can be kept at 2.36μg/cycle within the effective movement range by using an input voltage of 10Vpp and a load of 1.5 kΩ, which indicates the feasibility and controllability of our system without any complicated closed-loop sensor.

  3. Experience summary of the operation of the vaginal hysterectomy%顺行式阴式子宫切除术经验总结

    Institute of Scientific and Technical Information of China (English)

    朱正超

    2015-01-01

    目的:探讨顺行式阴式子宫切除手术(Anterogradc transvaginal total hysterectomy ATVH)的途径、方法及手术技巧。方法回顾2011年8月至2015年5月在我院开展的顺行式阴式子宫全切术25例临床研究资料。结果完成手术25例,平均手术时间(65±23.5) min,平均术后住院天数(5.5±0.5)天,术中出血量160.5ml。结论顺行式阴式子宫切除手术具有直观、简便、手术时间短等优点,值得推广。%Objective: To investigate the methods and techniques of transvaginal total hysterectomy ATVH Anterogradc (). From August 2011 to May 2015 in our hospital to carry out the 25 cases of the clinical research data of the direct vaginal hysterectomy. Results: 25 cases were completed, the average operation time (65 + 23.5) min, the average postoperative hospital stay (5.5 + 0.5) days, the amount of bleeding 160.5ml.Conclusion: the operation of the direct and vaginal hysterectomy with the advantages of direct viewing, simple operation, short operation time, etc., is worth promoting.

  4. Apresentação pélvica na gestação de termo em pacientes com partos vaginais prévios Breech presentation in term pregnancy in patients with previous vaginal deliveries

    Directory of Open Access Journals (Sweden)

    José Mauro Madi

    2004-12-01

    Full Text Available OBJETIVO: avaliar os resultados obstétricos e perinatais em casos de fetos em apresentação pélvica, de termo, nascidos de pacientes com partos vaginais prévios, comparando-os a fetos de termo, em apresentação cefálica. PACIENTES E MÉTODOS: foram analisados retrospectivamente 8.350 nascimentos ocorridos no período de março de 1998 a julho de 2003. Ocorreram 419 partos (5,1% em apresentação pélvica, dos quais selecionaram-se 58 casos (grupo pélvico, que deveriam ter as seguintes características: antecedentes de um ou mais filhos nascidos pela via transpélvica, idade gestacional igual ou superior a 37 semanas, ausência de malformações fetais, inexistência de intercorrências durante a gestação, peso do recém-nascido no nascimento igual ou superior a 2.500 g e inferior a 3.750 g, e sem cesárea anterior. Esse grupo foi comparado a outro formado por 1.327 fetos com características semelhantes, em apresentação cefálica, de gestantes sem cesárea prévia (grupo cefálico. Analisaram-se a idade materna, paridade, idade gestacional, via de parto, peso do recém-nascido, presença de mecônio, índice de Apgar no primeiro e quinto minutos, necessidade de internação na unidade de tratamento intensivo neonatal e ocorrência de recém-nascidos pequenos e grandes para a idade gestacional. Os dados obstétricos e perinatais foram analisados pelo chi² e teste t de Student. Considerou-se como significante pPURPOSE: to assess the obstetric and perinatal outcomes in cases of term newborns in breech presentation, in patients with previous vaginal deliveries, comparing them to term newborns in vertex presentation. METHODS: 8,350 deliveries retrospectively from March 1998 to July 2003 were analysed. Of 419 deliveries (5.1% in breech presentation, 58 cases were selected for the study (breech group, according to the following criteria: patients who had had one or more babies through vaginal delivery, gestational age ³37 weeks, no fetal

  5. 20 CFR 662.430 - Under what conditions may One-Stop operators designated to operate in a One-Stop delivery system...

    Science.gov (United States)

    2010-04-01

    ... designated to operate in a One-Stop delivery system established prior to the enactment of WIA be designated... DESCRIPTION OF THE ONE-STOP SYSTEM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT One-Stop Operators § 662.430 Under what conditions may One-Stop operators designated to operate in a One-Stop delivery system...

  6. [The influence of the intrapartum inventions on the maternal and neonatal outcomes of vaginal birth after cesarean].

    Science.gov (United States)

    Wu, S W; He, D; Zhang, W Y

    2017-02-21

    Objective: To investigate the maternal and neonatal outcomes after different intrapartum interventions for vaginal birth after cesarean (Vaginal Birth After Cesarean-section, VBAC). Methods: One hundred and forty three cases in Beijing Obstetrics & Gynecology Hospital, Capital Medical University from January 2015 to November 2016 were selected retrospectively.The relationship between the intrapartum inventions such as induction style, oxytocin usage and spinal analgesia and the maternal and neonatal outcomes such as delivery way, labor time, postpartum hemorrhage and fetal distress were analyzed in pregnant women underwent VBAC. Results: (1) Maternal and neonatal outcomes: No maternal and newborn deaths occurred in the 143 cases of VBAC.One hundred and thirteen cases underwent vaginal delivery (79.0%) and 30 cases underwent operative vaginal delivery (21.0%). Twenty-four cases (16.8%) occurred postpartum hemorrhage, 32 cases (24.3%) fetal distress, and 2 (1.4%) asphyxia.(2) Intrapartum inventions: 123 cases (86.0%) were spontaneous onset of labor and 20 cases (14.0%) induction of labor.41 cases (30.6%) used oxytocin during labor to strengthen contractions, 37 cases (25.9%) underwent spinal analgesia.The operative vaginal delivery rate in the induction labor group was significantly higher than that in natural labor group (P<0.05). The duration of the first stage, second stage and total labor in the group using oxytocin were significantly longer than those in the group not using oxytocin (P<0.05). The rate of operative vaginal delivery in the group using oxytocin was significantly higher than that in the group not using oxytocin (P<0.05). The duration of the first stage, second stage and total labor in analgesia group were significantly longer than those in the group not using analgesia (P<0.05). The incidence of postpartum hemorrhage and operative vaginal delivery in analgesia group was significantly higher than those in the group not using analgesia (P<0

  7. Vaginal dryness alternative treatments

    Science.gov (United States)

    Alternative treatments for vaginal dryness ... Question: Is there a drug-free treatment for vaginal dryness? Answer: There are many causes of vaginal dryness . It may be caused by reduced estrogen level, infection, medicines, and ...

  8. 选择性剖宫产和阴道分娩对产后盆底功能的影响%Effects of selective cesarean section and vaginal delivery on postpartum pelvic floor function

    Institute of Scientific and Technical Information of China (English)

    张慧敏

    2012-01-01

    目的:探讨不同分娩方式对产后早期盆底功能的影响.方法:随机抽取2011年1~5月在荣成市妇幼保健院分娩的产妇65例,根据不同分娩方式分为选择性剖宫产组(32例)和阴道顺产组(33例).分别于产后6周及12周行POP -Q评分、尿垫试验、超声检测残余尿以及会阴超声检查,比较两组产妇压力性尿失禁(SUI)、盆腔器官脱垂(POP)的发生率及膀胱颈移动度情况.结果:产后6周和产后12周随访时,SUI发生率选择性剖宫产组3.13% (1/32)和0(0/19),顺产组24.24% (8/33)和27.78% (5/18),两组比较差异无统计学意义(P >0.05);POP发生率选择性剖宫产组37.50% (12/32)和36.84% (7/19),顺产组72.73%(24/33)和77.78% (14/18),差异有统计学意义(P<0.05).产后6周和产后12周会阴超声显示选择性剖宫产组与顺产组膀胱颈角度及膀胱颈旋转角度比较差异有统计学意义(P<0.05).结论:选择性剖宫产可降低产后早期POP的发生率,并可减少发生SUI的风险.%Objective: To explore the effects of different delivery modes on early postpartum pelvic floor function. Methods; Sixty -five pregnant women who deliveried in the hospital from January to May in 2011 were selected randomly, then they were divided into selective cesarean section group (32 cases) and vaginal delivery group (33 cases) according to different delivery modes. POP - Q score, pad test, residual urine detection by ultrasonography and perineal ultrasonography were carried out at six and twelve weeks after delivery; the incidences of stress urinary incontinence (SUI) and pelvic organ prolapse ( POP) , and the degree of bladder neck mobility were compared between the two groups. Results: During follow - up at six and twelve weeks after delivery, the incidences of SUI in selective cesarean section group were 3. 13% (1/32) and 0 (0/19), respectively, while the incidences of SUI in vaginal delivery group were 24. 24% (8/33) and 27. 78% (5

  9. Leaving a mark on healthcare delivery with operations analysis

    NARCIS (Netherlands)

    Vanberkel, P.T.; Zonderland, M. E.; Boucherie, R.J.; Hans, E.W.

    2012-01-01

    In the Dutch context, we see similar problems as outlined in Green’s (2012) commentary and also an increased interest by healthcare providers to use operations analysis to confront them. In this commentary, we provide our take on the same problems to extend the discussion and to highlight additional

  10. Leaving a mark on healthcare delivery with operations analysis

    NARCIS (Netherlands)

    Vanberkel, P.T.; Golden, B.L.; Seidmann, A.; Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Hans, Elias W.

    In the Dutch context, we see similar problems as outlined in Green’s (2012) commentary and also an increased interest by healthcare providers to use operations analysis to confront them. In this commentary, we provide our take on the same problems to extend the discussion and to highlight additional

  11. 剖宫产术后再次妊娠经阴道分娩的成败因素探索%Study of Key Success Factors About Vaginal Delivery With Repeated Pregnancy After Cesarean Section

    Institute of Scientific and Technical Information of China (English)

    张海燕; 王天成

    2012-01-01

    目的 探讨剖宫产术后再次妊娠的分娩方式,分析经阴道分娩的可能性.方法 采取回顾性分析法,对2009年3月至2011年12月在南京迈皋桥医院既往有剖宫产史再次分娩的116例孕妇为研究对象,对其进行剖宫产后再次妊娠经阴道分娩(VBAC)的可能性分析(本研究遵循的程序符合南京迈皋桥医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与之签署临床研究知情同意书).结果 116例孕妇中,仅15例(12.9%)接受经阴道试产,10例(66.6%,10/15)阴道分娩成功,106例(91.4%)再次剖宫产分娩终止妊娠.本组具备阴道试产条件但选择择期剖宫产术终止妊娠的孕妇为27例(23.3%);因既往病史不清选择再次剖宫产术分娩的为13例(11.2%).本组实际剖宫产率显著高于有明确剖宫产指针的剖宫产率,且差异有统计学意义(P<0.05).结论 剖宫产术后再次妊娠分娩并非剖宫产的绝对指征,对符合条件的孕妇可以在严密监护下阴道试产.%Objective To investigate the delivery of repeated pregnancy after cesarean section.Evaluate the likelihood of vaginal birth after caesarean(VBAC).Methods There were 116 pregnant women with previous cesarean section delivery who would delivery again from March 2009 to December 2011 in Nanjing Maigaoqiao Hospital.Their outcomes were analyzed by retrospective analysis method.Informed consent was obtained from all participants.Results Among 116 pregnant women of 15 cases (12.9%)of vaginal trial production,10 cases(66.6 %,10/15) were successful.Once again the cesarean section rate was 91.4% (106/116).There were 27 cases(23.3%) who had vaginal production conditions but chose elective cesarean section.Formerly medical history of previous cesarean section delivery were not clear of 13 cases (11.2%) who also chose elective cesarean section.There had significance difference between actual cesarean section rate and indication for

  12. Contraceptive vaginal rings: a review.

    Science.gov (United States)

    Brache, Vivian; Faundes, Anibal

    2010-11-01

    Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception.

  13. 妊娠和阴道分娩对肛提肌形态学及阴道黏膜神经分布的影响%Effect of pregnancy and spontaneous delivery on the morphology of levator ani muscle and expression f vaginal nerve fibers

    Institute of Scientific and Technical Information of China (English)

    滕莉荣; 边旭明; 朱兰; 郎景和; 刘俊涛; 杨剑秋; 任海涛; 赵燕环; 陈琳

    2008-01-01

    Objective To investigate the effect of pregnancy and spontaneous delivery on the morphologic characteristics of the levator ani muscle and innervation of the vaginal mucosa. Methods Eight nullipara without pelvic floor dysfunction (PFD) and 64 normal primipara undergoing spontaneous delivery were enrolled in this study during July to December 2006 in Peking Union Medical College Hospital. Biopsy specimens of levator ani muscle (LAM) and anterior and posterior vaginal walls were obtained from the puerpera as well as from the 8 nullipara undergoing vaginal operation. The structures of LAM were examined with histological techniques. Vaginal mucosa specimens were examined using immunohistochemistry staining for protein gene product 9. 5 ( PGP 9. 5), vasoactive intestinal poptide (VIP) and ne uropeptide Y ( NPY),and the positive stained nerve fibers were calculated respectively. Results The LAMs of the puerpera undergoing spontaneous delivery presented myogenetic and neurogenetic changes, both acute and chronic.Type Ⅰ muscular fibers were predominant(79% )with both types increasing in diameters [ (86±9)μm and (79±15) μm]. Significantly different ( P < 0. 05 ) innervation of PGP 9. 5, VIP, and NPY nerve fiberswas observed between epithelial lamina of anterior vaginal wall(5.9±3. 3, 7. 6±3. 1 and 8. 2±3. 2, respectively) and that of posterior vaginal wall (3. 8±2. 9, 5.9±3. 1 and 6. 0±3.0, respectively), with the nerve fibers being more in epithelial lamina of anterior vaginal wall, while no difference in the innervation of nerve fibers was observed in the lamina propria. Significantly different( P <0. 05 ) innervation of PGP 9. 5 and VIP nerve fibers was observed in the lamina propria of the anterior vaginal wall in puerperal undergoing vaginal delivery (6.9±3.2 and 4.9±2. 1) compared with those in nullipara (3.9±3.6 and 3. 1±1.2). Conclusions Pathologic changes occur in LAMs and pelvic floor nerves during labor and delivery. LAM fibers become hypertrophy

  14. A randomized trial of levonorgestrel intrauterine system insertion 6 to 48 h compared to 6 weeks after vaginal delivery; lessons learned.

    Science.gov (United States)

    Stuart, Gretchen S; Lesko, Catherine R; Stuebe, Alison M; Bryant, Amy G; Levi, Erika E; Danvers, Antoinette I

    2015-04-01

    The objective of this randomized trial was to compare breastfeeding among women who received a levonorgestrel-releasing intrauterine system within 6-48 h (early) or 4-6 weeks (standard) after an uncomplicated vaginal birth. Analysis groups of 86 women in each arm were needed to demonstrate a 20% difference in any breastfeeding. Thirty-five women were randomized to the early (N=17) and standard (N=18) arms. The combination of unsuccessful placement (2/17; 12%), expulsions (7/17; 41%) and removals (3/17; 18%) reached 71% (12/17) in the early arm, so the study was stopped. In our small study cohort, levonorgestrel-releasing intrauterine system insertion between 6 and 48 h after vaginal birth was associated with a high rate of expulsion or removal soon after insertion.

  15. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

    OpenAIRE

    Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J.; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

    2017-01-01

    Introduction Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-fu...

  16. Vaginal Cancer Overview

    Science.gov (United States)

    ... are here Home > Types of Cancer > Vaginal Cancer Vaginal Cancer This is Cancer.Net’s Guide to Vaginal Cancer. Use the menu below to choose the Overview/ ... social workers, and patient advocates. Cancer.Net Guide Vaginal Cancer Introduction Statistics Medical Illustrations Risk Factors and Prevention ...

  17. Vaginal Dinoprostone Versus Intravenous Oxytocin for Labor Induction in Patients Not Responsive to a First Dose of Dinoprostone: A Randomized Prospective Study.

    Science.gov (United States)

    Antonazzo, Patrizio; Laoreti, Arianna; Personeni, Carlo; Grossi, Elena; Martinelli, Anna; Cetin, Irene

    2016-06-01

    To evaluate the efficacy of 2 different regimens for labor induction in patients with unfavorable cervix not responsive to a first dose of dinoprostone vaginal insert. Between November, 2011 and June, 2014, 338 patients underwent induction of labor. After standard 24 hours treatment, 94 singleton term pregnancies remained with a Bishop score ≤6 and were randomized into 2 different regimens: repeated vaginal dinoprostone (group A, n = 47) or intravenous oxytocin (group B, n = 47). Primary outcome was vaginal delivery, and the secondary outcomes were interval between labor induction and delivery and operative delivery rates. Vaginal deliveries were significantly higher (group A: 26/47 (55.3%) and group B 16/47 (34.0%), P labor induction and onset of labor and between labor induction and delivery were lower in the group treated with oxytocin. Neonatal outcomes were similar in the 2 groups. A second dinoprostone vaginal insert is an effective and safe choice for patients with unfavorable cervix not responsive to a first 24 hours administration of dinoprostone for cervical ripening, and its use is associated with lower cesarean section rates. © The Author(s) 2015.

  18. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  19. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  20. 产前护理干预对疤痕子宫阴道分娩孕妇分娩结局的影响%Effect of Prenatal Nursing Intervention on Delivery Outcome of Pregnant Women with Scar Uterus Vaginal Delivery

    Institute of Scientific and Technical Information of China (English)

    陈娟

    2016-01-01

    Objective To investigate the prenatal effect of nursing intervention on scar uterus vaginal delivery pregnant women delivery outcome. Methods 108 patients with scar uterus vaginal delivery women,both from June 2013 to February 2015 in our hospital women with scarred uterus can be checked for vaginal delivery,using random number table method for packet basis grouped,the implementation of routine nursing care of pregnant women as the control group,enforce prenatal care intervention in the routine nursing care pregnant women as the experimental group,two groups of pregnant women before and after nursing the anxiety,depression,pregnant women neonatal situation and pregnant women on nursing quality satisfaction degree were compared.Results After nursing, the indexes of the experimental group were better than those of the control group, the difference was statistically significant ( <0.05).Conclusion Prenatal nursing intervention can effectively improve birth outcomes of scar uterus vaginal delivery of pregnant women,reduce maternal adverse phenomenon,improve the score of neonatal body condition,has significant advantages in clinical nursing application.%目的:探讨产前护理干预对疤痕子宫阴道分娩孕妇分娩结局的影响。方法选取我院108例疤痕子宫阴道分娩孕妇﹐以随机数字表法为分组依据将孕妇进行分组﹐实行常规护理的孕妇设为对照组﹐实行在常规护理上实行产前护理干预的孕妇为实验组﹐对两组孕妇的护理前后的在护理前后焦虑﹑抑郁情况﹐孕妇分娩情况和新生儿的情况以及孕妇对护理质量满意程度。结果护理后实验组各项指标均优于对照组﹐差异有统计学意义(<0.05)。结论疤痕子宫阴道分娩孕妇进行产前护理干预可以有效改善分娩结局﹐降低孕妇不良现象的发生﹐提高新生儿的身体状况评分﹐在临床护理应用上具有显著优势。

  1. Estrogen receptors in human vaginal tissue

    NARCIS (Netherlands)

    Wiegerinck, M.A.H.M.; Poortman, J.; Agema, A.R.; Thijssen, J.H.H.

    1980-01-01

    The presence of specific estrogen receptors could be demonstrated in vaginal tissue, obtained during operation from 38 women, age 27–75 yr. In 23 premenopausal women the receptor concentration in the vaginal tissue varied between 12 and 91 fmol/mg protein, no significant difference in the receptor

  2. 改良会阴侧切术应用于经阴道分娩初产妇的临床疗效观察%The Clinical Effect Observation on Improveed Lateral Episiotomy on Primipara Vaginal Delivery

    Institute of Scientific and Technical Information of China (English)

    张晓敏

    2015-01-01

    Objective To observe the clinical effect of improved lateral episiotomy on primipara vaginal delivery.Methods A total of 340 patients who delivered in Linquxian People′s Hospital during Jan.2012 and Oct.2013 were selected as research subjects.They are equally divided into two groups by random number table method,170 cases in each group.Patients in traditional operative group adopted traditional lateral epi-siotomy while patients in modified operative group adopted improved lateral episiotomy .Then the intraopera-tive blood loss,the suture time,the postpartum incision pain grading,wound healing classification and the quality of life of the two groups were compared .Results Intraoperative blood loss in the modified operative group was significantly less than the traditional operative group[(14.6 ±2.7) mL vs (31.2 ±7.4) mL,P0.05 ) .Conclusion Improved lateral episiotomy can obviously decrease the intraoperative blood loss and lighten the pain ,and the postpartum recovery is faster as well.%目的:观察改良会阴侧切术应用于经阴道分娩初产妇的临床疗效。方法选取2012年1月至2013年10月在临朐县人民医院分娩的初产妇340例作为研究对象,采用随机数字表法将产妇分为两组,各170例。传统手术组采用传统的会阴侧切术,改良手术组采用改良会阴侧切术,比较产妇的术中出血量、切口缝合时间、产后切口的疼痛分级、切口的愈合分级、产妇生活质量。结果改良手术组术中出血量显著少于传统手术组[(14.6±2.7) mL 比(31.2±7.4) mL,P<0.05];改良手术组切口缝合时间显著短于传统手术组[(8.1±0.4) min 比(10.4±0.9) min,P <0.05]。改良手术组产妇产后切口疼痛较传统手术组轻( P <0.05),改良手术组切口愈合程度优于传统手术组(P<0.05)。两组产妇分娩后6个月的生活质量比较差异无统计学意义(P>0.05)。结论改良

  3. OM Forum--The Vital Role of Operations Analysis in Improving Healthcare Delivery

    OpenAIRE

    Green, Linda V.

    2012-01-01

    There is now a broad consensus among healthcare professionals that the U.S. healthcare delivery system is woefully inefficient and needs to be radically redesigned. Healthcare costs have always been a driving force in policy and management, but quality has become equally important in driving decisions, particularly since emerging payment systems include metrics on clinical and operational performance. With the increasing use of information technology to capture financial, operational, and cli...

  4. Severe maternal morbidity and the mode of delivery.

    Science.gov (United States)

    Pallasmaa, Nanneli; Ekblad, Ulla; Gissler, Mika

    2008-01-01

    To define the rate of severe maternal morbidity in different modes of delivery and to find out if the rate of severe morbidity has changed over a 5-year time span. Retrospective register-based study. Finnish Medical Birth Registry and Hospital Discharge Registry. All singleton deliveries in Finland in 1997 and 2002 (n=110,717). Diagnoses and operative interventions recorded in the Hospital Discharge Registry indicating a severe maternal complication were linked with Birth Register data and compared by mode of delivery: spontaneous vaginal delivery (VD), instrumental VD, elective cesarean section and non-elective cesarean section. Main outcome measures were severe maternal morbidity: deep venous thromboembolism and amniotic fluid embolism, major puerperal infection, severe hemorrhage, events requiring operative intervention after delivery, uterine rupture and inversion, and intestinal obstruction. Severe maternal morbidity was more frequent in cesarean than vaginal deliveries (p<0.001), and more frequent in non-elective than in elective operations (p<0.001). The rate of severe maternal morbidity increased considerably from 1997 to 2002; from 5.9 to 7.6 per 1,000 in all deliveries (p<0.001), from 4.0 per 1,000 to 5.2 per 1,000 in spontaneous vaginal deliveries (p=0.005), from 9.9 per 1,000 to 12.1 per 1,000 in elective cesarean sections (CSs) (p=0.164), and from 19.6 per 1,000 to 27.2 per 1,000 in non-elective CSs (p=0.090), respectively. Severe maternal morbidity has increased both in cesarean and vaginal deliveries from 1997 to 2002. Cesarean delivery, even an elective one, carries a significantly higher risk of life-threatening maternal complications than VD.

  5. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  6. Desquamative inflammatory vaginitis.

    Science.gov (United States)

    Reichman, Orna; Sobel, Jack

    2014-10-01

    Desquamative inflammatory vaginitis (DIV) is an uncommon form of chronic purulent vaginitis. It occurs mainly in Caucasians with a peak occurrence in the perimenopause. Symptoms and signs are nonspecific; DIV is a diagnosis of exclusion, and other causes of purulent vaginitis should be excluded. The main symptoms include purulent discharge, vestibulo-vaginal irritation, and dyspareunia. Examination of vaginal walls shows signs of inflammation with increased erythema and petechiae. Through microscopy (wet mount) of the vaginal secretions, DIV is defined by an increase in inflammatory cells and parabasal epithelial cells (immature squamous cells). Vaginal flora is abnormal and pH is always elevated above 4.5. Although etiology and pathogenesis remain unknown, the favorable response to anti-inflammatory agents suggests that the etiology is immune mediated. Either local vaginal clindamycin or vaginal corticosteroids are adequate treatment. As a chronic condition, maintenance treatment should be considered as relapse is common. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Application Research on High Risk Pregnancy Management in the Scarred Uterus Vaginal Delivery%高危妊娠管理在瘢痕子宫阴道分娩中的应用研究

    Institute of Scientific and Technical Information of China (English)

    王玉华

    2016-01-01

    Objective To study the application of high risk pregnancy management in the scarred uterus vaginal delivery. Methods 168 cases of pregnant women with scarred uterus admitted in our hospital from August 2012 to November 2015 were selected and randomly divided into two groups with 84 cases in each, the control group were given routine nursing, the observation group were given high-risk pregnancy management, and the delivery method, delivery outcome, perinatal weight and length of stay were compared between the two groups. Results After the high-risk pregnancy management, the vaginal trial production rate, success rate of trial production and vaginal birth rate in the observation group were obviously higher than those in the control group, and the differences had statistical significance, P<0.05, the bleeding volumes after postpar-tum 2h and 24h in the observation group were obviously lower than those in the control group, and the differences had sta-tistical significance, P<0.05;the birth weight of newborns in the observation group was obviously lower than that in the con-trol group, and the length of stay was lower than that in the control group, and the difference had statistical significance, P<0.05. Conclusion The high-risk pregnancy management can change the delivery method of pregnant women, improve the delivery outcome of pregnant women with scarred uterus and reduce the postpartum bleeding volume.%目的:探讨高危妊娠管理在瘢痕子宫阴道分娩中的应用。方法选取2012年8月-2015年11月该院接收的168例瘢痕子宫孕妇,随机分组,各84例,对照组给予常规护理,观察组给予高危妊娠管理,比较两组产妇分娩方式、分娩结局、围生儿体重、住院时间。结果高危妊娠管理后观察组阴道试产率、试产成功率、阴道分娩率均显著高于对照组,差异有统计学意义(P<0.05);观察组产后2 h出血量、24 h出血量均显著低于对照组

  8. MOIST VAGINAL PACKING FOR UTERO-VAGINAL PROLAPSE-A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Manidip

    2013-02-01

    Full Text Available ABSTRACT: BACKGROUND : Utero-vaginal prolapse is a common condition in ag ed women and often they come to us with decubitus ulcer. Prolong ed vaginal packing not only will heal the decubitus ulcer but also it may help in returning th e normal rugosity of the vaginal skin. AIMS: To assess the role of prolonged moist vaginal packing in utero-vaginal prolpase. SETTINGS & DESIGN: It was an OPD based prospective study conducted at t he gynecology OPD of College of Medicine & JNM Hospital, WBUHS, Kalyani, Nadia, West Bengal and Jawaharlal Nehru Institute of Medical Sciences, Porompat, Imphal, Manipur. METHODS & MATERIAL: Hundred (100 patients of utero-vaginal prolapse with decubitus ulce r were studied. After initial staging (POP- Q staging, daily moist (5% povidone-iodine solution soaked gauze vaginal packing at home was advised. After 2 weeks, re-examination done for decubitus ulcer healing. Packing continued till operation (interval 1- 1½ month. Preoperative s taging and modification of operation were noted. On follow up complication (mainly recurrence was noted. RESULTS: Initial staging was stage 3 - 39%, stage 4 - 61%. Preoperative scoring r evealed stage 3 became stage 2 in 54% cases and stage 4 became stage 3 in 49% cases. This improv ement helped us to avoid excessive excision of vaginal mucosa. CONCLUSION: Prolonged pre-operative moist gauze vaginal packing may improve the outcome of the disease.

