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Sample records for spontaneous vaginal deliveries

  1. Comparison of outcomes between operative vaginal deliveries and spontaneous vaginal deliveries in southeast Nigeria.

    Science.gov (United States)

    Lawani, Lucky O; Anozie, Okechukwu B; Ezeonu, Paul O; Iyoke, Chukwuemeka A

    2014-06-01

    To evaluate the incidence of, indications for, and outcome of operative vaginal deliveries compared with spontaneous vaginal deliveries in southeast Nigeria. A retrospective cohort study was conducted involving cases of operative vaginal delivery performed at Ebonyi State University Teaching Hospital over a 10-year period. Data on the procedures were abstracted from the operation notes of the medical records of parturients. An incidence of 4.7% (n = 461) was recorded. The most common indications for vacuum and forceps delivery were prolonged second stage of labor (44.9%) and poor maternal effort (27.8%). The only indication for destructive operation was intrauterine fetal death (3.7%). The risk ratio (RR) for hemorrhage/vulvar hematoma was 1.14 (95% confidence interval [CI], 0.53-2.48) for vacuum-assisted delivery and 5.49 (95% CI, 0.82-36.64) for forceps delivery. The RR for genital laceration was 1.21 (95% CI, 0.44-3.30) for vacuum-assisted delivery and 9.41 (95% CI, 1.33-66.65) for forceps delivery. The risk of fetal scalp bruises and caput succedaneum was higher for operative vaginal delivery than for spontaneous vaginal delivery, with no significant difference in maternal morbidity. The perinatal mortality rate was 0.9 per 1000 live births. Operative vaginal delivery by experienced healthcare providers is associated with good obstetric outcomes with minimal risk. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Symptoms of anal and urinary incontinence following cesarean section or spontaneous vaginal delivery.

    Science.gov (United States)

    Altman, Daniel; Ekström, Asa; Forsgren, Catharina; Nordenstam, Johan; Zetterström, Jan

    2007-11-01

    The objective of the study was to compare the prevalence of incontinence disorders in relation with spontaneous vaginal delivery or cesarean section. Two hundred women with spontaneous vaginal deliveries only were compared with 195 women with cesarean deliveries only 10 years after first delivery. When compared with cesarean section, vaginal delivery was associated with an increased frequency of stress urinary incontinence (P = .006) and an increased use of protective pads (P = .008) as well as an increased frequency of fecal urgency (P = .048) and gas incontinence (P = .01). At multivariate regression analysis, mode of delivery showed no significant association with incontinence symptoms other than an increased risk for flatus incontinence in women with a history of obstetric anal sphincter injury (odds ratio 3.1; 95% confidence interval, 1.5 to 8.9). Incontinence symptoms are more common following spontaneous vaginal delivery when compared with cesarean section 10 years after first delivery. However, cesarean section is not associated with a major reduction of anal and urinary incontinence.

  3. 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

  4. Maternal CD4+ microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section.

    Science.gov (United States)

    Buxmann, H; Reitter, A; Bapistella, S; Stürmer, M; Königs, C; Ackermann, H; Louwen, F; Bader, P; Schlößer, R L; Willasch, A M

    2016-07-01

    Maternal CD4+ cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. To evaluate maternal CD4+ cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4+ cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4+ cells (95% confidence interval (CI): 0.00-0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01-0.66% maternal cells (95% CI: -0.06-0.16; P=0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4+ cells in one (0.05%; 95% CI: -0.02-0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: -0.06-0.16; P=0.04). There was no MTCT in any of the newborns. In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4+ cell transfer to newborns compared to planned caesarean section. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Assisted Vaginal Delivery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Assisted Vaginal Delivery Home For Patients Search FAQs Assisted Vaginal Delivery ... Delivery FAQ192, February 2016 PDF Format Assisted Vaginal Delivery Labor, Delivery, and Postpartum Care What is assisted ...

  6. Functional MRI of the pelvic floor: postpartum changes of primiparous women after spontaneous vaginal delivery

    International Nuclear Information System (INIS)

    Lienemann, A.; Fischer, T.; Reiser, M.; Anthuber, C.

    2003-01-01

    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 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.) [de

  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. Vaginal delivery - discharge

    Science.gov (United States)

    Pregnancy - discharge after vaginal delivery ... return in: 4 to 9 weeks after your delivery if you're not breastfeeding 3 to 12 ... can start sexual activity around 6 weeks after delivery, if the discharge or lochia has stopped. Women ...

  9. Treatment of Parturition-Induced Rupture of Pubic Symphysis after Spontaneous Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    C. Gräf

    2014-01-01

    Full Text Available Parturition-induced rupture of pubic symphysis is an uncommon but severe complication of delivery. Characteristic symptoms are an immediate onset of suprapubic and/or sacroiliac pain within the first 24 hours postpartum, often accompanied by an audible crack. Diagnosis can be confirmed by imaging including X-ray, Magnet Resonance Imaging (MRI, and ultrasound. However, there is no consensus on the optimal therapy. Conservative treatment is predominantly used. It has been reported that, in cases of extreme symphyseal rupture with pelvic instability or persisting pain after conservative therapy, operative treatment achieves a successful outcome. In this report, we present a case of a twenty-year-old primigravida who developed suprapubic pain after a nonoperative vaginal birth with shoulder dystocia. A rupture of pubic symphysis with a gap of 60 mm was confirmed by means of X-ray and MRI. Simultaneously, other pelvic joint injuries could be excluded. Operative treatment by an open reduction and internal plate fixation yielded excellent results.

  10. [Operative vaginal deliveries training].

    Science.gov (United States)

    Dupuis, O

    2008-12-01

    The appropriate use of forceps, vacuums or spatulas facilitates the rapid delivery of foetuses faced with life-threatening situations. It also makes possible the relief of certain cases of prolonged second-stage labor. In France, operative vaginal delivery (OVD) accounts for approximately 10% of all births. OVD training aims to optimize maternal, as well as neonatal safety. It should enable trainees to indicate or contraindicate an OVD safely, as well as to choose the appropriate instrument, use it correctly, and master quality control principles. Traditional OVD training is confronted with both spatial and time-related limitations. Spatial constraints involve both the teacher and trainee who only have limited visual access to the pelvic canal, and the head of the foetus; the time constraint occurs whenever the OVD occurs in an emergency setting. These limitations have been further aggravated by new constraints: decreasing time dedicated to training (European safety rules prohibit work the day after night duty), increasing litigation, and constraints imposed by society. Training by means of simulation removes such limitations making it possible to both avoid exposing pregnant women to the hazards of traditional training, and adapt the training to the skills of each trainee. OVD training should include forceps, vacuums and the use of spatulas. The OVD skills of obstetricians should be audited regularly on both a personal and a confidential level. Such audits could be based on a method using a simulator. Prospective studies comparing traditional and simulation-based training should be encouraged.

  11. 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

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    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

  12. Instrumental vaginal delivery - an assessment of use in a tertiary ...

    African Journals Online (AJOL)

    Background: Majority of women in sub-Saharan Africa expect to achieve spontaneous vaginal delivery at the end of pregnancy. This is usually possible, but, a few women will receive one form of assistance or another (forceps or vacuum) to avert maternal or foetal morbidity or mortality. Training and research in instrumental ...

  13. TRIPLET GESTATION: Successfully planned vaginal delivery aided ...

    African Journals Online (AJOL)

    Intrapartum management and vaginal delivery of triplet gestation is of particular challenge to the obstetrician. It occurs more frequently of late due to the increase in the use of fertility therapies. We present three cases of triplet gestations with successful vaginal deliveries aided by the use of intrapartum ultrasound scan.

  14. 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....

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

    NARCIS (Netherlands)

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

    2016-01-01

    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 bladder dysfunction at a

  16. 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|info:eu-repo/dai/nl/375367292

    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

  17. Evaluation of risk factors in cesarean delivery among multiparous women with a history of vaginal delivery.

    Science.gov (United States)

    Derbent, Aysel Uysal; Karabulut, Aysun; Yıldırım, Melahat; Simavlı, Serap Aynur; Turhan, Nilgün Öztürk

    2012-01-01

    To predict the risk of cesarean delivery (CS) for multiparous women who have undergone previous vaginal delivery. A prospective observational study was performed, among multiparous pregnancies that were between 38 and 41 gestational weeks and had a singleton, vertex presentation fetus. Women's physical activity score, obstetric history, intrapartum and postpartum events were assessed. Multivariable logistic regression was used to explore risk factors associated with CS. Of the 245 total 83.7% had spontaneous labor and 16.3% were induced. Seventy-five percent of the induced women required CS, whereas only 19.5% of those with spontaneous labor required CS (pcesarean delivery among previously vaginally delivered women and maternal weight gain, physical activity score, cervical dilatation, and fetal weight are most accurate parameters in the prediction of the risk of CS delivery. Intrapartum CS has an increased risk of maternal morbidity.

  18. Pregnancy outcome and factors affecting vaginal delivery of twins at ...

    African Journals Online (AJOL)

    2012-12-13

    Dec 13, 2012 ... and strong aversion for caesarean delivery, vaginal delivery would be more acceptable. This study aims to determine the predictors of vaginal delivery in ... vaginal delivery or loss of more than 1000 ml of blood during caesarean section. Fetal presentations were determined using clinical examination and ...

  19. Episiotomy and increase in the risk of obstetric laceration in a subsequent vaginal delivery.

    Science.gov (United States)

    Alperin, Marianna; Krohn, Marijane A; Parviainen, Kristiina

    2008-06-01

    To examine whether episiotomy at first vaginal delivery increases the risk of spontaneous obstetric laceration in the subsequent delivery. A review was conducted of women with consecutive vaginal deliveries at Magee-Womens Hospital between 1995 and 2005, using the Magee Obstetrical Maternal and Infant database. The primary exposure of interest was episiotomy at first vaginal delivery. Multivariable polytomous logistic regression modeling of potential risk factors was used to estimate odds ratios (ORs) for obstetric laceration in the second vaginal delivery. A total of 6,052 patients were included, of whom 47.8% had episiotomy at first delivery. Spontaneous second-degree lacerations at the time of second delivery occurred in 51.3% of women with history of episiotomy at first delivery compared with 26.7% without history of episiotomy (Phistory of episiotomy at first delivery compared with 1.7% without history of episiotomy (Pdelivery after controlling for confounders. Based on these findings, for every four episiotomies not performed one second-degree laceration would be prevented. To prevent one severe laceration, performing 32 fewer episiotomies is required. Episiotomy at first vaginal delivery increases the risk of spontaneous obstetric laceration in the subsequent delivery. This finding should encourage obstetric providers to further restrict the use of episiotomy. II.

  20. 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

  1. Preactivated thiomers for vaginal drug delivery vehicles.

    Science.gov (United States)

    Friedl, Heike E; Dünnhaupt, Sarah; Waldner, Claudia; Bernkop-Schnürch, Andreas

    2013-10-01

    It was the purpose of this study to design and evaluate a chitosan derivative as mucoadhesive excipient for vaginal drug delivery systems. The chemical modification of chitosan was achieved by conjugation of thioglycolic acid (TGA) resulting in 1594 μmol thiol groups per gram of polymer followed by the linkage of mercaptonicotinic acid (MNA) to the immobilized thiol groups via disulfide bonding leading to 702 μmol ligand per gram of preactivated polymer. The mucoadhesive properties of these polymers within newly designed vaginal formulations (Chitosan-TGA and Chitosan-TGA-MNA) and commercially available vaginal formulations (Candibene®, Daktarin®, Dalacin®, GynoPevaryl®) were tested over a time period of 24 h via a mucoadhesion test system simulating vaginal conditions, tensile studies and mucus polymer interaction studies via viscosity measurements. Within the vaginal test system simulating vaginal in situ conditions, a 1.5-fold increase in mucoadhesion could be observed for preactivated thiomer formulations after 24 h in comparison to commercially available formulations. Similar results were achieved for tensile studies, as the chitosan-TGA-MNA containing formulation resulted in a 4.9-fold increase in total work of adhesion (TWA) in comparison to Candibene which showed the highest TWA value of all tested commercial formulations. Also in terms of rheology investigations of mucus/formulation mixtures, a 5.8-fold increase in dynamic viscosity for chitosan-TGA-MNA containing mixtures could be observed in comparison to the mucus-free control. In contrast, commercially available formulations achieved a maximum enhancement of 1.9-fold. These outcomes confirm that the newly developed polymer is a promising tool for vaginal drug delivery likely providing a prolonged vaginal residence time due to its comparatively high mucoadhesive properties. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    E-mail: ourgodreigns2004@yahoo.co.uk. Abstract. Background: Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. Materials and ...

  3. Vaginal delivery after one cesarean section

    Directory of Open Access Journals (Sweden)

    Bianca Totta Patrício

    2012-11-01

    Full Text Available ABSTRACT Objective: to identify the validity of trial of labor in women with second pregnancy and previous cesarean section, to observe vaginal deliverance and probable maternal and perinatal complications. Methods: prospective cohort study of labors (03/2010 - 03/2011. The dependent variables analyzed: vaginal delivery or cesarean section, puerperal and perinatal results complications. The control variables were: epidemiological data, previous maternal and perinatal history, maternal and fetal wellness, labor induction, weekly day and hour of labor, moment of information and birth justification to the patient. The statistical comparison used the chi-squared test with 5% significance and the program Statistical Package for Social Sciences. Results: significance in steady union and married women for cesareans sections, and single in vaginal births (p = 0.004; complete membranes were significant in cesareans sections and rupture of them to vaginal deliveries (p = 0,.001. There was a predominance of cesareans sections during 12:01 - 24:01 hours, and vaginal births from 00:01 - 6:00 hours (p = 0.036. There were no significant events in maternal and fetal complications. Newborns of c-sections were significantly heavier (p = 0.011; extra-uterine vital conditions of 1 and 5 minutes presented no difference between cesarean sections and vaginal births. Conclusion: the trial of labor in 80 patients with second pregnancy and one previous cesarean section avoided the second cesarean section in 42,5% in this patients. The results confirm that trial of labor should be stimulated to labor patients with second pregnancy and one previous cesarean section.

  4. Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery.

    Science.gov (United States)

    Wu, Erica; Kaimal, Anjali J; Houston, Kathryn; Yee, Lynn M; Nakagawa, Sanae; Kuppermann, Miriam

    2014-05-01

    We sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. We conducted a longitudinal study of mode of delivery preferences among women who were preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale). Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone. Copyright © 2014 Mosby, Inc. All rights reserved.

  5. Vaginal Birth After Cesarean Delivery: Deciding on a Trial of Labor After a Cesarean Delivery (TOLAC)

    Science.gov (United States)

    f AQ FREQUENTLY ASKED QUESTIONS FAQ070 LABOR, DELIVERY, AND POSTPARTUM CARE Vaginal Birth After Cesarean Delivery • What is a vaginal birth after cesarean delivery (VBAC)? • What is a trial of labor ...

  6. An audit of instrumental vaginal delivery in Aminu Kano Teaching ...

    African Journals Online (AJOL)

    Context: Operative vaginal delivery is used to shorten the second stage of labour. Objective: The aim of this study is to determine the incidence of instrumental vaginal deliveries in a large teaching hospital. Study design and setting: Descriptive study involving 354 women, who either had forceps or vacuum operative vaginal ...

  7. 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.

  8. 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.

  9. Vacuum Assisted Vaginal Deliveries in Sagamu | Adefuye | Nigerian ...

    African Journals Online (AJOL)

    A retrospective review of all cases of vacuum assisted vaginal deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2001 is presented. During the study period there were 4962 deliveries and assisted vaginal deliveries by vacuum was 223, giving an incidence of ...

  10. Pregnancy outcome and factors affecting vaginal delivery of twins at ...

    African Journals Online (AJOL)

    Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy. Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital ...

  11. The incidence and risk factors for retained placenta after vaginal delivery - a single center experience.

    Science.gov (United States)

    Ashwal, Eran; Melamed, Nir; Hiersch, Liran; Wiznitzer, Arnon; Yogev, Yariv; Peled, Yoav

    2014-12-01

    We aimed to determine the incidence and risk factors for retained placenta immediately after vaginal delivery in a single, university-affiliated tertiary center. A case-control study. Women who delivered vaginally and diagnosed with suspected retained placenta were compared to control group of women with spontaneous vaginal delivery with spontaneous non-complicated placental separation between the years 2007 and 2012. Eligibility was limited to singleton fetuses in vertex presentation with no history of more than one cesarean section, stillbirth or major fetal anomaly. Overall, 33,925 women delivered vaginally, of them, 491 (1.4%) underwent revision of uterine cavity due to suspected retained placenta. Women with retained placenta were characterized by a higher rate of previous cesarean section (OR 1.71, 95% CI 1.23-2.36), previous abortions, lower parity (OR 0.79, 95% CI 0.68-0.91), lower gestational age at delivery. Hypertensive disorders, oligohydramnios and labor and delivery interventions as induction of labor (OR 1.84, 95% CI 1.30-2.59), neuro-axial analgesia (OR 1.60, 95% CI 1.27-2.00) and vacuum delivery (OR 1.89, 95% CI 1.48-2.41) were independently associated with uterine revision for retained placenta. Risk factors for manual revision due to retained placenta can be recognized. This data should be taken into consideration in the assessment of women immediately after delivery.

  12. Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery.

    Science.gov (United States)

    Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Ofek Shlomai, Noa; Porat, Shay

    2018-02-24

    Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score cesarean group compared with those delivered by the vaginal route alone. Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations.

    Science.gov (United States)

    Lappen, Justin R; Hackney, David N; Bailit, Jennifer L

    2016-10-01

    The prevailing obstetric practice of planned cesarean delivery for triplet gestations is largely empiric and data on the optimal route of delivery are limited. The primary objectives of this study are to determine the likelihood of success in an attempted vaginal delivery and assess maternal and neonatal outcomes of attempted vaginal vs planned cesarean delivery of triplets using a multiinstitution obstetric cohort. We performed a retrospective cohort study using data from the Consortium on Safe Labor, identifying triplet pregnancies with delivery at a gestational age ≥28 weeks. Women with a history of cesarean delivery and pregnancies complicated by chromosomal or congenital anomalies, twin-twin transfusion syndrome, or a fetal demise were excluded. The attempted vaginal group included all women with spontaneous or induced labor and excluded all women delivering by prelabor cesarean delivery, including those coded as elective or for fetal malpresentation. Primary maternal outcomes included infection (composite of chorioamnionitis, endometritis, wound separation, and wound infection), blood transfusion, or transfer to the intensive care unit. Primary neonatal outcomes included neonatal asphyxia, mechanical ventilation, and composite neonatal morbidity, consisting of ≥1 of the following: birth injury, 5-minute Apgar delivery group was restricted to include only women with evidence of induction or augmentation or labor. 188 triplet sets were identified of which 80 sets (240 neonates) met inclusion criteria and 24 sets (30%) had an attempted vaginal delivery. The rate of successful attempted vaginal delivery was 16.7% (4 triplet sets; 12 neonates). No women had a combined mode of delivery. Women attempting vaginal delivery were more likely to have preterm labor (45.8 vs 12.5%, P delivery did not differ by mode of delivery. Attempted vaginal delivery was associated with a higher risk of maternal transfusion (20.8% vs 3.6%, P = .01) and neonatal mechanical

  14. Outcomes of Operative Vaginal Delivery during Trial of Labor after Cesarean Delivery.

    Science.gov (United States)

    Brock, Clifton O; Govindappagari, Shravya; Gyamfi-Bannerman, Cynthia

    2017-07-01

    Objective  The objective of this study is to determine the maternal and neonatal morbidity associated with attempting operative vaginal delivery (OVD) compared with the alternative of a laboring repeat cesarean delivery (LRCD) in women attempting a trial of labor after cesarean delivery (TOLAC). Methods  This is a secondary analysis of a multicenter prospective study designed to assess perinatal outcomes of OVD in women with a prior uterine scar. The study includes women who attempted TOLAC and reached +2 station with a fully dilated cervix. Composites on neonatal and maternal morbidity were compared between women in whom OVD was attempted and those who underwent LRCD by fitting multivariate logistic regression models. Results  In total, 6,489 women attempting TOLAC reached 2+ station with a fully dilated cervix. Of these, 5,640 (86.9%) had a spontaneous vaginal delivery, 762 (11.7%) underwent attempted OVD, and 87 (1.3%) had an LRCD. Compared with attempting OVD, LRCD was associated with greater neonatal morbidity (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.13-5.15) and less maternal morbidity (OR: 0.28; 95% CI: 0.14-0.55). Maternal morbidity of OVD is driven by perineal injury. Conclusion  In laboring women with a previous uterine scar, attempting OVD is associated with greater maternal and less neonatal morbidity than LRCD. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Persistent Pain After Cesarean Delivery and Vaginal Delivery: A Prospective Cohort Study.

    Science.gov (United States)

    Kainu, J Petter; Halmesmäki, Erja; Korttila, Kari T; Sarvela, P Johanna

    2016-12-01

    Persistent pain after cesarean delivery and vaginal delivery has been the subject of only a few research articles. The primary outcome of our prospective study was the incidence of persistent pain and its association to mode of delivery. We also studied the nature and intensity of pain after delivery. A questionnaire was distributed on postpartum day 2 to 1052 women who had given birth vaginally and to 502 who had undergone cesarean delivery in a tertiary maternity hospital in Helsinki, Finland, in 2010. A second questionnaire was mailed to the women 1 year later. We recorded the women's health history, obstetric history and previous pain history, details of cesarean delivery or vaginal delivery, and description of pain, if present. The incidence of persistent pain at 1 year after delivery was greater after cesarean delivery (85/379 [22%]) than after vaginal delivery (58/713 [8%]: P delivery as a predictor of persistent pain. The incidence of persistent pain graded as moderate or more severe (25/379 [7%] vs 25/713 [4%]: P = .022, relative risk 1.9, 95% confidence interval 1.1-3.2) was also greater after cesarean delivery than vaginal delivery. The incidence of persistent pain was significantly more common in women with a history of previous pain and among primiparous women in logistic regression analysis. The women with persistent pain had experienced more pain the day after cesarean delivery (P = .023) and during vaginal delivery (P = .030) than those who did not report persistent pain. Complications such as perineal trauma, episiotomy, vacuum extraction, endometritis, wound infection, or ante- or postpartum depression did not predispose women to persistent pain. Dyspareunia was reported by 41% of women after vaginal delivery and by 2% after cesarean delivery among women with persistent pain at 1 year. The incidence of persistent pain at 1 year is greater after cesarean delivery than after vaginal delivery. Pain shortly after cesarean delivery and during vaginal

  16. Vaginal drug delivery systems: A Review of Current Status | Dobaria ...

    African Journals Online (AJOL)

    Among the various routes of drug delivery, the vaginal route offers many advantages due to its large permeation area, rich vascularization, avoidance of first pass metabolism and relatively low enzymatic activity. Several studies have shown that the vaginal cavity is an effective route for drug administration intended mainly ...

  17. RANDOMIZED TRIAL OF CESAREAN VERSUS VAGINAL DELIVERY FOR EFFECTS ON THE PELVIC FLOOR IN SQUIRREL MONKEYS

    Science.gov (United States)

    LINDO, Fiona M.; CARR, Emily S.; REYES, Michelle; GENDRON, Jilene M.; (R), RT; RUIZ, Julio C.; PARKS, Virginia L.; KUEHL, Thomas J.; LARSEN, Wilma I.

    2016-01-01

    Objectives Vaginal delivery is a risk factor in pelvic floor disorders. We previously described changes in the pelvic floor associated with pregnancy and parturition in the squirrel monkey, a species with a human-like pattern of spontaneous age and parity associated pelvic organ prolapse. The potential to prevent or diminish these changes with scheduled cesarean section has not been evaluated. In a randomized, controlled trial, we compare female squirrel monkeys undergoing spontaneous vaginal delivery with those undergoing scheduled primary cesarean section for pelvic floor muscle volumes, muscle contrast changes, and dynamic effects on bladder neck position. Study Design Levator ani, obturator internus, and coccygeus muscle volumes and contrast uptake were assessed by magnetic resonance imaging in 20 nulliparous females examined prior to pregnancy, a few days after delivery, and 3 months post-partum. The position of bladder neck relative to boney reference line also was assessed with abdominal pressure using dynamic magnetic resonance imaging. Results Baseline measurements of 10 females randomly assigned to scheduled primary cesarean sections were not different from those of 10 females assigned to spontaneous vaginal delivery. Levator ani and obturator internus muscle volumes did not differ between groups, while volumes were reduced (p pelvic support of the bladder was not protected by this intervention suggesting that effects of pregnancy and delivery are not uniformly prevented by this procedure. PMID:26366665

  18. 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

  19. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Operative vaginal deliveries in Zaria, Nigeria | Adaji | Annals of ...

    African Journals Online (AJOL)

    Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common ...

  2. Impact of epidural analgesia on cesarean and operative vaginal delivery rates classified by the Ten Groups Classification System.

    Science.gov (United States)

    Lucovnik, M; Blajic, I; Verdenik, I; Mirkovic, T; Stopar Pintaric, T

    2018-05-01

    The Ten Group Classification System (TGCS) allows critical analysis according to the obstetric characteristics of women in labor: singleton or multiple pregnancy, nulliparous, multiparous, or multiparous with a previous cesarean delivery, cephalic, breech presentation or other malpresentation, spontaneous or induced labor, and term or preterm births. Labor outcomes associated with epidural analgesia may be different among the different labor classification groups. The aim of this study was to explore associations between epidural analgesia and cesarean delivery, and epidural analgesia and assisted vaginal delivery, in women classified using the TGCS. Slovenian National Perinatal Information System data for the period 2007-2014 were analyzed. All women after spontaneous onset or induction of labor were classified according to the TGCS, within which cesarean and vaginal assisted delivery rates were investigated (P cesarean delivery rates. Women in group 1 (nulliparous term women with singleton fetuses in cephalic presentation in spontaneous labor) with epidural analgesia had a higher cesarean delivery rate. In most TGCS groups women with epidural analgesia had higher assisted vaginal delivery rates. Epidural analgesia is associated with different effects on cesarean delivery and assisted vaginal delivery rates in different TGCS groups. Copyright © 2018. Published by Elsevier Ltd.