  9. Cesarean Delivery in Adolescents.

    Science.gov (United States)

    Katz Eriksen, Jennifer L; Melamed, Alexander; Clapp, Mark A; Little, Sarah E; Zera, Chloe

    2016-10-01

    To examine the effect of maternal age on indication for primary cesarean delivery in low-risk nulliparous women. Retrospective cohort study. Urban academic tertiary care center. Nulliparous women younger than 35 years of age delivering vertex-presenting singletons at term. Participants underwent spontaneous, operative or cesarean delivery. Mode of delivery, indication, and timing of cesarean delivery. Adolescents were half as likely to undergo cesarean delivery overall (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.43-0.54), and more than one-third less likely to undergo cesarean delivery in labor (OR, 0.59; 95% CI, 0.53-0.66). Adjustment for potential confounders did not alter the strength of these associations. Adolescents were half as likely to undergo cesarean delivery for failure to progress (OR, 0.49; 95% CI, 0.43-0.54). There was no difference in the odds of cesarean delivery for nonreassuring fetal status (OR, 0.91; 95% CI, 0.77-1.06), or genital herpes (OR, 1.44; 95% CI, 0.57-3.68). Induction, macrosomia, oxytocin augmentation, and any labor complication were all associated with increased risk of cesarean delivery. There was no difference in the duration of second stage for adolescents who delivered by cesarean delivery compared with adults (240.0 vs 237.7 minutes; P = .84), but adolescents who delivered vaginally had a second stage that was one-third shorter than adults (62.5 vs 100.3 minutes; P cesarean delivery overall, and 40% less likely to undergo a primary cesarean delivery in labor, even after adjustment for multiple maternal, neonatal, and labor characteristics. This difference is not explained by differences in the duration of the second stage of labor. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  10. Application effect of delivery ball combined with doula delivery in fetal position correction of vaginal delivery%分娩球联合导乐分娩在阴道分娩纠正胎方位中的应用效果

    Institute of Scientific and Technical Information of China (English)

    龚逞英

    2015-01-01

    Objective To explore the application effect of delivery ball combined with doula delivery in the fetal posi-tion correction of vaginal delivery. Methods 200 primiparae in our hospital from January 2011 to March 2015 were se-lected and randomly divided into the experiment group and the control group,100 puerperae in each group.The experi-ment group was given delivery ball combined with doula method in the delivery,and the control group was given tradi-tional delivery method.The way of delivery,total stage of labor,bleeding amount and pain grade in two groups was com-pared. Results In the experiment group,90 puerperae changed to the occiput anterior position.The proportion of natural labor in the experiment group was higher than that in the control group,with significant difference (P<0.05).The degree of pain during delivery in the experimental group was less than that in the control group,with significant difference (P<0.05).The total stage of labor in the experiment group was (6.55±2.18) hours,which was shorter than (11.94±3.83) hours in the control group,with significant difference (P<0.05).The amount of postpartum 2-hour bleeding in the experiment group was less than that in the control group,with significant difference (P<0.05). Conclusion The application effect of delivery ball combined with doula delivery is significant,which can effectively relieve pain,reduce the rate of cesarean section,it is worthy of clinical promotion and application.%目的:探讨分娩球联合导乐分娩在阴道分娩纠正胎方位中的应用效果。方法选取2011年1月~2015年3月本院的200例经初产妇作为研究对象,随机分为实验组和对照组,各100例。实验组采用分娩球联合导乐法,对照组采用传统分娩的方法,比较两组的分娩方式、总产程、出血量和疼痛程度。结果实验组中,90例转至枕前位。实验组的顺产所占比例显著高于对照组,差异有统计学意义(P<0.05)。实验组分娩过程中的疼

  11. Twin delivery: method, timing and conduct.

    Science.gov (United States)

    Barrett, Jon F R

    2014-02-01

    The incidence of twin pregnancy has increased worldwide over the past 10 years, largely as a consequence of the assisted reproductive technologies. Issues such as intrapartum monitoring and operative interventions, especially relating to the second twin, provide a unique challenge in labour and delivery. Epidemiological and cohort data suggest that twins have a three-fold higher mortality rate than singletons, and that the second twin might have a better outcome if delivered by lower segment caesarean section. The recently completed Twin Birth Study has found that planned vaginal lower segment caesarean section is not advantageous to the fetus. In the light of this large randomised-controlled trial, vaginal delivery if twin A presents by the vertex is recommended as long as guidelines for the conduct of such delivery are followed.

  12. MEASUREMENT OF CERVICAL LENGTH BY VAGINAL SONOGRAPHY: PREDICTION OF PRETERM LABOR

    Directory of Open Access Journals (Sweden)

    F MEHRABIAN

    2001-12-01

    Full Text Available Introduction: Preterm delivery remains a major source of perinatal morbidity and mortality. The patient at risk for preterm delivery could be identified before the onset of uterine activity. Cervical shortening associates with increased risk of preterm delivery. Vaginal ultrasound for measurement of the cervical length can contribute to the prediction, diagnosis and management of preterm delivery. Methods: 780 women attending the antenatal clinic of the Shahid Beheshti and Alzahra hospitals (January 1997 - February 1998 were selected. They had no complications. pregnant with gestational ages between 28-30 weeks were recruited in to the study. Cervical length was recorded by vaginal sonography. They followed up to delivery time. Results: The mean cervical length of the term and preterm groups were statisticaly significantly different. The likelihood ratios of cervical length at various cutoff points were calculated. The appropriate cutoff point based on the receiver operating characteristic curve (35mm was associated with a significant increased likelihood of preterm delivery. Discussion: A single transvaginal sonographic measure of cervical length at 28-30 weeks gestational age can be used to predict the risk of preterm delivery using a cutoff point on 35mm.

  13. Mathematical model of microbicidal flow dynamics and optimization of rheological properties for intra-vaginal drug delivery: Role of tissue mechanics and fluid rheology.

    Science.gov (United States)

    Anwar, Md Rajib; Camarda, Kyle V; Kieweg, Sarah L

    2015-06-25

    Topically applied microbicide gels can provide a self-administered and effective strategy to prevent sexually transmitted infections (STIs). We have investigated the interplay between vaginal tissue elasticity and the yield-stress of non-Newtonian fluids during microbicide deployment. We have developed a mathematical model of tissue deformation driven spreading of microbicidal gels based on thin film lubrication approximation and demonstrated the effect of tissue elasticity and fluid yield-stress on the spreading dynamics. Our results show that both elasticity of tissue and yield-stress rheology of gel are strong determinants of the coating behavior. An optimization framework has been demonstrated which leverages the flow dynamics of yield-stress fluid during deployment to maximize retention while reaching target coating length for a given tissue elasticity.

  14. Vaginitis test - wet mount

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003916.htm Vaginitis test - wet mount To use the sharing features on this page, please enable JavaScript. The vaginitis wet mount test is a test to detect ...

  15. Vaginal birth after cesarean section

    Directory of Open Access Journals (Sweden)

    Vidyadhar B Bangal

    2013-01-01

    Full Text Available Background: The rate of primary cesarean section (CS is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. Aims: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC in selected cases of one previous lower segment CS (LSCS. Materials and Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. Conclusion: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

  16. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. Fewer than 1 in

  17. COMPARATION OF PROLACTION LEVELS OF THE VAGINAL AND CAESAREAN DELIVERY%阴道与剖宫产分娩产妇催乳素水平的对比

    Institute of Scientific and Technical Information of China (English)

    司守娜

    2011-01-01

    [目的]比较阴道与剖宫产分娩后产妇催乳素水平的差异.[方法]选择自2010年2-7月产科收治分娩的102例产妇,其中择期剖官产产妇53例(剖官产组),自然分娩产妇49例(阴道分娩组),采用放射免疫分析法,测定其产前、产后24 h和72 h时血催乳素(PRL)的水平.两组乳汁分泌量的比较,观察其分娩后新生儿的体重及出生4d后两组新生儿体重的变化进行对比分析.[结果]两组产前、产后24 h及72 h血PRL比较差异无统计学意义(P>0.05),两组分娩过程中其PRL均下降,剖官产组与阴道分娩组比较,降低显著(P 0.05);剖官产组和阴道分娩组新生儿出生后4 d,剖宫产组新生儿体重下降5.46%,阴道分娩组新生几体重下降2.72%,差异有统计学意义(P 0.05). PRL decreased during labor in both groups and the caesarean group decreased more significantly (P 0.05); After 4d, birth weight of caesarean group decreased by 5.46%, and decreased by 2.72% of vaginal delivery group, and the difference was significant (P< 0.05). [Conclusion] PRL in vaginal delivery group with high concentrations, early lactation, and milk quantity is better than that of the caesarean section group. Birth weight of vagianl delivery group decreases lower than that of the caesarean group. Quality of obstetric basis, breast-feeding, correct guidance of caesarean section should be improved to help mothers with early postoperative activities and confidence in breastfeeding.

  18. 经阴道分娩初产妇行会阴侧切术85例分析%Analysis of 85 cases of primiparas with vaginal delivery treated with lateral episiotomy

    Institute of Scientific and Technical Information of China (English)

    蒋玉

    2016-01-01

    Objective:To analyze the effect of lateral episiotomy on the delivery outcome of primiparas with vaginal delivery. Methods:170 cases of primiparas with vaginal delivery were divided into two groups randomly.The observation group was given lateral episiotomy,and the control group was given traditional protection of perineum.The second stage of labor time,perineal laceration,postpartum 2 h hemorrhage volume and neonatal asphyxia incidence of two groups were compared.Results:The second stage of labor time in the observation group was shorter than that of the control group;the postpartum 2 h hemorrhage volume was less than that of the control group(P<0.05).The incidence of perineal laceration in observation group was lower than that in control group,and the neonatal asphyxia Apgar score was better than that of the control group(P<0.05).Conclusion:Lateral episiotomy could reduce the occurrence of perineal laceration and neonatal asphyxia,shorten the process of labor,reduce the amount of postpartum hemorrhage,which protect the pelvic muscles.%目的:分析会阴侧切术对经阴道分娩初产妇分娩结局的影响。方法:收治阴道分娩初产妇170例,随机分为两组。观察组行会阴侧切术,对照组行传统的单纯会阴保护,比较两组第二产程时间、会阴裂伤、产后2 h出血量及新生儿窒息发生情况。结果:观察组第二产程短于对照组,产后2 h出血量少于对照组(P<0.05)。观察组会阴裂伤发生率低于对照组,且新生儿窒息Apgar评分优于对照组(P<0.05)。结论:会阴侧切术可减少会阴裂伤和新生儿窒息的发生,缩短产程,减少产后出血量,保护盆底肌肉。

  19. Neglected vaginal pessary

    Directory of Open Access Journals (Sweden)

    Meenu Jain

    2014-02-01

    Full Text Available Vaginal pessary may be opted for management of uterine prolapse as a safe option, but to avoid complications regular follow-up is a must. We are reporting a case of neglected vaginal pessary in a 72 year old female which got embedded in vaginal mucosa and required excision of vaginal band for its removal. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 291-292

  20. Vaginitis: diagnosis and management.

    Science.gov (United States)

    Quan, Martin

    2010-11-01

    Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.

  1. 阴道分娩产妇重复式会阴阴道消毒对发生切口感染的影响%Effect of repeated perineal and vaginal disinfection on incision infections in puerpera after vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    袁琳; 王静; 赵丽春

    2015-01-01

    目的:探讨重复式会阴阴道消毒对阴道分娩产妇会阴侧切切口感染的影响,为降低阴道分娩产妇切口感染的发生提供参考依据。方法选取2010年1月-2013年12月医院4038例阴道分娩的初产妇为研究对象,根据进入产房分娩时间按照奇偶数分组,重复式消毒组产妇共2329例,采用重复式阴道消毒方式进行消毒后再行会阴侧切术;传统消毒组产妇共1709例,采用传统消毒方式消毒后在行会阴侧切术;分析两组产妇会阴侧切切口感染的发生及感染病原菌的构成,数据采用SPSS17.0软件进行统计分析。结果重复式消毒组及传统消毒组产妇发生医院感染率分别为4.47%及7.37%,比较差异有统计学意义( P<0.05);产妇切口感染率重复式消毒组为0.73%、传统消毒组为2.63%,切口感染率重复式消毒组明显低于传统消毒组,比较差异有统计学意义( P<0.05);切口感染部位共分离出病原菌52株,其中革兰阴性菌、革兰阳性菌、真菌分别占28.85%、69.23%、1.92%。结论阴道分娩产妇采用重复式会阴阴道消毒能明显降低产妇会阴侧切切口感染发生率,引起会阴切口感染的病原菌以革兰阳性菌为主。%OBJECTIVE To investigate the effect of repeated perineal and vaginal disinfection on incision infections in puerpera after episiotomy during vaginal delivery ,so as to provide the reference for reducing the occurrence of incision infections after vaginal delivery .METHODS A total of 4 038 primipara who underwent vaginal delivery during Jan .2010-Dec .2013 were selected as the research subjects and grouped by odevity according to the deliv‐ery time .The 2 329 puerpera in the repeated disinfection group received lateral episiotomy after repeated vaginal disinfection ,and the 1 709 puerpera in the traditional disinfection group received lateral episiotomy after traditional

  2. Multicriteria Cost Assessment and Logistics Modeling for Military Humanitarian Assistance and Disaster Relief Aerial Delivery Operations

    Science.gov (United States)

    2015-03-01

    goal programming model , and we used Excel/ VBA to create an auto- matic, user-friendly interface with the decision maker for model input and analysis of...ARL-TR-7229•MAR 2015 US Army Research Laboratory Multicriteria Cost Assessment and Logistics Modeling for Military Humanitarian Assistance and...Cost Assessment and Logistics Modeling for Military Humanitarian Assistance and Disaster Relief Aerial Delivery Operations by Nathaniel Bastian

  3. Pregnancy outcome in asymptomatic women with abnormal vaginal ...

    African Journals Online (AJOL)

    Patients with symptomatic vaginal infections, obvious risk factors for preterm delivery ... many of them were not willing to return for frequent visits. .... SD = standard deviation; GA = gestational age; BV = bacterial vaginosis. Table 2. Adverse ...

  4. Clinical outcome and safety analysis of vaginal delivery after cesarean section%剖宫产术后阴道分娩的临床结局及安全性分析

    Institute of Scientific and Technical Information of China (English)

    李云秀; 纪艳洁; 陈敏红; 祝丽琼

    2015-01-01

    Objective To explore the clinical outcome and safety of vaginal delivery after cesarean section. Methods 512 cases of scarred uterus who delivered in Tangxia Hospital of Dongguan and Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January to December 2014 and had a second pregnancy were retrospectively analyzed. Results Among 512 cases of scarred uterus,163 cases were vaginal trial labour (VBAC group),accounting for 31.84% of scarred uterus delivery.Among them,vaginal trial labourwas carried out successfully in 126 cases,with the successful rate of vaginal trial labour of 77.3%.Trial labourwas failed in 37 cases and switched to cesarean section,with the failure rate of trial labour of 22.7%;Cesarean section without trial labourwas performed in 349 cases (ERCS group),accounting for 68.16% of the scarred uterus pregnancy;386 out of the 512 cases of scarred uterus were given a second cesarean sec-tion(including 37 cases of failed vaginal trial labour),accounting for 75.39%of scarred uterus delivery.In the comparison of pregnancy outcome in VBAC group and ERCS group,VBAC group was higher than ERCS group in the volume and rate of postpartum bleeding,but VBAC group was shorter than ERCS group in the length of stay and lower than ERCS group in the medical expenses,which were statistically different(P0.05). Conclusion As for the pregnant women with a second pregnancy after cesarean section,if the indication of trial labour is properly understood,severe monitoring is performed during the labour,and vaginal trial labour is safe and feasible with a high successful rate,then the rate of cesarean sec-tion can be reduced to a certain extent.%目的:探讨剖宫产术后阴道分娩的临床结局及安全性。方法对东莞市塘厦医院及中山大学孙≥仙纪念医院于2014年1~12月分娩的512例瘢痕子宫再次妊娠者进行回顾性分析。结果512例瘢痕子宫中,阴道试产163例(VBAC组),占瘢痕子宫分娩的31.84%,

  5. Evaluation and Management of Vaginitis

    Science.gov (United States)

    Carr, Phyllis L; Felsenstein, Donna; Friedman, Robert H

    1998-01-01

    OBJECTIVE To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections, and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting. DATA SOURCES Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997 were reviewed. DATA SYNTHESIS Techniques that enable the identification of the various strains of candida have helped lead to a better understanding of the mechanisms of recurrent candida infection. From this information a rationale for the treatment of recurrent disease can be developed. Bacterial vaginosis has been associated with complications, including upper genital tract infection, preterm delivery, and wound infection. Women undergoing pelvic surgery, procedures in pregnancy, or pregnant women at risk of preterm delivery should be evaluated for bacterial vaginosis to decrease the rate of complications associated with this condition. New, more standardized criteria for the diagnosis of bacterial vaginosis may improve diagnostic consistency among clinicians and comparability of study results. Use of topical therapies in the treatment of bacterial vaginosis are effective and associated with fewer side effects than systemic medication. Trichomonas vaginalis, although decreasing in incidence, has been associated with upper genital tract infection. Therapy of T. vaginalis infection has been complicated by an increasing incidence of resistance to metronidazole. CONCLUSIONS Vaginitis is a common medical problem in women that is associated with significant morbidity and previously unrecognized complications. Research in recent years has improved diagnostic tools as well as treatment modalities for all forms of vaginitis. PMID:9613891

  6. Laparoscopic repair of vaginal evisceration: a case report.

    Science.gov (United States)

    Lledó, Jose Bueno; Roig, Manuel Planells; Serra, Alfonso Serralta; Astaburuaga, Carmen Rodero; Giménez, Fernando Dobón

    2002-12-01

    Vaginal evisceration, although rare, is usually present in postmenopausal women with a history of vaginal surgery and high-grade pelvic floor dysfunction. Operative management is directed toward resecting any compromised bowel, repairing vaginal defect, and correcting the defect in the pelvic floor, which is associated with most cases, either in the same intervention or in a second procedure. Laparoscopy allows for assessment of the viability of the compromised bowel and the vaginal defect suture with advantages common to minimally invasive techniques. We report the first case in the international literature of vaginal evisceration managed by laparoscopy.

  7. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy.

    Science.gov (United States)

    Abe, Akiko; Matoda, Maki; Okamoto, Sanshiro; Kondo, Eiji; Kato, Kazuyoshi; Omatsu, Kohei; Umayahara, Kenji; Utsugi, Kuniko; Takeshima, Nobuhiro

    2015-04-02

    We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care.

  8. [Complications of cesarean deliveries].

    Science.gov (United States)

    Valgeirsdottir, Heiddis; Hardardottir, Hildur; Bjarnadottir, Ragnheidur I

    2010-01-01

    The objective of the study was to determine the rate of complications which accompany cesarean sections at Landspitali University Hospital (LSH). All deliveries by cesarean section from July 1st 2001 to December 31st 2002 were examined in a retrospective manner. Information was collected from maternity records regarding the operation and its complications if they occurred, during or following the operation. During this period 761 women delivered by cesarean section at LSH. The overall complication rate was 35,5%. The most common complications were; blood loss > or =1000 ml (16.5%), post operative fever (12.2%), extension from the uterine incision (7.2%) and need for blood transfusion (4.3%). Blood transfusion was most common in women undergoing cesarean section after attempted instrumental vaginal delivery (20%). Fever and extension from the uterine incision were most common in women undergoing cesarean section after full cervical dilation without attempt of instrumental delivery (19,4%). These complications were least likely to occur if the patient underwent an elective cesarean section. Complications following cesarean section are common, especially if labor is advanced. Each indication for an operative delivery should be carefully weighed and the patient informed accordingly.

  9. Prepubertal vaginal discharge: Vaginoscopy to rule out foreign body.

    Science.gov (United States)

    Ekinci, Saniye; Karnak, İbrahim; Tanyel, Feridun Cahit; Çiftçi, Arbay Özden

    2016-01-01

    Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n=2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.

  10. 瘢痕子宫再妊娠孕妇经阴道分娩的临床产程观察%Observation on the clinical labor of pregnant women with uterine scar pregnancy again by vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    刘春

    2016-01-01

    Objective:To analyze the clinical labor of pregnant women with uterine scar pregnancy again by vaginal delivery. Methods:80 pregnant women with uterine scar pregnancy again were selected.They were divided into the two groups.The success of natural labor group was selected as the experimental group with 30 cases.The cesarean section group was selected as the control group with 50 cases.The rupture of uterus,postpartum hemorrhage,labor duration,and length of stay between groups were observed. Results:The postpartum hemorrhage,labor duration and hospitalization time of the experimental group were less than those of the control group.The rate of postpartum fever and uterine rupture in the experimental group were lower than those in the control group,and the patients in the experimental group were significantly better than the control group.The differences were statistically significant (P<0.05).Conclusion:Vaginal delivery used in pregnant women with uterine scar who pregnancy again can reduce the incidence of complications,shorten the length of hospital stay and production time,which with less postpartum hemorrhage.%目的:分析瘢痕子宫再妊娠孕妇经阴道分娩的临床产程。方法:收治瘢痕子宫再次妊娠患者80例,分为两组,30例试产成功组为试验组,50例剖腹产组为对照组。观察两组患者子宫破裂、产后出血、生产时间及住院时间等。结果:试验组产妇产后出血、生产时间及住院时间均少于对照组;试验组产后发热率、子宫破裂率均低于对照组,差异有统计学意义(P<0.05)。结论:瘢痕子宫再妊娠孕妇采用阴道分娩,能够降低并发症的发生率,缩短住院时间和生产时间,产后出血量较少。

  11. Diagnóstico pré-natal e parto transpelviano na osteogênese imperfeita: relato de caso Prenatal diagnosis and vaginal delivery in osteogenesis imperfecta: a case report

    Directory of Open Access Journals (Sweden)

    Alex Sandro Rolland de Souza

    2006-04-01

    Full Text Available A osteogênese imperfeita é doença do tecido conjuntivo devida a anormalidades quantitativas ou qualitativas do colágeno tipo I, transmitida geneticamente, por gene autossômico dominante ou recessivo, que determina fragilidade óssea. Relata-se o caso clínico de paciente de 19 anos, primigesta, encaminhada ao setor de medicina fetal com ultra-sonografia pregressa evidenciando encurtamento de extremidades fetais. Na avaliação morfológica, identificou-se contorno craniano irregular com deformidade à compressão do pólo cefálico, membros com rizo e mesomelia, rarefação óssea e encurvamento de ossos longos (fraturas. A paciente evoluiu com parto transpelviano na 35ª semana de gestação. O recém-nascido apresentou Apgar de 6 no 1ª minuto e 8 no 5ª minuto, sexo masculino, pesando 1.990 gramas. Observado crânio irregular, ossificação diminuída, esclera azulada e fraturas consolidadas com deformidades em todos os membros. O recém-nascido apresentou boa evolução neonatal, recebendo alta hospitalar em boas condições. O diagnóstico pré-natal é de grande importância para adequado acompanhamento da gravidez e a via de parto transpelviana não ocasionou piora do prognóstico neonatal, pois não foram diagnosticadas fraturas recentes.Osteogenesis imperfecta is a connective tissue disorder due to quantitative and qualitative anomalies in type 1 collagen, genetically transmitted by a dominant or recessive autosomal gene, leading to bone fragility. We report a case of a 19-year-old G1 PO patient referred to our institution following a screening ultrasound that demonstrated short limb fetal extremities. A level 3 scan was performed which evidenced an irregular cranial shape and compression of the cephalic pole with moderate transducer pressure. Limb shortening, decreased echoes and fractures of long bones were found on our scan evaluation. A vaginal delivery occurred at 35 weeks of gestation. The male newborn, weighing 1.990 grams

  12. Pudendal nerve block for vaginal birth.

    Science.gov (United States)

    Anderson, Deborah

    2014-01-01

    Pudendal nerve block is a safe and effective pain relief method for vaginal birth. Providing analgesia to the vulva and anus, it is used for operative vaginal birth and subsequent repair, late second stage pain relief with spontaneous vaginal birth, repair of complex lacerations, or repair of lacerations in women who are unable to achieve adequate or satisfactory pain relief during perineal repair with local anesthesia. Key to its efficacy is the knowledge of pudendal nerve anatomy, the optimal point of infiltration of local anesthetic, and an understanding of the amount of time necessary to effect adequate analgesia.

  13. The Feasibility Analysis of Vaginal Delivery in Repeated Pregnancy After Cesarean Section%剖宫产术后再次妊娠经阴道分娩可行性分析

    Institute of Scientific and Technical Information of China (English)

    陈佩芬; 李林娜

    2014-01-01

    Objective:To investigate the feasibility of vaginal delivery in repeated pregnancy after cesar-ean section .Method:The case history information of 323 pregnant women with previous cesarean section de-livery were collected for retrospective study .The average quantity of postpartum hemorrhage ,the rate of post-partum hemorrhage , neonatal asphyxia and puerperalism ,the average of hospitalization days were compared between the vaginal trial production group ( Group A) with 83 cases and the repeate cesarean section group (Group B) with 240 cases.And 83 cases of vaginal trial productio at the same period in non-uterine scar (Group C) were compared also.Result: Among 323 pregnant women, 83 cases (25 7.0%)of vaginal trial production,73 cases(87.95%,73/83) were successful.Repeate cesarean section was 240 (74.30 %,240/323).Ther were no significant difference ( P>0.05) in the rate of postpartum hemorrhage and the rate of neonatal asphyxia ,There's significant difference ( P <0.01) in the average quantity of postpartum hemorrhage and the average of hospitalization days between Group A and Group B .And there's no significant difference between Group A and Group C .The three groups were not concurrent maternal puerperal disease .Conclu-sion: Vaginal trial production is save and feasible in repeated pregnancy after cesarean section delivery by intensive care and need to strictly control the indications .It also can reduce the hospitalization days .%目的:探讨剖宫产术后再次妊娠经阴道分娩的可行性。方法:回顾性分析本院收治的323例具有剖宫产史再次妊娠产妇的临床资料。将剖宫产术后选择经阴道试产组83例与选择再次剖宫产组240例的产后平均出血量、产后出血、新生儿窒息、产褥病、平均住院天数进行比较,并随机抽取同期非疤痕子宫选择经阴道试产组83例进行对照。结果:323例中83例选择阴道试产,占25.70%(83/323),其中73

  14. 15 Month follow up of African children following vaginal cleansing with benzalkonium chloride of their HIV infected mothers during late pregnancy and delivery

    Science.gov (United States)

    Mandelbrot, L; Msellati, P; Meda, N; Leroy, V; Likikouet, R; Van de Perre, P; Dequae-Merchadoux, L; Sylla-Koko, F; Ouangre, A; Ouassa, T; Ramon, R; Gautier-Charpenti..., L; Cartoux, M; Dosso, M; Dabis, F; Welffens-Ekra, C

    2002-01-01

    Objectives: To study mother to child HIV-1 transmission (MTCT) and infant mortality following benzalkonium chloride (BC) disinfection. Methods: A randomised, double blind phase II placebo controlled trial. Women testing positive for HIV-1 infection in prenatal care units in Abidjan, Côte d'Ivoire, and Bobo-Dioulasso, Burkina Faso, from November 1996 to April 1997 were eligible, with their informed consent. Women self administered daily a vaginal suppository of 1% BC (53) or matched placebo (54) from 36 weeks of pregnancy, plus a single dose during labour. The neonate was bathed with 1% BC solution or placebo within 30 minutes after birth. MTCT rate was assessed based on repeated polymerase chain reaction (PCR) and serology results. For the present analysis, children were followed up to 15 months. Results: A total of 107 women were enrolled. Of 103 eligible liveborn children, 23 were HIV infected, 75 uninfected, and five of indeterminate status. MTCT transmission rate was 24.2% overall (95% confidence interval (CI): 14.3% to 30.4%). On an intent to treat basis, the transmission rate did not differ between the two groups (23.5%, CI 13.8 to 38.5, in the BC group and 24.8%, CI 15.0 to 39.6, in the placebo group at 15 months). Similarly, there was no difference in mortality at 15 months (22.9%, CI 13.7 to 36.9, in the BC group and 16.5%, CI 9.0 to 29.4, in the placebo group). Conclusion: This analysis failed to suggest any benefit of BC disinfection on mother to child HIV transmission or perinatal and infant mortality. PMID:12181464

  15. Trachelectomy for cancer of the cervix: dargent's operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III

    DEFF Research Database (Denmark)

    Ottosen, Christian

    2011-01-01

    Radical vaginal trachelectomy is today an established method of treating selected women with cervical cancer stage IA2 and IB1, with tumour size less than 2cm without precluding future childbearing. This technique has been used for more than 20 years with reassuring oncological safety and excellent...... obstetrical outcomes. The procedure is a combination of laparoscopy for pelvic lymphadenectomy and challenging classic vaginal surgery to resect the tumour, part of the parametrium and upper vagina. Complications are in the range of 8-13%. Recurrence and death occur in 5 and 3%, respectively, as good...

  16. The observation and nursing of premature vaginal delivery of 32 cases of scarred uterus pregnancies%32例瘢痕子宫再次妊娠早产阴道分娩的观察与护理

    Institute of Scientific and Technical Information of China (English)

    翁筱枫

    2013-01-01

    To identify nursing experience of preterm vaginal delivery in 32 scarred uterus pregnancies. Advantage prepartum (intrapartal)environment, reasonable staff arrangement, positive psychological nursing care are so beneficial to release the uneasy and anxious status of puerperal as to colaborating with the nursing treatment. Possess intrapartal pain management and labor and complication monitoring, mitigating the labor pain, preventing from complicated diseases such as protraction disorder and uterine rupture, ending up with normal delivery. Postpartum hemorrhage and premature infant nursing care are essential to decrease the risk of vital diseases.%  总结32例瘢痕子宫再次妊娠早产阴道分娩的护理经验。分娩前环境、人员安排使患者处于舒适、优美的分娩环境,对患者进行心理护理指导,缓解患者的焦虑、紧张情绪极,主动和积极配合护理治疗。分娩时加强疼痛管理及产程和并发症的监测和观察,以减少患者痛苦,防止产程延长及子宫破裂等严重并发症的发生,以确保胎儿顺利分娩。产后阴道出血的观察与护理以及早产儿护理使母婴度过危险阶段,确保母婴的安全。

  17. Induced vaginal birth after previous caesarean section

    OpenAIRE

    Akylbek Tussupkaliyev; Andrey Gayday; Bibigul Karimsakova; Saule Bermagambetova; Lunara Uteniyazova; Guldana Iztleuova; Gulkhanym Kusherbayeva; Meruyert Konakbayeva; Assylzada Merekeyeva; Zamira Imangaliyeva

    2016-01-01

    Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC) remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administra...

  18. Vaginal bleeding between periods

    Science.gov (United States)

    ... may cause occasional spotting) Ectopic pregnancy Miscarriage Other pregnancy complications Vaginal dryness due to lack of estrogen after menopause Stress Stopping and starting birth control pills or estrogens ...

  19. A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

    Directory of Open Access Journals (Sweden)

    Vijay Kanna

    2015-10-01

    Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes. A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 and micro;g of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate. [Int J Res Med Sci 2015; 3(10.000: 2553-2560

  20. A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn

    Directory of Open Access Journals (Sweden)

    Osman Köse

    2013-01-01

    Full Text Available Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD, which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1 cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST, Pelvic Organ Prolapse Quantification (POP-Q evaluation, Incontinence Impact Questionnaire (IIQ-7, and Urogenital Distress Inventory (UDI-6 scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

  1. SELLING, DELIVERY AND TRADE MARKETING – AN OPERATIONAL TRIDENT OF THE DISTRIBUTION SYSTEM

    Directory of Open Access Journals (Sweden)

    Ioana Olariu

    2014-01-01

    Full Text Available This paper highlights the way in which a distribution system can be made operational in FMCG, starting from the interaction between three components of the system: selling, delivery and trade marketing. On this basis, I have categorized the improvement opportunities of each component, using the appropriate key performance indicators (KPIs of the system objectives. The optimal configuration of instruments and successful interaction of these components, improve the distribution system contribution to company performance. A specific system, defined for solving marketing problems, must be designed according to this purpose, and in this regard, all the significant elements and relationships must be subordinate to the objective by which it will achieve the desired solution. Business objectives achievement can be measured as effectiveness - the degree to which objectives were achieved, or as efficiency - the degree to which objectives have been achieved in the available resources. For evaluating the effectiveness with which an operative marketing system turns its sources into necessary results to solve a problem, it requires certain criteria to measure performance. These three elements: selling, delivery and trade marketing, are a trident of distribution which can lead to an optimal approach of market opportunities.

  2. 自然分娩中限制会阴切开的应用%Restrictive use of episiotomy during spontaneous vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    李玉玲; 郭培奋; 孔欣; 彭翠霞

    2012-01-01

    Objective To compare the maternal and neonatal outcomes of restrictive use of episiotomy (only if tearing becomes apparent) versus routine episiotomy (in all cases) . Methods 314 nulliparous women at ≥37 weeks of gestation with live singleton cephalic pregnancies and no contraindication to vaginal birth, who were recruited from November 2010 to March 2011 in this department, received restrictive use of episiotomy while 739 nulliparous women from January to November in 2010 underwent episiotomy as control group. In both groups, we strengthened cardiotocograph mornitoring and intrapartum care and improved the management of the perineum ( hand on or hand off) . Total duration of labor including the first and the second stages of labour, and blood loss in 2 hours postpartum were recorded as a continuous variable. Apgar scores and anal sphincter (third or fourth degree) tears were also recorded. Results No significant difference was observed in each stage of labour between the two groups (P > 0. 05) . Restrictive use of episiotomy resulted in more blood loss than in the control group (P <0. 01) . Since the cases with severe perineum tear and neonatal asphyxia in both groups were rare, they were excused from Fisher' s exact test. However, the rate of neonatal asphyxia was a little higher in restrictive use group. Conclusions According to this clinical observation, the rate of episiotomy should and could be properly reduced, as the routine and restritive use of episiotomy results in no significant difference in labor duration, anal sphincter tear or neonatal asphyxia.%目的 探索头位初胎自然分娩中实施"限制会阴切开"对产程、严重会阴裂伤、新生儿出生评分的影响.方法 自然分娩头位足月初产妇314例作为限制会阴切开组,加强产程观察、产时对胎儿胎心率监测及改进接产手法,对具有明确会阴侧切适应证者实施会阴切开助产,对于无必要者则严格限制会阴切开;以常规会阴切开

  3. Histerectomia vaginal: o laparoscópico é necessário? Vaginal hysterectomy: is the laparoscope necessary?

    Directory of Open Access Journals (Sweden)

    Octacílio Figueiredo Netto

    1998-10-01

    pode ser realizada na grande maioria dos casos.Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2% were nulliparous, and 104 (26.0% had never delivered vaginally. Three hundred and three patients (75.7% had a history of previous pelvic surgery, the most common being cesarean section (48.7%. The most frequent indication was leiomyoma (61.2%, and the mean uterine volume was 239.9 cm³ (30-1228 cm³. Vaginal hysterectomy was successfully performed in 396 patients (99.0%, and 73 surgeries (18.2% were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%. Intraoperative complications included 6 cystotomies (1.5% and one rectal laceration (0.2%. There were four conversions (1.0% to the abdominal route. Postoperative complications occurred in 24 patients (6.0%. Two hundred and eighty-one patients (70.2% were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.

  4. Desquamative Inflammatory Vaginitis: The Unknown

    National Research Council Canada - National Science Library

    María Trinidad Alumbreros Andújar; Ana González López; Celia Pérez Parra; Rafael López Pérez; Carmen Céspedes Casas; María Mercedes Ramírez Gómez; Castor Martin Francisco; Francisco Javier Haya Palazuelos

    2015-01-01

    Introduction: Desquamative inflammatory vaginitis (DIV) is a chronic inflammatory process of unknown etiology, characterized by genital pain and profuse vaginal discharge, mainly affecting perimenopausal women...

  5. The influence of cesarean section and vaginal delivery on the pelvic floor function and effect of postpartum pelvic floor electromyography stimulation%剖宫产与顺产对盆底功能的影响及产后盆底肌电刺激康复治疗效果对比研究

    Institute of Scientific and Technical Information of China (English)

    袁迎九; 后建丽; 丁文清

    2016-01-01

    目的:观察剖宫产及顺产对产妇盆底功能的影响,分析产后盆底肌电刺激康复治疗对其改善作用。方法300例产妇根据分娩方式分为剖宫产组(n=150)和阴道顺产组(n=150),比较产后两组间盆底功能障碍性疾病(PFD)发生率差异,比较产后6周两组间盆底肌力差异及血清松弛素(RLX)水平及产妇盆底结缔组织中胶原含量差异。选择盆底肌力<3级的产妇进行产后盆底肌电刺激康复治疗,比较治疗前后盆底肌力差异。结果剖宫产盆腔器官脱垂(POP)发生率、盆底肌力受损率及PFD发生率显著低于顺产组;剖宫产组阴道横断面肌力分级显著高于顺产组,神经肌肉刺激治疗仪检测结果显示显示剖宫产组盆底Ⅰ、Ⅱ类肌纤维的肌电压高于顺产组,疲劳度则低于剖宫产组;剖宫产组血清RLX水平显著低于顺产组,产妇盆底结缔组织中胶原含量则显著高于顺产组,组间差异有统计学意义(P<0.05)。接受盆底肌电刺激康复治疗后,剖宫产组和顺产组手测阴道横断面肌力、盆底Ⅰ类肌纤维肌电压、盆底Ⅱ类肌纤维肌电压显著提升,血清RLX水平显著下降,治疗前后差异均有统计学意义(P<0.05)。结论相比于顺产,剖宫产对盆底功能造成的损伤较小,盆底肌电刺激康复治疗能有效改善PFD患者的盆底功能。%Objective To study the influence of cesarean section and vaginal delivery on the pelvic floor function,and to analyze the improvement effect of postpartum pelvic floor electromyography stimulation. Methods 300 women were divided into cesarean section group (n=150) and vaginal delivery group (n=150) according to the mode of delivery,then the difference of incidence of pelvic floor dysfunction disease (PFD) among the two groups were compared,and the differences of the pelvic floor muscle strength and serum levels of RLX,collagen content in the pelvic

  6. MANAGEMENT OF VAGINAL DISCHARGE

    African Journals Online (AJOL)

    Enrique

    Vaginal infection is one of the top 25 reasons for women to consult doctors in the. USA. The 3 most common ... VAGINAL DISCHARGE IN POSTMENOPAUSAL WOMEN. In this age group, the .... More than one host fac- tor may be involved and ...

  7. Vaginal infections update.

    Science.gov (United States)

    Mashburn, Jane

    2012-01-01

    Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

  8. Management of persistent vaginitis.

    Science.gov (United States)

    Nyirjesy, Paul

    2014-12-01

    With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis.

  9. Vaginal seeding or vaginal microbial transfer from the mother to the cesarean born neonate

    DEFF Research Database (Denmark)

    Haahr, Thor; Glavind, Julie; Axelsson, Paul

    2017-01-01

    Recent evidence suggests cesarean delivery (CD) to be a risk factor for inflammatory and metabolic diseases such as asthma, allergies and other chronic immune disorders in the child. One hypothetical pathogenesis of these associations has been proposed to be a disruption of the neonatal colonizat...... to children delivered vaginally. This article is protected by copyright. All rights reserved....

  10. Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

    Science.gov (United States)

    Clark, Susz; Van Steenvort, Jon K

    2008-01-01

    Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

  11. The contraceptive vaginal ring.

    Science.gov (United States)

    Edwardson, Jill; Jamshidi, Roxanne

    2010-03-01

    The contraceptive vaginal ring offers effective contraception that is self-administered, requires less frequent dosing than many other forms of contraception, and provides low doses of hormones. NuvaRing (Organon, Oss, The Netherlands), the only contraceptive vaginal ring approved for use in the United States, contains etonogestrel and ethinyl estradiol. It is inserted into the vagina for 3 weeks, followed by a 1-week ring-free period, and works by inhibiting ovulation. Most women note a beneficial effect on bleeding profiles and are satisfied with NuvaRing. Commonly reported adverse events include vaginitis, leukorrhea, headaches, and device-related events such as discomfort. Serious adverse events are rare. In Chile and Peru, progesterone-only vaginal contraceptive rings are available for nursing women. Studies are ongoing examining new formulations of vaginal contraceptive rings.

  12. Co-operative radical pelvic surgery: a role for the gynecologist in vaginal reconstruction using a uterine myoserosal flap in urological and anorectal cancer surgery.

    Science.gov (United States)

    Saadeh, Feras Abu; Cheema, Iwad; McCormick, Paul; Gleeson, Noreen

    2015-06-01

    This study describes a new technique for reconstructing the vagina and vestibule after radical extirpative surgery for urological and anorectal malignancy. The uterus is always excised when exenterative surgery is performed for gynecological cancer. The use of the uterus as a graft gives the gynecologic oncologist/reconstructive surgeon a role in the multidisciplinary team with urologists when the anterior vaginal wall and vestibule are excised and with the anorectal surgeons when the posterior vaginal wall and perineum are excised for nongynecological cancers. In some such cases, only the anterior or posterior wall of the vagina may be excised, leaving a healthy full-length, one-third, or half-circumference vaginal sleeve. A myoserosal flap is raised from the in situ uterus. The ectocervix is excised, and the adnexa are detached or excised. The uterus is opened to generate a hexagonal flap. The endometrium and endocervix are excised/ablated with electrocautery. The flap is advanced to the edge of the remaining anterior vestibule or reconstituted perineum. The serosal surface of the uterus forms the new wall of the vagina and undergoes metaplastic transformation to squamous epithelium within 3 months. The very satisfactory anatomical and functional outcome means that this technique merits further evaluation.

  13. Management of Vaginal Cancer.

    Science.gov (United States)

    Shrivastava, S B L; Agrawal, Gaurav; Mittal, Megha; Mishra, Priyanshi

    2015-01-01

    Vaginal cancer is a rare gynecologic cancer with very little documentation. Literature search to have useful information for the management of vaginal cancer and share. We have searched the PUBMED database, Google search engine and other database. A total of 26 references were taken into account. Once spread from primary other cancers or vulva is ruled out, vaginal cancer is designated to be primary in origin. It was revealed that majority of vaginal cancers reported are squamous cell carcinomas. The most common risk factors implicated are Human Papiloma Virus, age. Most common presenting symptoms were abnormal vaginal bleeding,. Diagnosis requires pathological confirmation. Management depends on staging work-up. Vaginal cancer is staged by FIGO system of staging and TNM staging. There are many prognostic factors influencing the choice of treatment. Lymph node metastasis is one of the important prognostic factors, others to mention are histology, size, age. In a recent SEER analysis of over 2000 patients, the 5 year disease specific survival was 84% for stage 1, 75% for stage II and 57% for advanced tumors. Early carcinomas are generally treated with either surgery or radiation therapy. Advanced cancers are treated with radiation therapy with simultaneous administration of combined chemotherapy. Preventive strategies include safe sex and HPV vaccination. Primary vaginal cancer is a rare entity, if there is no history of cancer cervix or vulva in past or absence of cervical squamous cell carcinoma or vulvar carcinoma within 5 years is usually considered as primary vaginal cancer. Though early stage vaginal cancers have better outcome treated with surgery or radiotherapy or surgery followed by radiotherapy, radiotherapy alone is preferred mode of treatment in vaginal cancers.

  14. Setting Customer Expectation in Service Delivery: An Integrated Marketing-Operations Perspective

    OpenAIRE

    Teck H. Ho; Yu-Sheng Zheng

    2004-01-01

    Service firms have increasingly been competing for market share on the basis of delivery time. Many firms now choose to set customer expectation by announcing their maximal delivery time. Customers will be satisfied if their perceived delivery times are shorter than their expectations. This gap model of service quality is used in this paper to study how a firm might choose a delivery-time commitment to influence its customer expectation, and delivery quality in order to maximize its market sh...

  15. Observation on effect of improved midwifery vaginal delivery to reduce episiotomy rate%改良助产方式对降低阴道分娩会阴侧切率的效果观察

    Institute of Scientific and Technical Information of China (English)

    叶兆兰; 张轶兰; 彭继蓉

    2016-01-01

    目的:探讨改良助产方式对于降低阴道分娩产妇会阴侧切率的效果。方法按照随机数字表的分组方法将成都市妇女儿童中心医院2014年1月至12月间3400例产妇分为观察组和对照组,各1700例。对照组产妇接受传统助产方式助产,观察组产妇接受改良助产方式助产。比较两组产妇会阴侧切率及裂伤程度、产后出血量、疼痛程度、新生儿出生Apgar评分及住院时间。结果观察组分娩时会阴情况显著优于对照组,会阴完整率、侧切率均显著低于对照组(χ2值分别为23.100、11.442,均P<0.01),而会阴Ⅰ度裂伤发生率显著高于对照组(χ2=17.553,均P<0.01),两组会阴Ⅱ度裂伤发生率比较无显著性差异(χ2=0.901,P>0.05)。观察组产后出血量、VAS评分及住院时间均显著优于对照组(t值分别为52.128、23.272、39.637,均P<0.05),而新生儿出生Apgar评分比较无显著性差异( t=0.000,P>0.05)。结论改良助产方式可较好的保护会阴,降低会阴侧切率,具有较高的临床应用价值,值得临床推广应用。%Objective To explore the effect of improved midwifery vaginal delivery on reducing episiotomy rate.Methods According to random number table method, 3 400 puerperas admitted in Chengdu Center of Women and Children Hospital during January to December in 2014 were divided into observation group and control group, and 1 700 cases were recruited in each group.The control group received traditional way of midwifery, while the observation group received improved midwifery vaginal delivery.The maternal episiotomy rate and laceration, postpartum bleeding volume, pain degree, neonatal Apgar score and hospitalization time were compared between two groups. Results The perineum of cases in the observation group was significantly better than that in the control group, and the perineum complete rate and

  16. Screening of mucoadhesive vaginal gel formulations

    Directory of Open Access Journals (Sweden)

    Ana Ochoa Andrade

    2014-12-01

    Full Text Available Rational design of vaginal drug delivery formulations requires special attention to vehicle properties that optimize vaginal coating and retention. The aim of the present work was to perform a screening of mucoadhesive vaginal gels formulated with carbomer or carrageenan in binary combination with a second polymer (carbomer, guar or xanthan gum. The gels were characterised using in vitroadhesion, spreadability and leakage potential studies, as well as rheological measurements (stress and frequency sweep tests and the effect of dilution with simulated vaginal fluid (SVF on spreadability. Results were analysed using analysis of variance and multiple factor analysis. The combination of polymers enhanced adhesion of both primary gelling agents, carbomer and carrageenan. From the rheological point of view all formulations presented a similar behaviour, prevalently elastic and characterised by loss tangent values well below 1. No correlation between rheological and adhesion behaviour was found. Carbomer and carrageenan gels containing the highest percentage of xanthan gum displayed good in vitro mucoadhesion and spreadability, minimal leakage potential and high resistance to dilution. The positive results obtained with carrageenan-xanthan gum-based gels can encourage the use of natural biocompatible adjuvants in the composition of vaginal products, a formulation field that is currently under the synthetic domain.

  17. Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada Women's representations and experiences with vaginal and cesarean delivery in public and private maternity hospitals

    Directory of Open Access Journals (Sweden)

    Andréa de Sousa Gama

    2009-11-01

    Full Text Available Este estudo analisa as diferentes representações e experiências quanto ao parto vaginal e cesárea de mulheres de diferentes estratos sócio-econômicos, bem como a natureza das relações profissionais de saúde/usuárias no contexto institucional em que estão inseridas. A pesquisa de natureza qualitativa foi desenvolvida em três maternidades do Município do Rio de Janeiro, Brasil, sendo uma pública, uma conveniada com o SUS e uma particular, com mulheres que tiveram os dois tipos de parto. Os resultados revelam que o modelo de organização dos serviços público e privado apresentam variações que produzem diferentes tipos de assistência e de relação entre os profissionais de saúde e as usuárias, dando forma a experiências distintas entre as mulheres pesquisadas. Todavia, ao empreendermos uma crítica assentada nas relações de gênero, podemos verificar que o modelo de assistência ao parto permanece submetendo quem deve ser sujeito e reproduzindo o projeto da medicalização - mesmo que este processo se manifeste de formas diferenciadas entre os grupos estudados -, o que reduz o campo da assistência e inviabiliza um lugar de poder diferenciado das usuárias.This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system. The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the

  18. Wide Operational Range Processor Power Delivery Design for Both Super-Threshold Voltage and Near-Threshold Voltage Computing

    Institute of Scientific and Technical Information of China (English)

    Xin He; Gui-Hai Yan; Yin-He Han; Xiao-Wei Li

    2016-01-01

    The load power range of modern processors is greatly enlarged because many advanced power management techniques are employed, such as dynamic voltage frequency scaling, Turbo Boosting, and near-threshold voltage (NTV) technologies. However, because the efficiency of power delivery varies greatly with different load conditions, conventional power delivery designs cannot maintain high efficiency over the entire voltage spectrum, and the gained power saving may be offset by power loss in power delivery. We propose SuperRange, a wide operational range power delivery unit. SuperRange complements the power delivery capability of on-chip voltage regulator and off-chip voltage regulator. On top of SuperRange, we analyze its power conversion characteristics and propose a voltage regulator (VR) aware power management algorithm. Moreover, as more and more cores have been integrated on a singe chip, multiple SuperRange units can serve as basic building blocks to build, in a highly scalable way, more powerful power delivery subsystem with larger power capacity. Experimental results show SuperRange unit offers 1x and 1.3x higher power conversion efficiency (PCE) than other two conventional power delivery schemes at NTV region and exhibits an average 70%PCE over entire operational range. It also exhibits superior resilience to power-constrained systems.

  19. The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery

    Science.gov (United States)

    Jones, Jason J; Chu, Jeffrey; Graham, Jacob; Zaluski, Serge; Rocha, Guillermo

    2016-01-01

    Purpose The aim of this study was to evaluate the operational impact of using preloaded intraocular lens (IOL) delivery systems compared with manually loaded IOL delivery processes during routine cataract surgeries. Methods Time and motion data, staff and surgery schedules, and cost accounting reports were collected across three sites located in the US, France, and Canada. Time and motion data were collected for manually loaded IOL processes and preloaded IOL delivery systems over four surgery days. Staff and surgery schedules and cost accounting reports were collected during the 2 months prior and after introduction of the preloaded IOL delivery system. Results The study included a total of 154 routine cataract surgeries across all three sites. Of these, 77 surgeries were performed using a preloaded IOL delivery system, and the remaining 77 surgeries were performed using a manual IOL delivery process. Across all three sites, use of the preloaded IOL delivery system significantly decreased mean total case time by 6.2%–12.0% (P<0.001 for data from Canada and the US and P<0.05 for data from France). Use of the preloaded delivery system also decreased surgeon lens time, surgeon delays, and eliminated lens touches during IOL preparation. Conclusion Compared to a manual IOL delivery process, use of a preloaded IOL delivery system for cataract surgery reduced total case time, total surgeon lens time, surgeon delays, and eliminated IOL touches. The time savings provided by the preloaded IOL delivery system provide an opportunity for sites to improve routine cataract surgery throughput without impacting surgeon or staff capacity. PMID:27382245

  20. Rationale and Safety Assessment of a Novel Intravaginal Drug-Delivery System with Sustained DL-Lactic Acid Release, Intended for Long-Term Protection of the Vaginal Microbiome.

    Directory of Open Access Journals (Sweden)

    Hans Verstraelen

    Full Text Available Bacterial vaginosis is a prevalent state of dysbiosis of the vaginal microbiota with wide-ranging impact on human reproductive health. Based on recent insights in community ecology of the vaginal microbiome, we hypothesize that sustained vaginal DL-lactic acid enrichment will enhance the recruitment of lactobacilli, while counteracting bacterial vaginosis-associated bacteria. We therefore aimed to develop an intravaginal device that would be easy to insert and remove, while providing sustained DL-lactic acid release into the vaginal lumen. The final prototype selected is a vaginal ring matrix system consisting of a mixture of ethylene vinyl acetate and methacrylic acid-methyl methacrylate copolymer loaded with 150 mg DL-lactic acid with an L/D-lactic acid ratio of 1:1. Preclinical safety assessment was performed by use of the Slug Mucosal Irritation test, a non-vertebrate assay to evaluate vaginal mucosal irritation, which revealed no irritation. Clinical safety was evaluated in a phase I trial with six healthy nulliparous premenopausal volunteering women, with the investigational drug left in place for 7 days. Colposcopic monitoring according to the WHO/CONRAD guidelines for the evaluation of vaginal products, revealed no visible cervicovaginal mucosal changes. No adverse events related to the investigational product occurred. Total release from the intravaginal ring over 7 days was estimated through high performance liquid chromatography at 37.1 (standard deviation 0.9 mg DL-lactic acid. Semisolid lactic acid formulations have been studied to a limited extent in the past and typically consist of a large volume of excipients and very high doses of lactic acid, which is of major concern to mucosal safety. We have documented the feasability of enriching the vaginal environment with pure DL-lactic acid with a prototype intravaginal ring. Though the efficacy of this platform remains to be established possibly requiring further development, this

  1. [Improvement of vaginal relaxation by vaginal narrowing technique with double suturing].

    Science.gov (United States)

    Liu, Sanhu; Cen, Ying; Liu, Quan

    2009-12-01

    To investigate the surgical procedures and outcomes of curing the mild and medium vaginal relaxation by double suturing vaginal muscularis. From May 2005 to November 2008, 8 patients (aged 30-45 years old) with mild and medium vaginal relaxation were treated. All the patients were married and had reproductive history of natural childbirth. The double semiring suture was performed in the region 4 cm and 0.5 cm away from the vaginal orifice, respectively, forming the first and the second semicircle to make vagina outside 1/3 segments and vagina muscles tighten. The time of operation was 20-30 minutes (average 25 minutes). There was no obvious bleeding and injury of the rectum and urethra during operation. All the incisions healed by first intention. The vagina accommodated 2 fingers without scar on its mucosa 1-2 months after operation. Eight patients were followed up for 6-24 months and the patients resumed their sexual life 4-8 weeks after operation with satisfied improvement. The technique of double suturing vaginal muscularis is easy and simple to perform with mild injury, fast postoperative recovery, and less postoperative complications. It is one of the effective methods to treat mild and medium vaginal relaxation.

  2. Vaginal toxic shock reaction triggering desquamative inflammatory vaginitis.

    Science.gov (United States)

    Pereira, Nigel; Edlind, Thomas D; Schlievert, Patrick M; Nyirjesy, Paul

    2013-01-01

    The study aimed to report 2 cases of desquamative inflammatory vaginitis associated with toxic shock syndrome toxin 1 (TSST-1)-producing Staphylococcus aureus strains. Case report of 2 patients, 1 with an acute and 1 with a chronic presentation, diagnosed with desquamative inflammatory vaginitis on the basis of clinical findings and wet mount microscopy. Pretreatment and posttreatment vaginal bacterial and yeast cultures were obtained. Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial culture results after oral antibiotic therapy were negative. Desquamative inflammatory vaginitis may be triggered through TSST-1-mediated vaginal toxic shock reaction.