  3. ANAL INCONTINENCE AFTER UNRECOGNISED ANAL SPHINCTER TEAR AT VAGINAL DELIVERY

    Directory of Open Access Journals (Sweden)

    Mija Blaganje

    2018-02-01

    Full Text Available Background: Anal sphincter tears during vaginal delivery may result in serious sequel. Anal sphincter tears occur in approximately 2–19 % of all vaginal deliveries and are the most common precursor for faecal incontinence,1 however »occult« anal sphincter injury has been defined in 33 % of primiparous women following vaginal delivery.2 Methods: 31-year old primiparous woman received transfusion due to atony after delivery. Episiotomy, second degree perineal tear and vaginal tear were surgically corrected immediately after delivery. In the following days inability to control passing of liquid stools and flatulence together with stress urinary incontinence appeared. The complaint persisted. Ultrasound and EMG examination confirmed rupture of the external anal sphincter, which had been missed at delivery. Over a year after delivery the patient had a posterior colporraphy with surgical correction of external anal sphincter, which did not result in any clinical improve- ment. On follow-up ultrasound examination a hypoechoegenic area between the external sphincter and vaginal wall was detected. The patient was referred to The University Hos- pital in Graz, where the tear will be treated with autologous myoblast transplantation in a clinical trial. Conclusions: Treatment of a missed anal sphincter tear is complicated, expensive and unpleasant for the patient. Early detection with immediate appropriate surgical correction after delivery is most efficient, but it takes experience.

  4. Defibulation during vaginal delivery for women with type III female genital mutilation.

    Science.gov (United States)

    Rouzi, Abdulrahim A; Al-Sibiani, Sharifa A; Al-Mansouri, Nisma M; Al-Sinani, Nawal S; Al-Jahdali, Eetedal A; Darhouse, Khalid

    2012-07-01

    To assess the routine practice of defibulation during vaginal delivery for women who have undergone female genital mutilation or cutting. A case-control study was conducted on women from Sudan, Somalia, Ethiopia, Egypt, and Yemen who delivered at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 1, 2000, to November 30, 2011. Women who had defibulation were identified, and their records were examined. For each woman who had defibulation, a woman from the same nationality who delivered without defibulation on the same day or the next days was chosen as a control. Data collected included demographics, mode of delivery, blood loss, intraoperative and postoperative complications, and labor outcome. During the study period, 388 women underwent defibulation during vaginal delivery. Women who did not have defibulation were chosen as a control group (n=388). In the defibulation group, 300 (77.3%) women were registered during pregnancy; 88 (22.7%) women were unregistered. Defibulation during vaginal delivery was successfully performed by residents and senior residents under the care of the attending on call. No cesarean delivery was performed because of female genital mutilation or cutting, and no spontaneous rupture of the scar occurred. There were no statistically significant differences between women who had defibulation with those who did not or between infibulated registered and unregistered women in the duration of labor, episiotomy rates, blood loss, Apgar score, or fetal birth weight. Defibulation during vaginal delivery is a valid management option. Labor attendants should be trained to perform it.

  5. Risk factors for cesarean delivery in primigravida during spontaneous labor

    International Nuclear Information System (INIS)

    Hc, C.; Yahya, M.S.; Mooi, C.S.

    2015-01-01

    Objective: To identify the risk factors for cesarean delivery among primigravida at Hospital Serdang. Methodology: This was a case control study which involved total 260 of 130 primigravida patients that underwent cesarean section (cases) and 130 primigravida patients that underwent vaginal delivery (control) at obstetrics and gynaecology department of Hospital Serdang, Malaysia from January until June 2013. A standardized proforma was used to collect the data of each primigravida patient presenting in spontaneous labour at term with singleton pregnancy with either caesarean or vaginal delivery. Results: Majority of the cases were Malaysian (86.9%) and mostly were from Malay ethnic group (75.4%). In multivariate logistic regression analysis, presence of hypertension status (odds ratio (OR) 5.7, 95% CI; 1.56-20.84) and gestational age less than 40 weeks (OR 2.60, 95% CI 1.34-5.02), fetal weight more than 3000 gm (OR 1.8, 95% CI 1.1-2.95), were associated with higher odds of cesarean delivery. Conclusion: Primigravida with presence of hypertension, having gestational age less than 40 weeks and heavier fetus were associated with higher odds of cesarean delivery. (author)

  6. 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.

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

    Science.gov (United States)

    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.

  8. factors influencing the use of episiotomy during vaginal delivery in ...

    African Journals Online (AJOL)

    2008-05-05

    May 5, 2008 ... extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased .... 3. argentine Episiotomy trial collaborative Group. routine versus selective episiotomy: a randomised controlled trial. Lancet. 1993 ...

  9. Instrumental vaginal deliveries at the University of Maiduguri ...

    African Journals Online (AJOL)

    Conclusions: Training of resident doctors and other medical staff in charge of deliveries and the use of less traumatic devices are essential in the effort to promote the correct use of the instrument and the avoidance of complications. Keywords: vacuum, forceps, instrumental Vaginal delivery. Tropical Journal of Obstetrics ...

  10. The intelligence quotient of school aged children delivered by cesarean section and vaginal delivery

    Science.gov (United States)

    Khadem, Nayereh; Khadivzadeh, Talaat

    2010-01-01

    BACKGROUND: There has always been an asking question with physicians and health staff whether delivery mode can effect on child intelligence. This study was conducted to compare the intelligence quotient (IQ) of school aged children delivered by cesarean section and vaginal delivery in Mashhad, Iran. METHODS: This study conducted in two stages; a cross-sectional section in which 5000 randomly selected children, who were 6-7 years old, attended at 10 Cognitive Examination Posts in Mashhad. The examination was performed by the Exceptional Education and Training Institute affiliated to Ministry of Education for all 6-7 years old children at the entry to the primary school. At the second stage, we selected two matched groups of 189 children who delivered by cesarean section or spontaneous vaginal delivery and then compared their IQ scores. RESULTS: The cesarean delivery group had significantly higher IQ test scores. Maternal and paternal educational levels were related to children’s IQ scores. After adjusting of maternal and paternal education, maternal age and parity, there was not any significant difference between IQ scores of cesarean delivery and natural vaginal delivery groups 101(3.67) vs. 100.7(4.28). CONCLUSIONS: Based on our findings, the association between cesarean deliveries with better cognitive development in children cannot be supported. PMID:21589777

  11. Sexual satisfaction after child birth: vaginal versus elective cesarean delivery

    OpenAIRE

    Hantoushzadeh S; Shariat M; Rahimi Foroushani A; Ramezanzadeh F; Masoumi M

    2009-01-01

    "nBackground: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication) makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. "nMethods: A cohort study was conducted on 303 primi...

  12. Vaginal rings for delivery of HIV microbicides

    Directory of Open Access Journals (Sweden)

    McCoy CF

    2012-11-01

    Full Text Available R Karl Malcolm, Susan M Fetherston, Clare F McCoy, Peter Boyd, Ian MajorSchool of Pharmacy, Queen's University Belfast, Belfast, UKAbstract: Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing.Keywords: controlled release, sustained release, antiretroviral, dapivirine, SILCS diaphragm, silicone elastomer, thermoplastic

  13. Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women

    OpenAIRE

    Maja Milosavljevic; Dusica Lecic Tosevski; Ivan Soldatovic; Olivera Vukovic; Cedo Miljevic; Amir Peljto; Milutin Kostic; Miranda Olff

    2016-01-01

    Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women we...

  14. Sexual satisfaction after child birth: vaginal versus elective cesarean delivery

    Directory of Open Access Journals (Sweden)

    Hantoushzadeh S

    2009-03-01

    Full Text Available "nBackground: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. "nMethods: A cohort study was conducted on 303 primiparous women who had delivered vaginaly and 315 primiparous delivered by elective cesarean section in seven private hospitals in Tehran, employing data of demographic characteristics like age, education, BMI, obstetric history (weight gain in pregnancy, history of pelvic pain and vaginal discharge, stress incontinence history (prepregnancy and during pregnancy and effect of delivery on sexual satisfaction in several follow-ups until 12 months after delivery. "nResults: Sexual satisfaction after delivery in vaginal group was significantly more than cesarean group. (76% vs 60%, p<0.0001. There was no relation between pelvic pain & delivery type (in several follow- up. "nConclusions: Instead of social conception of have more sexual satisfaction after cesarean delivery, outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. Therefore Request of cesarean section by mother for having more sexual satisfaction after childbirth is not logic.

  15. Efforts to promote vaginal delivery after a previous cesarean section.

    Science.gov (United States)

    Hamai, Yoko; Imanishi, Yukio

    2012-01-01

    The aim of this study was to examine the results of vaginal delivery in patients with a past history of cesarean section. The type of delivery, interventions during delivery, and the prognoses of the mothers and babies were examined in 145 women with a history of cesarean section over the 10-year period from January 2000 to December 2009. A scheduled cesarean section was performed in 27 cases. Vaginal delivery was recommended in 118 cases and the success rate was 94.9% (112/118). Uterine rupture was observed in one patient who experienced a natural rupture at home and whose previous cesarean section was an inverse T incision. No cases required a blood transfusion or hysterectomy. The prognoses of both mothers and babies were good and the vaginal delivery success rate was 94.9%. Uterine rupture was observed in one case. Vaginal delivery with previous cesarean section should be considered in cases with expectation and informed consent. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  16. The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference?

    Science.gov (United States)

    van Brummen, Henriette Jorien; Bruinse, Hein W; van de Pol, Geerte; Heintz, A Peter M; van der Vaart, C Huub

    2007-02-01

    A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI

  17. Successful Vaginal Delivery in Spite of a Large Pelvic Neurofibroma

    Directory of Open Access Journals (Sweden)

    Hüseyin Levent Keskin

    2010-08-01

    If not otherwise fetally or maternally indicated, initiation of labor and the course of labor should be observed and vaginal delivery should be attempted for the pregnant has a pelvic neurofibroma, before a decision for cesarean section is made.

  18. Human Papillomavirus Infection as a Possible Cause of Spontaneous Abortion and Spontaneous Preterm Delivery

    DEFF Research Database (Denmark)

    Ambühl, Lea Maria Margareta; Baandrup, Ulrik; Dybkær, Karen

    2016-01-01

    , and 10.9% (95% CI; 10.1–11.7) for umbilical cord blood. Summary estimates for HPV prevalence of spontaneous abortions and spontaneous preterm deliveries, in cervix (spontaneous abortions: 24.5%, and pretermdeliveries: 47%, resp.) and placenta (spontaneous abortions: 24.9%, and preterm deliveries: 50......%, resp.), were identified to be higher compared to normal full-term pregnancies (푃 spontaneous abortion, spontaneous preterm...

  19. 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

  20. Retention of Vaginal Breech Delivery Skills Taught in Simulation.

    Science.gov (United States)

    Stone, Heather; Crane, Joan; Johnston, Kathy; Craig, Catherine

    2018-02-01

    The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents' subjective comfort level to perform this skill clinically was assessed. This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval. Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  1. 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.

  2. Fracture of maternal sternum during spontaneous delivery.

    Science.gov (United States)

    Stubert, J; Gerber, B

    2009-12-01

    We report of a maternal sternal fracture during a spontaneous delivery in a 31-year-old primipara without a suitable trauma. The putative mechanism of fracture was strong hyperflexion of the thoracic spine and additional cervical flexion with pushing the chin to the thorax due to active management of labour. The history of the healthy woman was free of related risk factors. A possible promoting factor might be pregnancy-induced bone loss. Although there were clear symptoms, the diagnosis of the fracture was delayed by a week because nobody took account of such a possibility.

  3. Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients.

    Science.gov (United States)

    Lee, Hyun Joo; Jeon, Gyeong Sik; Kim, Man Deuk; Kim, Sang Heum; Lee, Jong Tae; Choi, Min Jeong

    2013-01-01

    To evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery. A retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24-46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention. The technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women. The cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  4. 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

    2018-03-01

    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 shoulder dystocia, the risk of 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.

  5. Vaginal delivery to reduce the risk of hypothermia to newborn

    Science.gov (United States)

    Zulala, Nuli Nuryanti; Sitaresmi, Mei Neni; Sulistyaningsih

    2017-08-01

    The prevalence of hypothermia in the world is in the range of 8.5% to 52%, while in Indonesia it is around 47%. Hypothermia has caused 6.3% of neonatal deaths. The method in the process of giving birth determines the way to take care of the newborn. This study aims to observe the effect of the method of delivery on the hypothermia in newborn. This research has obtained an approval from the Ethics Committee of Aisyiyah University, Yogyakarta. This prospective cohort study was conducted to 74 newborns in November 2016. The research subjects were divided into the group of Caesarian section (n = 28) and the group of vaginal delivery (n = 46). Axillary temperature was measured using a digital thermometer at 1st minute, 30th minute, 60th minute, 6th hour, 12th hour and 24th hour. The average temperature difference between the caesarian section group and vaginal delivery group at the 1st minute was at 36°C vs. 36.4° C, at 30th minute at 35.7°C vs. 36.5°C, at 60th minute at 36°C vs. 36.5°C), at 6th hour at 36.2 °C vs. 36.6°C), 12th hour at 36.4°C vs. 36.7°C, and at 24th hour at 36.7°C vs. 36.8°C. The results of the study showed that vaginal delivery could reduce the risk of hypothermia by 1.5 times compared to caesarian section (ρ-value 0.004 CI 95% 1.154 to 1.880)

  6. Failed manual removal of the placenta after vaginal delivery

    DEFF Research Database (Denmark)

    Bjurström, Johanna; Collins, Sally; Langhoff-Roos, Jens

    2018-01-01

    and the UK provide examples of various treatment strategies such as ultrasound-guided vaginal removal, removal of the placenta through a hysterotomy and just leaving the placenta in situ. The placentas were all retained, but it was only possible to diagnose abnormal invasion in the one case, which had......PURPOSE: A retained placenta after vaginal delivery where manual removal of placenta fails is a clinical challenge. We present six cases that illustrate the heterogeneity of the condition and discuss the etiology and terminology as well as the clinical management. METHODS: Members of the European...... a histopathological diagnosis of increta. Based on these cases we present a flow chart to aid clinical management for future cases. CONCLUSION: We need properly defined stringent terminology for the different types of retained placenta, as well as improved tools to predict and diagnose both abnormally invasive...

  7. 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.

  8. Pelvic floor disorders following vaginal or cesarean delivery.

    Science.gov (United States)

    Memon, Hafsa; Handa, Victoria L

    2012-10-01

    Pelvic floor disorders affect women of all ages and are associated with significant economic burden and poor quality of life. Current literature suggests an association between childbirth and these disorders. In this review, we summarize recent advancements in our understanding of this association. Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse. There is less evidence to suggest an association between vaginal delivery and overactive bladder symptoms. History of more than one perineal laceration increases the likelihood of developing prolapse. Similar association has not been established for episiotomy. Disruption or denervation of structural components of pelvic floor support system, particularly levator ani muscle complex, is associated with later development of pelvic floor disorders. Imbalance in homeostasis of connective tissue remodeling of the vaginal wall from overstretching during childbirth is another possible mechanism. Pelvic floor disorders represent a significant health problem affecting women of all ages. Identification of potential modifiable risk factors and advancement in understanding of the underlying pathophysiology is crucial for primary and secondary prevention of these disorders and for improvement in treatment strategies.

  9. 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.

  10. Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women.

    Science.gov (United States)

    Milosavljevic, Maja; Lecic Tosevski, Dusica; Soldatovic, Ivan; Vukovic, Olivera; Miljevic, Cedo; Peljto, Amir; Kostic, Milutin; Olff, Miranda

    2016-06-08

    Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women were assessed for PTSD using the gold standard interview for PTSD, Clinician-Administered PTSD Scale (CAPS). Risk factors were assessed including sociodemographic variables, personal medical history and clinical variables. After the first month, 2.4% women had acute full PTSD and another 9.5% had clinically significant level of PTSD symptoms. Following the second and the third month, partial PTSD was found in 5.9% and 1.3% of the women, respectively, and none of participants had full PTSD. Obstetrical interventions were the only significant risk factor for the development of PTSD. Symptoms of postpartum PTSD are not rare after a traumatic delivery, and associated with specific obstetrical risk factors. Awareness of these risk factors may stimulate interventions to prevent this important and neglected postpartum disorder.

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

    Science.gov (United States)

    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

  12. 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.

  13. Self-emulsifying drug delivery systems: Design of a novel vaginal delivery system for curcumin.

    Science.gov (United States)

    Köllner, S; Nardin, I; Markt, R; Griesser, J; Prüfert, F; Bernkop-Schnürch, A

    2017-06-01

    The aim of this study was to develop a vaginal self-emulsifying delivery system for curcumin being capable of spreading, of permeating the mucus gel layer and of protecting the drug being incorporated in oily nanodroplets towards mucus interactions and immobilization. The emulsifying properties of curcumin loaded SEDDS containing 30% Cremophor RH40, 20% Capmul PG-8, 30% Captex 300, 10% DMSO and 10% tetraglycol (SEDD formulation A) as well as 25% PEG 200, 35% Cremophor RH40, 20% Captex 355, 10% Caprylic acid and 10% Tween 80 (SEDD formulation B) after diluting 1+2 with artificial vaginal fluid were characterized regarding droplet size and zeta potential. Collagen swelling test was used to examine the irritation potential of SEDDS. Additionally to mucus binding studies, permeation studies in the mucus were performed. Furthermore, spreading potential of the novel developed formulations was compared with a commercial available o/w cream (non-ionic hydrophilic cream) on vaginal mucosa. SEDDS displayed a mean droplet size between 38 and 141nm and a zeta potential of -0.3 to -1.6mV. The collagen swelling test indicated no significant irritation potential of both formulations over 24h. An immediate interaction of unformulated curcumin with the mucus was determined, whereas both SEDDS facilitated drug permeation through the mucus layer. Formulation B showed a 2.2-fold improved transport ratio of curcumin compared to SEDD formulation A. In comparison to the vaginal cream, SEDD formulation A and B were able to spread over the vaginal mucosa and cover the tissue to a 17.8- and 14.8-fold higher extent, respectively. According to these results, SEDDS seems to be a promising tool for vaginal application. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation.

    Science.gov (United States)

    de Gregorio, Nikolaus; Friedl, Thomas; Schramm, Amelie; Reister, Frank; Janni, Wolfgang; Ebner, Florian

    2017-08-25

    Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure. © 2017 S. Karger AG, Basel.

  15. Vaginitis

    Science.gov (United States)

    ... The vulva may be red and swollen. The vaginal discharge usually is white, lumpy, and has no odor. ... trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There ...

  16. Pre-puncture ultrasound guided epidural insertion before vaginal delivery.

    Science.gov (United States)

    Nassar, Mahmoud; Abdelazim, Ibrahim A

    2015-10-01

    Palpation method is widely used in clinical practice to identify the puncture site during combined spinal-epidural (CSE) blocks. Tuffier's line, is an anatomical landmark between two iliac crests (inter-cristal), which is widely used to identify the puncture site during CSE blocks is not always an indicator for specific vertebral level or inter-vertebral space. One hundred and Ten (110) women were scheduled for normal vaginal delivery and were randomized into two equal groups; palpation group and an ultrasound guided group to detect the efficacy of puncture ultrasound before CSE blocks to increase chances of successful CSE procedure on the first attempt and to reduce the number of attempts or punctures during insertion of CSE catheter. There were no significant differences between two studied groups regarding; maternal age, weight and height, while, there was a significant difference between two studied groups regarding; parity. Percentage of successful CSE procedure on the first attempt was significantly higher (67.27%) in ultrasound compared to palpation group (40%). Number of punctures (attempts) were significantly less in ultrasound (1.2 ± 0.6) compared to palpation group (2.3 ± 0.8) and the number of redirections was also significantly less in ultrasound (1.4 ± 0.5) compared to palpation group (2.8 ± 1.6). Although, time to identify puncture site was significantly longer in ultrasound compared to palpation group and total procedure time was longer in ultrasound (9.1 ± 1.5 min) compared to palpation group (6.2 ± 1.2 min), there was no significant difference between two studied groups regarding; time to identify puncture site and total procedure time. Two cases of dural puncture in palpation versus no cases in ultrasound group and two cases of intravascular catheter placement (one in each group), with no significant difference between two groups. Pre- puncture ultrasound guided epidural insertion before vaginal delivery, increases the chance of a

  17. The frequent shift to intermediate flora in preterm delivery cases after abnormal vaginal flora screening

    Science.gov (United States)

    Honda, Hiroshi; Yokoyama, Takanori; Akimoto, Yumiko; Tanimoto, Hirotoshi; Teramoto, Mitsue; Teramoto, Hideki

    2014-01-01

    The effect of screening and treatment for abnormal vaginal flora on the reduction of preterm deliveries remains controversial. We evaluated whether this screening and treatment reduces the preterm delivery rate for general-population pregnant women. Pregnant women of the Intervention group (n = 574) underwent the screening test and the treatment of vaginal metronidazole during the early second trimester, and those of the Control group (n = 1,161) did not. We compared the preterm delivery rate between these two groups. We also compared the profiles of vaginal flora of the preterm delivery cases with those of the pregnant women with a normal course. There was no significant difference in the preterm delivery rate between these two groups. However, in the preterm delivery cases, a frequent shift to intermediate flora was observed not before but after the screening in the Intervention group. This shift may explain why most of the previous studies failed in regard to the prevention of preterm deliveries. PMID:24762852

  18. Intake of probiotic food and risk of spontaneous preterm delivery.

    Science.gov (United States)

    Myhre, Ronny; Brantsæter, Anne Lise; Myking, Solveig; Gjessing, Håkon Kristian; Sengpiel, Verena; Meltzer, Helle Margrete; Haugen, Margaretha; Jacobsson, Bo

    2011-01-01

    Preterm delivery represents a substantial problem in perinatal medicine worldwide. Current knowledge on potential influences of probiotics in food on pregnancy complications caused by microbes is limited. We hypothesized that intake of food with probiotics might reduce pregnancy complications caused by pathogenic microorganisms and, through this, reduce the risk of spontaneous preterm delivery. This study was performed in the Norwegian Mother and Child Cohort on the basis of answers to a food-frequency questionnaire. We studied intake of milk-based products containing probiotic lactobacilli and spontaneous preterm delivery by using a prospective cohort study design (n = 950 cases and 17,938 controls) for the pregnancy outcome of spontaneous preterm delivery (delivery were associated with any intake of milk-based probiotic products in an adjusted model [odds ratio (OR): 0.857; 95% CI: 0.741, 0.992]. By categorizing intake into none, low, and high intakes of the milk-based probiotic products, a significant association was observed for high intake (OR: 0.820; 95% CI: 0.681, 0.986). Women who reported habitual intake of probiotic dairy products had a reduced risk of spontaneous preterm delivery.

  19. VBAC Scoring: Successful vaginal delivery in previous one caesarean section in induced labour

    International Nuclear Information System (INIS)

    Raja, J.F.; Bangash, K.T.; Mahmud, G.

    2013-01-01

    Objective: To develop a scoring system for the prediction of successful vaginal birth after caesarean section, following induction of labour with intra-vaginal E2 gel (Glandin). Methods: The cross-sectional study was conducted from January 2010 to August 2011, at the Pakistan Institute of Medical Sciences in Islamabad. Trial of labour in previous one caesarean section, undergoing induction with intra-vaginal E2 gel, was attempted in 100 women. They were scored according to six variables; maternal age; gestation; indications of previous caesarean; history of vaginal birth either before or after the previous caesarean; Bishop score and body mass index. Multivariate and univariate logistic regression analysis was used to develop the scoring system. Results: Of the total, 67 (67%) women delivered vaginally, while 33 (33%) ended in repeat caesarean delivery. Among the subjects, 55 (55%) women had no history of vaginal delivery either before or after previous caesarean section; 15 (15%) had history of vaginal births both before and after the previous caesarean; while 30 (30%) had vaginal delivery only after the previous caesarean section. Rates of successful vaginal birth after caesarean increased from 38% in women having a score of 0-3 to 58% in patients scoring 4-6. Among those having a score of 7-9 and 10-12, the success rates were 71% and 86% respectively. Conclusion: Increasing scores correlated with the increasing probability of vaginal birth after caesarean undergoing induction of labour. The admission VBAC scoring system is useful in counselling women with previous caesarean for the option of induction of labour or repeat caesarean delivery. (author)

  20. Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term.

    Science.gov (United States)

    Froehlich, Rosemary J; Sandoval, Grecio; Bailit, Jennifer L; Grobman, William A; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Blackwell, Sean C; Tolosa, Jorge E

    2016-09-01

    To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery. This was a secondary analysis of a multicenter observational cohort of 115,502 deliveries from 2008 to 2011. Data were abstracted by trained and certified study personnel. We included women at 37 weeks of gestation or greater attempting vaginal delivery with live, nonanomalous, singleton, vertex fetuses and no history of cesarean delivery. Rates and odds ratios (ORs) were calculated for women with ultrasonography or clinical estimated fetal weight compared with women without documentation of estimated fetal weight. Further subgroup analyses were performed for estimated fetal weight categories (less than 3,500, 3,500-3,999, and 4,000 g or greater) stratified by diabetic status. Multivariable analyses were performed to adjust for important potential confounding variables. We included 64,030 women. Cesarean delivery rates were 18.5% in the ultrasound estimated fetal weight group, 13.4% in the clinical estimated fetal weight group, and 11.7% in the no documented estimated fetal weight group (Pcesarean delivery was 1.44 (95% confidence interval [CI] 1.31-1.58, Pcesarean delivery. When ultrasound estimated fetal weight was 4,000 g or greater, the adjusted OR was 2.15 (95% CI 1.55-2.98, Pdelivery at term, documentation of estimated fetal weight (obtained clinically or, particularly, by ultrasonography) was associated with increased odds of cesarean delivery. This relationship was strongest at higher fetal weight estimates, even after controlling for the effects of birth weight and other factors associated with increased cesarean delivery risk.

  1. 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.

  2. Ultrasonography of the uterus after normal vaginal delivery

    International Nuclear Information System (INIS)

    Al-Bdour, Abdel-Nabi A.; Akasheh, Hakam F.; Al-Husban, Naser A.

    2004-01-01

    To define the appearence of the uterus and the uterine cavity, as revealed by the ultrasound in normal women following a vaginal delivery. This prospective, longitudinal study took place at the Prince Hashem and the Prince Ali Military Hospitals, Amman Jordan from December 2002 to March 2003. Fifty four women were scanned on postpartum days 1, 7, 14, 28 and 56. Ultrasound operation was performed transabdominally for all women. The involution process of the uterus was assessed by measuring the anteroposterior diameter and uterine cavity. The appearence of the uterine cavity content was documented. Factors related to the involution process: parity, breast-feeding, smoking and infant's birth weight were also evaluated. The maximum anteroposterior diameter of the uterus diminished substantially and progressively from 93mm on day one postpartum to 38.5 mm on day 56. The maximum anteroposterior diameter of the uterine cavity diminished from15.2 mm on day one to 4.0 mm on day 56. The position of the uterus, its shape and the appearence of its cavity during the normal puerperium was observed. The uterus was most often retroverted and empty in the early puerperium. Fluid and debris in the whole cavity were seen in mid puerperium, the cavity was empty and appeared as a thin white line. No correlation was found between the involution of the uterus and parity, breast-feeding and infant's birth weight. Transabdominal sonography is suitable for examination of the uterus during the early puerperium period. The uterine body and position, as well as the cavity, are easy to examine by ultrasound. Accumulation of fluid and debris in the uterine cavity is a common and insignificant finding of the invluting uterus. (author)

  3. Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status.