  3. Morbidade neonatal e maternas relacionada ao tipo de parto Neonatal and maternal morbidity related to the type of delivery

    Directory of Open Access Journals (Sweden)

    Priscila Oliveira Cardoso

    2010-03-01

    Full Text Available Foi realizada uma análise da morbidade neonatal e materna e a mortalidade neonatal de acordo com o tipo de parto, cesariana ou vaginal. Foram estudadas prospectivamente 170 parturientes sem complicações gestacionais e com nascimento a termo: Grupo 1 (n = 95, puérpera com parto por via vaginal, Grupo 2 (n = 75, puérpera submetida à cesariana. Parâmetros maternos e fetais foram avaliados. Foi observada maior incidência de partos por via vaginal nas pacientes que estudaram até o ensino fundamental incompleto (p = 0,0045. Houve prevalência maior de partos prévios por via vaginal no Grupo 1 e de cesáreas no Grupo 2 (p An evaluation of infant morbimortality and mother morbidity was undertaken according to the type of delivery. A prospective study was undertaken on 170 puerperal patients divided into two groups: Group 1 (n = 95, natural or vaginal delivery, Group 2 (n = 75, submitted to caesarean delivery. Complications in mothers were classified in small, moderate and severe. The infant parameters were: period of pregnancy, weight on birth, Apgar score, necessity of intensive care and neurological disorders. Mothers who had not completed elementary school (p=0.0045 had more vaginal delivery. Previous vaginal deliveries were more common in Group 1 than caesarean section in Group 2 (p = < 0.001 (OR = 104.00; 21.11 < OR < 610.99. In Group 1, vaginal delivery was preferred by 78 (82,1% of mothers comparing to 28 (37.3% from Group 2, who preferred caesarean section (p = 0.0002 (OR = 4; 1.77 < OR < 9.17. Post-operative was more intense and frequent after caesarean section (8 cases than patients of Group 1 (2 cases (p = 0.018 (OR = 0.18; 0.03 < OR < 0.96. Obstetric trauma was found in 14 deliveries of Group 1 and 7 of Group 2 (p = 0.28. Infant hospitalization was greater in Group 2 (3.43 +/- 0.70 days in comparison with Group 1 (2.71 +/- 0.67 days (p < 0.0001. The infant morbidity was greater after vaginal deliveries, but maternal morbidity was

  4. Time to subsequent live birth according to mode of delivery in the first birth.

    Science.gov (United States)

    O'Neill, S M; Khashan, A S; Kenny, L C; Kearney, P M; Mortensen, P B; Greene, R A; Agerbo, E; Uldbjerg, N; Henriksen, T B

    2015-08-01

    To estimate the rate and time to next live birth by mode of delivery. Hospital-based cohort. Aarhus University Hospital (AUH), Denmark. All pregnant women attending AUH were invited to enroll in the Aarhus Birth Cohort (ABC) study between 1989 and 2010 (n = 91,625). Women were followed from their first live birth until the subsequent live birth or until censoring due to study end using Cox regression models. Rate and time to subsequent live birth according to mode of delivery. 46,162 index live births were identified, of which 22,462 (49%) had a subsequent live birth. Women with any type of caesarean had a 6% reduction in the rate of subsequent live birth (HR 0.94, 95% CI 0.89, 0.98), which remained unchanged in the analysis by type (emergency, HR 0.95, 95% CI 0.89, 1.02; elective, HR 0.91, 95% CI 0.85, 0.98) compared with women who had a spontaneous vaginal delivery (SVD). Operative vaginal delivery was associated with an 8% reduction in subsequent live birth rates (HR 0.92, 95% CI 0.86, 0.98) and vaginal delivery complicated by shoulder dystocia with a 19% reduction compared with SVD. Median time to next birth in days was shortest in women with a first caesarean (994 days, 95% CI 973, 1026) and longest in women with a vaginal delivery complicated by shoulder dystocia (1065 days, 95% CI 994, 1191). In women with planned pregnancies, the shortest median time to second birth was in women with breech vaginal deliveries (859 days, 95% CI 737, 1089) and the longest in women with vaginal deliveries complicated by shoulder dystocia (1193 days, 95% CI 1028, 1430). The impact of mode of delivery on subsequent rate and time to next birth was minimal in this study. The greatest reduction was among women with assisted vaginal delivery complicated by shoulder dystocia. This study is strengthened by data on pregnancy planning as well as information on complications of pregnancy, delivery and neonatal morbidities, all of which may influence a woman's decision on subsequent birth

  5. 米索前列醇用于预防经阴道自然分娩产后出血的研究%Study on misoprostol for prevention of postpartum hemorrhage after natural vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    李春秀; 高爱荣; 吕梅

    2011-01-01

    Objective: To compare the clinical efficacy and adverse reaction of misoprostol for the prevention of postpartum hemorrhage after natural vaginal delivery with two different routes of administration. Methods: 822 pregnant women (37 ~42 gestational weeks,single pregnancy, cephalic presentation, no pregnant complications, never using prostaglandin inhibitor) were selected from the hospital from February 2007 to February 2009, then they were divided into sublingual treatment group and rectal treatment group, 411 eases in each group. The cases in sublingual treatment group put 600 μg of misoprostol under the tongue as soon as the fetal anterior shoulder was delivered; while the cases in rectal treatment group put 600 μg of misoprostol into rectum deeply as soon as the fetal anterior shoulder was delivered; the amount of blood loss within 24 hours after delivery, the levels of hemachrome and HCT before and after delivery were detected; the blood pressures, pulse rates and the incidences of complications including shiver, fever, nausea, vomiting, headache and diarrhea before and after delivery were monitored; the cases with large vaginal bleeding were treated with intravenous injection of oxytocin (10 U ) . Results:The amount of blood loss within 24 hours after delivery in sublingual treatment group was significantly lower than that in rectal treatment group, the incidence of postpartum hemorrhage in sublingual treatment group was significantly lower than that in rectal treatment group, the proportions of the decrease of HCT≥10%, the decrease of hemachrome≥30 mg/L and cases using oxytocin in sublingual treatment group were significantly lower than those in rectal treatment group ( P < 0. 05 ). The incidences of shiver and fever in sublingual treatment group were significantly higher than those in rectal treatment group (P <0. 05). Conclusion:Sublingual treatment group (600 μg misoprostol) is superior to rectal treatment group (600 μg misoprostol) in

  6. Delayed vaginal reconstruction in the fibrotic pelvis following radiation or previous reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Berek, J.S.; Hacker, N.F.; Lagasse, L.D.; Smith, M.L.

    1983-06-01

    Vaginal reconstruction was performed in 14 patients who had developed vaginal stenosis secondary to extensive pelvic fibrosis after pelvic radiation therapy (12 patients) or prior vaginal reconstruction (2 patients). Sixteen procedures were performed using a split-thickness skin graft. All patients had satisfactory vaginal restoration, and 12 patients reported good vaginal function. No fistula developed as a result of the operative procedure, but one patient later developed a rectovaginal fistula resulting from tumor recurrence. Successful vaginal reconstruction can be achieved even years after initial therapy in patients who develop an obliterated vagina from previous radiation or surgery.

  7. A control study on doula support in vaginal delivery%导乐陪伴经阴道分娩效果对照研究

    Institute of Scientific and Technical Information of China (English)

    石英; 张雪峰; 王佳楣; 赵银珠

    2011-01-01

    group, and the difference were statistically significant ( t = 3. 788,10.974,12. 246 respectively, all P = 0. 000 ). The amount of postpartum hemorrhage within 2 hours ( 75.97 ± 63.15 mL ) after delivery was less in study group than that in control group ( 129.53 ± 78.9mL ), and the difference was statistically significant ( t = -21. 110,P = 0. 000 ). Statistically significant difference in the rate of fetal distress was observed between two groups ( 1.06% vs 3.68%, x2 =28.934,P =0. 000 ). Conclusion Doula support is helpful to shorten labor stages, decrease postpartum hemorrhage and reduce fetal distress incidences, and it is worthy of spread and application.

  8. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.

    Science.gov (United States)

    Thomas, Jane; Fairclough, Anna; Kavanagh, Josephine; Kelly, Anthony J

    2014-06-19

    ) is uncertain.PGE2 tablets, gels and pessaries (including sustained release preparations) appear to be as effective as each other, small differences are detected between some outcomes, but these maybe due to chance. Prostaglandins PGE2 probably increase the chance of vaginal delivery in 24 hours, they increase uterine hyperstimulation with fetal heart changes but do not effect or may reduce caesarean section rates. They increase the likelihood of cervical change, with no increase in operative delivery rates. PGE2 tablets, gels and pessaries appear to be as effective as each other, any differences between formulations are marginal but may be important.

  9. Adenocarcinoma arising from vaginal stump: unusual vaginal carcinogenesis 7 years after hysterectomy due to cervical intraepithelial neoplasia.

    Science.gov (United States)

    Shibata, Takashi; Ikura, Yoshihiro; Iwai, Yasuhiro; Tokuda, Hisato; Cho, Yuka; Morimoto, Noriyuki; Nakago, Satoshi; Oishi, Tetsuya

    2013-11-01

    Primary vaginal adenocarcinomas are one of the rarest malignant neoplasms, which develop in the female genital tract. Because of the extremely low incidence, their clinical and pathologic characteristics are still obscure. Recently, we experienced a case of vaginal adenocarcinoma that appeared 7 yr after hysterectomy because of cervical intraepithelial neoplasia. The patient, a 65-yr-old obese woman, was diagnosed as having adenocarcinoma in the vaginal stump and was treated by simple tumor excision and radiation. Immunohistochemical and molecular biologic examinations indicated a potential association with human papilloma virus infection in the development of the vaginal adenocarcinoma. There has been no evidence of recurrence for 3 yr after the operation.

  10. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia.

    Science.gov (United States)

    Senturk, Mehmet Baki; Cakmak, Yusuf; Atac, Halit; Budak, Mehmet Sukru

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients' requests influenced outcome. Trial of labor should take into consideration the patient's preference, together with the proper setting.

  11. Can Vaginitis Be Prevented?

    Science.gov (United States)

    ... the treatments? Are there complications? Does it affect pregnancy? How is it prevented? NICHD Research Information Clinical Trials Resources and Publications Can vaginitis be prevented? Skip sharing on social media links Share this: Page Content These steps can ...

  12. How Is Vaginitis Treated?

    Science.gov (United States)

    ... to learn the specific type of vaginitis. 1 Bacterial Vaginosis Bacterial vaginosis (BV) is treated with an antibiotic that gets ... diagnosed? Are there complications? » Related A-Z Topics Bacterial Vaginosis Sexually Transmitted Diseases (STDs) NICHD News and Spotlights ...

  13. Anterior vaginal wall repair

    Science.gov (United States)

    ... may have you: Learn pelvic floor muscle exercises ( Kegel exercises ) Use estrogen cream in your vagina Try ... Urinary incontinence - vaginal sling procedures Vagina Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  14. What Is Vaginal Cancer?

    Science.gov (United States)

    ... or epithelial lining ) because it is formed by epithelial cells. The vaginal wall underneath the epithelium is made up of connective tissue, muscle tissue, lymph vessels, and nerves. The vagina ...

  15. Study on the Restrictive Use of Episiotomy in Spontaneously Vaginal Delivery and the Type of Episiotomy%限制会阴切开及会阴切口选择的临床探讨

    Institute of Scientific and Technical Information of China (English)

    谭晓青; 余昕烊; 漆洪波

    2013-01-01

    目的:探讨限制会阴切开在头位自然分娩中的应用,比较会阴侧切与会阴正中切开两种术式母儿的结局.方法:收集2012年3~6月重庆医科大学附属第一医院产科自然分娩的586例足月单胎头位孕妇的临床资料进行回顾性分析,其中未行会阴切开196例(未行会阴切开组),行会阴侧切270例(会阴侧切组),行会阴正中切开120例(会阴正中切开组).比较3种方式对母儿的影响.结果:在产后出血、产后住院时间、产后恢复性交时间、产后性生活满意度及产后会阴疼痛评分方面,未行会阴切开组均优于会阴切开两组,差异均有统计学意义(P<0.05),而会阴正中切开组与会阴侧切组以上指标比较,差异无统计学意义(P>0.05);3组间产褥感染、预防性使用抗生素、产后尿失禁、盆腔脏器脱垂、新生儿Apgar评分和脐血pH值两两比较,差异均无统计学意义(P>0.05).而会阴正中切开组会阴Ⅰ~Ⅱ度裂伤率(6.67%)与会阴侧切组(1.48%)比较,有显著性升高(P<0.05).结论:头位自然分娩过程中,在无绝对会阴切开指征时,尽量保持会阴的完整性,对母儿预后无不良影响.在有严格的会阴切开指征时,优先选择会阴侧切,降低会阴裂伤的发生.%Objective:To explore the restrictive use of episiotomy in spontaneously vaginal delivery;and to compare the effects of midline and mediolateral episiotomies on delivery.Methods:A retrospective study was conducted including 586 vaginal delivery women at ≥37 weeks of gestation with live singleton cephalic pregnancies,who were recruited from March 2012 to June 2012 in the first affiliated hospital of Chongqing Medical University,among whom 196 women were with no episiotomy,270 women were with mediolateral episiotomy,120 women were with midline episiotomy.The matemal and neonatal outcomes of three types of episiotomy were compared.Results:The postpartum hemorrhage,length of stay after childbirth

  16. Optimization of European call options considering physical delivery network and reservoir operation rules

    Science.gov (United States)

    Cheng, Wei-Chen; Hsu, Nien-Sheng; Cheng, Wen-Ming; Yeh, William W.-G.

    2011-10-01

    This paper develops alternative strategies for European call options for water purchase under hydrological uncertainties that can be used by water resources managers for decision making. Each alternative strategy maximizes its own objective over a selected sequence of future hydrology that is characterized by exceedance probability. Water trade provides flexibility and enhances water distribution system reliability. However, water trade between two parties in a regional water distribution system involves many issues, such as delivery network, reservoir operation rules, storage space, demand, water availability, uncertainty, and any existing contracts. An option is a security giving the right to buy or sell an asset; in our case, the asset is water. We extend a flow path-based water distribution model to include reservoir operation rules. The model simultaneously considers both the physical distribution network as well as the relationships between water sellers and buyers. We first test the model extension. Then we apply the proposed optimization model for European call options to the Tainan water distribution system in southern Taiwan. The formulation lends itself to a mixed integer linear programming model. We use the weighing method to formulate a composite function for a multiobjective problem. The proposed methodology provides water resources managers with an overall picture of water trade strategies and the consequence of each strategy. The results from the case study indicate that the strategy associated with a streamflow exceedence probability of 50% or smaller should be adopted as the reference strategy for the Tainan water distribution system.

  17. Operational Marine Data Acquisition and Delivery Powered by Web and Geospatial Standards

    Science.gov (United States)

    Thomas, R.; Buck, J. J. H.

    2015-12-01

    As novel sensor types and new platforms are deployed to monitor the global oceans, the volumes of scientific and environmental data collected in the marine context are rapidly growing. In order to use these data in both the traditional operational modes and in innovative "Big Data" applications the data must be readily understood by software agents. One approach to achieving this is the application of both World Wide Web and Open Geospatial Consortium standards: namely Linked Data1 and Sensor Web Enablement2 (SWE). The British Oceanographic Data Centre (BODC) is adopting this strategy in a number of European Commission funded projects (NETMAR; SenseOCEAN; Ocean Data Interoperability Platform - ODIP; and AtlantOS) to combine its existing data archiving architecture with SWE components (such as Sensor Observation Services) and a Linked Data interface. These will evolve the data management and data transfer from a process that requires significant manual intervention to an automated operational process enabling the rapid, standards-based, ingestion and delivery of data. This poster will show the current capabilities of BODC and the status of on-going implementation of this strategy. References1. World Wide Web Consortium. (2013). Linked Data. Available:http://www.w3.org/standards/semanticweb/data. Last accessed 7th April 20152. Open Geospatial Consortium. (2014). Sensor Web Enablement (SWE). Available:http://www.opengeospatial.org/ogc/markets-technologies/swe. Last accessed 8th October 2014

  18. 20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

    Science.gov (United States)

    2010-04-01

    ... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute...

  19. A remotely operated drug delivery system with an electrolytic pump and a thermo-responsive valve

    KAUST Repository

    Yi, Ying

    2015-07-22

    Implantable drug delivery devices are becoming attractive due to their abilities of targeted and controlled dose release. Currently, two important issues are functional lifetime and non-controlled drug diffusion. In this work, we present a drug delivery device combining an electrolytic pump and a thermo-responsive valve, which are both remotely controlled by an electromagnetic field (40.5 mT and 450 kHz). Our proposed device exhibits a novel operation mechanism for long-term therapeutic treatments using a solid drug in reservoir approach. Our device also prevents undesired drug liquid diffusions. When the electromagnetic field is on, the electrolysis-induced bubble drives the drug liquid towards the Poly (N-Isopropylacrylamide) (PNIPAM) valve that consists of PNIPAM and iron micro-particles. The heat generated by the iron micro-particles causes the PNIPAM to shrink, resulting in an open valve. When the electromagnetic field is turned off, the PNIPAM starts to swell. In the meantime, the bubbles are catalytically recombined into water, reducing the pressure inside the pumping chamber, which leads to the refilling of the fresh liquid from outside the device. A catalytic reformer is included, allowing more liquid refilling during the limited valve\\'s closing time. The amount of body liquid that refills the drug reservoir can further dissolve the solid drug, forming a reproducible drug solution for the next dose. By repeatedly turning on and off the electromagnetic field, the drug dose can be cyclically released, and the exit port of the device is effectively controlled.

  20. Information delivery in team communication of MCR operators for an emergency task

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Kwang Sub; Park, Jin Kyun; Jung, Won Dae

    2005-01-01

    Team performance is a major measure to evaluate the ability of team when a lot of people perform a task of common purpose such as the main control room operators in the nuclear power plant. A team performance is affected the collaboration and communication among operators under dynamic situation as well as by the cognitive process of each team member. Specially, under the emergency situation, more clear and apparent communication in a team is a critical key for the appropriate response to emergency situation. As a general human factor analysis accesses the operator's behavior, it leads to a resulting action of planning, decision, problem-solving. In order to access the internal information and background information of his/her behavior, the verbal protocol analysis is applied. The impact factors on the team performance are derived from the state of the art for team performance, and it is found that the communication is a common key for all impact factors. And, in turn, the impact factors for the communication are accesses and the more detailed analysis is performed. The recorded data for the operator training for emergency situation of nuclear power plant training center are analyzed according to the verbal protocol analysis that are being generally utilized in cognitive psychology, educational psychology, and cognitive science. Two aspects, external (syntax) and internal (symantic) aspects of communication are reviewed. From the syntax analysis, it is found that the task of each step in EOP is separated according to each corresponding operator and the ordinary training is important, and the weak-points for a sentence presentation can be found team-by-team. And, from the symantic analysis for the diagnostic procedure of EOP is performed and the communication errors due to different situation awareness by operators could be found, and it lead to a diagnosis failure. The factors for different symantic cognition for a situation are analyzed and the affecting

  1. Pregnancy's stronghold on the vaginal microbiome.

    Directory of Open Access Journals (Sweden)

    Marina R S Walther-António

    Full Text Available OBJECTIVE: To assess the vaginal microbiome throughout full-term uncomplicated pregnancy. METHODS: Vaginal swabs were obtained from twelve pregnant women at 8-week intervals throughout their uncomplicated pregnancies. Patients with symptoms of vaginal infection or with recent antibiotic use were excluded. Swabs were obtained from the posterior fornix and cervix at 8-12, 17-21, 27-31, and 36-38 weeks of gestation. The microbial community was profiled using hypervariable tag sequencing of the V3-V5 region of the 16S rRNA gene, producing approximately 8 million reads on the Illumina MiSeq. RESULTS: Samples were dominated by a single genus, Lactobacillus, and exhibited low species diversity. For a majority of the patients (n = 8, the vaginal microbiome was dominated by Lactobacillus crispatus throughout pregnancy. Two patients showed Lactobacillus iners dominance during the course of pregnancy, and two showed a shift between the first and second trimester from L. crispatus to L. iners dominance. In all of the samples only these two species were identified, and were found at an abundance of higher than 1% in this study. Comparative analyses also showed that the vaginal microbiome during pregnancy is characterized by a marked dominance of Lactobacillus species in both Caucasian and African-American subjects. In addition, our Caucasian subject population clustered by trimester and progressed towards a common attractor while African-American women clustered by subject instead and did not progress towards a common attractor. CONCLUSION: Our analyses indicate normal pregnancy is characterized by a microbiome that has low diversity and high stability. While Lactobacillus species strongly dominate the vaginal environment during pregnancy across the two studied ethnicities, observed differences between the longitudinal dynamics of the analyzed populations may contribute to divergent risk for pregnancy complications. This helps establish a baseline for

  2. Menopause and the vaginal microbiome.

    Science.gov (United States)

    Muhleisen, Alicia L; Herbst-Kralovetz, Melissa M

    2016-09-01

    For over a century it has been well documented that bacteria in the vagina maintain vaginal homeostasis, and that an imbalance or dysbiosis may be associated with poor reproductive and gynecologic health outcomes. Vaginal microbiota are of particular significance to postmenopausal women and may have a profound effect on vulvovaginal atrophy, vaginal dryness, sexual health and overall quality of life. As molecular-based techniques have evolved, our understanding of the diversity and complexity of this bacterial community has expanded. The objective of this review is to compare the changes that have been identified in the vaginal microbiota of menopausal women, outline alterations in the microbiome associated with specific menopausal symptoms, and define how hormone replacement therapy impacts the vaginal microbiome and menopausal symptoms; it concludes by considering the potential of probiotics to reinstate vaginal homeostasis following menopause. This review details the studies that support the role of Lactobacillus species in maintaining vaginal homeostasis and how the vaginal microbiome structure in postmenopausal women changes with decreasing levels of circulating estrogen. In addition, the associated transformations in the microanatomical features of the vaginal epithelium that can lead to vaginal symptoms associated with menopause are described. Furthermore, hormone replacement therapy directly influences the dominance of Lactobacillus in the microbiota and can resolve vaginal symptoms. Oral and vaginal probiotics hold great promise and initial studies complement the findings of previous research efforts concerning menopause and the vaginal microbiome; however, additional trials are required to determine the efficacy of bacterial therapeutics to modulate or restore vaginal homeostasis.

  3. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

    Science.gov (United States)

    Dominguez-Bello, Maria G.; De Jesus-Laboy, Kassandra M.; Shen, Nan; Cox, Laura M.; Amir, Amnon; Gonzalez, Antonio; Bokulich, Nicholas A.; Song, Se Jin; Hoashi, Marina; Rivera-Vina, Juana I.; Mendez, Keimari; Knight, Rob; Clemente, Jose C.

    2016-01-01

    Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by Cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section are exposed to maternal vaginal fluids at birth. Similar to vaginally delivered babies, the gut, oral, and skin microbiome of these newborns during the first 30 days of life was enriched in vaginal bacteria underrepresented in unexposed C-section infants, albeit similarity to vaginally-delivered infants was higher in oral and skin than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section born infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section delivered babies. PMID:26828196

  4. Implementation and Operational Research: Expedited Results Delivery Systems Using GPRS Technology Significantly Reduce Early Infant Diagnosis Test Turnaround Times.

    Science.gov (United States)

    Deo, Sarang; Crea, Lindy; Quevedo, Jorge; Lehe, Jonathan; Vojnov, Lara; Peter, Trevor; Jani, Ilesh

    2015-09-01

    The objective of this study was to quantify the impact of a new technology to communicate the results of an infant HIV diagnostic test on test turnaround time and to quantify the association between late delivery of test results and patient loss to follow-up. We used data collected during a pilot implementation of Global Package Radio Service (GPRS) printers for communicating results in the early infant diagnosis program in Mozambique from 2008 through 2010. Our dataset comprised 1757 patient records, of which 767 were from before implementation and 990 from after implementation of expedited results delivery system. We used multivariate logistic regression model to determine the association between late result delivery (more than 30 days between sample collection and result delivery to the health facility) and the probability of result collection by the infant's caregiver. We used a sample selection model to determine the association between late result delivery to the facility and further delay in collection of results by the caregiver. The mean test turnaround time reduced from 68.13 to 41.05 days post-expedited results delivery system. Caregivers collected only 665 (37.8%) of the 1757 results. After controlling for confounders, the late delivery of results was associated with a reduction of approximately 18% (0.44 vs. 0.36; P < 0.01) in the probability of results collected by the caregivers (odds ratio = 0.67, P < 0.05). Late delivery of results was also associated with a further average increase in 20.91 days of delay in collection of results (P < 0.01). Early infant diagnosis program managers should further evaluate the cost-effectiveness of operational interventions (eg, GPRS printers) that reduce delays.

  5. Severe atrophic vaginitis causing vaginal synechiae and hematocolpos at menopause.

    Science.gov (United States)

    Segal, Saya; Harvie, Heidi S; Siegelman, Evan; Arya, Lily A

    2011-03-01

    Vaginal atrophy caused by decreased levels of ovarian estrogen production is common at menopause. Atrophic vaginitis severe enough to result in vaginal stricture of the upper two thirds of the vagina and subsequent hematocolpos is unusual. A 53-year-old woman presented with nonvisualization of the cervix at the time of her annual examination. Pelvic ultrasound reported a "vaginal cyst," and the final diagnosis of hematocolpos was made by magnetic resonance imaging. The woman was managed with surgical excision of vaginal synechiae followed by local vaginal estrogen therapy and dilators, with satisfactory results. Untreated severe atrophic vaginitis at menopause can result in a shortened vagina and hematocolpos. Magnetic resonance imaging is useful to characterize vaginal pathology in postmenopausal women.

  6. Development and evaluation of acid-buffering bioadhesive vaginal tablet for mixed vaginal infections.

    Science.gov (United States)

    Alam, Mohd Aftab; Ahmad, Farhan Jalees; Khan, Zeenat Iqbal; Khar, Roop Krishen; Ali, Mushir

    2007-12-14

    An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4), which is an attribute of a healthy vagina. The effervescent mixture (citric acid and sodium bicarbonate) along with a superdisintegrant (Ac-Di-sol) was used to enhance the swellability of the bioadhesive tablet. The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as an antibacterial) were used in the formulation along with Lactobacillus acidophilus spores to treat mixed vaginal infections. From the ex vivo retention study it was found that the bioadhesive polymers hold the tablet for more than 24 hours inside the vaginal tube. The hardness of the acid-buffering bioadhesive vaginal tablet was optimized, at 4 to 5 kg hardness the swelling was found to be good and the cumulative release profile of the developed tablet was matched with a marketed conventional tablet (Infa-V). The in vitro spreadability of the swelled tablet was comparable to the marketed gel. In the in vitro antimicrobial study it was found that the acid-buffering bioadhesive tablet produces better antimicrobial action than marketed intravaginal drug delivery systems (Infa-V, Candid-V and Canesten 1).

  7. The effects of surgical intervention on perineal pain after vaginal delivery%阴道分娩后产妇会阴疼痛状况调查与干预

    Institute of Scientific and Technical Information of China (English)

    刘婷; 邬燕萍; 杜艳鸿; 王隽隽

    2011-01-01

    Objective: To investigate the effects of surgical intervention on the incidence of postpartum perineal pain. Methods: 866 women who had vaginal delivery in the Obstetrics and Gynecology ward, Xuanwu Hospital during January 2009 and October 2009 were surveyed. According to the degrees of tears and types of episiotomies, they were divided into four groups: group 1 with an intact perineum or first-degree tears (184); group llwith second-degree tears (266); group III with a mediolateral cut (359), and group IV with a midline cut (42). The incidence of perineal pain at 1 to 3 days postpartum was calculated for the four groups. In addition, the parturients (866) were randomized into 3 groups receiving physiotherapy, medication, and physiotherapy plus medication respectively. The incidence of perineal pain was compared among the three groups. Results: The incidence of perineal pain among the four groups at 1 day postpartum was 34% (group I), 42% (group II), 94% (group III), and 55% (Group IV); 2 days postpartum was 25% (group I), 32% (group II), 81% (group III), and 35% (Group IV); and 3 days postpartum wasll% (group I), 22% (groupll), 61% (group III), and 18% (group IV). The incidence of perineal pain for the surgical intervention groups was higher than the tears groups. Especially, the incidence of perineal pain for the mediolateral cut group was higher than the other three groups. The frequency of perineal pain was not statistically different among the three groups receiving different treatments. Conclusion: Surgical intervention is a common cause for the perineal pain after vaginal delivery. It is recommended to select the adequate type of episiotomy according to the guidelines to decrease the incidence of postpartum perineal pain.%目的:了解阴道分娩后产妇会阴疼痛状况及外科干预对阴道分娩后会阴疼痛的影响.方法:调查2009年1-10月阴道分娩产妇866例,根据会阴裂伤及侧切情况分Ⅰ~Ⅳ组,分别统计产后1-3

  8. Obstructed Defecation Syndrome After Delivery Trauma

    Directory of Open Access Journals (Sweden)

    Mehrvarz

    2015-11-01

    Full Text Available Background Obstructed defecation syndrome (ODS occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed. Objectives In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR in females with one of the two modes of delivery (VD or caesarean section (C/S. Patients and Methods We used Longo’s ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant. Results In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3% had Vaginal Delivery VD and 11 (36.7% had Cesarean Section (C/S. The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery. Conclusions Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing.

  9. Increased maternal TSH and decreased maternal FT4 are associated with a higher operative delivery rate in low-risk pregnancies : A prospective cohort study

    NARCIS (Netherlands)

    Monen, L; Pop, V.J.M.; Hasaart, T H; Wijnen, H; Oei, S G; Kuppens, S M

    2015-01-01

    BACKGROUND: The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries.

  10. Parturition Pit: The Bony Imprint of Vaginal Birth

    Science.gov (United States)

    Meyer, Isuzu; Jackson, Bradford; Pitt, Michael J.; Larrison, Matthew C.

    2017-01-01

    Purpose To retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data. Materials and Methods We retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits. Results 482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (pbirths. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (pbirth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists. PMID:27270921

  11. Vaginal itching and discharge - child

    Science.gov (United States)

    ... vulvae; Itching - vaginal area; Vulvar itching; Yeast infection - child ... To prevent and treat vaginal irritation, your child should: Avoid colored or perfumed toilet tissue and bubble bath. Use plain, unscented soap. Limit bath time to 15 minutes or less. Ask ...

  12. General Information about Vaginal Cancer

    Science.gov (United States)

    ... Treatment Research Vaginal Cancer Treatment (PDQ®)–Patient Version General Information About Vaginal Cancer Go to Health Professional ... the vagina (also called the birth canal). Enlarge Anatomy of the female reproductive system. The organs in ...