    Science.gov (United States)

    Attanasio, Laura B; Hardeman, Rachel R; Kozhimannil, Katy B; Kjerulff, Kristen H

    2017-12-01

    Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P socioeconomic status women may be more able to realize their preferences in childbirth. © 2017 Wiley Periodicals, Inc.

  4. Tranfusion risk: is "two-step" vaginal delivery a risk for postpartum hemorrhage?

    Science.gov (United States)

    Straface, Gianluca; Bassi, Emma; De Santis, Marco; Scambia, Giovanni; Zanardo, Vincenzo

    2015-01-01

    In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery. This is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of PPH verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion. We found 17 cases of PPH (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two-step vaginal delivery (RR = 0.81 (0.56-1.22)), emergency cesarean section (RR = 2.88 (1.27-7.77)) and operative vaginal delivery (RR = 2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between PPH and as emergency cesarean delivery (p < 0.05) as operative vaginal delivery (p < 0.05). "Two-step" delivery approach did not increase the risk of PPH with respect to operative delivery, elective caesarean section and emergency caesarean section.

  5. Labor before a primary cesarean delivery: reduced risk of uterine rupture in a subsequent trial of labor for vaginal birth after cesarean.

    Science.gov (United States)

    Algert, Charles S; Morris, Jonathan M; Simpson, Judy M; Ford, Jane B; Roberts, Christine L

    2008-11-01

    To estimate the effect of the onset of labor before a primary cesarean delivery on the risk of uterine rupture if vaginal birth after cesarean (VBAC) is attempted in the next pregnancy. Longitudinally linked birth records were used to follow women from a primary cesarean delivery to a trial of labor at term for their next birth. The effects of characteristics of both the trial of labor and primary cesarean deliveries on the risk of uterine rupture were examined. Of 10,160 women who had a trial of labor, 39 (0.38%) had a uterine rupture. Women who were induced or augmented for their trial of labor had a greater relative risk (RR) of uterine rupture (crude RR 4.24, 95% confidence interval [CI] 2.23-8.07). Women whose primary cesarean delivery was planned or followed induction of labor also had an increased risk of uterine rupture (crude RR 2.61, 95% CI 1.24-5.49), and this risk remained after adjustment for other factors. Women with a history of either spontaneous labor or vaginal birth had one uterine rupture for every 460 deliveries; women without this history who required induction or augmentation to proceed with a VBAC attempt had one uterine rupture for every 95 deliveries. Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC. II.

  6. Risk factors for emergency cesarean delivery of the second twin after vaginal delivery of the first twin.

    Science.gov (United States)

    Suzuki, Shunji

    2009-06-01

    A case-control study of twins was performed to identify clinical predictions of emergency cesarean delivery in the second-born twin after vaginal delivery of the first twin. The obstetric records were reviewed of all twin vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007. There were 206 vaginal deliveries of first twins at >or=33 weeks of gestation. Of these deliveries, nine women (4.4%) underwent an emergency cesarean for the delivery of the second twin. The incidence of cesarean delivery for the second twin was significantly greater in cases with a history of infertility therapy (odds ratio: 5.0, 95% confidence intervals: 1.2-22), gestational age at >or=39 weeks (24, 4.7-120), nonvertex presentation (6.2, 1.5-26), operative delivery of the first twin (6.1, 1.5-24) and intertwin delivery time interval >30 min (7.2, 1.7-30). The most important risk factor of emergency cesarean delivery in the second twin was a gestational age of >or=39 weeks.

  7. 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

  8. 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

  9. [Cesarean section versus vaginal delivery--state-of-the-art paper].

    Science.gov (United States)

    Pomorski, Michał; Woytoń, Robert; Woytoń, Piotr; Kozłowska, Jolanta; Zimmer, Mariusz

    2010-05-01

    The aim of the study was to perform a comparative analysis of complications after vaginal deliveries and cesarean sections and to introduce emotional status of the mother as an indication for a cesarean section. 406 patients after vaginal deliveries and cesarean sections, that took place in the first quarter of 2009, were enrolled into the study. In the studied group of 406 patients, 200 women (49.2%) had cesarean section and 206 women (50.8%) delivered vaginally. In both groups there were no differences in the clinical state of newborns, which were assessed according to the Apgar score, and in umbilical cord blood pH. Hemoglobin concentration evaluated on the second day of puerperium was statistically significantly higher in the group of patients after cesarean section than after vaginal delivery. Episiotomy and laparotomy wound healing complications were observed in 2 (0.97%) and 3 (1.5%) cases, respectively. Due to lack of differences in complication rates between cesarean section and vaginal delivery patients, the emotional status of a pregnant woman should be considered as an indication for cesarean section.

  10. Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.

    Science.gov (United States)

    Flick, Randall P; Lee, Kunmoo; Hofer, Ryan E; Beinborn, Charles W; Hambel, Ellen M; Klein, Melissa K; Gunn, Paul W; Wilder, Robert T; Katusic, Slavica K; Schroeder, Darrell R; Warner, David O; Sprung, Juraj

    2011-06-01

    In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63). The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.

  11. Planned cesarean section versus planned vaginal delivery: comparison of lower urinary tract symptoms.

    Science.gov (United States)

    Ekström, Asa; Altman, Daniel; Wiklund, Ingela; Larsson, Christina; Andolf, Ellika

    2008-04-01

    We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9-42] and for urinary urgency (RR 7.3 95% CI 1.7-32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5-19) and at 3 months follow-up (OR 3.9, 95% CI 1.7-8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section.

  12. Trial of Labor After One Cesarean: Role of the Order and Number of Prior Vaginal Births on the Risk of Emergency Cesarean Delivery and Neonatal Admission

    Directory of Open Access Journals (Sweden)

    Peng Chiong Tan

    2008-09-01

    Conclusion: In women who have had prior vaginal birth attempting a trial of labor after cesarean, a vaginal delivery before cesarean delivery is an independent risk factor for repeat cesarean. Women with two or more prior vaginal births have a similar risk for repeat cesarean and neonatal admission to women with only one prior vaginal birth.

  13. Birth injury in a subsequent vaginal delivery among women with a history of shoulder dystocia.

    Science.gov (United States)

    Colombara, Danny V; Soh, Jason D; Menacho, Luis A; Schiff, Melissa A; Reed, Susan D

    2011-11-01

    To examine risk factors for birth injury in a subsequent vaginal delivery among women with a prior delivery complicated by shoulder dystocia. Population-based retrospective cohort study, Washington State (1987-2007). Logistic regression was used to assess risk factors associated with subsequent birth injury. Of 9232 women who met inclusion criteria, 223 (2.4%) had a subsequent vaginal delivery with birth injury. Birth injury in an index delivery, adjusted odds ratio (aOR) 2.6 [95% confidence interval (CI) 1.7-4.1] and factors in subsequent delivery: birth weight ≥4000 g, aOR 4.4 (95% CI: 3.0-6.3), gestational diabetes, aOR 1.9 (95% CI: 1.2-3.2), Hispanic ethnicity aOR 1.9 (95% CI: 1.2-2.9), and maternal obesity, aOR 1.8 (95% CI: 1.3-2.6) were associated with birth injury. Among women with prior delivery complicated by shoulder dystocia, the risk factors identified in this study should be carefully considered prior to deciding upon route of delivery - cesarean vs. vaginal delivery.

  14. A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound.

    Science.gov (United States)

    Eggebø, Tørbjorn Moe; Wilhelm-Benartzi, Charlotte; Hassan, Wassim A; Usman, Sana; Salvesen, Kjell A; Lees, Christoph C

    2015-09-01

    Accurate prediction of whether a nulliparous woman will have a vaginal delivery would be a major advance in obstetrics. The objective of the study was to develop such a model based on maternal characteristics and the results of intrapartum ultrasound. One hundred twenty-two nulliparous women in the first stage of labor were included in a prospective observational 2-centre study. Labor was classified as prolonged according to the respective countries' national guidelines. Fetal head position was assessed with transabdominal ultrasound and cervical dilatation by digital examination, and transperineal ultrasound was used to determine head-perineum distance and the presence of caput succedaneum. The subjects were divided into a testing set (n = 61) and a validation set (n = 61) and a risk score derived using multivariable logistic regression with vaginal birth as the outcome, which was dichotomized into no/cesarean delivery and yes/vaginal birth. Covariates included head-perineum distance, caput succedaneum, and occiput posterior position, which were dichotomized respectively into the following: ≤40 mm, >40 mm, <10 mm, ≥10 mm, and no, yes. Maternal age, gestational age, and maternal body mass index were included as continuous covariates. Dichotomized score is significantly associated with vaginal delivery (P = .03). Women with a score above the median had greater than 10 times the odds of having a vaginal delivery as compared with those with a score below the median. The receiver-operating characteristic curve showed an area under the curve of 0.853 (95% confidence interval, 0.678-1.000). A risk score based on maternal characteristics and intrapartum findings can predict vaginal delivery in nulliparous women in the first stage of labor. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. A Comparison of Vaginal Pressures and Abdominal Muscle Thickness According to Childbirth Delivery Method during the Valsalva Maneuver

    OpenAIRE

    Kim, Haroo; Kak, Hwang-Bo; Kim, Boin

    2014-01-01

    [Purpose] The purpose of this study was to compare the effect of childbirth delivery method on vaginal pressure and abdominal thickness during the Valsalva maneuver (VAL). [Subjects] Thirty healthy female volunteers (26–39 years of age) were selected for this research. Their delivery histories were: nulliparous 10, vaginal delivery 10, and Cesarean delivery 10. None of the participants had a history of incontinence. [Methods] In the crook-lying position, a perineometer probe was inserted into...

  16. Spontaneous de novo vaginal adenosis resembling Bartholin’s ...

    African Journals Online (AJOL)

    Adebayo Alade Adewole

    Keywords: Vaginal adenosis. Bartholin's cyst. Diethylstilbesterol. Vaginal adenocarcinoma. a b s t r a c t. Background: Vaginal adenosis is a rare benign condition with a small percentage of patients at risk of ... Diagnosis can be made from colposcopically directed biopsy of ... there was no vaginal discharge or bleeding.

  17. 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.

  18. [Great vesicovaginal fistula after normal vaginal delivery in a developed country].

    Science.gov (United States)

    López-Carpintero, Nayara; de la Fuente-Valero, Jesús; Salazar-Arquero, Francisco Javier; Hernández-Aguado, Juan José

    2015-12-01

    Obstetric fistulas in developed countries are infrequent and have been associated with instrumental vaginal delivery, manual removal of placenta and surgical complications during caesarean section. We present the diagnosis and treatment of an obstetric fistula of patient without clear risk factors in a developed country. The case presented is of a 37 weeks pregnant with history of previous cesarean section. A male of 2,600 g was born after a not prolonged vaginal delivery. In the immediate postpartum period, appeared evident hematuria and in the exploration a defect was detected in the vaginal anterior face at 3 cm from the urethral meatus. Cystoscopy showed a torn in bladder of 8 cm at the bottom. Reparation of vesicovaginal fistula was carried out with omentoplasty. Postoperative course was uneventful. A vesicovaginal fistula must be considered in any patient with hematuria. Early repair is essential for a favorable outcome.

  19. 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...

  20. 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

    OBJECTIVES: Progesterone treatment reduces the risk of preterm delivery in high-risk singleton pregnancies. Our aim was to evaluate the preventive effect of vaginal progesterone in high-risk twins. METHODS: This was a subanalysis of a Danish-Austrian, double-blind, placebo-controlled, randomized...

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

    NARCIS (Netherlands)

    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

  2. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

    NARCIS (Netherlands)

    Barrett, Jon F. R.; Hannah, Mary E.; Hutton, Eileen K.; Willan, Andrew R.; Allen, Alexander C.; Armson, B. Anthony; Gafni, Amiram; Joseph, K. S.; Mason, Dalah; Ohlsson, Arne; Ross, Susan; Sanchez, J. Johanna; Asztalos, Elizabeth V.; Farrell, Scott; Hanigsberg, Julia E.; Leduc, Line; Okun, Nanette; Bracken, Michael; Crowley, Patricia; Donner, Allan; Duley, Lelia; Ehrenkranz, Richard; Thorpe, Kevin; Castaldi, Jose Luis; Bertin, Marta Susana; Partida, Yamil; Galimberti, Diana; Messina, Analia; Voto, Liliana S.; Voto, Geraldine N.; Prieto, Marìa Josè; Buraschi, Fernanda; Sexer, Hèctor; Palermo, Mario; Varela, Dolores Montes; Savransky, Ricardo; Dunaievsky, Armando; Andina, Elsa; Laterra, Cristina; Susacasa, Sandra; Frailuna, Maria Alejandra; Almansa, Silvina Ramirez; Barrere, Maria Beatriz; García, Horacio; Rivero, Mabel; Gomez, Elena Elizabet; Schinini, Josefina; Ahlbom, Monica; Aguirre, Jesus Daniel; de Lourdes Martín, Raquel; Videla, Arturo; Mesas, Walter; Arias, Carlos; Castagnola, Maria Cecilia; Gorostiaga, Raul Abalos; Curioni, Miguel; Mohedano, Maria; Dip, Viviana; Roque, Alicia; Duhalde, Esteban Marcos; Dodd, Jodie; Deussen, Andrea; Crowther, Caroline; Gardener, Glenn; Chaplin, Jackie; Wilkins, Danielle; Mahomed, Kassam; Green, Anne; Baade, Robert; Haran, Mano; Hanafy, Ash; Davis, Greg; Roberts, Lynne; Tucker, Stephen; Duncan, Christine; Watson, David; Lawrence, Annemarie; Laubach, Monika; Breugelmans, Ria; Calderon, Iracema; Martins, Anice; Magalhães, Claudia; Cecatti, Jose Guilherme; Surita, Fernanda Garanhani; Rosado, Luiza; Vidal, Augusto Cortizo; de Souza, Goianice Ribeiro; Maia Filho, Nelson Lourenço; Santana, Danielly Scaranello Nunes; de Sa, Renato Augusto Moreira; Marcolino, Luciano; Marques, Caio Coelho; Zanella, Pedro Luis; Milan, Carla; Bollis, Márcia Dalmolin; Steibel, Gustavo; Ayub, Antonio C. K.; Moreira, Simone; Lima, Antonio Carlos Barbosa; Scavuzzi, Adriana; de Souza, Alex Sandro Rolland; de Moraes Filho, Olimpio Barbosa; Carvalho, Simone Angélica Leita Silva; Bornia, Rita Guerios; da Silva, Nancy Ribeiro; Spinola, Renata; Lopes, Laudelino Marques; Sass, Nelson; Korkes, Henri; Chalem, Elisa; Yokota, Eliana Junko Morita; Ribeiro, Ana J.; Wood, Stephen; Miller, Leslie; McLeod, Lynne; Fanning, Cora; Mueller, Valerie; Gregorovich, Sandra; Moore, Elaine; Gratton, Robert; Kennedy, Laura; Scheufler, Peter; Reid, Donna; Klam, Stephanie; Daitchman, Rhona; Farquharson, Duncan; Harrison, Kristy; Kulkarni, Ramesh; Scarfone, Rhonda; Laplante, Joanne; Carson, George; Williams, Suzanne; Rosman, David; Nemtean, Debbie; Olatunbosun, Femi; Pierson, Kathleen; Crane, Joan; Hutchens, Donna; Zaltz, Arthur; Brown, Melissa; Ornstein, Melanie; Visram, Soraya; Bordin, Jennifer; Siurna, Hiliary; Petruskavich, Shelly; Gagnon, Alain; Lee, Jennifer M.; Fernandez, Ariadna; Kaye, Stephen; Haslauer, Kelly-Ann; Cundiff, Geoffrey; Gomez, Ricardo; Kusanovic, Juan Pedro; Neculman, Karla Silva; Valenzuela, Luis Leighton; Leiva, Erika Madariaga; Cabrera, Juan Guillermo Romo; Ravanal, Mónica Molina; Orrego, Rodrigo Schiaffino; Matijevic, Ratko; Makhlouf, Ahmad; Saber, Osama; Abdelradey, Tarek; Kirss, Fred; Rull, Kristiina; Vaas, Pille; Hopp, Hartmut; Nonnenmacher, Andreas; Michaelis, Silke; Hasbargen, Uwe; Delius, Maria; Antsaklis, Aris; Drakakis, Peter; Major, Tamás; Bartha, Tünde; Salim, Raed; Harel, Linda; Chayen, Benny; Siev, Sima; Hallak, Mordechai; Mei-Dan, Elad; Gonen, Ron; Wolff, Leslie; Sadan, Oscar; Mansour-Schwake, Dalia; Petchinkin, Liana; Hakim, Marwan; Perlitz, Yuri; Ben-Ami, Moshe; Pansky, Samuel; Simms-Stewart, Donnette; Wilson, Monifa; El-Zibdeh, Mazen; AlFaris, Lama; Heres, Marion; Sluis, Aafje; Roumen, Frans J. M. E.; Rinkens, Jeannine; Willekes, Christine; Alleman, Sjaak; van Zandvoort, Simone Gordijn; Porath, Martina M.; Verhoeven, Corine; Mol, Ben Willem; Radfar, Forough; Khan, Sultana; Preis, Krzysztof; Swiatkowska-Freund, Malgorzata; Krasomski, Grzegorz; Kesiak, Marcin; Krekora, Michael; Zych, Katarzyna; Wilczynski, Jan; Breborowicz, Grzegorz; Dera, Anna; ur Rahman, Sajjad; Al-Jassim, Amal Abdullah; Stamatian, Florin; Caracostea, Gabriela; Gojnic, Miroslava; Fazlagic, Amira; Perovic, Milan; Vasiljevic, Brankica; Stefanovic, Toma; Gonce, Anna; Rodriguez, Sara Herrero; Massanes, Marta; Moratonas, Elena Carreras; Rodriguez, Carlota Rodo; Martinez, Silvia Arevalo; Llurba, Elisa; Franch, Anna Suy; de la Calle, Maria; Dans, Fernando; Sancha, Marta; Lopez, Sara; Palomo, Maria Luisa Canete; del Valle, María Dolores Maldonado; Martín, María Nieves Rodríguez; Delgado, Carolina Lázaro-Carrasco; Fournier, María Carmen Jiménez; Ojutiku, Dale; Masuku, Maxwell; Goodsell, Kerry; Southam, Donna; Tuffnell, Derek; Germaine, Tracey; Palethorpe, Rebecca; Farrar, Diane; Wright, Janet; Al-Taher, Hamed; Meehan, Helen; Bricker, Leanne; Dower, Michelle; Houghton, Gillian; Pascall, Angela; Longworth, Heather; Sau, Ashis; Thornton, James; Fisher, Joanne; Houda, Mohammed; Simm, Andy; Bugg, George; Deshpande, Ruta; Davis, Yvette; Holloway, Fiona; Welch, Ross; Hollands, Heidi; Young, Peter; Hinshaw, Kim; Bargh, Amanda; Edmundson, Dawn; Cameron, Helen; Alonso, Justo; Austt, Alfonso Garcia; Ortiz, Alejandra; Burgis, Judith; Brown, Stanette; Gregg, Anthony; Borowski, Kristi; Fleener, Diedre; Deaver, John; Sumersille, Melanie; Aronoff, Christine; Bland, Kimberly; Kontopoulos, Eftichia; Rivero, Yvette; Lovett, Stuart M.; Zatinsky, Shana; Diogo, Mary; Coonrod, Dean V.; Jimenez, Blanca Flor; Chan, Sunny; Hewson, Sheila A.; Hoac, Trinh; Kowal, Christine; Mangoff, Kathryn; Mergler, Sonya; Shi, Michael

    2013-01-01

    Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy. We randomly assigned women between 32 weeks 0 days and 38 weeks

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

    Science.gov (United States)

    Wu, Na; Zhang, Xinxin; Li, Feifei; Zhang, Tao; Gan, Yong; Li, Juan

    2015-01-01

    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.

  4. Instrumental vaginal deliveries at the University of Maiduguri ...

    African Journals Online (AJOL)

    Setting and Subjects: All cases of instrumental deliveries (obstetric forceps and vacuum extraction) at the University of Maiduguri Teaching Hospital, Maiduguri, between 1 of January 1993 and 31 of December 2000 were reviewed. Results: Out of a total of 10 881 deliveries recorded, 181 (1.67%) were by vacuum extraction ...

  5. Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women

    NARCIS (Netherlands)

    Milosavljevic, Maja; Lecic Tosevski, Dusica; Soldatovic, Ivan; Vukovic, Olivera; Miljevic, Cedo; Peljto, Amir; Kostic, Milutin; Olff, Miranda

    2016-01-01

    Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was

  6. Assessment of the delivery retention and distribution of a mucoadhesive vaginal mousse formulation

    International Nuclear Information System (INIS)

    Penglis, S.; Chatterton, B.; Kovacs, J.; Hunt, B.

    2002-01-01

    Full text: Local treatment is used for a number of vaginal conditions (eg candidiasis). Traditional vaginal delivery systems such as creams and foams may have limited residence time and uneven distribution within the vagina. Eight pre-menopausal women, mean age 27 were studied in a random crossover study with either commercially available vaginal cream or the test formulation, an aerosol mousse developed to provide a prolonged residence time and better distribution of vaginally applied medication. Both were labelled with 4MBq of 99m Tc DTPA. Following administration, distribution and retention were followed using a dual head gamma camera at short intervals for up to 7 hours with a delayed image at 24 hours. The vaginal image was divided into four quadrants and an external region, and geometric mean counts were calculated as an index of retention. External losses were collected on sanitary napkins, which were changed after each image acquisition. Despite the use of sanitary pads, by 24 hours 40% of the administered activity was not accounted for and this was probably lost during urination. There was no significant difference between the measured retention and distribution of the products. Scintigraphic techniques are useful in assessing the dynamics of local vaginal therapies. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  7. 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.

  8. Acceptability of a non-woven device for vaginal drug delivery of microbicides or other active agents.

    Science.gov (United States)

    Joanis, Carol L; Hart, Catherine W

    2010-06-01

    Vaginal microbicides could reduce incidence of HIV. However, the current method of delivering gel formulations (standard applicator) can result in acceptability concerns/issues. This study evaluated the concept of using a non-woven textile material (modified tampon) for vaginal drug delivery. The study was nested within a Phase I randomized safety trial of lime juice concentrations used intra-vaginally. Of 47 women completing the safety trial, 16 were interviewed about their experiences. Overall, women found the concept of non-woven materials for vaginal drug delivery acceptable for use in delivering yeast medications (13 of 16) and STI/HIV preventives (10 of 16).

  9. The Costs and Their Determinant of Cesarean Section and Vaginal Delivery: An Exploratory Study in Chongqing Municipality, China

    Directory of Open Access Journals (Sweden)

    Zhifei He

    2016-01-01

    Full Text Available Objectives. This study aims to analyze the cesarean section (CS rates and vaginal delivery rates in tertiary hospitals of China, explore the costs of two different deliveries, and examine the relative influencing factors of the costs in both CS and vaginal deliveries. Methods. 30,168 anonymized obstetric medical cases were selected from three sample tertiary hospitals in Chongqing Municipality from 2011 to 2013. Chi-square test was used to compare the distributions of CS and vaginal deliveries under different indicators. Mann–Whitney test and Kruskal-Wallis test were adopted to analyze the differences under different items. Multiple linear regression was used to determine the influencing factors of the costs of different delivery modes. Results. (1 The rates of CS were 69%, 65.5%, and 59.2% in the three sample tertiary hospitals in Chongqing from 2011 to 2013. (2 The costs and the length of stay of CS were greater than those of vaginal delivery, which had significant differences (P<0.005. (3 The areas, length of stay, age, medical insurance, and modes of delivery were the influencing factors of both CS and vaginal delivery costs. Discussion. The high CS rates in China must be paid significant attention. The indicators of two modes of delivery should be regulated strictly. CS rate reduction and saving medical resources will be the benefits if vaginal delivery is chosen by pregnant women.

  10. Instrumental vaginal delivery: a dying saving art; an experience at ...

    African Journals Online (AJOL)

    Of the 12 interviewed doctors only 4 (28.6%) had ever used vacuum for deliveries where out of 24 interviewed midwives, only 8 (33.3%) had ever used vacuum for delivery. All of them self reported to have a theoretical knowledge on the use of vacuum but only 5 (35.7%) of the interviewed doctors said they had a practical ...

  11. Mode of delivery following successful external cephalic version : Comparison with spontaneous cephalic presentations at delivery

    NARCIS (Netherlands)

    Kuppens, S.M.; Hutton, E.K.; Hasaart, T.H.; Aichi, N.; Wijnen, H.; Pop, V.J.M.

    2013-01-01

    Objective To compare the obstetric outcomes of pregnant women after successful external cephalic version (ECV) (cases) with a large group of pregnant women with a spontaneously occurring cephalic fetal position at delivery (controls). Methods We conducted a retrospective matched cohort study in a

  12. Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?

    Science.gov (United States)

    Macones, George A; Cahill, Alison; Pare, Emmanuelle; Stamilio, David M; Ratcliffe, Sarah; Stevens, Erika; Sammel, Mary; Peipert, Jeffrey

    2005-04-01

    This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who attempt VBAC relative to elective repeat cesarean delivery, the absolute risk of major complications remains low.

  13. Predictors of vaginal delivery in nulliparous mothers | Adeyemi ...

    African Journals Online (AJOL)

    Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was ...

  14. Major Placenta Previa with Assisted Vaginal Delivery and Primary ...

    African Journals Online (AJOL)

    An unbooked 20 year-old primigravida presented at 36 weeks gestation with severe antepartum hemorrhage due to major placenta previa in shock. She fell into labour during resuscitation prior to emergency caesarian section. She had outlet forceps delivery of a fresh still birth and developed primary postpartum ...

  15. Women's experiences of a vaginal delivery conducted by a private ...

    African Journals Online (AJOL)

    During the last decade the process of childbirth has undergone many changes in South Africa. Most women currently give birth in the hospital under the supervision of a medical practitioner because they b elong to a medical aidscheme which enables them to consult an obstetrician for their delivery. Due to this fact, a large ...

  16. Safe and sustained vaginal delivery of pyrimidinedione HIV-1 inhibitors from polyurethane intravaginal rings.

    Science.gov (United States)

    Johnson, Todd J; Srinivasan, Priya; Albright, Theodore H; Watson-Buckheit, Karen; Rabe, Lorna; Martin, Amy; Pau, Chou-Pong; Hendry, R Michael; Otten, Ron; McNicholl, Janet; Buckheit, Robert; Smith, James; Kiser, Patrick F

    2012-03-01

    The potent antiretroviral pyrimidinediones IQP-0528 (PYD1) and IQP-0532 (PYD2) were formulated in polyurethane intravaginal rings (IVRs) as prophylactic drug delivery systems to prevent the sexual transmission of HIV-1. To aid in the selection of a pyrimidinedione candidate and the optimal loading of the drug in the IVR delivery system, four pyrimidinedione IVR formulations (PYD1 at 0.5 wt% [PYD1(0.5 wt%)], PYD1(1 wt%), PYD2(4 wt%), and PYD2(14 wt%)) were evaluated in pigtail macaques over 28 days for safety and pyrimidinedione vaginal biodistribution. Kinetic analysis of vaginal proinflammatory cytokines, native microflora, and drug levels suggested that all formulations were safe, but only the high-loaded PYD2(14 wt%) IVR demonstrated consistently high pyrimidinedione vaginal fluid and tissue levels over the 28-day study. This formulation delivered drug in excess of 10 μg/ml to vaginal fluid and 1 μg/g to vaginal tissue, a level over 1,000 times the in vitro 50% effective concentration. The in vitro release of PYD1 and PYD2 under nonsink conditions correlated well with in vivo release, both in amount and in kinetic profile, and therefore may serve as a more biologically relevant means of evaluating release in vitro than typically employed sink conditions. Lastly, the pyrimidinediones in the IVR formulation were chemically stable after 90 days of storage at elevated temperature, and the potent nanomolar-level antiviral activity of both molecules was retained after in vitro release. Altogether, these results point to the successful IVR formulation and vaginal biodistribution of the pyrimidinediones and demonstrate the usefulness of the pigtail macaque model in evaluating and screening antiretroviral IVR formulations prior to preclinical and clinical evaluation.

  17. Destructive vaginal deliveries at a teaching hospital in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Zeidan, Amir; Abdella, Ahmed

    2007-01-01

    To assess the incidence, indications and complications of destructive vaginal deliveries. Retrospective study on the incidence, methods used, and outcomes of destructive vaginal deliveries (DVDs) performed by residents in obstetrics-gynecology from 1997 to 2002. Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia. Overall, there were 7.8 DVDs per 1000 deliveries, with an increasing trend during the five years of the study. Craniotomy was the most common (94%) DVD-procedure mainly used for cephalopelvic disproportion (CPD), accounting for 89% of the craniotomies. The proportion of craniotomy to all the DVDs used was significantly more (p-value Sidamo hospital (3243 g)), the average birth weight of the fetuses in the craniotomy group (2957 g) found in this study ivas smaller. This may indicate that, in Ethiopia, the role of small pelvic size in CPD is more important than fetal weight. To alleviate the painful and difficult travel of laboring mothers to major hospitals, training of general practitioners in destructive vaginal delivery, pre- and post procedure care need to be strengthened

  18. Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins.

    Science.gov (United States)

    Anselem, O; Mephon, A; Le Ray, C; Marcellin, L; Cabrol, D; Goffinet, F

    2015-11-01

    To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options. Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation. Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0-36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores. Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Predicting the difficulty of operative vaginal delivery by ultrasound measurement of fetal head station.

    Science.gov (United States)

    Kasbaoui, Sidi; Séverac, François; Aïssi, Germain; Gaudineau, Adrien; Lecointre, Lise; Akladios, Chérif; Favre, Romain; Langer, Bruno; Sananès, Nicolas

    2017-05-01

    Clinical assessment of fetal head station is difficult and subjective; it is mandatory before attempting operative vaginal delivery. The principal objective of our study was to assess whether measurement of the perineum-to-skull ultrasound distance was predictive of a difficult operative vaginal delivery. Secondary objectives included evaluation of the interobserver reproducibility of perineum-to-skull ultrasound distance and comparison of this measurement and digital examination in predicting a difficult operative delivery. This was a prospective cohort study including all cases of operative vaginal deliveries in singleton pregnancies in cephalic presentation >34 weeks' gestation, from 2012 through 2015. All data were entered prospectively in a medical record system specially devised to meet the requirements of this study. Of the 659 patients in whom perineum-to-skull ultrasound distance was measured prior to operative vaginal delivery, 120 (18%) met the composite criterion for a difficult extraction. Perineum-to-skull ultrasound distance measurement of ≥40 mm was significantly associated with the occurrence of a difficult extraction based on the composite criterion, after adjustment for parity, presentation type, and fetal macrosomia (odds ratio, 2.38; 95% confidence interval, 1.51-3.74; P = .0002). The intraclass correlation coefficient between the perineum-to-skull ultrasound distance measured by the first operator and that measured by the second operator was 0.96 (95% confidence interval, 0.95-0.97; P Measurement of the perineum-fetal skull ultrasound distance is a reproducible and predictive index of the difficulty of instrumental extraction. Ultrasound is a useful supplementary tool to the usual clinical findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Comparison between the Outcomes of Water Birth and Normal Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    Mitra Kolivand

    2014-10-01

    Full Text Available Background & aim: Warm water immersion during labor is associated with relaxation and pain reduction for pregnant women. This method is not extensively used in Iran, given the fear of infection and other maternal/neonatal complications. Alternative methods are required to increase the safety of normal vaginal delivery. The purpose of this study was to compare maternal and neonatal outcomes, associated with water birth and normal vaginal delivery. Methods:This analytical, cross-sectional study was performed on 43 water birth cases (study group and 62 subjects with normal vaginal delivery (control group. Random sampling and consensus were applied for normal vaginal delivery and water birth groups, respectively. Data were collected in a data collection form, using hospital records and interviews with mothers. For data analysis, descriptive and analytical tests including t-test and Chi-square were carried out, using SPSS version 15. Results: No significant difference was observed between the two groups in terms of labor and delivery complications; although three cases of complications during the second stage of labor and four cases of hospitalizations at birth were reported in the control group. The two groups were not significantly different in terms of hospitalization for the reason of neonatal period complications. Regarding maternal complications, there was a significant difference in the rate of episiotomy between the two groups (P=0.032. Postpartum hemorrhage was mostly observed in the control group, although the difference was not significant. Conclusion: In this study, no significant difference was observed in terms of maternal or neonatal complications between the two groups. Therefore, it seems that water birth is a safe method, associated with improved pregnancy outcomes.

  1. Novel mixed vesicles containing lactobacilli biosurfactant for vaginal delivery of an anti-Candida agent.

    Science.gov (United States)

    Abruzzo, Angela; Giordani, Barbara; Parolin, Carola; Vitali, Beatrice; Protti, Michele; Mercolini, Laura; Cappelletti, Martina; Fedi, Stefano; Bigucci, Federica; Cerchiara, Teresa; Luppi, Barbara

    2018-01-15

    The purpose of this work was to prepare and characterize an innovative formulation for vaginal delivery of econazole nitrate, commonly used for the treatment of Candida infections. A novel biosurfactant isolated from a vaginal Lactobacillus strain was used to prepare phosphatidylcholine based mixed vesicles. Biosurfactant was produced by Lactobacillus gasseri BC9, isolated from the vagina of a healthy premenopausal woman, and was chemically characterized by FT-IR and ESI-MS. Mixed vesicles, obtained through film rehydration and extrusion method, were characterized in terms of size, zeta potential, encapsulation efficiency, mucoadhesion properties and econazole release. Moreover, the antimicrobial activity of the mixed vesicles was tested towards both planktonic cultures and biofilms of Candida albicans. Biosurfactant produced by L. gasseri BC9 was composed by peptide-like molecules containing hydrocarbon chains and possessed a high surface activity together with a low critical micelle concentration. All the mixed vesicles presented optimal diameter range (226-337nm) for topical vaginal administration. Econazole-loaded mixed vesicles containing biosurfactant showed higher encapsulation efficiency and mucoadhesion ability with respect to vesicles containing Tween 80. Further, they allowed a sustained release of econazole nitrate, maintaining the antifungal activity against C. albicans planktonic culture. Notably, biosurfactant-based vesicles were significantly more active than free econazole in the eradication of Candida biofilm. In conclusion, mixed vesicles are promising new vaginal delivery systems for the potential employment in the treatment of chronic infections. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. A Rare Complication of a Vaginal Breech Delivery

    Directory of Open Access Journals (Sweden)

    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. Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery.

    Science.gov (United States)

    Ampt, Amanda J; Patterson, Jillian A; Roberts, Christine L; Ford, Jane B

    2015-12-01

    To determine whether rates of obstetric anal sphincter injuries (OASIS) are continuing to increase and whether risk of OASIS according to mode of delivery is constant over time. In a retrospective population-based study, data were obtained for vaginal singleton vertex deliveries at 37-41 weeks of pregnancy among primiparous women in New South Wales, Australia, between January 2001 and December 2011. Annual OASIS rates were determined among non-instrumental, forceps, and vacuum deliveries with and without episiotomy. Multivariable logistic regression was used to determine adjusted odds ratios for each delivery mode category by year. Trends in adjusted odds ratios over time for each delivery category were compared. OASIS occurred in 955 (4.1%) of 23 081 deliveries in 2001 and 1487 (5.9%) of 25 081 deliveries in 2011. After adjustment for known risk factors, the only delivery categories to show statistically significant increases in OASIS over the study period were non-instrumental deliveries without episiotomy (linear trend Pdeliveries with episiotomy (linear trend P=0.004). Overall, OASIS rates have continued to increase. Known risk factors do not fully explain the increase in OASIS rates in non-instrumental deliveries without an episiotomy and in forceps deliveries with an episiotomy. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. [A Structured and Photographic Documentation of the Vacuum-Assisted Vaginal Delivery].

    Science.gov (United States)

    Burkhardt, Tilo; Zimmermann, Roland

    2018-02-01

    The correct placement of the vacuum cup is essential to reduce both maternal and neonatal morbidity after a vacuum-assisted vaginal delivery. Therefore, a checklist based report with all relevant clinical findings and a photo of the infant's head with the location of vacuum tag was introduced to make the exact application of the cup reproducible for. training/instruction purpose. © Georg Thieme Verlag KG Stuttgart · New York.

  7. The neonate cry after cesarean section and vaginal delivery during the first minutes of life.

    Science.gov (United States)

    Branco, Anete; Behlau, Mara; Rehder, Maria Inês

    2005-05-01

    Although the option for vaginal delivery is most physiological, the achievement of cesarean section is very common in Brazil. The neonate cry represents the beginning of both processes, physiological adaptation and human vocal communication. The cry emission depends on the functioning of respiratory and laryngeal muscles, which are controlled by the nervous system. The acoustic analysis of neonate cry is useful in the assessment of healthy babies and can be used to characterize the signals of diseases through a previously multidisciplinary diagnosis, with immediate medical intervention. The present study compared the acoustic cry characteristics of 30 healthy newborn after a cesarean section and 30 healthy newborn after a vaginal delivery, of both genders, from the exact moment of birth until the first 5 min of life. Using the softwares VOXMETRIA and GRAM, it was possible to analyze the duration, frequency, intensity, occurrence, localization and inspiratory phonation, besides the type of spectrographic tracings. The acoustic cry characteristics of newborns after a C section and a vaginal delivery could evidence not only harmonic, expiratory, acute and strong emissions, but also emissions rich in sounds and varied in types of melody. The differences found can be related to the physiology of birth.

  8. French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery.

    Science.gov (United States)

    Haumonte, J-B; Raylet, M; Christophe, M; Mauviel, F; Bertrand, A; Desbriere, R; d'Ercole, C

    2018-03-01

    To validate Grobman nomogram for predicting vaginal birth after cesarean delivery (VBAC) in a French population and adapt it. Multicenter retrospective study of maternal and obstetric factors associated with VBAC between May 2012 and May 2013 in 6 maternity units. External validation and adaptation of the prenatal and intrapartum Grobman nomograms for vaginal birth prediction after cesarean delivery in a French cohort. The study included 523 women with previous cesarean deliveries; 70% underwent a trial of labor for a subsequent delivery (n=367) with a success rate of 65% (n=240). In the univariate analysis, 5 factors were associated with successful VBAC: previous vaginal delivery before the cesarean (P6 (P=0.03). A potentially recurrent indication (defined as arrest of dilation or descent as the indication for the previous cesarean) (P=0.039), a hypertensive disorder during pregnancy (P=0.05), and labor induction (P=0.017) were each associated with failed VBAC. External validation of the prenatal and intrapartum Grobman nomograms showed an area under the ROC curve of 69% (95% CI: 0.638, 0.736) and 65% (95% CI: 0.599, 0.700) respectively. Adaptation of the nomogram to the French cohort resulted in the inclusion of the following factors: maternal age, body mass index at last prenatal visit, hypertensive disorder, gestational age at delivery, recurring indication, cervical dilatation, and induction of labor. Its area under the curve to predict successful VBAC was 78% (95% CI: 0.738, 0.825). The nomogram to predict VBAC developed by Grobman et al. is validated in the French population. Adaptation to the French population, by excluding ethnicity, appeared to improve its performance. Impact of the nomogram use on the caesarean section rate has to be validated in a randomized control trial. Copyright © 2017. Published by Elsevier Masson SAS.

  9. Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus

    OpenAIRE

    Barbosa, Angélica Mércia Pascon; Dias, Adriano; Marini, Gabriela; Calderon, Iracema Mattos Paranhos; Witkin, Steven; Rudge, Marilza Vieira Cunha

    2011-01-01

    OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes ...

  10. Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement.

    Science.gov (United States)

    Dupont, Corinne; Occelli, Pauline; Deneux-Tharaux, Catherine; Touzet, Sandrine; Duclos, Antoine; Bouvier-Colle, Marie-Hélène; Rudigoz, René-Charles; Huissoud, Cyril

    2014-07-01

    Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits Observational descriptive study, in a French maternity unit in the Rhône-Alpes region. Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools. The primary outcomes were the prevalence of severe PPH after vaginal delivery and its quarterly monitoring with a control chart. The secondary outcomes included the global quality of care for women with severe postpartum haemorrhage, including the performance rate of each recommended procedure. Differences in these variables between 2005 and 2012 were tested. From 2005 to 2012, the prevalence of severe postpartum haemorrhage declined significantly, from 1.2% to 0.6% of vaginal deliveries (pcontinuous quality improvement efforts began seven years ago and used, among other tools, statistical process control charts. During this period, the prevalence of severe postpartum haemorrhage after vaginal delivery has been reduced by 50%. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Implementation of vaginal cleansing prior to cesarean delivery to decrease endometritis rates.

    Science.gov (United States)

    Felder, Laura; Paternostro, Amanda; Quist-Nelson, Johanna; Baxter, Jason; Berghella, Vincenzo

    2018-01-17

    Endometritis is a postpartum complication that is more common after cesarean delivery. It frequently requires intravenous antibiotic administration, prolonged hospital stays, and carries a risk of sepsis or abscess formation. Precesarean vaginal preparation has been shown to decrease the risk of endometritis in patients who have labored or have ruptured membranes. The objective of this study was to assess the practical implementation of a protocol for vaginal cleansing prior to cesarean delivery and the subsequent effect on endometritis rates in a clinical setting. This is a before-after retrospective cohort study evaluating the first 6 months of implementation of a vaginal cleansing protocol at a single institution. The primary outcome was the rate of implementation. Secondary outcomes included endometritis and other postoperative complications. The rate of implementation after 6 months was 68.3% (p < .001) and postoperative endometritis rates decreased from 14.0% before implementation to 11.7% after implementation (p .49, OR 0.77, CI 0.36-1.62). Postoperative fever decreased from 22.3% to 18.3% (p .256, OR 0.70, CI 0.37-1.30) and infectious wound complications were 4.5% and 5.8%, respectively (p .76, OR 1.07, CI 0.69-3.64). Implementation of a protocol for vaginal cleansing prior to cesarean delivery in women with ruptured membranes or in labor has high uptake, but in almost a third of eligible women it was not performed. The implementation, has led to a clinical, although not statistical, decrease in postoperative endometritis. Continued research is needed to explore how to improve uptake of this quality improvement measure.

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

    Directory of Open Access Journals (Sweden)

    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

  13. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section.

    Science.gov (United States)

    Kayman-Kose, Seda; Arioz, Dagistan Tolga; Toktas, Hasan; Koken, Gulengul; Kanat-Pektas, Mine; Kose, Mesut; Yilmazer, Mehmet

    2014-10-01

    The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation (TENS) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section. A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group (Group 1) or the TENS group (Group 2), while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group (Group 3) or the TENS group (Group 4). The patients in Group 2 had statistically lower visual analog scale (VAS) and verbal numerical scale (VNS) scores than the patients in Group 1 (p TENS (p = 0.006). The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo (p = 0.830). TENS is an effective, reliable, practical and easily available modality of treatment for postpartum pain.

  14. Frequency of instrumental vaginal delivery in patients with and without receiving epidural analgesia

    International Nuclear Information System (INIS)

    Phool, B.

    2013-01-01

    Aims and Objectives: Frequency of instrumental vaginal delivery in women receiving epidural analgesia and those who are not receiving.Study Design: It was a cohort study. Duration: 6th month. Results: Majority of the patients were found between 20 - 25 years of age in both A and B groups, in Group - A 46.11% (n = 83) and in Group - B 52.22% (n = 94), mean and standard deviation was calculated 26.21 +- 3.56 in Group - A and 27.34 +- 3.78 in Group - B, comparison of instrumental vaginal delivery reveals 10.55% (n = 19) in Group - A were with instrumental delivery while in Group - B only 2.78% (n = 5) cases were found delivered with instruments.Conclusion: Epidural analgesia is considered to be an effective method of pain relief during labor but due to the higher risk of increased duration of 2nd stage of labour it increases the possibility of instrumental delivery. (author)

  15. Odon device for instrumental vaginal deliveries: results of a medical device pilot clinical study.

    Science.gov (United States)

    Schvartzman, Javier A; Krupitzki, Hugo; Merialdi, Mario; Betrán, Ana Pilar; Requejo, Jennifer; Nguyen, My Huong; Vayena, Effy; Fiorillo, Angel E; Gadow, Enrique C; Vizcaino, Francisco M; von Petery, Felicitas; Marroquin, Victoria; Cafferata, María Luisa; Mazzoni, Agustina; Vannevel, Valerie; Pattinson, Robert C; Gülmezoglu, A Metin; Althabe, Fernando; Bonet, Mercedes

    2018-03-12

    A prolonged and complicated second stage of labour is associated with serious perinatal complications. The Odon device is an innovation intended to perform instrumental vaginal delivery presently under development. We present an evaluation of the feasibility and safety of delivery with early prototypes of this device from an early terminated clinical study. Hospital-based, multi-phased, open-label, pilot clinical study with no control group in tertiary hospitals in Argentina and South Africa. Multiparous and nulliparous women, with uncomplicated singleton pregnancies, were enrolled during the third trimester of pregnancy. Delivery with Odon device was attempted under non-emergency conditions during the second stage of labour. The feasibility outcome was delivery with the Odon device defined as successful expulsion of the fetal head after one-time application of the device. Of the 49 women enrolled, the Odon device was inserted successfully in 46 (93%), and successful Odon device delivery as defined above was achieved in 35 (71%) women. Vaginal, first and second degree perineal tears occurred in 29 (59%) women. Four women had cervical tears. No third or fourth degree perineal tears were observed. All neonates were born alive and vigorous. No adverse maternal or infant outcomes were observed at 6-weeks follow-up for all dyads, and at 1 year for the first 30 dyads. Delivery using the Odon device is feasible. Observed genital tears could be due to the device or the process of delivery and assessment bias. Evaluating the effectiveness and safety of the further developed prototype of the BD Odon Device™ will require a randomized-controlled trial. ANZCTR ACTRN12613000141741 Registered 06 February 2013. Retrospectively registered.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Squeezing flows of vaginal gel formulations relevant to microbicide drug delivery.

    Science.gov (United States)

    Kieweg, Sarah L; Katz, David F

    2006-08-01

    Efficacy of topical microbicidal drug delivery formulations against HIV depends in part on their ability to coat, distribute, and be retained on epithelium. Once applied to the vagina, a formulation is distributed by physical forces including: gravity, surface tension, shearing, and normal forces from surrounding tissues, i.e., squeezing forces. The present study focused on vaginal microbicide distribution due to squeezing forces. Mathematical simulations of squeezing flows were compared with squeezing experiments, using model vaginal gel formulations. Our objectives were: (1) to determine if mathematical simulations can accurately describe squeezing flows of vaginal gel formulations; (2) to find the best model and optimized parameter sets to describe these gels; and (3) to examine vaginal coating due to squeezing using the best models and summary parameters for each gel. Squeezing flow experiments revealed large differences in spreadability between formulations, suggesting different coating distributions in vivo. We determined the best squeezing flow models and summary parameters for six test gels of two compositions, cellulose and polyacrylic acid (PAA). We found that for some gels it was preferable to deduce model input parameters directly from squeezing flow experiments. For the cellulose gels, slip conditions in squeezing flow experiments needed to be evaluated. For PAA gels, we found that in the absence of squeezing experiments, rotational viscometry measurements (to determine Herschel-Bulkley parameters) led to reasonably accurate predictions of squeezing flows. Results indicated that yield stresses may be a strong determinant of squeezing flow mechanics. This study serves as a template for further investigations of other gels and determination of which sources of rheological data best characterize potential microbicidal formulations. These mathematical simulations can serve as useful tools for exploring drug delivery parameters, and optimizing formulations

  18. Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery.

    Science.gov (United States)

    Naguib, Ahmad H; Morsi, Hassan M; Borg, Tamer F; Fayed, Salah T; Hemeda, Hosam M

    2010-01-01

    To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery. This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 microg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval. There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups. Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.

  19. 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

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    . 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. CONCLUSIONS: Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal...

  1. Associação da Vaginose Bacteriana com o Parto Prematuro Espontâneo Association of Bacterial Vaginosis with Spontaneous Preterm Delivery

    Directory of Open Access Journals (Sweden)

    Mário Henrique Burlacchini de Carvalho

    2001-09-01

    Full Text Available Objetivo: relacionar a presença de vaginose bacteriana em gestantes com a ocorrência de parto prematuro espontâneo. Método: foram estudadas 611 gestantes do serviço pré-natal da Clínica Obstétrica do HCFMUSP. Foram incluídas gestantes com idade gestacional confirmada por ultra-sonografia no primeiro trimestre de gestação ou duas ultra-sonografias até a 20ª semana quando havia discordância da idade gestacional no primeiro exame. Os partos prematuros eletivos foram excluídos. A pesquisa da vaginose foi realizada na 23ª ou 24ª semana de gestação por meio da técnica de coloração de Gram. O pH vaginal foi pesquisado utilizando-se fita de pH Universal 0-14 produzida pela Merck. O conteúdo vaginal foi coletado com a paciente em posição ginecológica, utilizando-se espéculo não-lubrificado. O pH foi medido na parede lateral da vagina e o conteúdo para Gram foi coletado do fundo de saco vaginal utilizando-se de cotonete estéril. Resultado: das 611 gestantes envolvidas inicialmente no estudo, foram obtidos os resultados do parto em 541. A vaginose bacteriana foi diagnosticada por bacterioscopia em 19% dos casos. No grupo de gestantes com vaginose, 9,7% (10/103 evoluíram com parto prematuro, contra apenas 3,2% (14/438 no grupo negativo (p=0,008. A sensibilidade da bacterioscopia positiva para vaginose bacteriana para predição do parto prematuro foi de 41,7%, a especificidade de 82%, a acurácia de 80,2%, com taxa de falso-positivos de 18% e risco relativo de 1,8. Conclusão: a vaginose bacteriana diagnosticada pelo Gram do conteúdo vaginal representa fator de risco para o parto prematuro, com risco relativo de 1,8.Purpose: to evaluate the relationship between bacterial vaginosis (BV and spontaneous preterm delivery. Method: a total of 611 pregnant women from the general antenatal clinic of the "Clínica Obstétrica do Hospital das Clínicas da Universidade de São Paulo" were enrolled in this study. All pregnancies were

  2. 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

  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. Retzius' space haematoma after spontaneous delivery: a case report.

    Science.gov (United States)

    Fieni, Stefania; Berretta, Roberto; Merisio, Carla; Melpignano, Mauro; Gramellini, Dandolo

    2005-12-01

    We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization. At exploratory laparotomy a haemorrhagic infiltration was found in Retzius' space and the anterior wall of the bladder, which appeared thickened and swollen below the peritoneum. We tried to drain the haematoma, however, we failed to drain it completely because of the large blood infiltration in the bladder wall. Clinical and ultrasound follow-up examinations showed a progressive reduction of the haematoma which completely disappeared nine months later. The haemodynamic changes occurring during pregnancy and labour, associated with strong mechanical stress, seem to be among the major causative factors of haematoma formation. Moreover, the venous load in the pelvic vascular system is increased during pregnancy; a stress-induced increase in venous blood pressure might play a prominent role, especially in cases of venous ectasia, where the resistance of blood vessel walls is reduced. Intraoperative evidence seemed to suggest a haemorrhage secondary to the rupture of the venous vessels in the Santorini plexus. The rupture was probably caused by the thrust of the fetal head, associated with abnormality or fragility of the blood vessels, or by some pathologic changes occurring in the anatomical structures during pregnancy, which could not be accurately defined because of the severity and degree of the haematoma infiltration found intraoperatively.

  5. 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.

  6. Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

    Directory of Open Access Journals (Sweden)

    Buddhi Shrestha

    2016-12-01

    Full Text Available Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery. Methods:  A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed. Results: One hundred and four successful vacuum deliveries (2.9% were conducted among 3457 deliveries during our study period. Sixty seven (64.4% were primigravida and most (n=59, 56.7% parturients were of age group 20-30 years. The commonest (n=65, 62.5% indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7 had genital tract injury, 3.8% (n=4 had primary post-partum hemorrhage, 3.8% (n=4 had urinary retention, 2.8% (n=3 needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20 neonates had birth asphyxia, 4.8% (n=5 neonates had cephalohematoma, 0.96% (n=1 had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome. Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

  7. Loop electrosurgical excision of the cervix and risk for spontaneous preterm delivery in twin pregnancies

    DEFF Research Database (Denmark)

    Noehr, Bugge; Jensen, Allan; Frederiksen, Kirsten

    2009-01-01

    OBJECTIVE: To investigate the association between three cervical procedures (biopsy with no treatment, ablation, and loop electrosurgical excision procedure [LEEP]) and subsequent spontaneous preterm delivery in twin pregnancies using population-based data from various nationwide registries. METH...