  13. Vaginal birth after cesarean section (VBAC versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

    Directory of Open Access Journals (Sweden)

    B. S. Dhillon

    2014-06-01

    Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824 cesarean section and (10.1% (n=15664 were the number of previous cesarean section. In 84% (n=13151 had repeat cesarean delivery and 2513 (16% delivered vaginally. A trial of labor was planned in 4035 (25.8% women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7% delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%, foetal distress (25.8%, severe PIH/eclampsia (5.0%, previous 2 CS (0.7%, APH (1.4% and others (2.7%. In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 592-597

  14. Optimization of Spinal Anesthesia for Operative Delivery in High-Weight Women

    Directory of Open Access Journals (Sweden)

    I. P. Zharkov

    2008-01-01

    Full Text Available Objective: to develop a scheme for calculating the dose of a local anesthetic (LA for spinal anesthesia (SA during operative delivery, by taking into account the individual physical characteristics of a female patient. Subjects and methods. The course of SA was analyzed in 35 overweight women. In accordance with the body mass index (BMI, the patients were divided into 3 groups. In each group the authors identified subgroups with no arterial hypotension development (NAHD and with arterial hypotension development (AHD until a fetus was extracted. In each specific case, the used dose of a LA was compared with its dose calculated by the height of a patient and the difference between the BMI of a female patient and that taken as the normal value of 25 kg/m2. Results. When the doses of a LA, which were used for SA, were investigated, in all cases the doses of a LA were determined to be smaller than those calculated by the height of a patient. In the NAHD subgroups, the percentage reduction in LA doses was significantly greater than that in the AHD subgroups in all the three groups and the dose was increased as BMI rose from 13.6±1.6% in the NAHD subgroup in Group 1 to 34.7±1.2% in the same subgroup in Group 3. By comparing the percentage reduction in the LA dose and excess BMI, the authors established the correction coefficient for the LA dose calculated by height and derived a formula for calculating the dose of a LA, by taking into account the physical characteristics of a female patient. Conclusion. The LA dose calculation formula considering the individual physical characteristics of a female patient makes the determination of a LA dose more precise in order to optimize the course of anesthesia from the hemodynamic profile. Key words: spinal anesthesia, obesity, cesarean section.

  15. Vaginal metastasis of pancreatic cancer.

    Science.gov (United States)

    Benhayoune, Khadija; El Fatemi, Hinde; El Ghaouti, Meryem; Bannani, Abdelaziz; Melhouf, Abdelilah; Harmouch, Taoufik

    2015-01-01

    Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of symptoms from a vaginal metastasis.

  16. Vaginal hysterectomy as a primary route for morbidly obese women.

    Science.gov (United States)

    Sheth, Shirish S

    2010-07-01

    Vaginal hysterectomy is a least invasive and the choicest route when hysterectomy is possible by recourse to all the three available techniques. However in obese women, the common method is by the more invasive abdominal or laparoscopic route, with attendant morbidity. Vaginal hysterectomy was reviewed in 102 morbidly obese women (body mass index, BMI > or = 40) and compared with 50 comparable morbidly obese women who underwent abdominal hysterectomy and with vaginal hysterectomy in 200 normal weight women (BMI hysterectomy was slightly but significantly longer in the morbidly obese compared to those of normal weight, while the abdominal approach was significantly longer in the morbidly obese. Hospital stay was significantly longer for the abdominal operations in the obese. Surgical and anesthetic complications did not differ. In the absence of specific contraindications for vaginal hysterectomy it is recommended that the surgeon should perform hysterectomy vaginally and consider obesity as a contraindication for taking the abdominal route.

  17. The vaginal microflora in relation to gingivitis

    Directory of Open Access Journals (Sweden)

    Weibel Marianne

    2009-01-01

    Full Text Available Abstract Background Gingivitis has been linked to adverse pregnancy outcome (APO. Bacterial vaginosis (BV has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. Methods Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46, and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species. BV was defined by Gram stain (Nugent criteria. Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites. Results A Nugent score of 0–3 (normal vaginal microflora was found in 83 women (46.1%, and a score of > 7 (BV in 49 women (27.2%. Gingivitis was diagnosed in 114 women (63.3%. Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01. Independent of gingival conditions, vaginal bacterial counts were higher (p Prevotella bivia (p Prevotella disiens (p P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p 1.0 × 104 cells and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p P. disiens (95%CI: 1.8–7.5, p P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p Conclusion Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections.

  18. Vaginal suppositories containing Lactobacillus acidophilus: development and characterization.

    Science.gov (United States)

    Rodrigues, Francisca; Maia, Maria João; das Neves, José; Sarmento, Bruno; Amaral, Maria Helena; Oliveira, Maria Beatriz P P

    2015-01-01

    The aim of this study was to develop and characterize suppositories for vaginal delivery of Lactobacillus acidophilus. Formulations were performed in order to select suitable excipients based on suppository formation feasibility and cytotoxicity. Solid body and hollow-type suppositories were prepared by melting and molding using poly(ethylene glycol) (PEG) 400 and 4000 or Witepsol (WIT) H12 as excipients. L. acidophilus was incorporated in the molten mass before molding solid body suppositories or added as suspension into the cavity of hollow-type suppositories and sealed molten excipients. Cytotoxicity of the selected excipients was evaluated by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium and lactate dehydrogenase assays against VK2/E6E7, HEC-1-A and HeLa cells. Suppositories were characterized regarding organoleptic characteristics, mass uniformity, disintegration, breaking strength and L. acidophilus in vitro release. PEG 400, PEG 4000 and WIT H12 showed the absence of toxicity when tested using three different vaginal cell lines. Obtained vaginal suppositories presented uniform and mild texture, a content of about 1 × 10(8) colony-forming units, completely disintegrated in simulated vaginal environment in less than 60 min and provided sustained in vitro release of L. acidophilus. Release studies further demonstrated that incorporation of freeze-dried bacteria did not result in significant loss of viable bacteria, thus supporting that vaginal suppositories may possess good properties to promote the replacement of the vaginal flora in situations of urinary tract infection. Hollow-type suppositories showed to be promising delivery vehicles for vaginal delivery of probiotics.

  19. Vaginal and Vulvar Cancer

    Science.gov (United States)

    ... is passed from one person to another during sex. There is a vaccine that protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers. It is recommended for preteens (both boys and girls) aged 11 to 12 ...

  20. Staging for vaginal cancer.

    Science.gov (United States)

    Rajaram, Shalini; Maheshwari, Amita; Srivastava, Astha

    2015-08-01

    Vaginal cancer is a rare cancer comprising about 3% of all gynecologic cancers. Primary vaginal cancer should be carefully assigned as spread from cervix, vulva, and other metastatic tumors to vagina can occur. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Squamous cell carcinoma is still the most common histopathologic type followed by adenocarcinoma. With decreasing use of diethylstilbestrol in pregnancy, non-diethylstilbestrol-associated cancers are described. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging of vaginal cancer (2009) follows the same rules as cervical cancer; it is clinically staged and allows the use of routine investigative modalities for staging. Although FIGO encourages the use of advanced imaging modalities, such as computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET), to guide therapy, the imaging findings may not be used to change or reassign the stage. TNM staging is the pathologic staging system proposed by the American Joint Committee on Cancer, and information available from examination of the resected specimen, including pelvic and inguinal lymph nodes, may be used for staging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?

    Science.gov (United States)

    Stute, Petra

    2013-12-01

    In a multicenter, randomized, controlled, open-label, parallel- group trial hyaluronic acid vaginal gel (Hyalofemme) was compared to estriol vaginal cream (Ovestin) in women with vaginal dryness due to various causes. A total of 144 supposedly postmenopausal women below age 70 years were randomized in a 1:1 ratio to either receive hyaluronic acid vaginal gel (5 g per application) or estriol vaginal cream (0.5 g cream per application = 0.5 mg estriol) every 3 days for a total of ten applications, respectively. Exclusion criteria included vaginal infections, conventional contraindications to estrogens, use of vaginal products other than the investigational compounds, being unmarried, pregnant, or breastfeeding. The aim of the study was to test for non-inferiority of hyaluronic acid vaginal gel compared to estriol vaginal cream. The primary efficacy end point was the percentage (%) improvement in vaginal dryness, with the secondary end points being the percentage (%) improvements in vaginal itching, burning, and dyspareunia. Efficacy was assessed by using a visual analog scale (VAS) (0-10; 0 = absent, 10 = intolerable) at baseline (V0), during telephone contact after the third administration (V1), and at the final visit after the tenth administration (V2). Safety parameters included vaginal pH, endometrial thickness, and a vaginal smear for vaginal microecosystem assessment. Adverse events were recorded according to international guidelines. 133 women completed the study. At baseline, participants' characteristics did not differ significantly. Mean age was 54 years, time since menopause was 5 years on average, and cause of menopause was mostly natural. However, mean menstrual cycle days were also reported, although according to inclusion criteria only postmenopausal women were eligible for the study. At V1, an improvement in vaginal dryness was reported by about 49 % of women using hyaluronic acid vaginal gel, and by 53 % of women using estriol vaginal cream (p = 0

  2. 导乐仪应用于阴道分娩中的临床效果分析%ANALYSIS OF CLINICAL EFFECT ON DOULA INSTRUMENT USED IN THE VAGINAL DELIVERY

    Institute of Scientific and Technical Information of China (English)

    王红红; 胡美丽; 王雅慧; 王秀芳; 孙冰; 王志芳

    2014-01-01

    Objective To observe and analyze the clinical effect of Doula instrument in the vaginal delivery . Methods All vagina childbirth full -term pregnant women were come from author's hospital in October 2012 to September 2013 ,were randomly divided into Doula instrument group ,spinal anesthesia group ,tra-ditional anesthesia group .Doula instrument group selected Doula for labor analgesia ,spinal anesthesia group used epidural analgesia drug to analgesic ,traditional group was traditional labor anesthesia group , did not impose any intervention .The difference of birth process changes ,birth outcomes and labor pain re-action was observed among the three groups .Results Analgesic effective rate of Doula instrument group was 93 .0% ,98 .0% in spinal anesthesia group ,the difference was not statistically significant between two groups (P>0 .05) .The cervical dilation rate of doula instrument group was faster than spinal anesthesia group and traditional group (P0 .05) .Conclusion Analgesic effect of Doula instrument is significant with safe ,non-invasive and no side reaction on mother and child .It can able to accelerate the production process and promote natural childbirth ,so it is worth using in obstetrics promotion .%目的:观察分析导乐仪应用于阴道分娩中的临床效果。方法收集2012年10月-2013年6月阴道分娩的足月妊娠孕妇,随机分为导乐仪组、椎管麻醉组、传统组。导乐仪组选取导乐仪镇痛分娩,椎管麻醉组应用硬膜外药物麻醉的方法镇痛,传统组为传统待产不施加任何干预措施。观察三组孕妇的产程变化、分娩结局、对分娩痛的反应等。结果导乐仪组镇痛有效率为93.0%,椎管麻醉组的镇痛有效率为98.0%,二组比较差异无统计学意义(P>0.05);导乐仪组宫口扩张速度较椎管麻醉组和传统组快(P<0.05),第一产程、第二产程时间短于其他二组(P<0.05),阴道分娩率为97.0%

  3. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial.

    Science.gov (United States)

    Carbone, Jeanine F; Tuuli, Methodius G; Fogertey, Patricia J; Roehl, Kimberly A; Macones, George A

    2013-02-01

    To test the hypothesis that use of the Foley bulb plus vaginal misoprostol will result in shorter induction-to-delivery time compared with vaginal misoprostol alone. We randomized 123 women undergoing induction of labor with singleton pregnancies at 24 weeks of gestation or greater with an unfavorable cervix (Bishop score 6 or lower) to Foley bulb plus vaginal misoprostol (n=56) or vaginal misoprostol alone (n=61). Women with fetal malpresentation, multifetal gestation, spontaneous labor, contraindication to prostaglandins, nonreassuring fetal heart rate tracing, intrauterine growth restriction, anomalous fetus, fetal demise, or previous cesarean delivery or other significant uterine surgery were excluded. The primary outcome measure was induction-to-delivery time. Secondary outcomes were mode of delivery, tachysystole with fetal decelerations, terbutaline use, postpartum hemorrhage, chorioamnionitis, neonatal Apgar scores, and neonatal intensive care unit admission. Analysis followed the intention-to-treat principle. The mean induction-to-delivery time was shorter with the combination of the Foley bulb and vaginal misoprostol when compared with vaginal misoprostol alone (15.3±6.5 compared with 18.3±8.7 hours, difference -3.1 hours, 95% confidence interval [CI] -5.9 to -0.30). The combination also resulted in shorter induction to complete cervical dilation time (13.7±5.9 compared with 17.1±8.7 hours, difference -3.5 hours, 95% CI -6.7 to -0.4). There were no differences in labor complications or adverse neonatal and maternal outcomes. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01279343. I.

  4. Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International.

    Science.gov (United States)

    Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

    2014-02-01

    Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels-mobile outreach, social franchising, and clinics-to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice

  5. Vaginal birth after two or more previous cesarean sections.

    Science.gov (United States)

    Farmakides, G; Duvivier, R; Schulman, H; Schneider, E; Biordi, J

    1987-03-01

    The recommendation from the American College of Obstetricians and Gynecologists is to allow vaginal delivery after one cesarean section. This report is an update of our experience of 57 women with two or more cesarean sections who were allowed to labor.

  6. Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy?

    Science.gov (United States)

    Tuntiviriyapun, P; Panyakhamlerd, K; Triratanachat, S; Chatsuwan, T; Chaikittisilpa, S; Jaisamrarn, U; Taechakraichana, N

    2015-04-01

    The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. A cross-sectional descriptive study. Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters (vaginal atrophy score, vaginal pH, the number of lactobacilli, vaginal maturation index, and vaginal maturation value) were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. A total of 132 naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p atrophy score (r = 0.230, p atrophy symptoms and the objective parameters. Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem.

  7. Association between prior vaginal birth after cesarean and subsequent labor outcome.

    Science.gov (United States)

    Krispin, Eyal; Hiersch, Liran; Wilk Goldsher, Yulia; Wiznitzer, Arnon; Yogev, Yariv; Ashwal, Eran

    2017-03-27

    To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean. A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes. Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.

  8. Delivery times for caesarean section at Queen Elizabeth Central Hospital, Blantyre, Malawi: is a 30-minute 'informed to start of operative delivery time' achievable?

    Science.gov (United States)

    O'Regan, M

    2003-08-01

    A timesheet questionnaire was used to assess the time it took from informing the anaesthetist about a case to the start of operative delivery in 78 consecutive patients undergoing caesarean section. Median (IQR [range]) times for grade-1 cases (immediate threat to the life of the mother or fetus) and grade-2 cases (fetal or maternal compromise without immediate threat to life) were 20 (17-35 [6-75]) min and 41 (27-60 [17-136]) min, respectively. Delays occurred in all the component time intervals examined. The primary avoidable delay was the patient's late arrival in theatre. Many significant delays were apparently not perceived by the anaesthetist. In nine (69%) grade-1 cases, the 30-min target decreed by the Association of Anaesthetists of Great Britain & Ireland and the Obstetric Anaesthetists' Association was achieved.

  9. Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.

    Science.gov (United States)

    Dane, Cem; Rustemoglu, Yaprak; Kiray, Murat; Ozkuvanci, Unsal; Tatar, Zeynep; Dane, Banu

    2012-12-01

    Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.

  10. Delivery through innovation: CSIR research on water services infrastructure operation through franchising

    CSIR Research Space (South Africa)

    Wall, K

    2006-02-01

    Full Text Available There is a great need for institutional innovations aimed at improving access to basic water services in South Africa, and sustaining that improvement. In support of effective delivery, the CSIR, with the support of the Water Research Commission...

  11. Study on the feasibility of mother -infant discharge at 48 hours after vaginal delivery combined with home visit%正常产后48h母婴出院联合家庭访视的可行性研究

    Institute of Scientific and Technical Information of China (English)

    侯庆中; 王晨虹

    2012-01-01

    目的:评价经选择的母婴正常产后48 h出院联合家庭访视的可行性.方法:选择在深圳妇幼保健院正常产并接受产后家庭访视的10172例产妇和9297例新生儿为研究A组,同期拆线后出院的正常产产妇5286例和新生儿4604例为对照A组,比较两组产妇会阴伤口愈合不良发生率和婴儿再入院率.产后42天对1000例产妇进行有关母乳喂养和产褥期母婴情况的问卷调查,按照是否曾接受产后访视将调查对象分为研究B组和对照B组,比较两组母乳喂养成功率和产褥期抑郁症的发生率.结果:通过产后家庭访视,平均缩短住院时间(1.76±0.44)天,研究A组产妇会阴伤口愈合不良发生率明显低于对照A组(P<0.05);研究A组婴儿再入院率和对照A组相比,差异无统计学意义(P>0.05);研究B组母乳喂养成功率明显高于对照组(P<0.05);研究B组产褥期抑郁症的发生率明显低于对照B组(P<0.05).结论:对于经过选择的低风险产妇和婴儿,正常产后48 h出院联合家庭访视安全、经济、有效.%Objective: To evaluate the feasibility of selected mother - infant discharge at 48 hours after vaginal delivery combined with home visit Methods; A total of 10 172 mothers and 9 297 neonates who were discharged at 48 hours after vaginal delivery and received home visit were selected as study A group, while 5 286 mothers and 4 604 neonates who were discharged at 48 hours after vaginal delivery were selected as control A group, the incidences of poor perineal wound healing among the mothers and the readmission rates of infants in the two groups were compared. At 42 days after delivery, the knowledge about breastfeeding and maternal - infantile conditions during postpar-tum were investigated by a questionnaire among 1 000 mothers, then the research objects were divided into study B group and control B group according to they receiving home visit or not, the success rates of breastfeeding and the

  12. Vaginal biological and sexual health--the unmet needs.

    Science.gov (United States)

    Graziottin, A

    2015-01-01

    The vagina is a most neglected organ. It is usually clinically considered with a minimalistic view, as a 'connecting tube' for a number of physiologic functions: passage of menstrual blood, intercourse, natural conception and delivery. Unmet needs include, but are not limited to, respect of vaginal physiologic biofilms; diagnosis and care of the optimal tone of the levator ani, which surrounds and partly support it; care of its anatomic integrity at and after delivery and at pelvic/vaginal surgery; care of long-term consequences of pelvic radiotherapy; long-term care of the atrophic changes it will undergo after the menopause, unless appropriate, at least local, estrogen therapy is used; appreciation and respect of its erotic meaning, as a loving, receptive, 'bonding' organ for the couple. The vaginal erotic value is key as a non-visible powerful center of femininity and sexuality, deeply and secretly attractive in terms of taste, scent (together with the vulva), touch and proprioception. The most welcoming when lubrication, softness and vaginal orgasm award the woman and the partner with the best of pleasures. Prevention of sexual/vaginal abuse is a very neglected unmet need, as well. Who cares?

  13. Impact of Elective caesarean section and vaginal delivery on the term neonate respiratory distress syndrome%选择性剖宫产与阴道分娩对足月儿呼吸窘迫综合征发生的影响

    Institute of Scientific and Technical Information of China (English)

    刘萍

    2013-01-01

      目的:探讨选择性剖宫产与阴道分娩对足月儿呼吸窘迫综合征发生的影响。方法:选取我院妇产科2010年1月-2012年12月足月儿患者1236例,分析其剖宫产、选择性剖宫产发生率、阴道分娩与选择性剖宫产并发呼吸窘迫综合症发生率、不同孕周选择性剖宫产并发呼吸窘迫综合征发生率。结果:2012年剖宫产率(48.37%)、选择性剖宫产率(23.17%)明显高于2010年;选择性剖宫产并发 N RDS风险率(2.79%)明显高于阴道分娩组;37-38孕周选择性剖宫产并发 N RDS 风险率明显高于39-41孕周。结论:选择性剖宫产足月儿呼吸窘迫综合征发生风险明显增高,且随着胎龄增加逐渐降低。%Objective :To Discussion Impact of Elective caesarean section and vaginal delivery on the term neonate respiratory distress syndrome . Methods :Selected 1236 cases term neonates ,cesarean section rate ,elective caesarean section rate ,vaginal delivery and selective caesarean section and incidence of respiratory distress syndrome ,different gestational age selective cesarean section complicated with respiratory distress syndrome incidence were compared .Results :2012cesarean section rate (48 .37% ) ,elective caesarean section rate ,(23 .17% ) were significantly higher than in 2010 ;elec-tive caesarean section with NRDS risk rate (2 .79% ) were significantly higher than vaginal delivery group ;37 -38 gestational elective caesarean sec-tion with NRDS risk rate were significantly higher than 39 -41 gestational age .Conclusion:Elective caesarean section neonate respiratory distress syn-drome occurred significantly increased ,along with the gestational age increase gradually reduced .

  14. Steroidal contraceptive vaginal rings.

    Science.gov (United States)

    Sarkar, N N

    2003-06-01

    The development of steroid-releasing vaginal rings over the past three decades is reviewed to illustrate the role of this device as an effective hormonal contraceptive for women. Vaginal rings are made of polysiloxane rubber or ethylene-vinyl-acetate copolymer with an outer diameter of 54-60 mm and a cross-sectional diameter of 4-9.5 mm and contain progestogen only or a combination of progestogen and oestrogen. The soft flexible combined ring is inserted in the vagina for three weeks and removed for seven days to allow withdrawal bleeding. Progesterone/progestogen-only rings are kept in for varying periods and replaced without a ring-free period. Rings are in various stages of research and development but a few, such as NuvaRing, have reached the market in some countries. Women find this method easy to use, effective, well tolerated and acceptable with no serious side-effects. Though the contraceptive efficacy of these vaginal rings is high, acceptability is yet to be established.

  15. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest......, pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC...

  16. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    , pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC......The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest...

  17. No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years.

    Science.gov (United States)

    Zhu, Jia-Jun; Bao, Ying-Ying; Zhang, Guo-Lian; Ma, Li-Xin; Wu, Ming-Yuan

    2014-08-01

    To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery. In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route. There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), Pbirth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.

  18. No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

    Institute of Scientific and Technical Information of China (English)

    Jia-Jun Zhu; Ying-Ying Bao; Guo-Lian Zhang; Li-Xin Ma; Ming-Yuan Wu

    2014-01-01

    Background: To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery. Methods: In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route. Results: There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P Conclusions: In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.

  19. Early pregnancy vaginal microbiome trends and preterm birth.

    Science.gov (United States)

    Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G

    2017-09-01

    Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Nonculture 16S ribosomal RNA gene sequencing suggests important racial differences and pregnancy specific changes in the vaginal microbial communities. A recent study examining the association of the vaginal microbiome and preterm birth documented important findings but was performed in a predominantly white cohort. Given the important racial differences in bacterial communities within the vagina as well as persistent racial disparities in preterm birth, it is important to examine cohorts with varied demographic compositions. To characterize vaginal microbial community characteristics in a large, predominantly African-American, longitudinal cohort of pregnant women and test whether particular vaginal microbial community characteristics are associated with the risk for subsequent preterm birth. This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained by speculum exam at their routine prenatal visits. Sequencing of the V1V3 region of the 16S rRNA gene was performed on the Roche 454 platform. Alpha diversity community characteristics including richness, Shannon diversity, and evenness as well as beta diversity metrics including Bray Curtis Dissimilarity and specific taxon abundance were compared longitudinally in women who delivered preterm to those who delivered at term. A total of 77 subjects contributed 149 vaginal swabs longitudinally across pregnancy. Participants were predominantly African-American (69%) and had a preterm birth rate of 31%. In subjects with subsequent term delivery, the vaginal microbiome demonstrated stable community richness and Shannon diversity, whereas subjects with subsequent preterm delivery had significantly decreased vaginal richness

  20. High Dose Vaginal Misoprostol Versus Concentrated Oxytocin + Low Dose Vaginal Misoprostol for Mid-Trimester Labor Induction: A Randomized Trial

    Science.gov (United States)

    Nuthalapaty, Francis S.; Ramsey, Patrick S.; Biggio, Joseph R.; Owen, John

    2013-01-01

    Objective To compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for mid-trimester labor induction. Study Design Women at 14-24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 μg ×1, then 400 μg q 4 hr × 5 (Group 1) or escalating-dose concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 μg × 1, then 200 μg q 6 hr × 2, then 100 μg × 1 (Group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval. Results The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis due to a highly significant difference in one of the primary study outcomes. Twenty women were assigned to Group 1 and 18 were assigned to the Group 2. Median induction-to-delivery interval was significantly shorter in Group 1 (12 hr, range 4 - 44 hr) versus Group 2 (18 hr, range 7 - 36 hr; p=0.01). Induction success rate at 12 hours was significantly higher in the Group 1 (60%), compared to Group 2 (22%, p=.02). No significant difference was noted in the live birth rate between Group 1 and 2 (13%, 0%, p = 0.16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups. Conclusion Compared to concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens mid-trimester labor inductions. PMID:16157113

  1. Clinical analysis of 15 cases with vaginal intraepithelial neoplasia and vaginal cancer after operations of cervical cancer or cervical intraepithelial neoplasia%子宫颈癌或癌前病变术后再发阴道癌或癌前病变的临床分析

    Institute of Scientific and Technical Information of China (English)

    刘琦; 施雅; 张秦; 税迎春; 管群; 石群立

    2014-01-01

    Objective Although the correlation between high risk human papilloma virus (hrHPV) infection and cervical cancer ( CC ) or cervical intraepithelial neoplasia ( CIN ) is well known , vaginal cancer ( VC ) or vaginal intraepithelial neoplasia ( VAIN) also caused by hrHPV has not received enough attention .This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases . Methods The clinical charac-teristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hos-pital. Results The mean age was (53.6 ±10.82) years, ranged from 39 to 73 years.The duration from the first operation to devel-oped VAIN or VC was (25.07 ±18.31) months, ranged from 1 to 60 months.There are 4 cases developed VC, 4 cases VAINⅢand 2 cases VINⅡfrom 10 CC patients;and 3 cases developed VC , 2 cases VAINⅢfrom 5 CINⅢpatients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients (3 VC, 4 VAINⅢ and 1 VAINⅡpatients), pelvic lymphonectomy in 1;upper vaginectomy in 2 patients (1 VC, 1 VAINⅢ), radiation or chemo-radiation therapy in 3 (3 VC), interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2 (1 VC, 1 VAINⅡ). Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy .Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy , especially for hard to operate patients . Radiation therapy seems to be not very adaptable for VAIN patients .%目的:高危型人乳头瘤病毒( high risk human papilloma virus , hrHPV)与子宫颈癌及宫颈上皮内瘤样病变( cervical intraepithelial neoplasia , CIN)的相关性

  2. Pregnant women’s preference for vaginal or caesarean childbirth

    Directory of Open Access Journals (Sweden)

    Lígia Ebner Melchiori

    2009-10-01

    Full Text Available The study investigated the preference for delivery in 40 pregnant women using a semi-structured interview. Most women (75% reported a preference for vaginal delivery, mainly because they believe it will result in a speedy recovery and be better for them and/or their babies. Of the women interviewed, 15% preferred a caesarean section because they considered it be less painful. These preferences, in general, were influenced by friends. Most women said they had fear of parturition due to: feelings of pain/suffering, concern of something happening to them or their babies and because the situation is unknown or assessed in a negative fashion. The presence of trusted people, like one’s husband, mother or doctor, could minimize this fear. These results reinforce the contributions of health professionals, such as psychologists, in answering the psychosocial needs of pregnant women in situations of delivery and birth.   Keywords: vaginal birth; caesarean section; pregnancy; health psychology.

  3. Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment.

    Science.gov (United States)

    Chiu, Hannah; Steele, Donna; McAlister, Chryssa; Lam, Wai-Ching

    2015-02-01

    High-risk pathologies for rhegmatogenous retinal detachment (RRD) in otherwise healthy pregnant females are not contraindications for spontaneous vaginal delivery. However, 74% of European obstetrician-gynecologist (OBGYN) respondents in 2008 recommended operative delivery for females at risk for RRD. This discrepancy is likely due to an older study suggesting a causal relation between Valsalva-like manoeuvres and RRD. The purpose of this study is to determine current delivery recommendations for healthy pregnant females with high-risk pathologies for RRD among Canadian ophthalmologists and OBGYNs. Anonymous prospective cross-sectional survey sent via electronic link in 2013. χ(2) test of proportions was used to compare delivery recommendations between the 2 specialties. Multinomial logistic regression was used to identify predictors for recommendations. A total of 356 participants responded including 92 ophthalmologists and 27 trainees, and 185 OBGYNs and 52 trainees. For healthy pregnant females with previously treated retinal hole/tear or treated RRD, significantly more OBGYNs recommended cesarean section and significantly more ophthalmologists recommended spontaneous vaginal delivery. Length of practice and type of practice setting were significant predictors among obstetricians in their delivery recommendations. This study is the first to include obstetricians, ophthalmologists, and their trainees in a survey of the recommended mode of delivery for pregnant females with risk factors of RRD. Our results suggest that obstetricians concerned about potential RRD in pregnant patients may be unnecessarily recommending operative management. Educational sessions on the risk for RRD with spontaneous vaginal delivery may reconcile the current differences in recommendations between ophthalmologists and obstetricians. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  4. Interlibrary loan and document delivery best practices for operating and managing interlibrary loan services in all libraries

    CERN Document Server

    Hilyer, Lee Andrew

    2013-01-01

    A must-have for librarians and their staffs working at all levels?from beginner to expertInterlibrary Loan and Document Delivery is a how-to guide to organizing an interlibrary loan department, providing extensive content on copyright law, ILL management systems, and human resources. This comprehensive book includes an introduction to ILL operations, governing policies, up-to-date information on borrowing and lending, and considerations for medicals libraries and distance learning. It also includes an extensive listing of resources relevant to today's ILL that serves as a handy des

  5. Treatment Options by Stage (Vaginal Cancer)

    Science.gov (United States)

    ... Health Professional Vaginal Cancer Treatment Research Vaginal Cancer Treatment (PDQ®)–Patient Version General Information About Vaginal Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on ...