  8. How to identify twins at low risk of spontaneous preterm delivery

    DEFF Research Database (Denmark)

    Sperling, Lene; Kiil, C; Larsen, L U

    2005-01-01

    OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery....... METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous...... delivery at different cut-off levels of cervical length were determined. RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic...

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

    Science.gov (United States)

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

    2014-01-01

    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. Participants in this prospective cohort were recruited consecutively from June 2003 to July 2005 from all eligible women who delivered in the department. A validated questionnaire, the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF) was completed by all participants 2-3 days after delivery, and a similar second questionnaire was filled out 1 year later. Additional data were obtained from the medical records. The first questionnaire was completed by 1,018 women (63 %) and the second by 859 women (84 %). The study group comprised the 575 women without any UI before the pregnancy and who had a vaginal delivery. The primary analysis comprised 117 women with either SUI or MUI 1 year after the vaginal delivery and 403 women without any UI. In univariate analyses, the following factors were associated with SUI or MUI: prepregnancy body mass index (BMI) ≥ 30 (p pregnancy (p pregnancy [adjusted odds ratio (OR) 4.7, 95 % confidence interval (CI) 2.9-7.7) and inversely associated with oxytocin augmentation (adjusted OR 0.5, 95 % CI 0.3-0.9). SUI or MUI 1 year after the first vaginal delivery was strongly associated with UI during the pregnancy and inversely associated with oxytocin augmentation.

  10. Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Angélica Mércia Pascon Barbosa

    2011-01-01

    Full Text Available OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6% and two years after a cesarean (44.8% vs. 18.4%. Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%. Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies.

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

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    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.

  12. Evaluation on levator ani muscle injuries after vaginal delivery with MRI

    International Nuclear Information System (INIS)

    Wang Yi; Gong Shuigen; Zhang Weiguo; Chen Jinhua; Tan Yong

    2006-01-01

    Objective: To explore the MRI finding of female normal levator ani muscle and the levator ani muscle injuries and to evaluate the correlation between childbirth and levator ani muscle injuries. Methods: One hundred asymptomatic nulliparous women (control group) and 200 vaginally primiparous women (study group) were selected as the object of this study. Moreover, the study group was divided into two subgroups: group A (100 cases) with stress incontinence, group B (100 cases) without clinical symptoms. Multiplanar proton density magnetic resonance images were obtained at 0.5 cm intervals from these study individuals. All images were used to analyze the differentiation of MRI features between normal levator ani muscle and levator ani muscle injuries. Results: No levator ani injuries were identified in the control group. Fifty-four primiparous women (27%) had visible injuries in their levator ani muscles, 42 in group A and 12 in group B. Injuries were identified in the puborectalis muscle in 49 cases and in the iliococcygeus muscle in 5 cases(χ 2 =41.447, P<0.01). Within the puborectalis muscle, both unilateral and bilateral partial defects were usually found. Iliococcygeus injuries showed that the iliococcygeus muscle was atrophied in MR images. Conclusion: Vaginal delivery was an important cause of the levator ani muscle injuries which could result in pelvic floor dysfunction and pelvic organs prolapsed. MRI was an effective examination method of the levator ani muscle injuries. (authors)

  13. 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...... delivery. The primary analysis comprised 117 women with either SUI or MUI 1 year after the vaginal delivery and 403 women without any UI. RESULTS: In univariate analyses, the following factors were associated with SUI or MUI: prepregnancy body mass index (BMI) ≥ 30 (p pregnancy (p...... cohort were recruited consecutively from June 2003 to July 2005 from all eligible women who delivered in the department. A validated questionnaire, the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF) was completed by all participants 2-3 days after delivery, and a similar...

  14. Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amr Adel Mansy

    2018-03-01

    Conclusion: Although misoprostol is used in cervical ripening in labour induction and medical evacuation of missed abortion, its use to facilitate IUD insertion in women with tight cervix or in whom vaginal delivery was not experienced, has no role in pain reduction or increase the ease of IUD insertion.

  15. Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?

    Science.gov (United States)

    Murad-Regadas, Sthela Maria; Dealcanfreitas, Iris Daiana; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Pereira, Jacyara de Jesus Rosa

    2014-01-01

    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. 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. 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. Fecal incontinence symptoms did not correlate with anal pressures and anal sphincter anatomy changes, but women with sphincter defects have shorter anterior EAS and IAS and a longer gap.

  16. Ureaplasma parvum genotype, combined vaginal colonisation with Candida albicans, and spontaneous preterm birth in an Australian cohort of pregnant women.

    Science.gov (United States)

    Payne, Matthew S; Ireland, Demelza J; Watts, Rory; Nathan, Elizabeth A; Furfaro, Lucy L; Kemp, Matthew W; Keelan, Jeffrey A; Newnham, John P

    2016-10-18

    Detection of Ureaplasma, Mycoplasma and Candida spp. in the vagina during pregnancy has previously been associated with preterm birth (PTB). However, the prevalence of these microorganisms and the associated obstetric risks (likely to be population-specific) have not been determined in Australian women; furthermore, in the case of Ureaplasma spp., very few studies have attempted characterisation at the species level and none have examined genotype/serovar status to further refine risk assessment. In order to address these issues we sampled the vaginal fluid of 191 pregnant Australian women at three time points in pregnancy. Culture methods were used for detection of Ureaplasma spp. and Candida spp., and real-time PCR was used for speciation of U. parvum and U. urealyticum, non-albicans Candida spp., Mycoplasma hominis and Mycoplasma genitalium. High-resolution melt PCR was used to genotype U. parvum. Data on various lifestyle factors (including sex during pregnancy and smoking), antimicrobial use and pregnancy outcome were collected on all participants. Chi-square tests were used to assess the association of vaginal microorganisms with PTB. Detection of Ureaplasma spp. was higher among spontaneous PTB cases, specifically in the presence of U. parvum [77 % preterm (95 % confidence interval (CI) 50-100 %) vs. 36 % term (CI: 29-43 %), p = 0.004], but not U. urealyticum. The association with PTB strengthened when U. parvum genotype SV6 was detected (54 % preterm (CI: 22-85 %) vs. 15 % term (CI: 10-20 %), p = 0.002); this genotype was also present in 80 % (4/5) of cases of PTB Candida albicans in the same sample, the association with PTB remained strong for both U. parvum [46 % preterm (CI: 15-78 %) vs. 13 % term (CI: 8-18 %), p = 0.005] and U. parvum genotype SV6 [39 % preterm (CI: 8-69 %) vs. 7 % term (CI: 3-11 %), p = 0.003]. With the exception of Candida glabrata, vaginal colonisation status for all organisms was stable throughout

  17. Simple, Validated Vaginal Birth After Cesarean Delivery Prediction Model for Use at the Time of Admission

    Science.gov (United States)

    Metz, Torri D.; Stoddard, Gregory J.; Henry, Erick; Jackson, Marc; Holmgren, Calla; Esplin, Sean

    2017-01-01

    OBJECTIVE To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission. METHODS Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one subsequent delivery were included. Variables associated with successful VBAC were identified using multivariable logistic regression. Points were assigned to these characteristics, with weighting based on the coefficients in the regression model to calculate an integer VBAC score. The VBAC score was correlated with TOLAC success rate and was externally validated in an independent cohort using a logistic regression model. RESULTS A total of 5,445 women met inclusion criteria. Of those women, 1,170 (21.5%) underwent TOLAC. Of the women who underwent trial of labor, 938 (80%) had a successful VBAC. AVBAC score was generated based on the Bishop score (cervical examination) at the time of admission, with points added for history of vaginal birth, age younger than 35 years, absence of recurrent indication, and body mass index less than 30. Women with a VBAC score less than 10 had a likelihood of TOLAC success less than 50%. Women with a VBAC score more than 16 had a TOLAC success rate more than 85%. The model performed well in an independent cohort with an area under the curve of 0.80 (95% confidence interval 0.76–0.84). CONCLUSIONS Prediction of TOLAC success at the time of admission is highly dependent on the initial cervical examination. This simple VBAC score can be utilized when counseling women considering TOLAC. PMID:23921867

  18. 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 ...

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

    Science.gov (United States)

    Iskender, Cantekin; Kaymak, Oktay; Erkenekli, Kudret; Ustunyurt, Emin; Uygur, Dilek; Yakut, Halil Ibrahim; Danisman, Nuri

    2014-01-01

    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. 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. 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). BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

  20. 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 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.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.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.BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

  1. Successful Delivery of Twin Pregnancy in Class U3b/C2/V1 Uterus by Bilateral Caesarean Section after Spontaneous Conception

    Directory of Open Access Journals (Sweden)

    Yasmine El-Masry

    2015-01-01

    Full Text Available A case of a 19-year-old female with class U3b/C2/V1 uterus conceived a twin pregnancy with a fetus in each horn after spontaneous conception. She referred to our department with presentation of premature rupture of membranes, with a history of cesarean delivery of a single full term living fetus a year and a half before this delivery. Examination revealed two completely separate uterine horns with a fetus in each horn, two distinct externally rounded cervices, and a single vagina with a short nonobstructing vaginal septum in the upper part of the vagina. And as the appropriate mode of delivery is still unclear, each case should be managed as the condition requires, and in our case urgent bilateral caesarean sections were performed.

  2. Ultrassonografia do colo uterino versus índice de Bishop como preditor do parto vaginal Cervical ultrasonography versus Bishop score as a predictor of vaginal delivery

    Directory of Open Access Journals (Sweden)

    José Richelmy Brazil Frota Aragão

    2011-11-01

    with Bishop’s score for the prediction of vaginal delivery after labor induction, with 25 mcg of misoprostol. METHODS: a prospective study for the validation of a diagnostic test was conducted on 126 pregnant women with indication for labor induction. The patients were evaluated by Bishop’s score and transvaginal ultrasonography for cervical measurement. They also undergone obstetric transabdominal ultrasound to evaluate static and fetal weight, as well as the amniotic fluid index, and basal cardiotocography for the evaluation of fetal vitality. Labor was induced with vaginal and sublingual misoprostol, one of the tablets containing 25 mcg of the drug and the other only placebo. The tablets were administered every six hours, with a maximum number of eight. Frequency tables were obtained, and measures of central tendency and dispersion were calculated. ROC curves were constructed for the evaluation of Bishop’s score and ultrasonographic measurement of the uterine cervix for the prediction of vaginal delivery. RESULTS: the area under the ROC curve was 0.5 (p=0.8 for the ultrasonographic measurement of the uterine cervix, and 0.6 (p=0.02 for Bishop’s score (cut point ³4. Bishop’s score had a sensitivity of 56.2% and specificity of 67.9% for prediction of vaginal delivery, with a positive likelihood ratio of 1.75 and a negative one of 0.65. CONCLUSIONS: ultrasonographic measurement of the uterine cervix was not a good predictor of evolution to vaginal delivery among patients with misoprostol-induced labor. Bishop’s score was a better predictor of vaginal delivery under these circumstances.

  3. The natural history of pelvic vein thrombosis on magnetic resonance venography after vaginal delivery.

    Science.gov (United States)

    Khalil, Hisham; Avruch, Leonard; Olivier, Andre; Walker, Mark; Rodger, Marc

    2012-04-01

    Venous thromboembolism constitutes the leading cause of direct maternal mortality in the developed world. To date, there are no studies using magnetic resonance venography (MRV) to delineate the incidence and natural history of intraluminal filling defects in the postpartum period in patients with low thrombosis risk. This was a prospective cohort study of women at low thrombosis risk postvaginal delivery undergoing MRV in the early postpartum period. In 30 eligible and consenting participants, independently adjudicated MRV, conducted on a median of postpartum day 1, identified definite thrombosis in 30% (95% confidence interval [CI], 13.6-46.4%) of study participants. All episodes of definite thrombosis were identified in the iliac and ovarian veins. Probable thrombosis was identified in an additional 27% of study participants (95% CI, 10.3-41.7%), and possible thrombosis in an additional 10% (95% CI, 0-20.7%). In this group of low-risk postpartum patients, we identified a high prevalence of definite pelvic vein intraluminal filling defects of uncertain clinical significance. This study suggests that some degree of pelvic vein intraluminal filling defect may be a normal finding after uncomplicated vaginal delivery. Copyright © 2012 Mosby, Inc. All rights reserved.

  4. 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.

  5. 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.

  6. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania.

    Science.gov (United States)

    Kavle, Justine A; Stoltzfus, Rebecca J; Witter, Frank; Tielsch, James M; Khalfan, Sabra S; Caulfield, Laura E

    2008-06-01

    The study sought to identify determinants of blood loss at childbirth and 24 hours postpartum. The study was nested in a community-based randomized trial of treatments for anaemia during pregnancy in Wete Town, Pemba Island, Zanzibar, United Republic of Tanzania. Status of anaemia during pregnancy, nutritional information, obstetric history, and socioeconomic status were assessed at enrollment during routine antenatal care. Pregnant women presented for spontaneous vaginal delivery, and nurse-midwives collected information on labour and delivery via partograph. Blood-stained sanitary napkins and pads from childbirth and 24 hours postpartum were quantified using the alkaline hematin method. Moderate-to-severe anaemia (Hb delivery and the immediate postpartum period, after adjusting for maternal covariates and variables of biological relevance to blood loss. Greater blood loss was associated (pbirth, and grand multiparity. The findings provide unique evidence of a previously-suspected link between maternal anaemia and greater blood loss at childbirth and postpartum. Further research is needed to confirm these findings on a larger sample of women to determine whether women with moderate-to-severe anaemia are more likely to experience postpartum haemorrhage and whether appropriate antenatal or peripartum care can affect the relationships described here.

  7. Breastfeeding practices: does method of delivery matter?

    Science.gov (United States)

    Ahluwalia, Indu B; Li, Ruowei; Morrow, Brian

    2012-12-01

    Objective of this study was to assess the relationship between method of delivery and breastfeeding. Using data (2005-2006) from the longitudinal Infant Feeding Practices Study II (n = 3,026) we assessed the relationship between delivery method (spontaneous vaginal, induced vaginal, emergency cesarean, and planned cesarean) and breastfeeding: initiation, any breastfeeding at 4 weeks, any breastfeeding at 6 months, and overall duration. We used SAS software to analyze data using multivariable analyses adjusting for several confounders, including selected demographic characteristics, participants' pre-delivery breastfeeding intentions and attitude, and used event-history analysis to estimate breastfeeding duration by delivery method. We found no significant association between delivery method and breastfeeding initiation. In the fully adjusted models examining breastfeeding duration to 4 weeks with spontaneous vaginal delivery group as the reference, those with induced vaginal deliveries were significantly less likely to breastfeed [adjusted odds ratio (AOR) = 0.53; 95 % CI = 0.38-0.71]; and no significant relationship was observed for those who had planned or emergency cesarean deliveries. Again, compared with spontaneous vaginal delivery group, those with induced vaginal [AOR = 0.60; 96 % CI = 0.47-0.78] and emergency cesarean [AOR = 0.68; 96 % CI = 0.48-0.95] deliveries were significantly less likely to breastfeed at 6 months. Median breastfeeding duration was 45.2 weeks among women with spontaneous vaginal, 38.7 weeks among planned cesarean, 25.8 weeks among induced vaginal and 21.5 weeks among emergency cesarean deliveries. While no significant association was observed between delivery method and breastfeeding initiation; breastfeeding duration varied substantially with method of delivery, perhaps indicating a need for additional support for women with assisted deliveries.

  8. Repair of Spontaneous Perineal Laceration at Delivery, a Cultural ...

    African Journals Online (AJOL)

    opsig

    2006-12-02

    Dec 2, 2006 ... culture to repair a genital tear following delivery. Although, both of them could not offer any reason for this prohibition, they explained that a particular local herbal preparation is usually used to cover the wound area. Consequently, we have started recruiting women with the same sociocultural background ...

  9. Prevention of preterm delivery in twin gestations (PREDICT): a multicenter, randomized, placebo-controlled trial on the effect of vaginal micronized progesterone

    DEFF Research Database (Denmark)

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

    2011-01-01

    Studies on high-risk singleton gestations have shown a preventive effect of progesterone treatment on preterm delivery. This study was conducted to investigate the preventive effect of vaginal micronized progesterone in a large population of twin gestations....

  10. Dynamic mechanical behaviour of nanoparticle loaded biodegradable PVA films for vaginal drug delivery.

    Science.gov (United States)

    Traore, Yannick L; Fumakia, Miral; Gu, Jijin; Ho, Emmanuel A

    2018-03-01

    In this study, we investigated the viscoelastic and mechanical behaviour of polyvinyl alcohol films formulated along with carrageenan, plasticizing agents (polyethylene glycol and glycerol), and when loaded with nanoparticles as a model for potential applications as microbicides. The storage modulus, loss modulus and glass transition temperature were determined using a dynamic mechanical analyzer. Films fabricated from 2% to 5% polyvinyl alcohol containing 3 mg or 5 mg of fluorescently labeled nanoparticles were evaluated. The storage modulus and loss modulus values of blank films were shown to be higher than the nanoparticle-loaded films. Glass transition temperature determined using the storage modulus, and loss modulus was between 40-50℃ and 35-40℃, respectively. The tensile properties evaluated showed that 2% polyvinyl alcohol films were more elastic but less resistant to breaking compared to 5% polyvinyl alcohol films (2% films break around 1 N load and 5% films break around 7 N load). To our knowledge, this is the first study to evaluate the influence of nanoparticle and film composition on the physico-mechanical properties of polymeric films for vaginal drug delivery.

  11. 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

    To compare clerkship medical students' confidence in performing a simulated normal vaginal delivery (NVD) after participating in a simulation training session using two different models. Medical students were randomized to participate in a simulated NVD session using either an obstetrics mannequin or a birthing pelvis model. Questionnaires were used to assess confidence and evaluate the simulation before and immediately after the session and on the last day of the obstetrics clerkship rotation. One hundred ten students were randomized. At the start of the clerkship, both groups had similar obstetrics exposure and confidence levels. Only 15 students (13.9%) agreed they were ready to attempt a NVD with minimal supervision or independently. This increased significantly to 43 students (39.4%) immediately after the session. At the end of the clerkship, 79 of 81 responding students (97.5%) were confident that they could attempt a NVD with minimal supervision or independently. There were no significant differences noted between simulator groups at any point. The sessions were rated as equally useful and realistic, and this remained unchanged at the end of the clerkship. Simulated NVD training using either an obstetrics mannequin or a birthing pelvis model provides clerkship students with a positive experience and increases confidence immediately. It should be implemented early in the rotation, as it appears the clerkship experience also plays a large role in terms of students' confidence. Despite this, students maintain this type of learning is useful. Effective simulation training can easily be incorporated into clerkship training.

  12. 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.

  13. Modeling the intention to choose natural vaginal delivery: using reasoned action and social cognitive theories.

    Science.gov (United States)

    Kanani, Safieh; Allahverdipour, Hamid; AsghariJafarabadi, Mohammad

    2015-01-01

    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 attitude 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. 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. Self-efficacy, outcome expectations, and attitude toward NVD were associated with intention to choose the NVD. The study findings may play a role in designing educational interventions aimed at influencing the NVD and improving childbirth programs.

  14. 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

    Background: 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. Methods: 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. Results: 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. Conclusion: 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. PMID:27921002

  15. 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.)

  16. SPONTANEOUS FALLOPIAN TUBE EVISCERATION IN PROCIDENTIA AND PERFORATING CARCINOMATOUS VAGINAL WALL ULCER – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Marijan Lužnik

    2018-02-01

    stretched even after catheterization and unreponible likewise. In surgical procedure Steckel´s incision was used to avoid widely the area of vagina where tube exits. We did not try to repone the tube, so pouch of Douglas was opened first and after that uterovesical pouch as well. Hysterectomy with bilateral adnexectomy in situ and almost total vaginectomy has been made. In lower part of abdominal cavity there were not any pathological signs. Peritoneal cavity was closed with circular suture. Vesicorrhaphy in three layers and minimal rectorrhaphy with kolpoperineoplasty were made. Postoperative course of treatment was without complications. After eight days our patient has been discharged from the hospital. Pathohistologic findings were: Invasive squamous cell carcinoma of the vagina, large cell and keratinizing. Invasive growth is present near the opening through which a part of the uterus prominates. Maximal thickness of invasive growth is 0.8 cm, on the borders there is not any cancerous tissue left. Considering the pathologic findings, the patient has been appointed to the Gynecologic – oncologic counsel at University Department of Gynecology, Ljubljana. Diagnosis was Ca. vaginae stadium I.. State after vaginal histerectomy with colpectomy. The lesion removed with safety border. As for therapy; considering the age of the patient, consilium decided for observation. Conclusions. Because of the perforated vagina and opened path to the abdominal cavity the total uterine prolapse in this case was a life-threatening emergency. The fallopian tube partly closed the communication and it also acted as a wedge so the prolapsed uterus and vagina could not repone. An urgent operation has been necessary – we resolved the procidentia and removed the cancer.

  17. Cardiovascular disease risk in women with a history of spontaneous preterm delivery : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Heida, Karst Y.; Velthuis, Birgitta K.; Oudijk, Martijn A.; Reitsma, Johannes B.; Bots, Michiel L.; Franx, Arie; van Dunne, Frederique M.; Hoek, Annemieke

    Background Increasing evidence suggests a relation between having had spontaneous preterm delivery and cardiovascular disease in the future. We performed a systematic review and meta-analysis to assess the relation between a history of spontaneous preterm delivery and risk of ischaemic heart disease

  18. Cardiovascular disease risk in women with a history of spontaneous preterm delivery: A systematic review and meta-analysis

    NARCIS (Netherlands)

    Heida, Karst Y.; Velthuis, Birgitta K.; Oudijk, Martijn A.; Reitsma, Johannes B.; Bots, Michiel L.; Franx, Arie; van Dunné, Frederique M.; Cohen, Miriam; de Groot, Christianne J. M.; Hammoud, Nurah M.; Hoek, Annemiek; Laven, Joop S. E.; Maas, Angela H. E. M.; van Lennep, Jeanine E. Roeters; van Barneveld, Teus A.

    2016-01-01

    Background Increasing evidence suggests a relation between having had spontaneous preterm delivery and cardiovascular disease in the future. We performed a systematic review and meta-analysis to assess the relation between a history of spontaneous preterm delivery and risk of ischaemic heart disease

  19. Cardiovascular disease risk in women with a history of spontaneous preterm delivery : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Heida, Karst Y.; Velthuis, Birgitta K.; Oudijk, Martijn A.; Reitsma, Johannes B.; Bots, Michiel L.; Franx, Arie; Van Dunné, Frederique M.

    2016-01-01

    Background Increasing evidence suggests a relation between having had spontaneous preterm delivery and cardiovascular disease in the future. We performed a systematic review and meta-analysis to assess the relation between a history of spontaneous preterm delivery and risk of ischaemic heart disease

  20. Comparison of pelvic floor muscle strength between women undergoing vaginal delivery, cesarean section, and nulliparae using a perineometer and digital palpation.

    Science.gov (United States)

    Batista, Elicéia Marcia; Conde, Délio Marques; Do Amaral, Waldemar Naves; Martinez, Edson Zangiacomi

    2011-11-01

    To compare pelvic floor muscle (PFM) strength between women undergoing vaginal delivery, cesarean section, and nulliparae, investigating the factors associated with PFM strength, and observing the correlation between vaginal digital palpation and use of a perineometer. A cross-sectional study was conducted, including 31 women following vaginal delivery, 30 women following cesarean section, and 30 nulliparous women. PFM strength was measured by vaginal digital palpation and use of a perineometer. Multiple linear regression analysis with adjustment for covariables was used to compare the mean PFM strength and identify its associated factors. The mean PFM strength of women undergoing vaginal delivery and cesarean section was 25.6 ± 14.5 cmH(2)O and 39.6 ± 22.0 cmH(2)O (p history of vaginal delivery compared to those undergoing cesarean section. Non-white race/ethnicity negatively affected PFM strength. Our data suggest that vaginal digital palpation may be used in clinical practice because of its expressive correlation with use of a perineometer.

  1. Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study.

    Science.gov (United States)

    Bickford, Celeste D; Janssen, Patricia A

    2015-01-01

    As rates for cesarean births continue to rise, more women are faced with the choice to plan a vaginal or a repeat cesarean birth after a previous cesarean. The objective of this population-based retrospective cohort study was to compare the safety of planned vaginal birth with cesarean birth after 1-2 previous cesarean sections. We identified singleton term births in British Columbia from 2000 to 2008 using data from the British Columbia Perinatal Data Registry. Women carrying a singleton fetus in cephalic presentation at term (37-41 weeks of gestation completed) with 1-2 prior cesarean births were included. Those with gestational hypertension, pre-existing diabetes and cardiac disease were excluded. Maternal and neonatal outcomes were classified as either life-threatening or non-life threatening. We compared outcomes among women with none versus at least 1 previous vaginal birth, by planned method of delivery. We estimated relative risks (RR) and 95% confidence intervals (CI) for composite outcomes using Poisson regression. Of the 33 812 women in the sample, 5406 had a history of vaginal delivery and 28 406 did not. The composite risk for life-threatening maternal outcomes was elevated among women planning vaginal compared with cesarean birth both with and without a prior vaginal birth (RR 2.06, 95% CI 1.20-3.52) and (2.52, 95% CI 2.04-3.11). Absolute differences (attributable risk [AR]) were 1.01% and 1.31% respectively. Non-life threatening maternal outcomes were decreased among women planning a vaginal birth if they had had at least 1 prior vaginal delivery (RR 0.51, 95% CI 0.33-0.77; AR 1.17%). The composite risk of intrapartum stillbirth, neonatal death or life-threatening neonatal outcomes did not differ among women planning vaginal or cesarean birth with a prior vaginal delivery and non-life threatening neonatal outcomes were decreased, (RR 0.67, 95% CI 0.52-0.86); AR 1.92%). After 1 or 2 previous cesarean births, risks for adverse outcomes between planned

  2. [Vaginal birth after cesarean. A safe option?].

    Science.gov (United States)

    García-Benítez, Carlos Quesnel; López-Rioja, Miguel de Jesús; Monzalbo-Núñez, Diana Elena

    2015-02-01

    To compare the beginning and evolution of labor variables such as demographic characteristics, obstetric and perinatal outcomes of patients with vaginal birth after cesarean (VBAC). Observational, retrospective and retro elective trial purposes of comparative analysis, were divided into groups by the onset of labor; spontaneously versus induction and by the labor evolution; spontaneously versus conduction. Being analyzing by Student's T and Fisher test. According the ACOG criteria. 136 patients with prior cesarean section were eligible to labor. The indications of previous cesarean have a trend of a non-recurring etiology, being the elective cesarean section the most common. Regarding the onset, 78% was spontaneous and 22% had an induction. Comparing the demographic characteristics it stands a greater number of deliveries, history of vaginal delivery, a higher Bishop score, fetal weight estimated lower and higher intergenesic period. As a perinatal prognosis, the study has shown be safe with a positive outcome. Conclusions:Vaginal birth after cesarean is safe, that should be offered to all women with a low transverse incision, with an intergenesic period greater than 18 months, whit a singleton pregnancy, in a cephalic presentation, with an appropriate fetal weight, and without obstetric contraindications of vaginal delivery.

  3. Fish oil in various doses or flax oil in pregnancy and timing of spontaneous delivery

    DEFF Research Database (Denmark)

    Knudsen, V.K.; Hansen, Harald S.; Østerdal, M.L.

    2006-01-01

    treatment. Setting: The Danish National Birth Cohort. Sample: A total of 3098 women allocated into six treatment groups and one control group. Methods: The six intervention groups were offered fish oil capsules in doses of 0.1, 0.3, 0.7, 1.4 and 2.8 g of eicosapentaenoic acid and docosahexaenoic acid per......Objectives: To test the earlier suggested hypothesis that intake of long-chain n-3 fatty acids from fish oil may delay the timing of spontaneous delivery and to test if alpha-linolenic acid, provided as flax oil capsules, shows the same effect. Design: Randomised controlled trial including women...... day or 2.2 g of alpha-linolenic acid (ALA) per day from week 17-27 of gestation until delivery. Main outcome measures: Timing of spontaneous delivery. Results: No differences in timing of spontaneous delivery was detected in the fish oil groups or the flax oil group, compared with the control group...

  4. [Factors associated with successful vaginal birth in women with a cesarean section history].

    Science.gov (United States)

    Sepúlveda-Mendoza, Denisse Lorena; Galván-Caudillo, Marisol; Soto-Fuenzalida, Gonzalo Andrés; Méndez-Lozano, Daniel Humberto

    2015-12-01

    BAKCGROUND: Caesarean section is the main proceedings for ending of pregnancy in the world, and currently represents a public health problem. Some factors that benefit the likelihood of vaginal birth after a previous C-section have been described in literature, with scoring tools designed to predict success for trial of labor after a previous cesarean. There are few studies that identify predictors of success for vaginal delivery in Latin-American patients. To identify predictive factors associated to vaginal delivery success in patients with a prior cesarean delivery. Case-control study. We included patients with one previous cesarean delivery admitted at our hospital. The variables analyzed with a logistic regression system to predict vaginal delivery success probabilities. A total of 11 60 patients were included, 668 underwent C-section (considered control group), and 492 patients had a vaginal delivery (considered study group). The Factors associated to vaginal birth after cesarean delivery were maternal age (25.1±5.4 vs 24.7±5.5 years old, OR 0.967, p<0.05), fetal weight (3,253±389 vs 3,383±452 g, OR 0.99, p<0.05), previous vaginal delivery (49 vs 1 8.4%, OR 2.97, p<0.05) and spontaneous labor (90.8 vs 74.1%, OR 3.68, p<0.05, respectively). Maternal age, fetal weight, previous vaginal delivery and spontaneous labor were associated with vaginal delivery success in patients with a previous cesarean delivery.

  5. Plasma levels of cortisol and opioid peptide beta-endorphin during spontaneous vaginal delivery

    Directory of Open Access Journals (Sweden)

    Arsenijević Ljubica

    2006-01-01

    Full Text Available INTRODUCTION Labor pain is very frequent in clinical practice, but the underlying mechanisms as well as numerous neuroendocrine responses activated by such pain have not been fully explained yet. OBJECTIVE The objective of the study was to determine the influence of labor pain on plasma levels of cortisol and opioid peptide ß-endorphin. METHOD Cortisol and ß-endorphin levels were measured in blood plasma of: health, non-pregnant women (group 1, n=8, health pregnant women (group 2, n=8 and in parturitions, through fourth ages (group 3, n=8, Plasma level of cortisol was measured by radioimmunoassay, and ß-endorphin by enzyme immunoassay. Data were expressed as mean ± standard error of mean and were analyzed by Student's t test and Mann Whitney test. RESULTS Plasma level of cortisol in group 2 was significantly increased compared to the group 1. During labor progression, plasma level of cortisol was rising till the third labor age. Plasma level of cortisol in fourth labor age was not significantly different from the ag.e one and group 1. Plasma level of ß-endorphin was (n.g/L: in group 1:64±20, group 2:70±22, group 3:the first labor age: 75±15, the second labor age: 193±54, the third labor age: 346+97 and the fourth labor age: 114±31. CONCLUSION These results indicate that both ß-endorphin and cortisol are involved in regulation and modulation of labor pain and stress.

  6. Antithrombin activity, platelet count, hemoglobin concentration and hematocrit value determined immediately before vaginal delivery among healthy women.

    Science.gov (United States)

    Morikawa, Mamoru; Yamada, Takashi; Yamada, Takahiro; Koyama, Takahiro; Akaishi, Rina; Ishikawa, Satoshi; Takeda, Masamitsu; Nishida, Ryutaro; Araki, Naoto; Minakami, Hisanori

    2012-08-01

    To determine the normal reference values for antithrombin (AT) activity, platelet count (Plt), hemoglobin concentration (Hb), and hematocrit value (Ht) immediately before vaginal delivery among healthy pregnant women with singleton pregnancies and to determine association of these blood parameters with fetal growth. A complete blood count was performed and the AT activity was examined in 300 consecutive women admitted to hospital at > or = gestational week 36 for labor pains and/or the rupture of fetal membranes. All the women were normotensive and had singleton pregnancies, and none of the women had proteinuria, a weekly weight gain > or = 0.5 kg, or other specific complications upon admission. All the women attempted a vaginal delivery. The medians (5th-95th percentile) were 90% (71-110%) for AT activity, 234x10(9)/L (150-337x10(9)/L) for Plt, 11.0 g/dL (9.5-12.8 g/dL) for Hb, and 34.0% (30.4-38.6%) for Ht. Women with an Hb value of > or = the median (11.0 g/dL) gave birth to significantly smaller infants than their counterparts. A considerable number of healthy women exhibit a reduced AT activity and/or platelet count immediately before delivery. Hemoconcentration evidenced by a raised Hb value adversely effects on infant growth. Our data may be helpful when considering the normal ranges of these blood parameters for healthy parturient women.

  7. Proteomic Analysis of Early Mid-Trimester Amniotic Fluid Does Not Predict Spontaneous Preterm Delivery

    Science.gov (United States)

    Lenco, Juraj; Vajrychova, Marie; Link, Marek; Tambor, Vojtech; Liman, Victor; Bullarbo, Maria; Nilsson, Staffan; Tsiartas, Panagiotis; Cobo, Teresa; Kacerovsky, Marian; Jacobsson, Bo

    2016-01-01

    Objective The aim of this study was to identify early proteomic biomarkers of spontaneous preterm delivery (PTD) in mid-trimester amniotic fluid from asymptomatic women. Methods This is a case-cohort study. Amniotic fluid from mid-trimester genetic amniocentesis (14–19 weeks of gestation) was collected from 2008 to 2011. The analysis was conducted in 24 healthy women with subsequent spontaneous PTD (cases) and 40 randomly selected healthy women delivering at term (controls). An exploratory phase with proteomics analysis of pooled samples was followed by a verification phase with ELISA of individual case and control samples. Results The median (interquartile range (IQR: 25th; 75th percentiles) gestational age at delivery was 35+5 (33+6–36+6) weeks in women with spontaneous PTD and 40+0 (39+1–40+5) weeks in women who delivered at term. In the exploratory phase, the most pronounced differences were found in C-reactive protein (CRP) levels, that were approximately two-fold higher in the pooled case samples than in the pooled control samples. However, we could not verify these differences with ELISA. The median (25th; 75th IQR) CRP level was 95.2 ng/mL (64.3; 163.5) in women with spontaneous PTD and 86.0 ng/mL (51.2; 145.8) in women delivering at term (p = 0.37; t-test). Conclusions Proteomic analysis with mass spectrometry of mid-trimester amniotic fluid suggests CRP as a potential marker of spontaneous preterm delivery, but this prognostic potential was not verified with ELISA. PMID:27214132

  8. Proteomic Analysis of Early Mid-Trimester Amniotic Fluid Does Not Predict Spontaneous Preterm Delivery.

    Science.gov (United States)

    Hallingström, Maria; Lenco, Juraj; Vajrychova, Marie; Link, Marek; Tambor, Vojtech; Liman, Victor; Bullarbo, Maria; Nilsson, Staffan; Tsiartas, Panagiotis; Cobo, Teresa; Kacerovsky, Marian; Jacobsson, Bo

    2016-01-01

    The aim of this study was to identify early proteomic biomarkers of spontaneous preterm delivery (PTD) in mid-trimester amniotic fluid from asymptomatic women. This is a case-cohort study. Amniotic fluid from mid-trimester genetic amniocentesis (14-19 weeks of gestation) was collected from 2008 to 2011. The analysis was conducted in 24 healthy women with subsequent spontaneous PTD (cases) and 40 randomly selected healthy women delivering at term (controls). An exploratory phase with proteomics analysis of pooled samples was followed by a verification phase with ELISA of individual case and control samples. The median (interquartile range (IQR: 25th; 75th percentiles) gestational age at delivery was 35+5 (33+6-36+6) weeks in women with spontaneous PTD and 40+0 (39+1-40+5) weeks in women who delivered at term. In the exploratory phase, the most pronounced differences were found in C-reactive protein (CRP) levels, that were approximately two-fold higher in the pooled case samples than in the pooled control samples. However, we could not verify these differences with ELISA. The median (25th; 75th IQR) CRP level was 95.2 ng/mL (64.3; 163.5) in women with spontaneous PTD and 86.0 ng/mL (51.2; 145.8) in women delivering at term (p = 0.37; t-test). Proteomic analysis with mass spectrometry of mid-trimester amniotic fluid suggests CRP as a potential marker of spontaneous preterm delivery, but this prognostic potential was not verified with ELISA.

  9. Proteomic Analysis of Early Mid-Trimester Amniotic Fluid Does Not Predict Spontaneous Preterm Delivery.

    Directory of Open Access Journals (Sweden)

    Maria Hallingström

    Full Text Available The aim of this study was to identify early proteomic biomarkers of spontaneous preterm delivery (PTD in mid-trimester amniotic fluid from asymptomatic women.This is a case-cohort study. Amniotic fluid from mid-trimester genetic amniocentesis (14-19 weeks of gestation was collected from 2008 to 2011. The analysis was conducted in 24 healthy women with subsequent spontaneous PTD (cases and 40 randomly selected healthy women delivering at term (controls. An exploratory phase with proteomics analysis of pooled samples was followed by a verification phase with ELISA of individual case and control samples.The median (interquartile range (IQR: 25th; 75th percentiles gestational age at delivery was 35+5 (33+6-36+6 weeks in women with spontaneous PTD and 40+0 (39+1-40+5 weeks in women who delivered at term. In the exploratory phase, the most pronounced differences were found in C-reactive protein (CRP levels, that were approximately two-fold higher in the pooled case samples than in the pooled control samples. However, we could not verify these differences with ELISA. The median (25th; 75th IQR CRP level was 95.2 ng/mL (64.3; 163.5 in women with spontaneous PTD and 86.0 ng/mL (51.2; 145.8 in women delivering at term (p = 0.37; t-test.Proteomic analysis with mass spectrometry of mid-trimester amniotic fluid suggests CRP as a potential marker of spontaneous preterm delivery, but this prognostic potential was not verified with ELISA.

  10. Decision-making in operative vaginal delivery: when to intervene, where to deliver and which instrument to use? Qualitative analysis of expert clinical practice.

    Science.gov (United States)

    Bahl, Rachna; Murphy, Deirdre J; Strachan, Bryony

    2013-10-01

    To identify the decision-making process involved in determining when to intervene, where to deliver and the optimal choice of instrument for operative vaginal deliveries in the second stage of labour. A qualitative study using interviews and video recordings took place at two university teaching hospitals (St. Michael's Hospital Bristol and Ninewells Hospital, Dundee). Ten obstetricians and eight midwives were identified as experts in conducting or supporting operative vaginal deliveries. Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting low cavity vacuum and mid-cavity rotational forceps deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by three researchers and then compared for consistency of interpretation. The experts reviewed the coded interview and video data for respondent validation and clarification. The themes that emerged following the final coding were used to identify the decision-making process when planning and conducting an operative vaginal delivery. Key decision points were reported in selecting when and where to conduct an operative vaginal delivery and which instrument to use. The final decision-making list highlights the various decision points to consider when performing an operative vaginal delivery. We identified clinical factors that experts take into consideration when selecting where the delivery should take place and the preferred choice of instrument. This detailed illustration of the decision-making process could aid trainees' understanding of the approach to safe operative vaginal delivery, aiming to minimise morbidity. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. 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.

  13. 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 ...

  14. Predictors for failure of vacuum-assisted vaginal delivery: a case-control study

    NARCIS (Netherlands)

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

    2016-01-01

    To identify potential predictors for failed vacuum-assisted delivery. 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 defined as a delivery

  15. 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.

  16. Successful spontaneous pregnancy and delivery following myomectomy and uterine artery embolization (UAE – A case report

    Directory of Open Access Journals (Sweden)

    Z.K. Balghari

    2011-03-01

    Full Text Available Uterine artery embolization has emerged as an effective treatment for symptomatic uterine fibroids. Nevertheless because of the uncertainty about the effects of UAE on fertility, women who still want to become pregnant are sometimes excluded from treatment. Pregnancy after UAE has been described in the published literature in the form of case reports, case series and retrospective cohort studies. We present an interesting case of a successful spontaneous pregnancy and delivery in a 42year old woman, who was diagnosed to have fibroids and endometriosis. She had a myomectomy followed by two procedures of UAE for recurrent fibroids and was treated for extensive endometriosis.

  17. Development of amino acid substituted gemini surfactant-based mucoadhesive gene delivery systems for potential use as noninvasive vaginal genetic vaccination.

    Science.gov (United States)

    Singh, Jagbir; Michel, Deborah; Getson, Heather M; Chitanda, Jackson M; Verrall, Ronald E; Badea, Ildiko

    2015-02-01

    Recently, we synthesized amino acid- and peptide-substituted gemini surfactants, 'biolipids' that exhibited high transfection efficiency in vitro. In this study, we developed these plasmid DNA and gemini surfactant lipid particles for noninvasive administration in vaginal cavity. Novel formulations of these gene delivery systems were prepared with poloxamer 407 to induce in situ gelling of the formulation and diethylene glycol monoethyl ether to improve their penetration across mucosal tissue. Poloxamer at 16% w/v concentration in diethylene glycol monoethyl ether aqueous solution produced dispersions that gelled near body temperature and had a high yield value, preventing leakage of the formulation from the vaginal cavity. Intravaginal administration in rabbits showed that the glycyl-lysine-substituted gemini surfactant led to a higher gene expression compared with the parent unsubstituted gemini surfactant. This provides a proof-of-concept that amino acid substituted gemini surfactants can be used as noninvasive mucosal (vaginal) gene delivery systems to treat diseases associated with mucosal epithelia.

  18. Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials

    NARCIS (Netherlands)

    Tajik, P.; van der Ham, D. P.; Zafarmand, M. H.; Hof, M. H. P.; Morris, J.; Franssen, M. T. M.; de Groot, C. J. M.; Duvekot, J. J.; Oudijk, M. A.; Willekes, C.; Bloemenkamp, K. W. M.; Porath, M.; Woiski, M.; Akerboom, B. M.; Sikkema, J. M.; Nij Bijvank, B.; Mulder, A. L. M.; Bossuyt, P. M.; Mol, B. W. J.

    2014-01-01

    To investigate whether vaginal Group B Streptococcus (GBS) colonisation or other baseline characteristics of women with preterm premature rupture of membranes (PPROM) can help in identifying subgroups of women who would benefit from immediate delivery. Secondary analysis of the PPROMEXIL trials.

  19. Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery : a secondary analysis of the PPROMEXIL trials

    NARCIS (Netherlands)

    Tajik, P.; van der Ham, D. P.; Zafarmand, M. H.; Hof, M. H. P.; Morris, J.; Franssen, M. T. M.; de Groot, C. J. M.; Duvekot, J. J.; Oudijk, M. A.; Willekes, C.; Bloemenkamp, K. W. M.; Porath, M.; Woiski, M.; Akerboom, B. M.; Sikkema, J. M.; Bijvank, B. Nij; Mulder, A. L. M.; Bossuyt, P. M.; Mol, B. W. J.

    Objective To investigate whether vaginal Group B Streptococcus (GBS) colonisation or other baseline characteristics of women with preterm premature rupture of membranes (PPROM) can help in identifying subgroups of women who would benefit from immediate delivery. Design Secondary analysis of the

  20. Risks of vaginal breech delivery at term compared with elective cesarean section - reply to comments by Walker and Powell, and Sholapurkar

    NARCIS (Netherlands)

    Vlemmix, Floortje; Mol, Ben Willem; Kok, Marjolein

    2015-01-01

    We thank both Walker and Powell (1), as well as Sholapurkar (2) for their interest in our work. Walker and Powell note that the risk of neonatal mortality for planned vaginal breech delivery (VBD) in our study is lower than the mortality reported in the term breech trial and comparable to the risk

  1. Use of urea and creatinine levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes and delivery interval after membrane rupture.

    Science.gov (United States)

    Gezer, Cenk; Ekin, Atalay; Golbasi, Ceren; Kocahakimoglu, Ceysu; Bozkurt, Umit; Dogan, Askin; Solmaz, Ulaş; Golbasi, Hakan; Taner, Cuneyt Eftal

    2017-04-01

    To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM. A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM. In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p 6.7 mg/dl for urea and >0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were >19.4 mg/dl for urea and >0.23 mg/dl for creatinine. Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM.

  2. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry

    NARCIS (Netherlands)

    van Bavel, Jeroen; Hukkelhoven, Chantal W. P. M.; de Vries, Charlotte; Papatsonis, Dimitri N. M.; de Vogel, Joey; Roovers, Jan-Paul W. R.; Mol, Ben Willem; de Leeuw, Jan Willem

    2017-01-01

    Obstetric anal sphincter injuries (OASIS) are associated with an increased risk of faecal incontinence after vaginal delivery. The aim of this retrospective population-based cohort study was to assess whether mediolateral episiotomy is associated with a reduction in the rate of OASIS during

  3. Risk of uterine rupture in women undergoing trial of labour with a history of both a caesarean section and a vaginal delivery.

    Science.gov (United States)

    de Lau, Hinke; Gremmels, Hendrik; Schuitemaker, Nico W; Kwee, Anneke

    2011-11-01

    To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery. A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method. Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.

  4. Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial.

    Science.gov (United States)

    Maged, Ahmed Mohamed; Hassan, AbdelGany M A; Shehata, Nesreen A A

    2016-05-01

    The objective of this study is to compare the effectiveness and safety of carbetocin vs. oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery. A prospective randomised study was conducted in which 100 pregnant women were randomised into 2 equal groups: group 1 received Carbetocin 100 µgm (Pabal(®) Ferring, UK) and group 2 received oxytocin 5 IU (Syntocinon(®), Novartis, Switzerland). The amount of blood loss and the need for other uterotonics were significantly lower in the carbetocin group (811 ± 389.17 vs. 1010 ± 525.66 and 10/50 vs. 21/50). There was no significant difference between the carbetocin and oxytocin groups regarding occurrence of major PPH (6 vs. 11), the need for blood transfusion (6 vs. 9), the difference between blood haemoglobin levels before delivery and 24 h after delivery (0.6 ± 0.28 vs. 0.56 ± 0.25), respectively. There was no significant difference between the 2 study groups regarding both systolic and diastolic blood pressure measured immediately after the drug administration and at 30 and 60 min later. Regarding the drugs side effects, there was no significant difference between the 2 groups in the occurrence of nausea, vomiting, tachycardia, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitations and itching. Carbetocin is a better alternative to oxytocin in management of atonic PPH with non-significant hemodynamic changes or side effects .

  5. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental perfusion and function at 11-13 weeks.

    Science.gov (United States)

    Beta, Jarek; Akolekar, Ranjit; Ventura, Walter; Syngelaki, Argyro; Nicolaides, Kypros H

    2011-01-01

    To develop a model for prediction of spontaneous delivery before 34 weeks based on maternal factors, placental perfusion and function at 11-13 weeks' gestation. Two groups of studies: first, screening study of maternal characteristics, serum pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotrophin (β-hCG) and uterine artery pulsatility index (PI). Second, case-control studies of maternal serum or plasma concentration of placental growth factor (PlGF), placental protein 13 (PP13), a disintegrin and metalloprotease 12 (ADAM12), inhibin-A and activin-A. Regression analysis was used to develop a model for the prediction of spontaneous early delivery. Spontaneous early delivery occurred in 365 (1.1%) of the 34 025 pregnancies. A model based on maternal factors could detect 38.2% of the preterm deliveries in women with previous pregnancies at or beyond 16 weeks and 18.4% in those without, at a false positive rate (FPR) of 10%. In the preterm delivery group, compared with unaffected pregnancies there were no significant differences in the markers of placental perfusion or function, except for PAPP-A which was reduced. Patient-specific risk of preterm delivery is provided by maternal factors and obstetric history. Placental perfusion and function at 11-13 weeks are not altered in pregnancies resulting in spontaneous early delivery. Copyright © 2011 John Wiley & Sons, Ltd.

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

    OpenAIRE

    Demian Arturo Herrera Morban

    2015-01-01

    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 consig...

  7. [Vaginal delivery after previous cesarean: comparison between own method and Weinstein's predictive score].

    Science.gov (United States)

    Poreba, R; Dudkiewicz, D; Drygalski, M; Poreba, A; Sipiński, A

    2000-04-01

    121 women after previous caesarean section were examined. The amount of successful labours were compared (according to the own diagnostic card) with the foreseeing probability of vaginal labours according to Weinstein's score. 63% pregnant woman was classified to the natural labour on the base of the own diagnostic card, probability of natural labour according to Weinstein's score were more or equal than 67%. There were no agreement between prognostic Weinstein's scale and our own method in the cases of failed attempt of labour followed by caesarean section.

  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|info:eu-repo/dai/nl/341652385; 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. Comparison of readmission rates between groups with early versus late discharge after vaginal or cesarean delivery: a retrospective analyzes of 14,460 cases.

    Science.gov (United States)

    Bostanci Ergen, Evrim; Ozkaya, Enis; Eser, Ahmet; Abide Yayla, Cigdem; Kilicci, Cetin; Yenidede, Ilter; Eser, Semra Kayatas; Karateke, Ates

    2018-05-01

    The aim of this retrospective analysis was to show the readmission rate of cases with and without early discharge following vaginal or cesarean delivery. After exclusion of cases with pregnancy, delivery and neonatal complications, a total of 14,460 cases who delivered at Zeynep Kamil Women and Children's Health Training and Research Hospital were retrospectively screened from hospital database. Subjects were divided into two groups as Group 1: early discharge (n = 6802) and Group 2: late discharge (n = 7658). Groups were compared in terms of readmission rates and indications for readmission. There were 6802 cases with early discharge whereas the remaining women were discharged after 24 h for vaginal delivery and 48 h following cesarean delivery on regular bases. Among cases with early discharge, 205 (3%) cases readmitted to emergency service with variable indications, while there were 216 (2.8%) readmitted women who were discharged on regular bases. Most common indication for readmission was wound infection in both groups. Neonatal sex distributions were similar between groups (p > .05), where as there was a higher rate of cesarean deliveries in Group 2 (p discharge (p discharges following vaginal or cesarean delivery without any mortality or permanent morbidity and cost analyses revealed 68 Turkish liras lower cost with early discharge.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Acute stress and depression 3 days after vaginal delivery--observational, comparative study.

    Science.gov (United States)

    Imsiragić, Azijada Srkalović; Begić, Drazen; Martić-Biocina, Sanja

    2009-06-01

    During the first month postpartum, 85% of women experience some form of mood disorders. The most common are: postpartum blues, non-psychotic postpartum depression, puerperal psychosis. Delivery of a child can be traumatic for some women. Several authors have found that women could get symptoms of one form of posttraumatic stress disorder (PTSD) after childbirth. However, etiology of established postpartum disorders is still unknown. The aim of this study is to detect symptoms of acute stress reaction and acute depressive state as a consequence of peripartal complications, as early as three days postpartum using Impact of Events Scale revised (IES-R) and the Edinburgh Postnatal Depression Scale (EPDS) questionnaires and to demonstrate their potential usage for the early detection of vulnerable mothers with greater risk to develop any of postpartum psychiatric disorder, including PTSD. For that purpose 103 subjects, without previous medical history of psychiatric illness, were included in the investigation. Long duration of delivery (> or = 12 h), very painful delivery, complication and illness of mother during and after delivery as a consequence of delivery, preterm delivery (before week 36) and/or illness of the child (as a consequence of delivery or congenital) are considered to be risk factors for acute stress reaction and acute depressive state after delivery. Sixty one out of 103 investigated mothers had one or more researched peripartal complications. A statistically significant difference has been found between the control (n=42) and the peripartal complications (n=61) groups in both the mean IES-R (4.67 +/- 5.43 and 13.50 +/- 14.12, respectively, p depressive state in the peripartal complications group there were no cases of these states in the control group. Based on our findings we conclude that using IES-R and EPDS questionnaires as early as three days after delivery could provide an early detection of previously healthy mothers with greater risk for

  12. Validation of prediction model for successful vaginal birth after Cesarean delivery based on sonographic assessment of hysterotomy scar.