  6. Vaginal contraceptives still evolving.

    Science.gov (United States)

    Pearson, R M

    1986-01-01

    The effort to develop vaginal contraceptives began in the distant past and is still underway today. 1000 years ago, South American Indians inserted into the vagina bark strips impregnated with quinine. In medieval times women used vaginal inserts of cloth soaked in honey or vinegar. Quinine pessaries were introduced into Europe in the late 1800s, and in the early 1900s investigators began to study the effects of various chemicals on sperm motility. Following World War II, surfactant spermicides which disrupt the sperm membrane were developed and marketed. Many of these preparations contained nonoxynol-9. Currently, the D-isomer of propranolol is being examined as a spermicidal contraceptive, and several bacteriocides, e.g., benzalkonium and chlorhexidine, are being developed as spermicides which reduce the penetrability of cervical mucus. Other chemicals being investigated act by inhibiting the acrosome reaction. Advantages of vaginal contraceptives are that they are inexpensive, reversible, and relatively safe and easy to use. Generally they require no medical intervention or supervision. In addition, spermicides may kill or inhibit the growth of organisms responsible for sexually transmitted diseases. Disadvantages of spermicides are that they are generally less effective than many other methods, some interfere with sexual spontaneity, they may cause local irritations, and some women find them messy to use. Recently, concerns were expressed about the possible teratogenic effects of sperimicides. Most of these concerns proved to be unfounded. Given the many new avenues of research, the major disadvantage of sperimicides, i.e., their high failure rates, may be minimized in the near future.

  7. Neoplasia vaginal intraepitelial

    OpenAIRE

    Baquedano M.,Laura; Lamarca B,Marta; José G,Yasmina; Rubio C,Patricia; Ruiz C,Miguel Ángel

    2013-01-01

    Objetivo: Actualizar los conocimientos disponibles sobre la neoplasia vaginal intraepitelial (VAIN) especialmente en el diagnóstico y tratamiento. Métodos: Revisión de la literatura en Pubmed de los últimos 20 años, especialmente de los publicados desde 2005 hasta la actualidad y considerando sobre todo los ensayos clínicos aleatorizados. Resultados: Su prevalencia real es desconocida, aunque es una patología rara generalmente en mujeres posmenopaúsicas. Su fisiopatología es similar a la neop...

  8. Twin-to-twin delivery time: neonatal outcome of the second twin.

    Science.gov (United States)

    Schneuber, Susanne; Magnet, Eva; Haas, Josef; Giuliani, Albrecht; Freidl, Thomas; Lang, Uwe; Bjelic-Radisic, Vesna

    2011-12-01

    To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

  9. Cervicovaginal aerobic microflora of women with spontaneous abortion or preterm delivery in Araraquara-Brazil Microbiota aeróbica cérvico-vaginal de mulheres com aborto espontâneo ou prematuridade fetal em Araraquara - Brasil

    Directory of Open Access Journals (Sweden)

    Maria Stella G. Raddi

    1998-10-01

    Full Text Available Microbiological routine exams of endocervix and vaginal specimens of 22 women with clinical history of recent spontaneous abortion or premature rupture of membranes were accomplished. Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus agalactiae, Candida sp and Gardnerella vaginalis were recovered from 54.5% (12 of the women. Ureaplasma urealyticum was frequently isolated (45.5% but 5 out of 22 had U. urealyticum only. Our report stands for the importance of quantitative as well as qualitative investigation on genital microflora in pregnant women, since it is likely to influence on pregnancy outcome.Rotina bacteriológica do conteúdo vaginal e cervical de 22 mulheres com histórico de aborto recente ou ruptura precoce das membranas foi realizada. Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus agalactiae, Candida sp e Gardnerella vaginalis foram isolados em 54,5% (12 das pacientes. Apesar de Ureaplasma urealyticum ter sido frequentemente encontrado (45,5%, somente em 5 das 22 mulheres foi o único microrganismo presente nos materiais analisados. Esses resultados chamam a atenção para a importância de investigação quantitativa bem como qualitativa da microbiota genital em gestantes, tendo em vista ter consequências na gestação.

  10. Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Azubuike Uzoma

    2009-01-01

    Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

  11. Vaginal haemangioendothelioma: an unusual tumour.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with "something coming down". Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our "knowledge bank" to guide management of these unusual tumours.

  12. [Vaginal metastasis of renal carcinoma (author's transl)].

    Science.gov (United States)

    Carl, P; Marx, F J

    1977-11-01

    Four cases of vaginal metastases of renal carcinoma are reported. This is an incidence of 1.3% in 313 operated patients (from 1/1/70 to 12/31/76). A surgical treatment of primary renal carcinoma and vaginal metastasis seems to be reasonable in there cases. Since in accordance with the literature metastatic involvement of vagina and vulva seems not to be a very rare finding, the diagnostic in renal carcinoma should imply a gynecologic examination. Although in carcinoma of the left kidney metastatic spreading into the external female genitalia most probably occurs by a retrograde venous pathway (left ovarian vein), the way of dissemination in carcinoma of the right side is unclear.

  13. Twin delivery: how should the second twin be delivered?

    Science.gov (United States)

    Olofsson, P; Rydhström, H

    1985-11-01

    In a series of 803 pairs of twins born between 1973 and 1982, 0.33% of second twins were delivered by cesarean section after vaginal delivery of the first twin. During the last year the frequency has increased to 7%, calling attention to the problem of declining obstetric skills and experience. This has caused us to update the routines of intrapartum management of twin gestations. In the present program only commonly available obstetric techniques are used. The potentially hazardous twin delivery is excluded from a trial of vaginal delivery. Hopefully, the program will help other obstetricians to decide in favor of vaginal delivery in selected twin gestations.

  14. Resultados neonatais no parto vaginal espontâneo comparados aos dos partos com fórcipe de Simpson-Braun em primíparas Neonatal outcome of spontaneous deliveries as compared to Simpson-Braun forceps deliveries in nulliparous women

    OpenAIRE

    Belmiro Gonçalves Pereira; Michel Gardere Camargo; Egle Cristina Couto; Eliana Amaral; Renato Passini Jr; Mary Angela Parpinelli

    2004-01-01

    OBJETIVO: comparar os resultados neonatais dos partos vaginais espontâneos ou assistidos com fórcipe de Simpson-Braun em nulíparas. MÉTODO: em estudo de corte retrospectivo foram avaliados dois grupos de primíparas atendidas no Centro Obstétrico do CAISM/UNICAMP, que tiveram parto vaginal sob analgesia epidural. O grupo fórcipe foi formado por 119 pacientes que tiveram parto a fórcipe de Simpson-Braun, e o grupo normal por 114 casos de parto vaginal espontâneo. Foram estudadas as variáveis ne...

  15. Randomized Trial of Vaginal Prostaglandin E2 Versus Oxytocin for Labor Induction in Term Premature Rupture of Membranes

    National Research Council Canada - National Science Library

    Kunt, Cigdem; Kanat-Pektas, Mine; Gungor, Ayse Nur Cakir; Kurt, Raziye Keskin; Ozat, Mustafa; Gulerman, Cavidan; Gungor, Tayfun; Mollamahmutoglu, Leyla

    2010-01-01

    ...) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM...

  16. FG90 chitosan as a new polymer for metronidazole mucoadhesive tablets for vaginal administration.

    Science.gov (United States)

    Perioli, Luana; Ambrogi, Valeria; Pagano, Cinzia; Scuota, Stefania; Rossi, Carlo

    2009-07-30

    Topical administration of the antibacterial metronidazole (MET) represents the most common therapy in the treatment of bacterial vaginosis (BV). The formulations generally available for BV therapy are creams, gels, vaginal lavages and vaginal suppositories. In this study, a new dosage form, containing MET, was developed with the aim to realize vaginal mucoadhesive tablets by including bioadhesive polymers as chitosan (FG90C), polyvinylpyrrolidone (PVPK90) and polycarbophil (PCPAA1), blended in different ratios. All formulations were characterized by studies of DSC, friability, hardness, hydration, mucoadhesion, in vitro release and antibacterial activity. All polymer mixtures employed were used to prepare tablets with the compactness and hardness so as allow the application on vaginal mucosa. FG90C performances improved in particular when mixed to PVPK90 (1:1 ratio). This kind of delivery system is suitable for formulating MET for topical application representing a good alternative to traditional dosage forms for vaginal topical administration.

  17. Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth and obstetric techniques

    DEFF Research Database (Denmark)

    Foldspang, Anders; Mommsen, Søren; Djurhuus, Jens Christian

    1999-01-01

    OBJECTIVES: This study examined the association between pregnancy, vaginal childbirth and obstetric techniques, and the prevalence of urinary incontinence among adult women aged 20 to 59 years. METHODS: A cross-sectional survey enrolled a random sample of 6240 women aged 20 to 59 years who were...... mailed a self-administered questionnaire focusing on urinary incontinence and other health variables. More than 75% of the women responded. The present analysis includes 4345 women who were not pregnant and did not experience a vaginal childbirth during 1994. RESULTS: Multivariate prevalence odds ratios...... showed increases in relation to urinary incontinence during pregnancy, urinary incontinence immediately after a vaginal childbirth, and age of 30 years or more at the second vaginal childbirth. No multivariate associations were found for forceps delivery or vacuum extraction delivery, episiotomy...

  18. Applied research of cesarean section and vaginal delivery technique in full - term pregnancy fetal distress in labor%剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

    Institute of Scientific and Technical Information of China (English)

    黄美英

    2012-01-01

    目的:探讨剖宫产与阴道助产术在足月妊娠临产胎儿窘迫中的应用效果.方法:对浙江省安吉县第三人民医院2006年2月~2010年12月120例足月妊娠临产时出现胎儿窘迫的病例按照随机原则,分别采用剖宫产及阴道助产术产钳法进行分娩,比较两种处理方式的母婴结局.结果:剖宫产组与阴道产钳组影响胎儿窘迫的脐带因素、胎盘因素、母体因素、胎儿因素发生率分别为46.03% (29/63)、35.09% (20/57),11.11% (7/63)、15.78% (9/57),9.52% (6/63)、8.77% (5/57),4.76% (3/63)、5.26% (3/57),两组脐带因素、胎盘因素比较差异有统计学意义(P<0.05);胎心监护NST两种方式下的新生儿、胎儿窘迫症状术后改善率分别为80.95% (51/63)、87.72% (50/57),两组比较均具有统计学差异(P<0.05).结论:胎儿窘迫主要发生于临产过程中,应根据孕妇产程进展采取适当的方式,及时抢救新生儿,降低新生儿窒息,在严密监护条件下,阴道助产术可以减少足月妊娠临产胎儿窘迫的发生率.%Objective: To study the clinical effect of cesarean section and vaginal delivery technique in full - term pregnancy fetal distress in labor. Methods; The 120 patients who were full - term pregnancy and fetal distress in labor cases in our hospital from February 2006 to December 2010 were divided into cesarean section group and vaginal midwifery group by random sampling. Then the maternal and neonatal outcomes were compared between the two groups. Results; In the factors of affecting fetal distress, umbilical cord factor, placental factor, maternal factor and fetal factor was46. 03% (29/63) , 11.11% (7/63) , 9. 52% (6/63) , 4. 76% (3/63) respectively in cesarean section group, and 35.09% (20/57), 15.78% (9/57), 8.77% (5/57), 5.26% (3/57) respectively in vaginal forceps group. Umbilical cord factor and placenta factor were significant differences between the two groups ( P < 0.05). The improving

  19. Vaginal microbicides: An overview

    Directory of Open Access Journals (Sweden)

    Hany Abdel-Aleem

    2011-03-01

    Full Text Available It is estimated that more than 340 million new cases of curable sexually transmitted infections occur every year throughout the world in men and women age (15–49years. Women bear an increasing burden of the epidemic as both caregivers for the ill and because of their heightened risk of infection due to biological, economic and social vulnerabilities. There is an urgent need for new prevention strategies that women can use themselves and initiate. A vaginal microbicide defined as substances intended to reduce or prevent transmission of HIV and/or other sexually transmitted infections (STIs when applied topically to genital mucosal surfaces, provides a woman-controlled method applied before sex that could kill, neutralize, or block HIV and other sexually transmitted diseases.

  20. IMPACT OF CANAL DESIGN LIMITATIONS ON WATER DELIVERY OPERATIONS AND AUTOMATION

    Science.gov (United States)

    Irrigation canals are often designed for water transmission. The design engineer simply ensures that the canal will pass the maximum design discharge. However, irrigation canals frequently operated far below design capacity. Because demands and the distribution of flow at bifurcations (branch points...

  1. Mode of delivery and subsequent reproductive patterns. A national follow-up study

    DEFF Research Database (Denmark)

    Fussing-Clausen, Caroline; Geirsson, Reynir T; Hansen, Thomas

    2014-01-01

    % CI 0.76-0.787) decreased likelihood for subsequent delivery. Emergency cesarean section meant 16% fewer (95% CI 0.84-0.85), and vaginal instrumental delivery 4% fewer subsequent deliveries (95% CI 0.95-0.96). Hazard ratios were largely unchanged after controlling for parity and year of birth. Small...... births. A first or later delivery by cesarean section implied decreased likelihood of subsequent delivery compared with women with a first vaginal birth....

  2. A study comparing vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for cervical ripening and labour induction

    Directory of Open Access Journals (Sweden)

    Binti R. Bhatiyani

    2017-01-01

    Full Text Available Background: Induction of labor is a commonly practised intervention in modern obstetrics. The objective of this study was to compare the efficacy of vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for labour induction. It aims to assess the induction delivery interval, the outcome of labour, the incidence of instrumental delivery and Cesarean section. The neonatal outcomes and maternal complications would also be assessed. Methods: 105 women with singleton viable pregnancies of 28 weeks or more gestation with cephalic presentation, intact membranes and an unfavorable cervix (Bishops score less than 6 were randomly assigned to induction of labor using vaginal misoprostol or Foley catheter in combination with vaginal misoprostol. Women in the misoprostol only group received 25 micrograms of misoprostol per vagina every 4 hours for a maximum of six doses. Whereas women in the combination group received vaginal misoprostol and in addition Foley catheter was introduced through the cervix for 12 hours. Interruption of the trial was done in case of failure to enter the active phase of labour after 24 hours of induction, fetal distress, hyperstimulation, hypersensitivity to drugs. Results: The induction to delivery time was shorter in misoprostol group as compared to the Foley with misoprostol group by 3 hours. There was no significant change in Bishops score after induction with Foley in combination with misoprostol as compared to misoprostol alone. There was no increase in the maternal and fetal complications in the misoprostol group as compared to Foley with misoprostol. Conclusions: Misoprostol alone was more efficacious for ripening and inducing agent as compared to Foley in combination with misoprostol.

  3. Induction of labour by balloon catheter with extra-amniotic saline infusion (BCEAS): a randomised comparison with PGE2 vaginal pessaries

    DEFF Research Database (Denmark)

    Lyndrup, J; Nickelsen, Carsten Nahne Amtoft; Weber, Tom

    1994-01-01

    section followed BCEAS than PGE2 (29% and 10%, respectively; P Apgar scores and umbilical artery pH and SBE). The women, delivering vaginally, commented......: The efficiency of inducing vaginal delivery and the level of 'disadvantages following induction of labour' (DisFIL scorings). RESULTS: Overall, BCEAS was less efficient inducing vaginal delivery than vaginal PGE2 (P ...) primiparous women group, and particularly in the subgroup of these having very low pelvic scores (Lange score, scorings were not significantly different. However, higher rates of caesarean...

  4. Effect of vaginal intercourse on spontaneous labor at term: a randomized controlled trial.

    Science.gov (United States)

    Castro, Catarina; Afonso, Maria; Carvalho, Rui; Clode, Nuno; Graça, Luís Mendes

    2014-12-01

    This study aimed at evaluating the effect of vaginal intercourse on spontaneous labor onset at term. In a randomized controlled trial, patients with singleton, cephalic, term, and low-risk pregnancy were assigned to either vaginal intercourse at least twice a week or abstinence. The following data were assessed: demographics, parity, vaginal coitus frequency before and during pregnancy, Bishop score at 38th weeks, gestational age at delivery, mode of delivery, and days between recruitment and delivery. The primary outcome was spontaneous labor onset. Of the 123 patient analyzed, 63 were assigned to study group and 60 to control group. Mean interval between study recruitment and delivery was higher in sexually active women (15.05 days ± 0.8 compared with 14.17 days ± 0.8, p = 0.45) as well as the rate of cesarean delivery (14.3 % compared with 10 %, p = 0.58), but the differences were not statistically significant. The rate of spontaneous labor was similar in both groups (84.1 % in vaginal coitus group; 75 % in control group, p = 0.26). Our results showed that vaginal intercourse does not hasten spontaneous labor onset at term.

  5. Analysis of Risk Factors for Post-Hysterectomy Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Mahmut Kuntay kuntay Kokanali

    2015-03-01

    Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000: 63-71

  6. Photo-redox activated drug delivery systems operating under two photon excitation in the near-IR.

    Science.gov (United States)

    Guardado-Alvarez, Tania M; Devi, Lekshmi Sudha; Vabre, Jean-Marie; Pecorelli, Travis A; Schwartz, Benjamin J; Durand, Jean-Olivier; Mongin, Olivier; Blanchard-Desce, Mireille; Zink, Jeffrey I

    2014-05-07

    We report the design and synthesis of a nano-container consisting of mesoporous silica nanoparticles with the pore openings covered by "snap-top" caps that are opened by near-IR light. A photo transducer molecule that is a reducing agent in an excited electronic state is covalently attached to the system. Near IR two-photon excitation causes inter-molecular electron transfer that reduces a disulfide bond holding the cap in place, thus allowing the cargo molecules to escape. We describe the operation of the "snap-top" release mechanism by both one- and two-photon activation. This system presents a proof of concept of a near-IR photoredox-induced nanoparticle delivery system that may lead to a new type of photodynamic drug release therapy.

  7. Prolonged antifungal effects of clotrimazole-containing mucoadhesive thermosensitive gels on vaginitis.

    Science.gov (United States)

    Chang, Jung Yun; Oh, Yu-Kyoung; Kong, Hak Soo; Kim, Eun Jung; Jang, Dong Deuk; Nam, Ki Taek; Kim, Chong-Kook

    2002-07-18

    To develop more effective treatment for vaginal candidasis, clotrimazole (CT) was formulated in mucoadhesive thermosensitive gels (MTG). Several MTG formulations composed of poloxamers (P) 407, 188, and polycarbophil (PC) were prepared. P188 and PC increased the mucoadhesiveness but reduced the syringebility of liquid forms of the gels. Based on the balance between the mucoadhesiveness and syringebility, MTG composed of P407/P188/PC (15/15/0.2 or 15/20/0.2) were further studied. Of the two MTG, the formulation with 15% of P188 gelled at higher temperature and revealed lower elastic modulus. In vitro, sustained release of CT from MTG was observed. In vivo antifungal activity of CT, tested against Candida albicans vaginitis in female rats, was significantly prolonged after vaginal delivery using MTG. At 10 days post-dose, the c.f.u. of C. albicans was more than 10(4)-fold decreased in MTG-treated groups. Moreover, the vaginal delivery of CT in MTG enhanced the viability of epithelial cells without affecting the morphology of vaginal mucosa. These results indicate that CT-containing vaginal MTG might be further developed for safe, convenient, and effective treatment of vaginal candidasis with reduced dosing interval.

  8. Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi.

    Science.gov (United States)

    Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

    2014-01-01

    Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Ethical issues in cesarean delivery.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2017-08-01

    Cesarean delivery is the most common and important surgical intervention in obstetric practice. Ethics provides essential guidance to obstetricians for offering, recommending, recommending against, and performing cesarean delivery. This chapter provides an ethical framework based on the professional responsibility model of obstetric ethics. This framework is then used to address two especially ethically challenging clinical topics in cesarean delivery: patient-choice cesarean delivery and trial of labor after cesarean delivery. This chapter emphasizes a preventive ethics approach, designed to prevent ethical conflict in clinical practice. To achieve this goal, a preventive ethics approach uses the informed consent process to offer cesarean delivery as a medically reasonable alternative to vaginal delivery, to recommend cesarean delivery, and to recommend against cesarean delivery. The limited role of shared decision making is also described. The professional responsibility model of obstetric ethics guides this multi-faceted preventive ethics approach. Copyright © 2017. Published by Elsevier Ltd.

  10. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy

    Directory of Open Access Journals (Sweden)

    SA Kingsberg

    2009-08-01

    Full Text Available SA Kingsberg¹, S Kellogg², M Krychman³1University Hospitals Case Medical Center, Case Western Reserve University Cleveland OH, USA; 2The Pelvic and Sexual Health Institute of Philadelphia, Drexel University College of Medicine, Philadelphia, USA; 3Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USAAbstract: Vulvovaginal atrophy (VVA and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms.Keywords: dyspareunia, postmenopausal vulvovaginal atrophy, vaginal estrogen therapy

  11. A comparative study of hysteroscopic electrocoagulation and vaginal operation in the treatment of cesarean scar diverticulum%宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的对比研究

    Institute of Scientific and Technical Information of China (English)

    于芳; 贾海军; 廖飞燕; 王杜平; 王庆一

    2015-01-01

    目的:对比分析宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的临床效果。方法选取2012~2014年在珠海市妇幼保健院30例子宫切口瘢痕憩室患者的临床资料,14例患者采用腹腔镜下行宫腔镜电凝术纳入电凝组,16例患者采用腹腔镜联合阴式手术纳入阴式组,比较两组患者手术时间、术中出血量、住院时间,术后2月、6月经期恢复情况。结果电凝组手术时间(31.50±7.03) min、术中出血量(4.25±1.39)mL,均少于阴式组[(75.38±10.88)min,(16.25±7.44) mL](P﹤0.05)。术后6月经期恢复正常率阴式组[93.8%(15/16)]高于电凝组[64.3%(9/14)](P﹤0.05)。结论宫腔镜电凝治疗子宫切口瘢痕憩室,具有手术时间短、术中创伤出血少,为近期有生育要求者的首选治疗方法,而阴式手术远期效果更佳。%Objective To compare the clinical effect of hysteroscopic electrocoagulation and vaginal operation in the treatment of cesarean scar diverticulum.Methods Clinical data of 30 patients with cesarean scar diverticulum in Zhuhai Maternal and Child Health Hospital from 2012 to 2014 were selected. 14 cases treated by hysteroscopic electrocoagulation were selected into electrocoagulation group, 16 cases treated by laparoscopy combined with vaginal operation were selected into vaginal operation group. The operation time, blood loss, hospital stay, and menstrual period recovery rates 2 months and 6 months after the operation were compared.Results The operation time [(31.50 ±7.03) min] and blood loss [(4.25 ±1.39) mL] of electrocoagulation group were less than that of vaginal operation group[(75.38 ±10.88) min, (16.25 ±7.44) mL] (P<0.05).The menstrual period recovery rate after 6 months of vaginal operation group [93.8%(15/16)]was higher than electrocoagulation group [64.3%(9/14)] (P <0.05 ) .Conclusion With shorter operation time and less blood loss during the operation

  12. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    There are many causes of abnormal vaginal bleeding. HORMONES Most often, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the cause, doctors call the problem dysfunctional uterine bleeding (DUB) . DUB is more ...

  13. How Is Vaginal Cancer Diagnosed?

    Science.gov (United States)

    ... light is inserted into the bladder through the urethra. If suspicious areas or growths are seen, a biopsy will be done. Cystoscopy may be recommended if a vaginal cancer is large and/or located in the front ...

  14. Drugs Approved for Vaginal Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) to prevent vaginal cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  15. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing features ... the blood from soaking your clothes. What Causes Bleeding Later in Pregnancy? When labor begins, the cervix ...

  16. 导乐分娩配合GT-4A导乐分娩镇痛仪在阴道分娩中的临床应用%Clinical application of Daole childbirth combined with the GT-4A Daole childbirth for vaginal delivery

    Institute of Scientific and Technical Information of China (English)

    任晓娅; 刘艳云; 田亚菊; 张芳; 牟岩涛; 韩娜; 贾艳君

    2015-01-01

    目的:探讨导乐分娩配合GT-4A导乐分娩镇痛仪在阴道分娩中的临床应用效果。方法选择足月妊娠拟阴道试产孕妇240例,将其随机分为对照组,导乐组及硬膜外组,每组80例。导乐组给予全程导乐分娩配合GT-4A导乐分娩镇痛仪分娩,硬膜外组给予硬膜外麻醉镇痛分娩,对照组给予传统方式分娩。比较三组产妇产程时间、各产程疼痛程度、剖宫产率、新生儿评分及产后并发症发生情况。结果与对照组比较,导乐组与硬膜组产程时间明显缩短,疼痛程度明显减轻,剖宫产率明显降低,新生儿Apgar评分明显提高,产后并发症明显降低,差异均具有统计学意义(P<0.05);而导乐组干预效果优于硬膜组,两组间比较差异均具有统计学意义(P<0.05)。结论导乐分娩配合GT-4A导乐分娩镇痛仪能有效降低患者分娩疼痛,改善无痛分娩质量,减轻无痛分娩术后并发症,提高分娩质量,值得在临床上推广应用。%Objective To explore the clinical application of Daole childbirth combined with the GT-4A Daole childbirth for vaginal delivery. Methods Two hundred and forty pregnant women of full-term pregnancy scheduled for vaginal trial production were divided into the control group, Daole group and epidural group, each with 80 cases. The pregnant women in the Daole group were treated with Daole childbirth combined with the GT-4A Daole childbirth in the whole progress, and those in the epidural group were treated with epidural analgesia childbirth. The women in the control group were treated with traditional childbirth. Then the labor time, degree of labor pain, cesarean section rate, neonatal score and postpartum complications were compared between the three groups. Results Com-pared with the control group, Daole group and epidural group had significantly shorter labor time, reduced degree of la-bor pain was, lowered rate of cesarean section, increased

  17. Double-balloon catheter and sequential vaginal prostaglandin E2 versus vaginal prostaglandin E2 alone for induction of labor after previous cesarean section.

    Science.gov (United States)

    Kehl, Sven; Weiss, Christel; Wamsler, Michael; Beyer, Jana; Dammer, Ulf; Heimrich, Jutta; Faschingbauer, Florian; Sütterlin, Marc; Beckmann, Matthias W; Schleussner, Ekkehard

    2016-04-01

    To evaluate the efficacy of inducing labor using a double-balloon catheter and vaginal prostaglandin E2 (PGE2) sequentially, in comparison with vaginal PGE2 alone after previous cesarean section. A total of 264 pregnant women with previous cesarean section undergoing labor induction at term were included in this prospective multicentre cohort study. Induction of labor was performed either by vaginal PGE2 gel or double-balloon catheter followed by vaginal PGE2. The primary outcome measure was the cesarean section rate. The cesarean section rate was 37 % without any statistically significant difference between the two groups (PGE2: n = 41, 37 % vs. balloon catheter/PGE2: n = 41, 42 %; P = 0.438). The median (range) number of applications of PGE2 [2 (1-10) versus 1 (0-8), P cesarean section were "no previous vaginal delivery" (OR 5.391; CI 2.671-10.882) and "no oxytocin augmentation during childbirth" (OR 2.119; CI 1.215-3.695). The sequential application of double-balloon catheter and vaginal PGE2 is as effective as the sole use of vaginal PGE2 with less applications and total amount of PGE2.

  18. Freeze-dried mucoadhesive polymeric system containing pegylated lipoplexes: Towards a vaginal sustained released system for siRNA.