    Science.gov (United States)

    Baranov, A; Salvesen, K Å; Vikhareva, O

    2018-02-01

    To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population. Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18-35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was retrieved from hospital records. Individual probabilities of successful VBAC were calculated using a previously published model. Predicted individual probabilities were divided into deciles. For each decile, observed VBAC rates were calculated. To assess the accuracy of the prediction model, receiver-operating characteristics curves were constructed and the areas under the curves (AUC) were calculated. Complete sonographic data were available for 120 women. Eighty (67%) women underwent trial of labor after Cesarean delivery (TOLAC) with VBAC occurring in 70 (88%) cases. The scar was visible in all 80 women at the first-trimester scan and in 54 (68%) women at the second-trimester scan. AUC was 0.44 (95% CI, 0.28-0.60) among all women who underwent TOLAC and 0.51 (95% CI, 0.32-0.71) among those with the scar visible sonographically at both ultrasound examinations. The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

  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. Second-Trimester Anterior Cervical Angle in a Low-Risk Population as a Marker for Spontaneous Preterm Delivery.

    Science.gov (United States)

    Sepúlveda-Martínez, Alvaro; Díaz, Francisco; Muñoz, Hernán; Valdés, Enrique; Parra-Cordero, Mauro

    2017-01-01

    The aim of this article is to assess the use of the anterior cervical angle (ACA) as a predictor of spontaneous preterm delivery (sPTD) at 20+0-24+6 weeks of gestation in an unselected population. We conducted a nested case-control study that included 93 women who later delivered spontaneously history, CL and ACA at 20+0-24+6 weeks of gestation can predict approximately 40% of the severe preterm births. © 2016 S. Karger AG, Basel.

  15. Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect.

    Science.gov (United States)

    Ng'ang'a, Njoki; Ratzersdorfer, Jonathan; Abdelhak, Yaakov

    2017-06-05

    Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. The effect of addition of dexamethasone to levobupivacaine in parturients receiving combined spinal-epidural for analgesia for vaginal delivery

    Directory of Open Access Journals (Sweden)

    Amr Samir Wahdan

    2017-01-01

    Full Text Available Background and Aims: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. Methods: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Forty females were included randomly in either Group L (received intrathecal levobupivacaine 0.25% in 2 mL or Group LD (received intrathecal levobupivacaine 0.25% combined with dexamethasone 4 mg in 2 mL. The primary outcome was the duration of spinal analgesia. Secondary outcomes included the total dose of epidural local anaesthetic given, time to delivery, neonatal outcome and adverse effects. Results: The duration of spinal analgesia was significantly longer in the LD group compared with L group (80.5 ± 12.4 min vs. 57.1 ± 11.5 min, respectively; P< 0.001. In Group LD compared with Group L, time from spinal analgesia to delivery was significantly lower (317.4 ± 98.9 min vs. 372.4 ± 118.8 min, respectively; P = 0.027, and total epidural levobupivacaine consumption was significantly lower (102.4 ± 34.8 mg vs. 120.1 ± 41.9 mg, respectively; P = 0.027. The two groups were comparable with respect to characteristics of sensory and motor block, haemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects. Conclusion: Intrathecal dexamethasone plus levobupivacaine prolongs the duration of spinal analgesia during combined spinal-epidural CSE for labour analgesia.

  17. [Usefulness assessment of selected proinflammatory cytokines' level in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery].

    Science.gov (United States)

    Kalinka, Jarosław; Wasiela, Małgorzata; Sobala, Wojciech; Brzezińska-Błaszczyk, Ewa

    2005-09-01

    Recent studies have suggested that proinflammatory cytokines might play a crucial role in the mechanism of preterm labour and delivery. The main aim of this prospective study was to evaluate the usefulness of selected proinflammatory cytokines' (IL-1 alpha, IL-1 beta, IL-6 and IL-8) levels in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery. Cervico-vaginal fluids were obtained from 107 pregnant women at 22 to 34 weeks' gestation, including 61 women with threatened preterm labour (TPL) and 46 women with physiological course of pregnancy (reference group). Those samples were analyzed for the concentrations of selected cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture. Mean gestational age at the time of sampling was 28.6 weeks. Mean time between sampling and delivery was 8,24 weeks in TPL group and 10.2 weeks in reference group. BV was diagnosed in 25.2% of subjects under study. M. hominis and U. urealyticum were diagnosed more frequently among women from TPL group (25.9% vs 14.9% and 36.2% vs 17.0%, respectively). Out of 107 women 15 (14.0%) delivered before 37th week of gestation. The rate of preterem delivery was significantly higher in threatened preterm labour group--21.3% is comparison to reference group--4.3%. Median cervico-vaginal concentration of IL-1 alpha, IL-1 beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Only women with lower genital tract infection and one cytokine's low concentration (below 25th percentile) presented a higher risk of preterm delivery--OR=2,91. If IL-1 alpha and IL-1 beta concentrations were below 25th percentile, the calculated risk of preterm delivery was OR = 4.65. The highest risk was noted for women with lower genital tract infection and low cervico-vaginal concentrations of IL-1 alpha and IL-8--OR = 8.0 (3.20-20.01). The early

  18. Amniotic fluid "sludge"; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery.

    Science.gov (United States)

    Adanir, Ilknur; Ozyuncu, Ozgur; Gokmen Karasu, Ayse Filiz; Onderoglu, Lutfu S

    2018-01-01

    The aim of our study is to determine prevalence and clinical significance of the presence of amniotic fluid "sludge" among asymptomatic patients at high-risk for spontaneous preterm delivery, prospectively. In our study, 99 patients at high risk for spontaneous preterm delivery were evaluated for the presence of amniotic fluid sludge with transvaginal ultrasonography at 20-22, 26-28, and 32-34 gestational weeks, prospectively; between August 2009 and October 2010 in Hacettepe University Hospital. And, these patients were followed up for their delivery weeks and pregnancy outcomes. We defined the high-risk group as the patients possessing one or more of the followings; a history of spontaneous preterm delivery, recent urinary tract infections, polyhydramnios, uterine leiomyomas, müllerian duct anomalies, and history of cone biyopsy or LEEP. Patients with multiple gestations, placenta previa, fetal anomalies, or symptoms of preterm labor at first examination were excluded. We have obtained ethical board approval from Hacettepe University (16.07.2009-HEK/No:09-141-59). The prevalence of amniotic fluid sludge in the study population was 19,6% (18/92). The rates of spontaneous preterm delivery at preterm delivery (p = 0.002). A higher proportion of neonates born to patients with amniotic fluid sludge had a neonatal morbidity (50% (9/18) vs. 24,3% (18/74), p = 0.044) and died in the perinatal period, (p = 0,013) than those born to patients without sludge. When we combined sludge and cervical lenght (CL) (preterm delivery; it catched more women with preterm delivery, (p = 0.000). While sensitivity of sludge was 37,5%, and sensitivity of CL was 34%, sensitivity of "sludge positive or CL ≤25 mm" was 56% for preterm birth (PTB) in high-risk group. The prevalence of amniotic fluid sludge is 19,6% and "sludge" is an independent risk factor for spontaneous preterm delivery among asymptomatic patients at high-risk for spontaneous preterm delivery. PTB is

  19. Ruptured rudimentary horn pregnancy with a history of an uneventful vaginal delivery.

    Science.gov (United States)

    Mishra, Nitin; Yadav, Nitin; Koshiya, Darshan; Jhanwar, Vikas

    2015-01-01

    Pregnancy in a rudimentary uterine horn is a rare event with an estimated incidence of 1 in 76,000 to 1 in 1,40,000 pregnancies. Unicornuate uterus with a rudimentary horn has a high incidence of obstetric and gynecological complications. Ruptured ectopic pregnancy in the rudimentary horn is one of the most dreaded complications, which can have grave consequences for both mother and fetus. In the majority of the cases, it is detected after rupture of the horn, usually during the first or second trimester of pregnancy. An ultrasonographic diagnosis made prior to rupture of the rudimentary horn may prevent this catastrophic outcome. We report a case of a G2 P1 L1 with a ruptured left rudimentary horn pregnancy at 16 weeks of gestation that was misdiagnosed as a pregnancy in the left uterine horn of a bicornuate uterus on prior prenatal ultrasound. The patient presented to our hospital with abdominal pain and vaginal bleeding. A diagnosis of ruptured left rudimentary horn pregnancy was made on the basis of emergency ultrasound and was later confirmed on laparotomy. The left rudimentary horn along with the ipsilateral fallopian tube was excised.

  20. Loop electrosurgical excision of the cervix and subsequent risk for spontaneous preterm delivery: a population-based study of singleton deliveries during a 9-year period

    DEFF Research Database (Denmark)

    Noehr, Bugge; Jensen, Allan; Frederiksen, Kirsten

    2009-01-01

    OBJECTIVE: Our aim was to assess the association between loop electrosurgical excision procedure (LEEP) and the subsequent risk for spontaneous preterm delivery, with the use of population-based data from various nationwide registries. STUDY DESIGN: The study population consisted of all singleton...

  1. What is vaginal birth after cesarean (VBAC)?

    Science.gov (United States)

    ... Pinterest Email Print What is vaginal birth after cesarean (VBAC)? VBAC refers to vaginal delivery of a baby after a previous pregnancy was delivered by cesarean delivery. In the past, pregnant women who had ...

  2. Spontaneous and indicated preterm delivery risk is increased among overweight and obese women without prepregnancy chronic disease.

    Science.gov (United States)

    Kim, S S; Mendola, P; Zhu, Y; Hwang, B S; Grantz, K L

    2017-10-01

    To investigate the independent impact of prepregnancy obesity on preterm delivery among women without chronic diseases by gestational age, preterm category and parity. A retrospective cohort study. Data from the Consortium on Safe Labor (CSL) in the USA (2002-08). Singleton deliveries at ≥23 weeks of gestation in the CSL (43 200 nulliparas and 63 129 multiparas) with a prepregnancy body mass index (BMI) ≥18.5 kg/m 2 and without chronic diseases. Association of prepregnancy BMI and the risk of preterm delivery was examined using Poisson regression with normal weight as reference. Preterm deliveries were categorised by gestational age (extremely, very, moderate to late) and category (spontaneous, indicated, no recorded indication). Relative risk of spontaneous preterm delivery was increased for extremely preterm among obese nulliparas (1.26, 95% CI: 0.94-1.70 for overweight; 1.88, 95% CI: 1.30-2.71 for obese class I; 1.99, 95% CI: 1.32-3.01 for obese class II/III) and decreased for moderate to late preterm delivery among overweight and obese multiparas (0.90, 95% CI: 0.83-0.97 for overweight; 0.87, 95% CI: 0.78-0.97 for obese class I; 0.79, 95% CI: 0.69-0.90 for obese class II/III). Indicated preterm delivery risk was increased with prepregnancy BMI in a dose-response manner for extremely preterm and moderate to late preterm among nulliparas, as it was for moderate to late preterm delivery among multiparas. Prepregnancy BMI was associated with increased risk of preterm delivery even in the absence of chronic diseases, but the association was heterogeneous by preterm categories, gestational age and parity. Obese nulliparas without chronic disease had higher risk for spontaneous delivery <28 weeks of gestation. © 2017 Royal College of Obstetricians and Gynaecologists.

  3. Nutraceutical delivery systems: resveratrol encapsulation in grape seed oil nanoemulsions formed by spontaneous emulsification.

    Science.gov (United States)

    Davidov-Pardo, Gabriel; McClements, David Julian

    2015-01-15

    The aim of this work was to fabricate nanoemulsions-based delivery systems to encapsulate resveratrol. Nanoemulsions were formed using spontaneous emulsification method: 10% oil phase (grape seed oil plus orange oil) and 10% surfactant (Tween 80) were titrated into 80% aqueous phase. An optimum orange oil-to-grape seed oil ratio of 1:1(w/w) formed small droplets (d ≈ 100 nm) with good stability to droplet growth. The maximum amount of resveratrol that could be dissolved in the oil phase was 120 ± 10 μg/ml. The effect of droplet size on the chemical stability of encapsulated resveratrol was examined by preparing systems with different mean droplet diameters of 220 ± 2; 99 ± 3; and 45 ± 0.4 nm. Encapsulation of resveratrol improved its chemical stability after exposure to UV-light: 88% retention in nanoemulsions compared to 50% in dimethylsulphoxide (DMSO). This study showed that resveratrol could be encapsulated within low-energy nanoemulsion-based delivery systems and protected against degradation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Vaginal Atrophy

    Science.gov (United States)

    ... urinary signs and symptoms: Vaginal dryness Vaginal burning Vaginal discharge Genital itching Burning with urination Urgency with urination ... others). Also make an appointment if you have vaginal symptoms, such as unusual ... burning or soreness. Causes Genitourinary syndrome of menopause ( ...

  5. The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage: a double-blind randomised controlled trial.

    Science.gov (United States)

    Mirghafourvand, Mojgan; Mohammad-Alizadeh, Sakineh; Abbasalizadeh, Fatemeh; Shirdel, Mina

    2015-02-01

    To determine the effect of prophylactic tranexamic acid (TA) on calculated and measured blood loss after vaginal delivery in women at low risk of postpartum haemorrhage. In this double-blind randomised controlled trial, 120 women with a singleton pregnancy were randomly allocated to receive either one gram intravenous TA or placebo in addition to 10 IU oxytocin after delivery of the fetus. Calculated blood loss was determined based on haematocrit before delivery and 12-24 h postdelivery. The quantity of blood loss was measured during two time periods: from delivery of the fetus to placental expulsion and from placental expulsion to the end of the second hour after childbirth. The mean (SD) calculated total blood loss (519 (320) vs 659 (402) mL, P = 0.036) and measured blood loss from placental delivery to 2 h postpartum (69 (39) vs 108 (53) mL, P  1000 mL was lower in the TA group (7% vs 18%, P = 0.048). Prophylactic TA reduces blood loss after vaginal delivery in women with a low risk of postpartum haemorrhage. The prophylactic use of TA may reduce blood loss complications and enhance maternal health. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  6. Neonatal morbidity after spontaneous labor onset prior to intended cesarean delivery at term: a cohort study.

    Science.gov (United States)

    Glavind, Julie; Milidou, Ioanna; Uldbjerg, Niels; Maimburg, Rikke; Henriksen, Tine B

    2017-04-01

    We aimed to investigate if labor onset before planned cesarean delivery (CD) affects the risk of neonatal admission, respiratory distress, or neonatal infectious morbidity. Our cohort included singleton term pregnant women with intended CD who delivered at Aarhus University Hospital from 1990 to 2012. Two groups of women were identified: women with intended CD performed before labor (nonlabor CD) and women with intended CD performed after spontaneous labor onset (labor-onset CD); in both groups there was no other maternal or fetal medical indication for an immediate CD or for early-term CD scheduling. Data were stratified in early-term (37-38 weeks) and full-term (39-40 weeks) deliveries. The main outcome measures were neonatal admission, respiratory distress and neonatal infectious morbidity. Among 103 919 live births, 5071 deliveries were nonlabor CDs and 731 were labor-onset CDs. Compared to nonlabor CD, labor-onset CD was associated with similar risks of neonatal admission and respiratory distress, both at early and full term, but with a two- to three-fold increased risk of newborn septicemia or antibiotic treatment at early term. Labor onset at early term was associated with a lower risk of maternal blood loss of more than 500 mL, but with a higher risk of postoperative antibiotic treatment and endometritis. Labor onset before planned CD was not associated with a decrease in neonatal respiratory morbidity, but may be associated with increased risks of neonatal infection. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  7. 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. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. 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.

  9. 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.

  10. Vacuum-assisted vaginal delivery simulation--quantitation of subjective measures of traction and detachment forces.

    Science.gov (United States)

    Eskander, Ramy; Beall, Marie; Ross, Michael G

    2012-10-01

    Excessive traction has been alleged as the cause of newborn complications associated with vacuum delivery. We sought to quantify subjective levels of physician vacuum traction in a simulated obstetric delivery model, dependent upon level of training. Three groups of physicians, based on training level applied traction (minimal, average, maximal) on a pre-applied vacuum model and forces were continually recorded. Detachment force was recorded with traction in both the pelvic axis and at an oblique angle. Quantified traction force increased from subjective minimal to average to maximal pulls. Within each level, there were no differences between the groups in the average traction force. Detachment force was significantly less when traction was applied at an oblique angle as opposed to the pelvic axis (11.1 ± 0.3 vs 12.2 ± 0.3 kg). Providers appear to be good judges of the force being applied, as a clear escalation in force is noted with minimal, average and maximal force pulls. There appears to be a relatively short learning curve for use of the vacuum, as junior residents' applied force was not different from those of more experienced practitioners. Using the KIWI device, detachment force is lower when traction is applied at an oblique angle.

  11. Simultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Szu-Ying Ho

    2010-12-01

    Full Text Available Uterine rupture is the primary concern when a patient chooses a trial of labor after a cesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross hematuria occurs. We report the case of a patient with uterine rupture during a trial of labor after cesarean delivery. She had a normal course of labor and no classic signs of uterine rupture. However, gross hematuria was noted after repair of the episiotomy. The patient began to complain of progressive abdominal pain, gross hematuria and oliguria. Cystoscopy revealed a direct communication between the bladder and the uterus. When opening the bladder peritoneum, rupture sites over the anterior uterus and posterior wall of the bladder were noted. Following primary repair of both wounds, a Foley catheter was left in place for 12 days. The patient had achieved a full recovery by the 2-year follow-up examination. Bladder injury and uterine rupture can occur at any time during labor. Gross hematuria immediately after delivery is the most common presentation. Cystoscopy is a good tool to identify the severity of bladder injury.

  12. An assessment of mode of delivery in history indicated versus ultrasound indicated vaginally placed cervical cerclage.

    Science.gov (United States)

    Story, Lisa; Shennan, Andrew

    2017-03-01

    Treatment modalities to reduce the incidence of preterm birth are currently limited. Cerclage, is a common and established intervention in most obstetrics units worldwide, however, many questions regarding its efficacy, with respect to pregnancy outcomes remain unanswered. This study aims to investigate whether an antenatal placed cerclage affects the subsequent mode of delivery in women at high risk of preterm birth who labour. A retrospective case controlled study was performed at St Thomas's Hospital London. Women who had undergone cervical cerclage were identified using a pre-existing database (n=152). Cases were excluded where a C-section had been performed prior to labour (n=26), datasets were incomplete (n=5) or a rescue cerclage was performed (n=2). Remaining cases were categorised into those who had: history indicated (n=68) or ultrasound indicated (n=51) cerclage. Control cases were obtained from the same database who also laboured but had not undergone cerclage, matched according to gestational age at delivery and parity (n=114). Demographic details and outcome data were recorded. Groups were compared using Chi Squared analysis for discrete variables and t-test for continuous variables using IBM SPSS Statistics version 22. There was no statistical difference in the emergency C-section rate between history indicated and ultrasound indicated cerclage, or between patients who received cerclage and those who had not (p=0.592). The emergency C-section rate for each group was: history indicated, 25%, ultrasound indicated 18% and no cerclage 18%. Women at risk of preterm birth have high rates of emergency C-section despite the fact that the majority were multiparous. However, they can be reassured that cervical cerclage does not increase this risk. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study.

    Science.gov (United States)

    Sengpiel, Verena; Bacelis, Jonas; Myhre, Ronny; Myking, Solveig; Devold Pay, Aase Serine; Haugen, Margaretha; Brantsæter, Anne-Lise; Meltzer, Helle Margrete; Nilsen, Roy Miodini; Magnus, Per; Vollset, Stein Emil; Nilsson, Staffan; Jacobsson, Bo

    2014-11-02

    Health authorities in numerous countries recommend periconceptional folic acid supplementation to prevent neural tube defects. The objective of this study was to examine the association of dietary folate intake and folic acid supplementation during different periods of pregnancy with the risk of spontaneous preterm delivery (PTD). The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 66,014 women with singleton pregnancies resulting in live births in 2002-2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until pregnancy week 24. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4-5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,755). The median total folate intake was 313 μg/d (interquartile range IQR 167-558) in the overall population and 530 μg/d (IQR 355-636) in the supplement users. Eighty-five percent reported any folic acid supplementation from effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Preconceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of spontaneous PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.

  14. Functional nutrients in infants born by vaginal delivery or Cesarean section

    Directory of Open Access Journals (Sweden)

    Gianluca Lista

    2017-12-01

    Full Text Available The development of a proper neonatal microbiota is of great importance, especially for the effects that dysbiosis has in acute and chronic diseases’ onset. The microbiota, particularly the intestinal one, plays a crucial role in maintaining the health of the host, preventing colonization by pathogenic bacteria and significantly influencing the development and maturation of a normal gastrointestinal mucosal immunity. Several factors may interfere with the physiological development of microbiota, such as diseases during pregnancy, type of delivery, maternal nutrition, type of neonatal feeding, use of antibiotics, exposition to hospital environment (e.g., neonatal intensive care unit and genetic factors. Thanks to a proper maternal and neonatal supplementation with specific functional nutrients, it is now possible to correct dysbiosis, thus reducing the risks for the newborn’s health. In this review of the literature, we give an overview of the studies highlighting the composition of the maternal, fetal and neonatal microbiota, the factors potentially responsible for dysbiosis and the use of functional nutrients to prevent diseases’ onset.

  15. Life-threatening neonatal epidural hematoma caused by precipitous vaginal delivery.

    Science.gov (United States)

    Josephsen, Justin B; Kemp, Joanna; Elbabaa, Samer K; Al-Hosni, Mohamad

    2015-01-30

    Neonatal in-hospital falls occur relatively frequently, although they are likely underreported. Significant intracranial head trauma from a fall or birth injury is not common in the immediate newborn period. Furthermore, intracranial bleeding requiring surgical intervention is exceedingly rare. We present an unusual case of an in-hospital fall in the delivery room requiring neurosurgical intervention. A term infant, appropriate for gestational age, delivered precipitously from a maternal standing position. The vertex neonate struck the linoleum floor after an approximate 80-cm fall, landing headfirst. The physical and neurological exams were initially normal, and skull films did not demonstrate an obvious fracture. The baby was closely observed, undergoing continuous cardiorespiratory monitoring. After the patient had an episode of apnea, a scalp hematoma was noted. A computed tomography (CT) scan revealed a left parietal fracture with an acute epidural hematoma, which required emergent craniotomy. The infant had an unremarkable post-operative course and had a normal neurodevelopmental assessment at 15 months of age. Close, continuous observation is recommended for infants following an in-hospital fall or after significant birth trauma. A high degree of suspicion for intracranial hemorrhage must be maintained. Fall prevention strategies should focus on careful baby handling by the convalescing mother.

  16. Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study.

    Science.gov (United States)

    Dagdeviren, Hediye; Cengiz, Huseyin; Heydarova, Ulkar; Caypinar, Sema Suzen; Kanawati, Ammar; Guven, Ender; Ekin, Murat

    2016-11-01

    Prevention of postpartum haemorrhage (PPH) is essential in the pursuit of improved health care for women. Oxytocin, the most commonly used uterotonic agent to prevent PPH, has no established the route of administration. In this study we aimed to compare whether the mode of oxytocin administration, i.e., intravenous and intramuscular administration, has an effect on the potential benefits and side effects. A total of 256 women were randomised into two groups: intramuscular group (128) or intravenous group (128). Estimated blood loss during the third stage of labour was similar between the two groups (p = 0.572). Further there were no statistically significant difference was noted between the two groups in terms of the mean duration of labor, duration of the third stage of labor, manual removal of the placenta, need for instrumental delivery, need for blood transfusion, PPH ≥500 mL, PPH ≥1000 mL, or length of hospital stay. Using oxytocin by intravenous and intramuscular route has a similar efficacy and adverse effects.

  17. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry.

    Science.gov (United States)

    van Bavel, Jeroen; Hukkelhoven, Chantal W P M; de Vries, Charlotte; Papatsonis, Dimitri N M; de Vogel, Joey; Roovers, Jan-Paul W R; Mol, Ben Willem; de Leeuw, Jan Willem

    2018-03-01

    Obstetric anal sphincter injuries (OASIS) are associated with an increased risk of faecal incontinence after vaginal delivery. The aim of this retrospective population-based cohort study was to assess whether mediolateral episiotomy is associated with a reduction in the rate of OASIS during operative vaginal delivery. We used data from the Dutch Perinatal Registry (Perined) that includes records of almost all births between 2000 and 2010 in The Netherlands. In a cohort of 170,969 primiparous and multiparous women whose delivery was recorded, we estimated the association between mediolateral episiotomy and OASIS following both vacuum and forceps deliveries using univariate and multivariate logistic regression analysis. The incidences of OASIS following vacuum delivery in 130,157 primiparous women were 2.5% and 14% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.14, 95% CI 0.13-0.15), and in 29,183 multiparous women were 2.0% and 7.5%, respectively (adjusted OR 0.23, 95% CI 0.21-0.27). The incidences of OASIS following forceps delivery in 9,855 primiparous women were 3.4% and 26.7% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.09, 95% CI 0.07-0.11), and in 1,774 multiparous women were 2.6% and 14.2%, respectively (adjusted OR 0.13, 95% CI 0.08-0.22). The use of a mediolateral episiotomy during both vacuum delivery and forceps delivery is associated with a fivefold to tenfold reduction in the rate of OASIS in primiparous and multiparous women.

  18. 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

    "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. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  19. 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.

  20. 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

  1. 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....

  2. Vaginal Infections

    Science.gov (United States)

    ... around your vagina , or a problem with your vaginal discharge (fluid). If you've had sexual contact with ... discharge Types of vaginal infections Ways to avoid vaginal infections Abnormal discharge top You may wonder if the fluid, or ...

  3. Vaginal dryness

    Science.gov (United States)

    ... Light bleeding after intercourse Painful sexual intercourse Slight vaginal discharge Vaginal soreness, itching or burning ... the vagina are thin, pale or red. Your vaginal discharge may be tested to rule out other causes ...

  4. Social disadvantage and the black-white disparity in spontaneous preterm delivery among California births.

    Directory of Open Access Journals (Sweden)

    Suzan L Carmichael

    Full Text Available We examined the contribution of social disadvantage to the black-white disparity in preterm birth. Analyses included linked vital and hospital discharge records from 127,358 black and 615,721 white singleton California births from 2007-11. Odds ratios (OR were estimated by 4 logistic regression models for 2 outcomes: early (<32 wks and moderate (32-36 wks spontaneous preterm birth (ePTB, mPTB, stratified by 2 race-ethnicity groups (blacks and whites. We then conducted a potential impact analysis. The OR for less than high school education (vs. college degree was 1.8 (95% confidence interval 1.6, 2.1 for ePTB among whites but smaller for the other 3 outcome groups (ORs 1.3-1.4. For all 4 groups, higher census tract poverty was associated with increased odds (ORs 1.03-1.05 per 9% change in poverty. Associations were less noteworthy for the other variables (payer, and tract percent black and Gini index of income inequality. Setting 3 factors (education, poverty, payer to 'favorable' values was associated with lower predicted probability of ePTB (25% lower among blacks, 31% among whites but a 9% higher disparity, compared to probabilities based on observed values; for mPTB, respective percentages were 28% and 13% lower probability, and 17% lower disparity. Results suggest that social determinants contribute to preterm delivery and its disparities, and that future studies should focus on ePTB and more specific factors related to social circumstances.