    Science.gov (United States)

    Furst, Tania; Dakwar, George R; Zagato, Elisa; Lechanteur, Anna; Remaut, Katrien; Evrard, Brigitte; Braeckmans, Kevin; Piel, Geraldine

    2016-08-28

    Topical vaginal sustained delivery of siRNA presents a significant challenge due to the short residence time of formulations. Therefore, a drug delivery system capable to adhere to the vaginal mucosa is desirable, as it could allow a prolonged delivery and increase the effectiveness of the therapy. The aim of this project is to develop a polymeric solid mucoadhesive system, loaded with lipoplexes, able to be progressively rehydrated by the vaginal fluids to form a hydrogel and to deliver siRNA to vaginal tissues. To minimize adhesive interactions with vaginal mucus components, lipoplexes were coated with different derivatives of polyethylene glycol: DPSE-PEG2000, DPSE-PEG750 and ceramide-PEG2000. Based on stability and diffusion properties in simulated vaginal fluids, lipoplexes containing DSPE-PEG2000 were selected and incorporated in hydroxyethyl cellulose (HEC) hydrogels. Solid systems, called sponges, were then obtained by freeze-drying. Sponges meet acceptable mechanical characteristics and their hardness, deformability and mucoadhesive properties are not influenced by the presence of lipoplexes. Finally, mobility and stability of lipoplexes inside sponges rehydrated with vaginal mucus, mimicking in situ conditions, were evaluated by advanced fluorescence microscopy. The release rate was found to be influenced by the HEC concentration and consequently by the viscosity after rehydration. This study demonstrates the feasibility of entrapping pegylated lipoplexes into a solid matrix system for a prolonged delivery of siRNA into the vagina.

  19. Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

    Science.gov (United States)

    Wanyonyi, Sikolia; Muriithi, Francis G

    2015-10-01

    Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

  20. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    Directory of Open Access Journals (Sweden)

    Senturk MB

    2015-07-01

    Full Text Available Mehmet Baki Senturk,1 Yusuf Cakmak,2 Halit Atac,2 Mehmet Sukru Budak3 1Department of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey; 2Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey; 3Department of Obstetrics and Gynecology, Diyarbakir Research Hospital, Diyarbakir, Turkey Abstract: Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01, but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05. In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of

  1. Uterus preserving vaginal surgery versus vaginal hysterectomy for correction of female pelvic organ prolapse.

    Science.gov (United States)

    Iliev, Vasil N; Andonova, Irena T

    2014-01-01

    The objective of this study is to evaluate uterus preserving vaginal procedure of cervical amputation with uterosacral ligament plication (modified Manchester operation) and compare it to vaginal hysterectomy regard recurrence rate, duration of surgery, blood loses, intra and post-operative complications, duration of hospital stay. Consecutive women with pelvic organ prolapse who underwent either vaginal hyste-rectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardized questionnaires. 66 patients were included in the study with a one year follow-up. We found no significant difference in: recurrence of POP and reintervention (recurrence with required treatment n (%): 3(10) vs. 5(15), p=0.28) and hospital stay (mean±SD days: 5±2 vs. 7±2, p=0.97). Significant less blood loses (250±210 ml. vs. 360±230 ml.) and shorter operation time (67±20 min. vs 102±22 min.) in modified Manchester group, but significant more urinary retention (cases: 8 vs 6) in modified Manchester group. The overall functional outcome was acceptable for both procedures. We found an excellent performance of both procedures regarding recurrences and intra and post-operative complications. A high degree of acceptance-satisfaction shows the modified Manchester operation and is good option for the treatment of uterine prolapse in younger women who wish to keep their uterus and in all cases of genital prolapse with elongation of uterine cervix (when there is not other uterine pathology). Shorter operation time and lower blood lose are another factors for stronger recommendation of the modified Manchester operation for patients with concomitant diseases and/or older age patients with elevated risk from anesthesia and/or surgery.

  2. A universal combination treatment for vaginitis.

    Science.gov (United States)

    Bornstein, Jacob; Zarfati, Doron

    2008-01-01

    We compared a novel vaginal tablet consisting of 100 mg of clotrimazole and 100 mg of metronidazole ('Clo-Met') to a 100-mg clotrimazole tablet in the treatment of vaginitis. A multicenter, double-blind, randomized controlled study. Women with vaginal discharge and diagnosed as suffering from vaginitis caused by Trichomonas vaginalis, bacterial vaginosis or Candida albicans, or any combination of the three, and who had not received treatment for vaginitis during the previous month, were studied. 165 patients were enrolled into the study--84 into the combined therapy group, and 81 into the clotrimazole group. In women with Candida vaginitis, Clo-Met was more effective than clotrimazole treatment (p vaginal tablet consisting of clotrimazole and metronidazole is therapeutically effective in candidal vaginitis. The effectiveness of Clo-Met on bacterial vaginosis, T. vaginalis infection as well as on vaginal infections due to a combination of these microorganisms should be studied further.

  3. The Effect of Modes of Delivery on Infants' Feeding Practices

    Directory of Open Access Journals (Sweden)

    Gulshan Saeed

    2011-06-01

    Full Text Available Breast feeding has a great impact on the infant morbidity and mortality. According to Pakistan Demographic and Health survey (PDHS infant mortality rate is 78 deaths per 1,000 live births. World Health Organization recommends that exclusive breast feeding for six months can decrease infant mortality rate by one-third. The objective of the study was to find out how the mode of delivery had impact on the practice of breast feeding. Data were collected for 2500 consecutive patients during a period of two years, and it was seen that maternal initiative to breast feed was low and problems with lactation were much more in cases delivering their babies via cesarean sections than those delivering theirs by normal delivery. Vaginal and cesarean section deliveries took place in 54% and 46% of the case, respectively. Thirty percent of the women studied felt that they had no problems regarding breastfeeding, but 70% of them had some sort of problems with breastfeeding their babies. When the women were matched for the mode of delivery, 58% of women who had breastfeeding problems belonged to the cesarean delivery group and 42% of complaining mothers were from women with normal delivery. The relative risk of having problems with breastfeeding for women subjected to cesarean was 1.38 and the odds ratio was 0.61. The findings of the present study indicate that more in depth counseling sessions are required for women undergoing operative delivery to improve breast feeding among them

  4. MICROBIOLOGICAL PROFILE OF VAGINAL SWABS.

    Directory of Open Access Journals (Sweden)

    Sevitha

    2012-10-01

    Full Text Available ABSTRACT: BACKGROUND/OBJECTIVES: Bacterial vaginosis (BV, an alteration of vaginal flora involving a decrease in Lactobacilli and predo minance of anaerobic bacteria, is the most common cause of vaginal complaints for women of chil dbearing age .Causative agents include Gardnerella vaginalis, facultative lactobacilli, My coplasma hominis, Viridans streptococci & anaerobic bacteria. The most frequent manifestation s of genitourinary candidiasis is vulvovaginal candidiasis & is diagnosed in 40 % of women with vaginal complaints. The present study was undertaken to study the occurrence of Bac terial vaginosis & Vulvovaginal candidiasis in women with vaginal complaints. MATERIALS AND METHODS: The study included 100 High vaginal swabs with H/O white discharge per vaginum f or a period of 6 months from June 2011.Swabs were stained by Grams method & were cult ured. RESULTS: Out of 100 samples, in 35(35%Gram smear findings were normal & no growth in culture. 26(26%samples had polymorphs with Gardnerella morphotype, gram negative c urved rods, fusiforms & Lactobacilli were absent/present in low numbers(1 to 2+, the sme ar was interpreted as consistent with BV. 15 samples (15% had the growth of Candida spp. In the remaining 24 samples, the Gram stain findings had only vaginal epithelial cells with Lactobacilli, but the culture had the growth o f Group B Streptococcus 10(10%, E. coli & coliforms 10(10%,Enterococcus spp 14(14%which could just be colonisers. CONCLUSION: Bacterial vaginosis is the predominant cause of leuc orrhoea (26% followed by vulvovaginal candidiasis accounting for 15 % of the cases. Detection of intrapartum vaginal colonisation of Group B Streptococci, E. coli & colif orms & Enterococcus spp. in pregnant women is of significance as it can get transmitted to the neonate & cause sepsis

  5. Preparation for induction of labour of the unfavourable cervix with Foley catheter compared with vaginal prostaglandin.

    Science.gov (United States)

    Thomas, I L; Chenoweth, J N; Tronc, G N; Johnson, I R

    1986-02-01

    Ripening of the unfavourable cervix prior to induction of labour using traction on a Foley catheter (32 patients) was compared with 40 mg of prostaglandin F2 alpha in Tylose gel applied to the external cervical os and held in place for 12 hours with a vaginal diaphragm (25 patients). Each patient in the above groups had a modified Bishop score of 0-3 and was randomly allocated to one or other group. Comparison was made with a further 25 patients in whom the cervical score was 4-6. Timing of amniotomy and commencement of Syntocinon infusion were equivalent for all patients. Prostaglandins conferred no advantage over Foley catheter in terms of amniotomy-delivery interval, operative delivery rate, and condition of the baby one minute after birth. The disadvantages of prostaglandins for cervical ripening are a longer preparation-delivery interval, and cost ($77 versus $4.75 for the Foley catheter). Currently, prostaglandins are not officially approved for use in Australia for induction of labour. It is suggested, therefore, that the Foley catheter is preferable for ripening the unfavourable cervix as a prelude to amniotomy.

  6. The vaginal contraceptive sponge.

    Science.gov (United States)

    Edelman, D A

    1984-06-01

    The vaginal contraceptive sponge, approved on April 1, 1983 by the US Food Administration (FDA) for sale in the US as a single use, disposable, over-the-counter contraceptive, is made of polyurethane and designed to be biocompatible with the vaginal environment. The sponge is available in a single size, is round, and about 5.5 cm in diameter and 2.5 cm thick. An indentation on 1 side helps to ensure the sponge's correct placement against the cervix. A polyester retrieval loop attached to the sponge facilitates removal. Postcoital tests of the sponge without the spermicide indicated that it was ineffective in preventing sperm from entering the cervical canal. Before insertion, the contraceptive sponge is moistened with tap water to activate the spermicide and is inserted into the vagina with the indentation placed against the cervis. The sponge has been designed to provide continuous protection against pregnancy for at least 24 hours after insertion. Following a successful phase ii clinical trail of the sponge, in 1979 comparative phase iii clinical trials were initiated by Family Health International. The following trials were conducted: sponge versus the diaphragm (arcing-spring) used with a spermicide (nonoxynol-9) at 13 clinics in the US (1439 subjects) and at 2 clinics in Canada and the UK (502 subjects); sponge versus a foaming spermicidal (menfegol) suppository at 5 clinics in Yugoslavia, Taiwan, and Bangladesh (1386) subjects); and sponge versus spermicidal (nonoxynol-9) foam at 2 clinics in Israel and Thailand (366 subjects). In all trials the contraceptive methods were raondomly assigned. Clinics were required to follow up subjects for 1 year. Only the US study has been completed. In the comparative trials of the sponge and diaphragm (both US based and overseas) the pregnancy rates were significantly higher for the sponge. In the comparative trials of the sponge and foaming suppositories or spermicidal foam there were no significant differences between the

  7. Clinical characteristics of aerobic vaginitis and its association to vaginal candidiasis, trichomonas vaginitis and bacterial vaginosis.

    Science.gov (United States)

    Jahic, Mahira; Mulavdic, Mirsada; Nurkic, Jasmina; Jahic, Elmir; Nurkic, Midhat

    2013-12-01

    Examine clinical characteristics of aerobic vaginitis and mixed infection for the purpose of better diagnostic accuracy and treatment efficiency. Prospective research has been conducted at Clinic for Gynecology and Obstetrics, Department for Microbiology and Pathology at Polyclinic for laboratory diagnostic and Gynecology and Obstetrics Department at Health Center Sapna. Examination included 100 examinees with the signs of vaginitis. anamnesis, clinical, gynecological and microbiological examination of vaginal smear. The average age of the examinees was 32,62±2,6. Examining vaginal smears of the examinees with signs of vaginitis in 96% (N-96) different microorganisms have been isolated, while in 4% (N-4) findings were normal. AV has been found in 51% (N-51) of the examinees, Candida albicans in 17% (N-17), BV in 15% (N-15), Trichomonas vaginalis in 13% (N-13). In 21% (N-21) AV was diagnosed alone while associated with other agents in 30% (N-30). Most common causes of AV are E. coli (N-55) and E. faecalis (N-52). AV and Candida albicanis have been found in (13/30, 43%), Trichomonas vaginalis in (9/30, 30%) and BV (8/30, 26%). Vaginal secretion is in 70,05% (N-36) yellow coloured, red vagina wall is recorded in 31,13% (N-16) and pruritus in 72,54% (N-37). Increased pH value of vagina found in 94,10% (N-48). The average pH value of vaginal environment was 5,15±0,54 and in associated presence of AV and VVC, TV and BV was 5,29±0,56 which is higher value considering presence of AV alone but that is not statistically significant difference (p>0,05). Amino-odor test was positive in 29,94% (N-15) of associated infections. Lactobacilli are absent, while leukocytes are increased in 100% (N-51) of the examinees with AV. AV is vaginal infection similar to other vaginal infections. It is important to be careful while diagnosing because the treatment of AV differentiates from treatment of other vaginitis.

  8. Complications of vaginal hysterectomy - (Analysis of 1105 cases

    Directory of Open Access Journals (Sweden)

    Bhattacharya Menna

    1978-01-01

    Full Text Available Eleven hundred and five cases of vaginal hysterectomy are analysed and their complications discussed. More than 90% of the patients were between the ages of 31 to 60 years. The common indications for hysterectomy were prolapse (51% and dysfunctional uterine bleeding (34.9%. In four cases abdominal approach was necessary to complete the operation. The overall incidence of major complications was 4% and the corrected mortality rate was 0.18%. The complications of vaginal hysterec-tomy by other authors are discussed.

  9. [The etiologic diversity of vaginitis].

    Science.gov (United States)

    Bohbot, J-M; Sednaoui, P; Verriere, F; Achhammer, I

    2012-10-01

    To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study. One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)). One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs. Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  10. Newborns from deliveries with epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    Avramović Lidija

    2010-01-01

    Full Text Available Introduction. The use of epidural anaesthesia in delivery with the purpose to reduce pain and fear in a pregnant woman has the influence on the physiological status of the woman in childbirth and the course of delivery. From the epidural space of the pregnant woman, one part of free anaesthetic comes in the foetal circulation through the mother's circulation and placenta and connects with the foetal proteins. A lower value of albumins and serum proteins in the foetal circulation give bigger free fraction of anaesthetic which is accumulated in the foetal liver, brain and heart full of blood. Objective. The aim of the study was to examine the influence of epidural anaesthesia on the newborn. Methods. Retrospective study of 6,398 documents of newborns was performed in our Clinic of Gynaecology and Obstetrics 'Narodni front' during 2006. The first group was made of 455 newborns from deliveries with epidural anaesthesia and the second was the control group of 5,943 remaining newborns. In both groups we analysed the following: sex, week of gestation, weight, Apgar score, measure of care and resuscitation, perinatal morbidity and then the obtained results were compared. Results. Most of deliveries were vaginal without obstetric intervention (86.6%. The number of deliveries finished with vacuum extractor (4.6% was statistically significantly bigger in the group with epidural anaesthesia than in the control group. Most of the newborns in the first group were born on time (96.5% in 39.0±1.0 week of gestation and with foetal weight 3448±412 grammes. There was no statistical significance in Apgar score between both groups. Epidural anaesthesia does not increase the degree of the newborn's injury. Lower pH of blood was found in the newborns from deliveries with vacuum extractor or operated on (the Ceasarean section. Conclusion. Application of epidural anaesthesia decreases duration of delivery and has no adverse effects on the newborn and hypoxic

  11. Revisiting the mode of delivery and outcome of singleton breech ...

    African Journals Online (AJOL)

    Assisted vaginal breech delivery was associated wilh high rate of low Apgar score (score <7) at the 5th minute ... There was no difference in terms of birth injury, neonatal death and maternal morbidities between those that had assisted vaginal ...

  12. Case series of feasibility considerations that impact operational delivery strategy in the highly competitive rheumatoid arthritis space in Asia

    Directory of Open Access Journals (Sweden)

    Wai K

    2013-02-01

    Full Text Available Karen Wai,1 Lisa Marie Saldanha,1 Elvira Zenaida Lansang,1 Saumya Nayak,1 Anish Sule,2 Ken J Lee31Feasibility and Site Identification Asia, Quintiles East Asia Pte Ltd, Singapore; 2Feasibility and Site Identification India, Quintiles India, Mumbai, India; 3Site Services Asia, Quintiles East Asia Pte Ltd, SingaporeAbstract: The rheumatoid arthritis (RA clinical trial space is very competitive, and recruiting and retaining subjects is of critical importance. Feasibility studies are a central component of ensuring successful recruitment and retention. A feasibility study is an assessment of the practicality of a proposed study protocol, with the goal of understanding challenges and providing risk mitigation strategies leading to better subject enrolment and study start-up should the assessment be favorable. This paper presents findings from a retrospective case series of RA feasibilities, describing important parameters to consider in the highly competitive RA space in Asia. Key parameters identified and discussed are how decisions on clinical development strategy necessitate changes in the clinical operational delivery strategy, with focus on changes in inclusion and exclusion criteria and patient contribution load; how small the patient population becomes when the clinical trial needs to target the patient population that is refractory to standard therapy; regulatory timelines; and the competitive clinical trial landscape. Feasibility assessments are a snapshot in time exercise. Multiple parameters change over time, and, particularly in a space that has become competitive for subjects, one cannot rely on one static feasibility assessment to predict trial performance accurately. Continuous feasibility assessment will also provide insight into the resourcing needs on the part of the sponsor, contract research organization, and investigative site.Keywords: site selection, country selection, clinical operations, risk management, recruitment rates

  13. Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas’ Deliveries

    Science.gov (United States)

    Pembe, Andrea B.; Järnbert-Pettersson, Hans; Norman, Margareta; Wihlbäck, Anna-Carin; Hoesli, Irene; Todesco Bernasconi, Monya; Azria, Elie; Åkerud, Helena; Darj, Elisabet

    2016-01-01

    Background One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL). Objectives To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries. Methods A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study. Results AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04). Conclusion The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications. PMID:27783611

  14. Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries.

    Science.gov (United States)

    Wiberg-Itzel, Eva; Pembe, Andrea B; Järnbert-Pettersson, Hans; Norman, Margareta; Wihlbäck, Anna-Carin; Hoesli, Irene; Todesco Bernasconi, Monya; Azria, Elie; Åkerud, Helena; Darj, Elisabet

    2016-01-01

    One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL). To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries. A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study. AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04). The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.

  15. Vaginal Versus Oral Misoprostol for Second-Trimester Pregnancy Termination: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Sh Aghdaee

    2008-10-01

    Full Text Available Introduction: The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination. Methods: 60 consenting women who were at 14 to 28 weeks of gestation with indications for pregnancy termination were randomly assigned to two equal groups to receive either vaginal or oral misoprostol. The dosing regimen was 400µg as the initial dose followed by 400µg and up to 3 doses (1200µg if needed in each group. Efficacy and side effects were compared. Results: 30 patients randomly assigned to vaginal and 30 to oral misoprostol group. Demographic characteristics were similar in both the groups. The percentage of women who delivered was significantly higher in vaginal group than the oral group (86.7 vs.43.3, P=0.0006.The average induction to delivery interval was shorter in vaginal group, but this difference was not significant (9.7±4.2 vs. 12.7±7.3 P=0.083. No significant differences in complication rates or side effects were noted between the two groups. Conclusion: Vaginal administration of misoprostol resulted in a higher success rate for second trimester pregnancy termination, whereas, no significant differences in induction to delivery time and complication rates were noted between vaginal and oral groups.

  16. Citología Vaginal

    OpenAIRE

    Arrunategui, Ana María; Fundación Valle de Lili

    2001-01-01

    ¿Qué es una neoplasia?/ ¿Qué grupo de mujeres tiene un mayor riesgo de desarrollar cáncer del cuello de la matriz?/ ¿Cuáles son los síntomas más frecuentes del cáncer del cuello de la matriz?/ Anatomía de los órganos genitales femeninos/¿Cómo se realiza la prueba de la citología vaginal?/¿Cómo se interpretan los resultados de la citología vaginal?/ ¿Toda citología anormal es cáncer?/ ¿Qué otras utilidades tiene la citología vaginal?/ ¿Desde qué edad, hasta que edad y con qué frecuencia debe t...

  17. Vaginitis: current microbiologic and clinical concepts.

    Science.gov (United States)

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed. PMID:3510698

  18. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles.

    Science.gov (United States)

    Alperin, Marianna; Cook, Mark; Tuttle, Lori J; Esparza, Mary C; Lieber, Richard L

    2016-09-01

    Vaginal delivery and aging are key risk factors for pelvic floor muscle dysfunction, which is a critical component of pelvic floor disorders. However, alterations in the pelvic floor muscle intrinsic structure that lead to muscle dysfunction because of childbirth and aging remain elusive. The purpose of this study was to determine the impact of vaginal deliveries and aging on human cadaveric pelvic floor muscle architecture, which is the strongest predictor of active muscle function. Coccygeus, iliococcygeus, and pubovisceralis were obtained from younger donors who were ≤51 years old, vaginally nulliparous (n = 5) and vaginally parous (n = 6) and older donors who were >51 years old, vaginally nulliparous (n = 6) and vaginally parous (n = 6), all of whom had no history of pelvic floor disorders. Architectural parameters, which are predictive of muscle's excursion and force-generating capacity, were determined with the use of validated methods. Intramuscular collagen content was quantified by hydroxyproline assay. Main effects of parity and aging and the interactions were determined with the use of 2-way analysis of variance, with Tukey's post-hoc testing and a significance level of .05. The mean age of younger and older donors differed by approximately 40 years (P = .001) but was similar between nulliparous and parous donors within each age group (P > .9). The median parity was 2 (range, 1-3) in younger and older vaginally parous groups (P = .7). The main impact of parity was increased fiber length in the more proximal coccygeus (P = .03) and iliococcygeus (P = .04). Aging changes manifested as decreased physiologic cross-sectional area across all pelvic floor muscles (P < .05), which substantially exceeded the age-related decline in muscle mass. The physiologic cross-sectional area was lower in younger vaginally parous, compared with younger vaginally nulliparous, pelvic floor muscles; however, the differences did not reach statistical significance

  19. The effect of vaginal cream containing ginger in users of clotrimazole vaginal cream on vaginal candidiasis.

    Science.gov (United States)

    Shabanian, Sheida; Khalili, Sima; Lorigooini, Zahra; Malekpour, Afsaneh; Heidari-Soureshjani, Saeid

    2017-01-01

    Vulvovaginal candidiasis is one of the most common infections of the genital tract in women that causes many complications. Therefore, we examined the clinical effect of ginger cream along with clotrimazole compared to vaginal clotrimazole alone in this study. This double-blind clinical trial was conducted on 67 women admitted to the Gynecology Clinic of Hajar Hospital with vaginal candidiasis. The patients were divided randomly into two groups of 33 and 34 people. The diagnosis was made according to clinical symptoms, wet smear, and culture. Ginger-clotrimazole vaginal cream 1% and clotrimazole vaginal cream 1% were administered to groups 1 and 2, respectively, once a day for 7 days and therapeutic effects and symptoms were evaluated in readmission. Data analysis was performed using SPSS version 22, t-test and Chi-square. The mean value of variables itching (P > 0.05), burning (P > 0.05), and cheesy secretion (P cream containing ginger and clotrimazole 1% was more effective and may be more useful than the clotrimazole to treat vaginal candidiasis.

  20. Vaginal radical trachelectomy: an update.

    Science.gov (United States)

    Plante, Marie

    2008-11-01

    The vaginal radical trachelectomy has emerged as a valuable fertility-preserving treatment option for young women with early-stage disease. Cancer-related infertility is associated with feelings of depression, grief, stress, and sexual dysfunction. Data have shown that the overall oncological outcome is safe and that the obstetrical outcome is promising. In this article, we analyze the data on the vaginal radical trachelectomy published over the last 10 years in the context of what we have learned, what issues remain unclear, and what the future holds.

  1. Foley Catheter versus Vaginal Misoprostol for Labour Induction

    Directory of Open Access Journals (Sweden)

    Nasreen Noor

    2015-01-01

    Full Text Available Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p<0.01. The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley’s catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

  2. 制霉菌素pH敏感型阴道用凝胶给药系统的优化及评价%Optimization and evaluation of a pH-sensitive in situ gel of nystatin for vaginal delivery system

    Institute of Scientific and Technical Information of China (English)

    胡晓; 胡容峰; 白中稳

    2013-01-01

    目的:制备制霉菌素pH敏感原位凝胶并对其进行评价.方法:以卡波姆用量、聚乙烯醇用量为自变量,凝胶黏度为应变量,采用星点设计-效应面法优化此系统.考察了凝胶的pH敏感性,并采用了改良桨法、透析袋法和无膜释放法同时评价制剂的体外释放.结果:优化处方为卡波姆用量0.655%,PVA用量1.213%.筛选的优化处方制剂满足阴道可注入性和体内胶凝性能.溶蚀与扩散是该制剂中药物释放的两种主要机制.结论:制霉菌素pH敏感原位凝胶有望成为一种新型阴道局部给药系统制剂.%Objective:To prepare and evaluate nystatin in situ pH-sensitive gel.Methods:The system was optimized by central composite design-response surface methodology.The amounts of carbopol and polyvinyl alcohol were employed as independent variables while the gel viscosity was chosen as dependent variable.The pH-sensitivity was determined,and its in vitro release of the preparation was evaluated by improved paddle method,dialysis bag method and membrane-less diffusion method.Results:The optimized formulation consisted of 0.655% carbopol and 1.213% polyvinyl alcohol.It met the requirements for the vaginal injectability and gelationability in vivo.Gel erosion and drug diffusion were the two principal mechanisms of drug release from in situ gel.Conclusion:Nystatin in situ pH-sensitive gel is expected to become a new formulation for vaginal drug delivery system.

  3. Effects of vaginal prolapse surgery and ageing on vaginal vascularization

    NARCIS (Netherlands)

    Weber, M.A.

    2016-01-01

    Ageing affects pelvic floor anatomy and function, resulting in several disorders like pelvic organ prolapse (POP), lower urinary tract symptoms and vaginal atrophy (VA). In this thesis we searched for methods to link the function of pelvic organs to physiological changes. The effects of POP and vagi

  4. Effects of epidural analgesia on maternal and infant by vaginal delivery%硬膜外分娩镇痛对经阴道分娩母婴影响的临床研究

    Institute of Scientific and Technical Information of China (English)

    杨絮; 杨泳; 吕国义

    2015-01-01

    目的:探讨硬膜外镇痛对经阴道分娩母婴的安全性和有效性,为临床大范围开展分娩镇痛提供参考依据。方法选取2013年5月至2013年8月非合并其他系统疾病及产科合并症、拟经阴道分娩足月临产孕妇60例,随机分为硬膜外镇痛( EA)组和非镇痛( NA)组,每组30例。入待产室常规监测两组孕妇无创测量血压( NBP)、心率( HR)、脉搏血氧饱和度( SpO2);胎儿娩出即刻采集脐静脉血作血气分析;新生儿出生后1、5、10 min行Apgar评分;记录各产程时间,是否使用缩宫素,宫口扩张至6~7 cm时VAS评分及Bromage评分,产后24 h内出血量,初乳始动时间,新生儿神经行为评分。结果两组孕妇一般资料比较差异未见统计学意义。EA组第一产程和第二产程较NA组延长( P均0.05);EA组新生儿生后1 min/5 min Apgar评分为9.2±0.7/9.2±0.6,低于NA组(9.6±0.5/9.6±0.5,P0.05)。结论本研究所采用硬膜外分娩镇痛方法效果确切,不影响产后泌乳过程,不增加产后出血,不影响产妇下肢活动,对经阴道分娩产妇无不良影响,未见有实际临床意义的新生儿不良影响,对新生儿安全,值得推广。%Objective To investigate the security and effectiveness of epidural analgegia on virginal delivery maternal-neo-nates,in order to provide basis for widely carrying out labor analgesia. Methods Sixty parturient cases in the term of maternal, scheduled for virginal delivery from May to August in 2013,who had no systemic diseases or obstetric complications,were ran-domly divided into epidural analgesia( EA)group and non-analgesia( NA)roup,with 30 cases in each group. In the two groups,gravida with labour signs were sent into labor room,and the values of noninvasive blood pressure( NBP),heart rate ( HR)and pulse oxygen saturation( SpO2 )were recorded. The umbilical venous blood was drawn for blood gas analysis at the

  5. A New Method to Measure Vaginal Sensibility

    NARCIS (Netherlands)

    Lakeman, M. M. E.; Laan, E.; Vaart, C. H.; Roovers, J. P.

    2010-01-01

    Introduction: Vaginal surgery may affect sexual function both positively and negatively. Possibly, negative consequences of surgical interventions on sexuality may be caused by reduced sensibility of the vaginal wall. Aims: To develop a new method to measure vaginal sensibility. Methods: We develope

  6. Atrophic vaginitis: signs, symptoms, and better outcomes.

    Science.gov (United States)

    Reimer, Annabelle; Johnson, Laura

    2011-01-01

    Atrophic vaginitis is a common finding in women with low estrogen states. Many women believe their symptoms are expected signs of aging. NPs can provide therapeutic options to improve vaginal health and quality of life. This article reviews physiology, clinical manifestations, signs, symptoms, and treatment methods for atrophic vaginitis.

  7. Bioadhesive drug delivery system of diltiazem hydrochloride for ...

    African Journals Online (AJOL)

    1Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, 3Department of ... (including oral/buccal, nasal, vaginal or rectal) ... membrane and drug delivery device for extended .... The time required for complete.

  8. Birth after previous cesarean delivery: short-term maternal outcomes.

    Science.gov (United States)

    Lydon-Rochelle, Mona T; Cahill, Alison G; Spong, Catherine Y

    2010-08-01

    An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.

  9. How do delivery mode and parity affect pelvic organ prolapse?

    Science.gov (United States)

    Yeniel, A Özgür; Ergenoglu, A Mete; Askar, Niyazi; Itil, Ismaıl Mete; Meseri, Reci

    2013-07-01

    To determine the association between mode of delivery, parity, and pelvic organ prolapse, as assessed by the pelvic organ prolapse quantification system. Cross-sectional study. Tertiary referral center, Turkey. A total of 1964 women with benign gynecological disorders who presented between October 2009 and July 2011. Evaluation using the pelvic organ prolapse quantification system and questionnaire assessing previous obstetrics and medical history. Difference in pelvic organ prolapse stages between nulliparous and multiparous women, impact of parity and mode of delivery. In the study population, 86.4, 7.2 and 6.4% had pelvic organ prolapse of stages 0-I, II, and III-IV, respectively, and 7.9% had significant prolapse beyond the hymen. The mean age, parity, and number of vaginal deliveries were significantly higher in the prolapse than in the non-prolapse group. Vaginal delivery was associated with an odds ratio of 2.92 (95% confidence interval 1.19-7.17) for prolapse when compared with nulliparity. Each vaginal delivery increased the risk of prolapse (odds ratio 1.23; 95% confidence interval 1.12-1.35) after controlling for all confounding factors. Cesarean delivery had no impact on the odds for prolapse. Vaginal delivery was an independent risk factor for prolapse, and additional vaginal deliveries significantly increased the risk. However, cesarean delivery had no effect on the development of prolapse in this material. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Optical clearing of vaginal tissues

    Science.gov (United States)

    Chang, Chun-Hung; Myers, Erinn M.; Kennelly, Michael J.; Fried, Nathaniel M.

    2017-02-01

    Near-IR laser energy in conjunction with applied tissue cooling is being investigated for thermal remodeling of endopelvic fascia during minimally invasive treatment of female stress urinary incontinence. Previous simulations of light transport, heat transfer, and tissue thermal damage have shown that a transvaginal approach is more feasible than a transurethral approach. However, undesirable thermal insult to vaginal wall was predicted. This study explores whether an optical clearing agent (OCA) can improve optical penetration depth and completely preserve vaginal wall during subsurface treatment of endopelvic fascia. Several OCA mixtures were tested, and 100% glycerol was found to be optimal. Optical transmission studies, optical coherence tomography, reflection spectroscopy, and computer simulations of thermal damage to tissue using glycerol were performed. The OCA produced a 61% increase in optical transmission through porcine vaginal wall at 37 °C after 30 min. Monte Carlo (MC) light transport, heat transfer, and Arrhenius integral thermal damage simulations were performed. MC model showed improved energy deposition in endopelvic fascia using OCA. Without OCA, 62, 37, and 1% of energy was deposited in vaginal wall, endopelvic fascia, and urethral wall, compared with 50, 49, and 1% with OCA. Use of OCA also yielded 0.5 mm increase in treatment depth, allowing potential thermal tissue remodeling at 3 mm depth.

  11. Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.

    Science.gov (United States)

    Kennedy, Holly P; Doig, Eleanor; Tillman, Stephanie; Strauss, Amanda; Williams, Beth; Pettker, Christian; Illuzzi, Jessica

    2016-12-01

    One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates. © 2016 Wiley Periodicals, Inc.

  12. Vaginal leiomyoma: MRI features with pathologic correlation

    Directory of Open Access Journals (Sweden)

    Avantika Gupta

    2015-06-01

    Full Text Available We present a rare case of vaginal leiomyoma presenting as prolapsed vaginal mass in a 45 years old woman. The leiomyoma was found to arise from the right lateral vaginal fornix with a vascular stalk. MRI showed homogenous hypointense signals on T1W1 and iso to hyperintense signals on T2W1 images with moderate heterogenous enhancement on post contrast images. It was enucleated via vaginal route and the histopathological examination confirmed the diagnosis of vaginal leiomyoma.

  13. A prediction model of vaginal birth after cesarean in the preterm period.

    Science.gov (United States)

    Mardy, Anne H; Ananth, Cande V; Grobman, William A; Gyamfi-Bannerman, Cynthia

    2016-10-01

    A validated model exists that predicts the probability of vaginal birth after cesarean delivery in patients at term who are undergoing a trial of labor after cesarean delivery. However, a model that predicts the success of a vaginal birth after cesarean delivery in the preterm period has not been developed. We sought to develop and validate a predictive model for vaginal birth after cesarean delivery for women undergoing a trial of labor after cesarean delivery during the preterm period. We performed a secondary analysis of a prospective cohort study designed to evaluate perinatal outcomes in women with a prior cesarean scar. We included women with 1 prior low transverse cesarean delivery undergoing a trial of labor after cesarean delivery with a vertex singleton pregnancy in the preterm period (26-36 weeks). Using multivariable logistic regression modeling, we constructed a predictive model for vaginal birth after cesarean delivery with information known at admission for preterm delivery. Using a 70% to 30% random split of the data, the model was developed in the training data and subsequently confirmed in the validation data. Predictions and area under the curve were based on a 10-fold cross-validated jackknife estimation and based on 1000 bootstrap resampling methods. The adequacy of all models was evaluated based on the Hosmer-Lemeshow goodness-of-fit test. One thousand two hundred ninety-five women met our criteria for analysis. The significant predictors of vaginal birth after cesarean delivery success were chronic hypertension, hypertensive disease of pregnancy (gestational hypertension or preeclampsia), prior vaginal delivery, dilation on cervical examination at admission, prior vaginal birth after cesarean delivery, a recurring indication in a prior cesarean delivery, and induction of labor as well as a 2-way interactions between dilation and hypertensive disease of pregnancy, dilation and diabetes mellitus (pregestational or gestational), and induction

  14. Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section

    DEFF Research Database (Denmark)

    Barfod, Mette Nelun; Christensen, Lisa Bøge; Twetman, Svante Henrik Agardh;

    2012-01-01

    OBJECTIVE: The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C...

  15. The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Vogel, Ida; Thorsen, Poul; Hogan, Vijaya K.

    2006-01-01

    Objective. To examine associations of vaginal Ureaplasma urealyticum (UU) and bacterial vaginosis (BV) with preterm delivery (PTD), small for gestational age (SGA), and low birth weight (LBW). Material and methods. A population-based, prospective cohort study of 2,927 pregnancies. After exclusion...

  16. Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2.

    Science.gov (United States)

    Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

    2011-12-01

    We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obstetric complications in these patients include miscarriages, stillbirths, premature rupture of the membranes, preterm labour, uterine prolapse, uterine rupture and severe postpartum haemorrhage. There has been much controversy over the appropriate mode of delivery. Abdominal deliveries are complicated by delayed wound healing and increased perioperative blood loss. Vaginal deliveries may be complicated by tissue friability causing extensive perineal tears, pelvic floor and bladder lesions. Our case highlights that in specific, controlled situations it is possible to have a vaginal delivery even after previous caesarean section in patients with EDS.

  17. The effect of maneuvers for shoulder delivery on perineal trauma

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Willert, Hanne; Krebs, Lone

    2016-01-01

    INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS: This was a rando......INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS......: This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as......-treated analysis. RESULTS: Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups...

  18. Risk of cesarean delivery among pregnant women with class III obesity.

    Science.gov (United States)

    Borghesi, Yves; Labreuche, Julien; Duhamel, Alain; Pigeyre, Marie; Deruelle, Philippe

    2017-02-01

    To identify factors associated with cesarean delivery among women with class III obesity attempting vaginal delivery. In a retrospective study, medical charts were reviewed for women aged 18 years or older with a singleton pregnancy of at least 37 weeks and a body mass index (calculated as weight in kilograms divided by the square of height in meters) of 40 or higher who were eligible to attempt vaginal delivery at a maternity hospital in Lille, France, between 1999 and 2012. Among 345 eligible women, 301 (87.2%) attempted vaginal delivery; 211 (70.1%) were successful and 90 (29.9%) delivered by cesarean. The frequency of nulliparity was higher among those undergoing cesarean after a trial of labor (64 [71.1%]) than among those who delivered vaginally (57 [27.0%]; Pcesarean (61 [67.8%] vs 96 [45.5%]; Pcesarean among women attempting vaginal delivery (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.25-4.22), whereas history of vaginal delivery was protective (OR 0.08, 95% CI 0.04-0.17). Nulliparous women with class III obesity attempting a vaginal delivery should be warned of the high risk of cesarean delivery, especially if they require induction. © 2016 International Federation of Gynecology and Obstetrics.

  19. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy.

    Science.gov (United States)

    Donders, G G; Van Calsteren, K; Bellen, G; Reybrouck, R; Van den Bosch, T; Riphagen, I; Van Lierde, S

    2009-09-01

    Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors. The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies. Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study. At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.12-0.56]. The absence of lactobacilli (AVF) was associated with increased risks of PTB (OR 2.4; 95% CI 1.2-4.8), EPTB (OR 6.2; 95% CI 2.7-14) and miscarriage (OR 4.9; 95% CI 1.4-17). BV was associated with increased risks of PTB (OR 2.4; 95% CI 1.1-4.7), EPTB (OR 5.3; 95% CI 2.1-12.9) and miscarriage (OR 6.6; 95% CI 2.1-20.9) and coccoid AV was associated with increased risks of EPTB (OR 3.2; 95% CI 1

  20. Antigonococcal effects of vaginal tampons.

    Science.gov (United States)

    Arko, R J; Wong, K H; Smith, S J; Finley-Price, K G

    1983-01-01

    Different brands of vaginal tampons varied significantly (p less than 0.0001) in their anti-bacterial effects when tested with 46 strains of Neisseria gonorrhoeae. Gonococcal strains recovered from patients with disseminated infections were substantially more sensitive to the anti-bacterial effects of tampons than were strains from patients with uncomplicated genital infections. Strains from patients with pelvic inflammatory disease were moderately sensitive. Tampons showing strong in-vitro antigonococcal effects were also generally effective in vivo in eliminating gonococcal infections from subcutaneous chambers in mice. Extracts of the Rely tampon showed no in-vitro antigonococcal effect, however, but did induce antibacterial activity when injected into subcutaneous chambers in mice. These results emphasise the importance of both in-vitro as well as in-vivo testing of tampon materials to elucidate more fully the nature of their antibacterial effects and their potential for affecting vaginal pathogens and disease processes. PMID:6403199

  1. [Cesarean section incidence and vaginal birth success rate at term pregnancy after myomectomy].

    Science.gov (United States)

    Mekiňová, L; Janků, P; Filipinská, E; Kadlecová, J; Ventruba, P

    To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn. Prospective, pilot, cohort study. Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno. Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation. Women from the study group (n = 67) underwent myomectomy because of symptomatic, solitary uterine fibroid. Women from the control group (n = 4079) had no history of myomectomy. Analysis was aimed at comparing the incidence of primary and acute CS and comparing success rate of vaginal delivery in both groups and determing the frequency of maternal complications and evaluation of post-partum condition of the newborn. A significantly higher incidence of primary cesarean section was observed in the study group with a history of myomectomy compared to the control group (n = 20, 29.9%; versus n = 396, 9.7 %, p cesarean section in both groups was recorded (n = 7, 10.4%; versus n = 570, 14.0%, p = 0.079). No statistically significant difference in the success of vaginal delivery in both groups was recorded (n = 40, 85.1%; versus n = 3113, 84.5%, p = 0.079). The excessive blood loss was the most frequent complication in both group (n = 9, 13.4%; versus n = 214, 5.2%, p = 0.057). No statistically significant difference in the incidence of uterine rupture and postpartum hysterectomy was recorded. No maternal or fetal death related to childbirth was observed. The history of myomectomy does not increase the incidence of acute cesarean section in the group of strictly selected patients suitable for vaginal birth and has no impact on the success of vaginal delivery. Careful management of labor is a prerequisite for a low risk of maternal complications and good perinatal outcomes.

  2. Vaginal Symptoms after Reconstructive Surgery for Prolapsed Pelvic Organ

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    Tahereh Eftekhar

    2010-09-01

    Full Text Available Objective: Pelvic organ prolapse is a common disorder in women over the world and its general treatment is surgery. Therefore it is important to consider if vaginal symptoms, quality of life and sexual function after surgery improve. The purpose of this study was to assess vaginal symptoms in women 3 months after surgery for pelvic organ prolapse.Materials and methods: In this study 50 eligible women were evaluated between March 2007 and May 2008. These women underwent physical examination for prolapse staging and medical status and completed the ICIQ–VS questionnaire pre– and post operation 3 months later.Results: Mean age was 44.86 (31–74 years and %72 were premenopausal. Vaginal symptoms, sexual function and quality of life scores improved in order (8.88 Vs 18.04, 17.16 Vs 34.48, 2.76 Vs 4.8, all P<0.05.Conclusion: Vaginal symptoms, sexual function and quality of life after surgery improved. It appears that in Iranian patients, the performance of reconstruction surgery alone results in satisfaction.

  3. Antifungal resistance in yeast vaginitis.

    Science.gov (United States)

    Dun, E.

    1999-01-01

    The increased number of vaginal yeast infections in the past few years has been a disturbing trend, and the scientific community has been searching for its etiology. Several theories have been put forth to explain the apparent increase. First, the recent widespread availability of low-dosage, azole-based over-the-counter antifungal medications for vaginal yeast infections encourages women to self-diagnose and treat, and women may be misdiagnosing themselves. Their vaginitis may be caused by bacteria, parasites or may be a symptom of another underlying health condition. As a result, they may be unnecessarily and chronically expose themselves to antifungal medications and encourage fungal resistance. Second, medical technology has increased the life span of seriously immune compromised individuals, yet these individuals are frequently plagued by opportunistic fungal infections. Long-term and intense azole-based antifungal treatment has been linked to an increase in resistant Candida and non-Candida species. Thus, the future of limiting antifungal resistance lies in identifying the factors promoting resistance and implementing policies to prevent it. PMID:10907778

  4. Outcome of Treatment of Anterior Vaginal Wall Prolapse and Stress Urinary Incontinence with Transobturator Tension-Free Vaginal Mesh (Prolift and Concomitant Tension-Free Vaginal Tape-Obturator

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    Sameh Azazy

    2008-12-01

    Full Text Available Objective. It is to assess the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift and concomitant tension-free vaginal tape-obturator (TVT-O system as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI. Patients and Methods. Between December 2006 and July 2007, 20 patients with anterior genital prolapse and voiding dysfunction were treated with the transobturator tension-free vaginal mesh (Prolift and concomitant tension-free vaginal tape-obturator (TVT-O. Sixteen patients had stress urinary incontinence and 4 patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. All patients underwent a complete urodynamic assessment. All the patients underwent pelvic examination 4–6 weeks after the operation, and anatomical and functional outcomes were recorded. Results. Twenty cystocoeles were repaired: 6 grade II, 12 grade III, and 2 grade IV. There were no vessel or bladder injuries. Eighteen patients had optimal anatomic results and 2 patients had persistent asymptomatic stage I prolapse. Conclusion. These preliminary results suggest that Prolift system offers a safe and effective treatment for female anterior vaginal wall prolapse. However, a long-term followup is necessary in order to support the good result maintenance.

  5. Vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy for enlarged myomatous uterus: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Fan Rong; Zhu Lan; Lang Jing-he; Shi Hong-hui; Gong Xiao-ming

    2011-01-01

    Objective:To compare the intraoperative condition and short-term outcomes of vaginal hysterectomy (VH) and laparoscopic assisted vaginal hysterectomy (LAVH) for enlarged myomatous uterus.Methods:Fifty patients from Peking Union Medical College Hospital (PUMCH) were randomly assigned to two treatment groups:VH (n=23) and LAVH (n=27).All procedures were performed by a single senior surgeon to maintain homogeneity.Results:The baseline characteristics of the two groups were comparable.The operative time for LAVH was significantly longer than for VH (76.7±23.2 vs.57.6±23.5 min,P<0.05),and LAVH costs more money than VH (6,923.07±622.96 vs.5,974.46±1,408.08 RMB,P<0.05).Major complications,uterine weight and the length of hospital stay were comparable between VH and LAVH group.One case of VH was converted to LAVH due to adhesion.Conclusions:Compared with LAVH,VH is a time- and cost-saving operative technique for enlarged myomatous uterus.VH should be the primary method for uterine removal,but LAVH may have advantages when adhesion is present.

  6. Lactobacillus for Vaginal Microflora Correction

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    Saule Saduakhasova

    2014-12-01

    Full Text Available Introduction. Despite the significant progress made in prevention, diagnosis, and treatment, there is still a high rate of vaginal dysbiosis in Kazakh women. The use of antibiotics in the treatment of vaginal dysbiosis contributes to the elimination of pathogens as well as microflora, which can lead to a decrease in local immunity and more favorable conditions for infection spread. The most physiologically safe and promising method for the restoration of vaginal biocenosis is the use of probiotics administered by a vaginal route.Methods. We have allocated 64 of cultures of Lactobacillus from the vaginal epithelium of healthy women of reproductive age and women with diagnosed bacterial vaginosis (BV. Identification of cultures was performed by PCR analysis of 16S ribosomal RNA.  Evaluation of biological significance was determined by the following criteria: high antagonistic activity against Candida albicans, Escherichia coli, Serratia marcescens, Proteus mirabilis, Klebsiella ozaenae, and Staphylococcus aureus; and production of hydrogen peroxide, resistance to antibiotics, adhesive activity. We studied the symbiotic relationship of selected biologically active of cultures to each other and received options for consortiums with  properties of  probiotics through co-cultivation.Results. Results of genotyping  showed that the isolated lactobacilli belong to the seven species: L. fermentum, L. salivarius, L. gasseri, L. crispatus, L. jensenii, L. plantarum, and L. delbrueskii. L. fermentum, L. salivarius, L. gasseri, and L. jensenii occur in women with suspected BV. The highest percentage of occurrence in the vagina of healthy women was L. fermentum (28%. Most strains of lactobacilli possess high inhibitory activity for all test-strains, except Candida albicans (37.5%. 56% of studied cultures revealed high adhesion to human erythrocytes. All lactobacillus strains were resistant to metronidazole, 80% to kanamycin, 57%  to vancomycin, and

  7. Concurrent chemoradiation for vaginal cancer.

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    David T Miyamoto

    Full Text Available BACKGROUND: It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT or concurrent chemoradiation therapy (CRT. METHODS: Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS and disease-free survival (DFS rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. RESULTS: The median age at diagnosis was 61 years (range, 18-92 years and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011. Twenty-three patients (45% in the RT group had a relapse at any site compared to 3 (15% in the CRT group (p = 0.027. With regard to the sites of first relapse, 10 patients (14% had local only, 4 (6% had local and regional, 9 (13% had regional only, 1 (1% had regional and distant, and 2 (3% had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04. CONCLUSIONS: Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

  8. Review of vaginal birth after primary caesarean section without prostaglandin induction and or syntocinon augmentation in labour.

    Science.gov (United States)

    Ogbonmwan, S E O; Miller, V; Ogbonmwan, D E; Akinsola, A A

    2010-04-01

    To show the results of vaginal birth after primary caesarean (VBAC) without using prostaglandin for induction and/or syntocinon augmentation are comparable when induction is done with these agents but without the added risks of uterine rupture. A review of the obstetric records of 16,498 parturient from 1 January 2001 to 31 December 2006 was carried out. The 229 cases of women who wanted VBAC were subjected to further analysis to determine the number of successful vaginal delivery after spontaneous onset of labour or membrane sweep. The instrumental vaginal delivery rate, analgesia commonly used and the complication rate were analysed. The result showed that 34.49% had spontaneous onset of labour, 27.07% laboured after membrane sweep and 38.42% had repeat urgent caesarean section as they failed to go into spontaneous labour. Of those who went into labour spontaneously or after membrane sweep, 67% had vaginal delivery, a further 13.97% had instrumental vaginal delivery and 16% had emergency caesarean section. There was no case of uterine rupture. VBAC can end successfully in a high proportion of cases without the use of prostaglandin or syntocinon for induction of labour and or syntocinon for augmentation in these women because of their associated increased relative risk of uterine rupture.

  9. 瘢痕子宫105例妊娠分娩方式的探讨%An investigation of patterns of delivery of women with scarred uterus pregnancy

    Institute of Scientific and Technical Information of China (English)

    马雨珊; 李芬

    2011-01-01

    目的 探讨瘢痕子宫再次妊娠分娩方式的选择.方法 选取铜川市人民医院2008年1月至2010年11月的瘢痕子宫临床资料共105例作为研究对象,根据研究目的分为阴道试产组28例和剖宫产组77例,选取同期经阴道试产分娩孕妇28例为阴道分娩对照组,组间进行比较,分析其子宫破裂风险大小、试产成功率、产后出血量、胎儿窘迫、新生儿窒息发生率,及经阴道成功分娩与前次手术指征的相关性.结果 ①阴道试产组试产成功率与阴道分娩对照组间比较差异无统计学意义(χ2=2.828,P>0.05);②阴道试产组与阴道分娩对照组比较出血量(t=1.058,P=0.296)、先兆子宫破裂(χ2=0.907,P=0.653)、胎儿窘迫(χ2=2.964,P=0.227)及新生儿窒息发生率(χ2=0.009,P=0.995)差异均无统计学意义;③阴道试产组成功分娩率与前次手术指征有一定相关性(相关系数=0.875,P=0.022).结论 瘢痕子宫再次妊娠后在一定条件下可阴道分娩,其先兆子宫破裂、试产成功率、产后出血量、胎儿窘迫及新生儿窒息发生率与对照组差异不大.只要严格掌握指征,部分瘢痕子宫产妇可安全经阴道分娩.%Objective To explore choices of delivery pattern of women with scarred uterus pregnancy. Methods The clinical data of 105 women with scarredly uterus pregnancy admitted to Tongchuan Municipal People' s Hospital of Shaanxi province in a period from January,2008 to November, 2010 were retrospectively analyzed (28 preganant women who tried to deliver vaginally were included in trial vaginal delivery group and 77 pregnant women who delivered by cesarean section were included in control group. Risk of uterine rupture, success rate of trial delivery, postpartum uterine hemorrhage amount, incidence rates of fetal distress and neonatal asphyxia, and relationship between successful vaginal delivery and indications of previous operation were analyzed and compared among the three groups

  10. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review.

    Science.gov (United States)

    Matsuhashi, Tomohiko; Nakanishi, Kazuho; Hamano, Eri; Kamoi, Seiryu; Takeshita, Toshiyuki

    2017-01-01

    Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

  11. Obstetrical approach in breech presentation delivery

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    G. Grgić

    2007-02-01

    Full Text Available Although it is accompanied by a higher number of intrapartal complications and a higher rate of prenatal mortality and morbidity the breech presentation is not considered to be an unfavourable presentation for delivery. However, delivery with the breech presentation requires a detailed and very careful approach in assessment of the way delivery is to be conducted and a serious approach of an obstetrician when making a final decision. This often results in a high rate of caesarean sections in certain institutions which has been up to 80-100% of all the breech presentations.The objective of this retrospective study was to establish incidence of deliveries of the breech presentations and to determine a way of completing delivery depending on a parity of mother and a condition of the newborn at delivery in the five-year period. The results have shown that breech presentation occurred in 4.69% of the total number of deliveries. There was no statistically significant difference in the way the delivery had been completed neither in the condition of newborns as a result of the way the delivery was completed. 50.75% of deliveries were completed with cesarean section and 49.25% of women delivered the breech presentation vaginally. An average Apgar score for those delivered vaginally was 8.05 and 7.52 for babies delivered naturally. Breech presentation requires a serious prepartal analysis of delivery factors based on which a significant number of deliveries can be conducted vaginally with a satisfactory condition of newborns at delivery.

  12. Vaginal rejuvenation using energy-based devices

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    Cheryl Karcher, MD

    2016-09-01

    Full Text Available Physiologic changes in a woman’s life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman’s quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.

  13. Dynamic Clinical Measurements of Voluntary Vaginal Contractions and Autonomic Vaginal Reflexes

    NARCIS (Netherlands)

    Broens, Paul M. A.; Spoelstra, Symen K.; Weijmar Schultz, Willibrord C. M.

    2014-01-01

    IntroductionThe vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists a

  14. A Simple Laparoscopic Procedure to Restore a Normal Vaginal Length After Colpohysterectomy With Large Upper Colpectomy for Cervical and/or Vaginal Neoplasia.

    Science.gov (United States)

    Leblanc, Eric; Bresson, Lucie; Merlot, Benjamin; Puga, Marco; Kridelka, Frederic; Tsunoda, Audrey; Narducci, Fabrice

    2016-01-01

    Colpohysterectomy is sometimes associated with a large upper colpectomy resulting in a shortened vagina, potentially impacting sexual function. We report on a preliminary experience of a laparoscopic colpoplasty to restore a normal vaginal length. Patients with shortened vaginas after a laparoscopic colpohysterectomy were considered for a laparoscopic modified Davydov's procedure to create a new vaginal vault using the peritoneum of the rectum and bladder. From 2010 to 2014, 8 patients were offered this procedure, after informed preoperative consent. Indications were 2 extensive recurrent vaginal intraepithelial neoplasias grade 3 and 6 radical hysterectomies for cervical cancer. Mean vaginal length before surgery was 3.8 cm (standard deviation, 1.6). Median operative time was 50 minutes (range, 45-90). Blood loss was minimal (50-100 mL). No perioperative complications occurred. Median vaginal length at discharge was 11.3 cm (range, 9-13). Sexual intercourse could be resumed around 10 weeks after surgery. At a median follow-up of 33.8 months (range, 2.4-51.3), 6 patients remained sexually active but 2 had stopped. Although this experience is small, this laparoscopic modified Davydov's procedure seems to be an effective procedure, adaptable to each patient's anatomy. If the initial postoperative regular self-dilatation is carefully observed, vaginal patency is durably restored and enables normal sexual function.

  15. Effects of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean delivery%全程连续性助产护理对剖宫产术后阴道分娩产妇产痛程度及产程的影响

    Institute of Scientific and Technical Information of China (English)

    陈志芳; 吴宏荷; 孙晓琴; 吴迎春; 刘华华

    2016-01-01

    Objective:To investigate the effect of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean(VBAC)delivery.Methods:A total of 1 12 pregnant women who preferred VBAC were randomly divided into the control group and the observation group,with 56 cases in each group.The control group was given conventional nursing at different phase of ges-tation,and the observation group was applied with continuity midwifery care.The condition of labor pain and anxiety were assessed by visual analog pain scale(VAS)and anxiety visual analog scale(VAS-A).The natural births rate,incidence of fetal distress,postpartum hemorrhage rate,amount of bleeding and duration of labor were observed and compared between two groups.Results:The VAS,VAS-A at 24 h after delivery and amount of bleeding were significant lower in the observation group than those of the control group(P 0.05).The duration of first stage of labor,second stage of labor and total stage of labor were significant shorter in the observation group than those of the controls(P <0.05 or P <0.01 ).Conclusion:The continuity of midwifery care is effective in impro-ving negative emotion and reducing the duration of labor and amount of bleeding in puerpera undergoing VBAC delivery.%目的:探讨全程连续性助产护理对剖宫产术后阴道分娩(VBAC)产妇产痛程度及产程的影响。方法:VBAC 产妇112例随机分为对照组和观察组,各56例。对照组采用常规阶段式护理,观察组采用全程连续性助产护理。采用视觉模拟疼痛量表(VAS)和视觉模拟焦虑量表(VAS-A)分别评估两组产痛和焦虑状况;比较两组自然分娩率、胎儿窘迫率、产后出血率、出血量,以及两组中自然分娩产妇的产程。结果:观察组产后24 h 的 VAS 评分、VAS-A 评分及产后出血量显著低于对照组(P <0.05或 P <0.01)。两组自然分娩率、出血率及胎儿窘迫率无显著差异(P >0

  16. Preliminary Outcomes of a New, Safe, Tension-free Vaginal Tape Trocar.