  5. Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial.

    Science.gov (United States)

    Martinez de Tejada, B; Karolinski, A; Ocampo, M C; Laterra, C; Hösli, I; Fernández, D; Surbek, D; Huespe, M; Drack, G; Bunader, A; Rouillier, S; López de Degani, G; Seidenstein, E; Prentl, E; Antón, J; Krähenmann, F; Nowacki, D; Poncelas, M; Nassif, J C; Papera, R; Tuma, C; Espoile, R; Tiberio, O; Breccia, G; Messina, A; Peker, B; Schinner, E; Mol, B W; Kanterewicz, L; Wainer, V; Boulvain, M; Othenin-Girard, V; Bertolino, M V; Irion, O

    2015-01-01

    To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour. Multicentre, randomised, double-blind, placebo-controlled trial. Twenty-nine centres in Switzerland and Argentina. A total of 385 women with preterm labour (24(0/7) to 33(6/7) weeks of gestation) treated with acute tocolysis. Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis. Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis. Preterm birth occurred in 42.5% of women in the progesterone group versus 35.5% in the placebo group (relative risk [RR] 1.2; 95% confidence interval [95% CI] 0.93-1.5). Delivery at <32 and <34 weeks did not differ between the two groups (12.9 versus 9.7%; [RR 1.3; 95% CI 0.7-2.5] and 19.7 versus 12.9% [RR 1.5; 95% CI 0.9-2.4], respectively). The duration of tocolysis, hospitalisation, and recurrence of preterm labour were comparable between groups. Neonatal morbidity occurred in 44 (22.8%) cases on progesterone versus 35 (18.8%) cases on placebo (RR: 1.2; 95% CI 0.82-1.8), whereas there were 4 (2%) neonatal deaths in each study group. There is no evidence that the daily administration of 200 mg vaginal progesterone decreases preterm birth or improves neonatal outcome in women with preterm labour. © 2014 Royal College of Obstetricians and Gynaecologists.

  6. Pelvic Floor Disorders 6 Months after Attempted Operative Vaginal Delivery According to the Fetal Head Station: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Guillaume Ducarme

    Full Text Available To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD, and specifically midpelvic or low aOVD, on urinary incontinence (UI, anal incontinence (AI, and perineal pain at 6 months.Prospective cohort study.1941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital.Symptoms of urinary incontinence (UI using the Bristol Female Lower Urinary Tract Symptoms questionnaire, and symptoms of anal incontinence (AI severity using Fecal Incontinence Severity Index (FISI were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of UI, AI, and perineal pain at 6 months using multiple regression and adjusting for demographics, and risk factors of UI and AI, with adjusted odds ratios (aORs and 95% confidence intervals (95% CI.The study included 907 women (46.7% who responded to the questionnaire; 18.4% (167/907 had midpelvic aOVD, and 81.6% (740/907 low; and none of women with symptoms of UI (26.6%, and 22.4%, respectively; p = 0.31, AI (15.9%, and 21.8%; p = 0.09, the FISI score, and perineal pain (17.2%, and 12.7%; p = 0.14 differed significantly between groups. The same was true for stress, urge, and mixed-type UI, severe UI and difficulty voiding. Compared with low pelvic aOVD, the aORs for symptoms of UI in midpelvic aOVD were 0.70 (0.46-1.05 and AI 1.42 (0.85-2.39. Third- and fourth-degree tears were a major risk factor of symptoms of UI (aOR 3.08, 95% CI 1.35-7.00 and AI (aOR 3.47, 95% CI 1.43-8.39.Neither symptoms of urinary nor anal incontinence differed at 6 months among women who had midpelvic and low pelvic aOVD. These findings are reassuring and need further studies at long-term to confirm these short-term data.

  7. Quantifying Aerosol Delivery in Simulated Spontaneously Breathing Patients With Tracheostomy Using Different Humidification Systems With or Without Exhaled Humidity.

    Science.gov (United States)

    Ari, Arzu; Harwood, Robert; Sheard, Meryl; Alquaimi, Maher Mubarak; Alhamad, Bshayer; Fink, James B

    2016-05-01

    Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity. An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heat-and-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm). Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P humidity decreased drug delivery up to 44%. The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers. Copyright © 2016 by Daedalus Enterprises.

  8. Acute effects of air pollution on spontaneous abortion, premature delivery, and stillbirth in Ahvaz, Iran: a time-series study.

    Science.gov (United States)

    Dastoorpoor, Maryam; Idani, Esmaeil; Goudarzi, Gholamreza; Khanjani, Narges

    2018-02-01

    Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO 2 , PM 10 , SO 2 , O 3 , and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m 3 (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO 2 and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO 2 and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM 10 and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value polluted air during pregnancy may increase adverse pregnancy outcomes and stillbirth. Pregnant women should avoid polluted air.

  9. Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

    Science.gov (United States)

    2012-01-01

    Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended. PMID:22876799

  10. Intraplacental Choriocarcinoma: Rare or Underdiagnosed? Report of 2 Cases Diagnosed after an Incomplete Miscarriage and a Preterm Spontaneous Vaginal Delivery

    Science.gov (United States)

    Oliveira, Paula; Scigliano, Horácio; Nogueira, Rosete; Araújo, Célia; Ferreira, Soledade

    2017-01-01

    Intraplacental choriocarcinoma is a rare malignant tumor diagnosed after an abortion, an ectopic pregnancy, or a term or preterm pregnancy or following the diagnosis of a hydatidiform mole. During pregnancy, it may be more common than reported, as most patients are asymptomatic and placental choriocarcinomas are usually inconspicuous macroscopically and are often mistaken for an infarct. Based upon a case study methodology, we describe 2 cases of intraplacental choriocarcinoma: the first case was identified in the product of a uterine curettage following an incomplete miscarriage and the second in one of the placentas of a bichorionic twin pregnancy. Maternal investigation did not reveal evidence of metastatic disease and neither did the infants' one in the second case. The two cases underwent maternal surveillance with serum hCG and remained disease-free until the present. In conclusion, intraplacental choriocarcinoma is easily underdiagnosed but with current treatment, even in the presence of metastasis, the prognosis is excellent. A routine microscopic examination of all the placentas and products of miscarriage can increase the real incidence of this entity and consequently improve its management. PMID:28567059

  11. 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

  12. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury.

    Science.gov (United States)

    Jordan, Polly A; Naidu, Madhu; Thakar, Ranee; Sultan, Abdul H

    2018-03-29

    Our primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit's standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark's Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann-Whitney U tests. Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.

  13. Usefulness of maternal serum C-reactive protein with vaginal Ureaplasma urealyticum as a marker for prediction of imminent preterm delivery and chorioamnionitis in patients with preterm labor or preterm premature rupture of membranes.

    Science.gov (United States)

    Kwak, Dong-Wook; Cho, Hee-Young; Kwon, Ja-Young; Park, Yong-Won; Kim, Young-Han

    2015-07-01

    To assess whether maternal serum C-reactive protein (CRP) and genital mycoplasmas measured can help predict imminent preterm delivery or chorioamnionitis in patients with preterm labor (PL) or preterm premature rupture of membranes (PPROM). The study group consisted of 165 women with PL or PPROM. Vaginal cultures for genital mycoplasmas and maternal blood for CRP were obtained when they were admitted for the management of PL or PPROM. An elevated level of serum CRP was defined as ≥0.8 mg/dL. Histologic evaluation of the placenta was performed after delivery. The prevalence of positive vaginal fluid cultures for Ureaplasma urealyticum (UU) was 63.0%, and elevated maternal serum CRP was 32.7%. No outcome variables were associated with vaginal UU infection in patients with lower CRP levels. However, among women with elevated CRP, the mean gestational age at birth was significantly reduced, and low Apgar score, neonatal intensive care unit admission, histologic chorioamnionitis, and delivery within 7 days of admission were significantly more common in patients with vaginal UU. Although vaginal UU in PL or PPROM cannot act as the sole predictor of imminent preterm delivery or chorioamnionitis, it can provide predictive information in patients with elevated maternal serum CRP levels.

  14. [Low urinary tract symptoms after Thierry's spatula delivery at first pregnancy].

    Science.gov (United States)

    Provansal, M; Bretelle, F; Bannier, M; Gamerre, M; Mazouni, C

    2007-11-01

    This study was undertaken to evaluate prevalence of low urinary tract symptoms (LUTS) after Thierry's spatula delivery at first pregnancy. A retrospective study of 236 primiparous with instrumental delivery or spontaneous delivery who had delivered from January 2001 to December 2002. Low urinary tract symptoms (LUTS) were evaluated one year after delivery with a questionnaire. Incidence of LUTS was compared depending on mode of delivery. Of the 236 patients included, 88.1% replied to the questionnaire, 106 who delivered spontaneously and 102 who underwent Thierry's spatula delivery. The incidence of urinary incontinence was similar after instrumental deliveries and after spontaneous vaginal deliveries (34.9 versus 24.5%, p=0.10). In univariate analysis, symptoms of urinary urgency and urinary frequency were higher after instrumental delivery than after spontaneous delivery, respectively, 34.9 versus 22.5%, p=0.049 and 19.8 versus 8.8%, p=0.03. After controlling for confounding factors, no difference in LUTS was observed between the two groups; the respective adjusted odds-ratios (95% IC) were 1,5 (0.8-3) for urinary incontinence, 1.7 (0.9-3.5) for urgency and 2.5 (0.9-6.3) for urinary frequency. One year after delivery, one third of patients will present urinary incontinence and more than 50% will complain of bladder instability symptoms. Compared to spontaneous vaginal delivery, the use of Thierry's spatulas at first pregnancy does not induce higher risk of LUTS.

  15. A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

    Science.gov (United States)

    Romero, Roberto; Yeo, Lami; Miranda, Jezid; Hassan, Sonia; Conde-Agudelo, Agustin; Chaiworapongsa, Tinnakorn

    2014-01-01

    Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two-thirds of preterm births occur after the spontaneous onset of labor, and the remaining one-third after “indicated” preterm birth; however, the causes of spontaneous preterm labor and “indicated” preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25mm). PMID:23314512

  16. 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

  17. Combining different types of multifunctional liposomes loaded with ammonium bicarbonate to fabricate microneedle arrays as a vaginal mucosal vaccine adjuvant-dual delivery system (VADDS).

    Science.gov (United States)

    Wang, Ning; Zhen, Yuanyuan; Jin, Yiguang; Wang, Xueting; Li, Ning; Jiang, Shaohong; Wang, Ting

    2017-01-28

    To develop effective mucosal vaccines, two types of multifunctional liposomes, the mannosylated lipid A-liposomes (MLLs) with a size of 200nm and the stealth lipid A-liposomes (SLLs) of 50nm, both loaded with a model antigen and NH 4 HCO 3 , were fabricated together into microneedles, forming the proSLL/MLL-constituted microneedle array (proSMMA), which upon rehydration dissolved rapidly recovering the initial MLLs and SLLs. Mice vaccinated with proSMMAs by vaginal mucosa patching other than conventional intradermal administration established robust antigen-specific humoral and cellular immunity at both systemic and mucosal levels, especially, in the reproductive and intestinal ducts. Further exploration demonstrated that the MLLs reconstituted from the administered proSMMAs were mostly taken up by vaginal mucosal dendritic cells, whereas the recovered SLLs trafficked directly to draining lymph nodes wherein to be picked up by macrophages. Moreover, the antigens delivered by either liposomes were also cross-presented for MHC-I displaying by APCs thanks to lysosome escape and ROS (reactive oxygen species) stimulation, both of which occurred when lysosomal acidifying the liposome-released NH 4 HCO 3 into CO 2 and NH 4 + /NH 3 to rupture lysosomes by gas expansion and to cause ROS production by excessive ammonia induction, resulting in a mixed Th1/Th2 type response which was also promoted by liposomal lipid A via activation of TLR4. In addition, vaginal vaccination of the engineered HSV2 antigen gD-loaded proSMMAs successfully protected mice from the virus challenge. Thus, the proSMMAs are in fact a vaccine adjuvant-dual delivery system capable of eliciting robust humoral and cellular immunity against the invading pathogens, especially, the sexually transmitted ones. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Resuscitation of newborn in high risk deliveries

    International Nuclear Information System (INIS)

    Yousaf, U.F.; Hayat, S.

    2015-01-01

    High risk deliveries are usually associated with increased neonatal mortality and morbidity. Neonatal resuscitation can appreciably affect the outcome in these types of deliveries. Presence of personnel trained in basic neonatal resuscitation at the time of delivery can play an important role in reducing perinatal complications in neonates at risk. The study was carried out to evaluate the effects of newborn resuscitation on neonatal outcome in high risk deliveries. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore. Ninety consecutive high risk deliveries were included and attended by paediatricians trained in newborn resuscitation. Babies delivered by elective Caesarean section, normal spontaneous vaginal deliveries and still births were excluded. Neonatal resuscitation was performed in babies who failed to initiate breathing in the first minute after birth. Data was analyzed using SPSS-16.0. Results: A total of 90 high risk deliveries were included in the study. Emergency caesarean section was the mode of delivery in 94.4% (n=85) cases and spontaneous vaginal delivery in 5.6% (n=5). Preterm pregnancy was the major high risk factor. Newborn resuscitation was required in 37.8% (n=34) of all high risk deliveries (p=0.013). All the new-borns who required resuscitation survived. Conclusion: New-born resuscitation is required in high risk pregnancies and personnel trained in newborn resuscitation should be available at the time of delivery. (author)

  19. Effect of intracervical anesthesia on pain associated with the insertion of the levonorgestrel-releasing intrauterine system in women without previous vaginal delivery: a RCT.

    Science.gov (United States)

    Castro, T V B; Franceschini, S A; Poli-Neto, O; Ferriani, R A; Silva de Sá, M F; Vieira, C S

    2014-11-01

    Is the pain associated with levonorgestrel-releasing intrauterine system (LNG-IUS) insertion reduced by intracervical anesthesia in women without previous vaginal birth? Intracervical anesthesia was not associated with reduced pain in women without previous vaginal birth. The pain associated with the insertion of intrauterine contraceptives (IUCs) is a limiting factor for the use of these contraceptives by some women. No prophylactic pharmacological intervention has proven efficacy in relieving pain during or after the insertion of IUCs. However, previous studies included women with previous vaginal delivery, and injectable intracervical anesthesia was not evaluated in any of these studies. This was a randomized, open, parallel-group clinical trial that evaluated 100 women without previous vaginal delivery who wished to use the LNG-IUS for the first time. These women were evaluated immediately after LNG-IUS insertion and then 2 h and 6 h later. The 100 women were randomized into two groups: (i) use of a non-steroidal anti-inflammatory drug (NSAID) (ibuprofen, 400 mg) 1 h prior to LNG-IUS insertion; or (ii) 2% lidocaine intracervical injection 5 min prior to LNG-IUS insertion. The women were evaluated immediately after LNG-IUS insertion and then 2 h and 6 h after insertion. Two pain scales were used (the visual analogue scale and the facial pain scale) in addition to assessing the ease of insertion (as rated by the provider) and the level of discomfort during the procedure (as rated by the patient). Multivariate logistic regression was performed to analyze the predictors associated with moderate/severe pain. The pain and discomfort associated with LNG-IUS insertion, and the ease of insertion of the LNG-IUS did not differ between the groups. Nulliparity was more associated with moderate/severe pain [adjusted odds ratio (OR): 3.1 (95% confidence interval (CI): 1.3-7.80]. Injectable intracervical anesthesia use reduced the risk of moderate/severe pain by 40% [adjusted

  20. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis.

    Science.gov (United States)

    Donders, Gilbert G G; Vereecken, Annie; Bosmans, Eugene; Dekeersmaecker, Alfons; Salembier, Geert; Spitz, Bernard

    2002-01-01

    To define an entity of abnormal vaginal flora: aerobic vaginitis. Observational study. University Hospital Gasthuisberg, Leuven, Belgium. 631 women attending for routine prenatal care or attending vaginitis clinic. Samples were taken for fresh wet mount microscopy of vaginal fluid, vaginal cultures and measurement of lactate, succinate and cytokine levels in vaginal fluid. Smears deficient in lactobacilli and positive for clue cells were considered to indicate a diagnosis of bacterial vaginosis. Aerobic vaginitis was diagnosed if smears were deficient in lactobacilli, positive for cocci or coarse bacilli, positive for parabasal epithelial cells, and/or positive for vaginal leucocytes (plus their granular aspect). Genital complaints include red inflammation, yellow discharge, vaginal dyspareunia. Group B streptococci, escherichia coli, staphylococcus aureus and trichomonas vaginalis are frequently cultured. Vaginal lactate concentration is severely depressed in women with aerobic vaginitis, as in bacterial vaginosis, but vaginal succinate is not produced. Also in contrast to bacterial vaginosis, aerobic vaginitis produces a host immune response that leads to high production of interleukin-6, interleukin-1-beta and leukaemia inhibitory factor in the vaginal fluid. Aerobic vaginitis is associated with aerobic micro-organisms, mainly group B streptococci and E. coli. Its characteristics are different from those of bacterial vaginosis and elicit an important host response. The most severe form of aerobic vaginitis equals desquamative inflammatory vaginitis. In theory, aerobic vaginitis may be a better candidate than bacterial vaginosis as the cause of pregnancy complications, such as ascending chorioamnionitis, preterm rupture of the membranes and preterm delivery.

  1. Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency

    DEFF Research Database (Denmark)

    Sneider, Kirstine; Christiansen, Ole Bjarne; Sundtoft, Iben Blaabjerg

    2017-01-01

    register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997-2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage......, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015. RESULTS: Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted......PURPOSE: To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage. METHODS: Retrospective chart review of a representative...

  2. Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study.

    Science.gov (United States)

    Gundersen, Tina Djernis; Krebs, Lone; Loekkegaard, Ellen Christine Leth; Rasmussen, Steen Christian; Glavind, Julie; Clausen, Tine Dalsgaard

    2018-03-14

    To examine the association between postpartum urinary tract infection and intended mode of delivery as well as actual mode of delivery. Retrospective cohort study. All live births in Denmark between 2004 and 2010 (n=450 856). Births were classified by intended caesarean delivery (n=45 053) or intended vaginal delivery (n=405 803), and by actual mode of delivery: spontaneous vaginal delivery, operative vaginal delivery, emergency or planned caesarean delivery in labour or prelabour. The primary outcome measure was postpartum urinary tract infection (n=16 295) within 30 days post partum, defined as either a diagnosis of urinary tract infection in the National Patient Registry or redemption of urinary tract infection-specific antibiotics recorded in the Register of Medicinal Product Statistics. We found that 4.6% of women with intended caesarean delivery and 3.5% of women with intended vaginal delivery were treated for postpartum urinary tract infection.Women with intended caesarean delivery had a significantly increased risk of postpartum urinary tract infection compared with women with intended vaginal delivery (OR 1.33, 95% CI 1.27 to 1.40), after adjustment for age at delivery, smoking, body mass index, educational level, gestational diabetes mellitus, infection during pregnancy, birth weight, preterm delivery, preterm prelabour rupture of membranes, pre-eclampsia, parity and previous caesarean delivery (adjusted OR 1.24, 95% CI 1.17 to 1.46).Using actual mode of delivery as exposure, all types of operative delivery had an equally increased risk of postpartum urinary tract infection compared with spontaneous vaginal delivery. Compared with intended vaginal delivery, intended caesarean delivery was significantly associated with a higher risk of postpartum urinary tract infection. Future studies should focus on reducing routine catheterisation prior to operative vaginal delivery as well as improving procedures related to catheterisation. © Article author

  3. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis

    Directory of Open Access Journals (Sweden)

    Evelyn Kaambo

    2018-03-01

    Full Text Available A healthy vaginal microbiota is considered to be significant for maintaining vaginal health and preventing infections. However, certain vaginal bacterial commensal species serve an important first line of defense of the body. Any disruption of this microbial barrier might result in a number of urogenital conditions including aerobic vaginitis (AV and bacterial vaginosis (BV. The health of the vagina is closely associated with inhabitant microbiota. Furthermore, these microbes maintain a low vaginal pH, prevent the acquisition of pathogens, stimulate or moderate the local innate immune system, and further protect against complications during pregnancies. Therefore, this review will focus on vaginal microbial “health” in the lower reproductive tract of women and on the physiological characteristics that determine the well-being of reproductive health. In addition, we explore the distinct versus shared characteristics of BV and AV, which are commonly associated with increased risk for preterm delivery.

  5. Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child.

    Science.gov (United States)

    Cooper, Brandy; Berlinski, Ariel

    2015-12-01

    Some pediatric patients receiving therapeutic aerosols undergo tracheostomy, and others who are tracheostomized continue requiring inhaled therapies upon decannulation. It is unknown whether a dose adjustment is required. Different devices are available for facial and tracheostomy delivery, and in some instances, the assisted technique is used. We hypothesized that the change from face mask to tracheostomy would result in a decrease in the lung dose. A breathing simulator connected in series to a filter holder and an anatomically correct head model of a child was used. The drug captured in the filter was termed the lung dose. Breathing patterns with tidal volumes of 50, 155, and 300 mL were tested. Albuterol hydrofluoroalkane (pressurized metered-dose inhaler [pMDI]) with an AeroChamber Mini (face and 4.5-mm tracheostomy), AeroTrach (4.5-mm tracheostomy), and AeroChamber (face) and albuterol (2.5 mg/3 mL) with a continuous output nebulizer (face and 4.5-mm tracheostomy) were tested. Masks were used for facial delivery. Four units of each device were tested. Particle size of the pMDI was measured by cascade impaction. Albuterol concentration was determined via spectrophotometry (276 nm). Switching from facial to tracheostomy delivery increased lung dose with nebulizer (all breathing patterns). When a pMDI was used, lung dose was unchanged or increased for the 50- and 155-mL and decreased for the 300-mL breathing pattern. The use of the assisted technique increased lung dose only during nebulization with the 300-mL breathing pattern. The particle size of the pMDI decreased by 19-23% when traveling through the tracheostomy tube, which retained tracheostomy was variable and depended on the delivery device and the breathing pattern. There is no advantage of using the assisted technique to enhance aerosol delivery. Copyright © 2015 by Daedalus Enterprises.

  6. Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

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    Erez Offer

    2012-08-01

    Full Text Available Abstract Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983. The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended.

  7. Vaginal progesterone vs intramuscular 17α-hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth in singleton gestations: systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Saccone, G; Khalifeh, A; Elimian, A; Bahrami, E; Chaman-Ara, K; Bahrami, M A; Berghella, V

    2017-03-01

    Randomized controlled trials (RCTs) have recently compared intramuscular 17α-hydroxyprogesterone caproate (17-OHPC) with vaginal progesterone for reducing the risk of spontaneous preterm birth (SPTB) in singleton gestations with prior SPTB. The aim of this systematic review and meta-analysis was to evaluate the efficacy of vaginal progesterone compared with 17-OHPC in prevention of SPTB in singleton gestations with prior SPTB. Searches of electronic databases were performed to identify all RCTs of asymptomatic singleton gestations with prior SPTB that were randomized to prophylactic treatment with either vaginal progesterone (intervention group) or intramuscular 17-OHPC (comparison group). No restrictions for language or geographic location were applied. The primary outcome was SPTB EMBARAZOS CON FETO ÚNICO: REVISIÓN SISTEMÁTICA Y METAANÁLISIS DE ENSAYOS CONTROLADOS ALEATORIOS: RESUMEN OBJETIVO: Recientemente se han realizado varios ensayos controlados aleatorios (ECA) que comparaban el caproato de 17α-hidroxiprogesterona (17-OHPC, por sus siglas en inglés) por vía intramuscular con la progesterona por vía vaginal para la reducción del riesgo de parto pretérmino espontáneo (PPTE) en embarazos con feto único de gestantes con historial de PPTE. El objetivo de esta revisión sistemática y metaanálisis fue evaluar la eficacia de la progesterona vaginal en comparación con la 17-OHPC en la prevención de embarazos con feto único de gestantes con historial de PPTE. MÉTODOS: Se realizaron búsquedas en bases de datos electrónicas para identificar todos los ECA con embarazos de feto único asintomáticos con historial de PPTE antes de ser asignados al azar a un tratamiento profiláctico, ya fuera con progesterona vaginal (grupo de intervención) o con 17-OHPC intramuscular (grupo de control). No se aplicaron restricciones respecto al idioma o la ubicación geográfica. El resultado primario fue PPTE embarazos de feto único e historial de PPTE. Sin

  8. Mode of Delivery Preferences in a Diverse Population of Pregnant Women

    Science.gov (United States)

    YEE, Lynn M.; KAIMAL, Anjali J.; HOUSTON, Kathryn A.; WU, Erica; THIET, Mari-Paule; NAKAGAWA, Sanae; CAUGHEY, Aaron B.; FIROUZIAN, Atoosa; KUPPERMANN, Miriam

    2014-01-01

    OBJECTIVE To assess women’s preferences for vaginal versus cesarean delivery in four contexts: prior cesarean, twins, breech presentation, and absent indication for cesarean. STUDY DESIGN Cross-sectional study of pregnant women at 24-40 weeks gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these two delivery approaches. RESULTS Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the four contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean before choosing a planned cesarean, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. While uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-to-1 scale with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable to those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity. CONCLUSIONS While most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently employed to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach. PMID:25446662

  9. Alterations in pelvic floor muscles and pelvic organ support by pregnancy and vaginal delivery in squirrel monkeys

    Science.gov (United States)

    Reyes, Michelle; Gendron, Jilene M.; Pierce, Lisa M.; Runge, Val M.; Kuehl, Thomas J.

    2014-01-01

    Introduction and hypothesis The objective of this study was to measure the effects of pregnancy and parturition on pelvic floor muscles and pelvic organ support. Methods Levator ani, obturator internus, and coccygeus (COC) muscle volumes and contrast uptake were assessed by MRI of seven females prior to pregnancy, 3 days, and 4 months postpartum. Bladder neck and cervix position were measured dynamically with abdominal squeezing. Results The sides of three paired muscles were similar (p>0.66). COC volumes were greater (p<0.004) after parturition than before pregnancy or after recovery. COC contrast uptake increased (p<0.02) immediately after delivery. Bladder neck position both in the relaxed state and abdominal pressure descended (p<0.04) after delivery and descended further (p<0.001) after recovery. Cervical position in the relaxed state before delivery was higher (p<0.001) than postpartum but was unchanged (p=0.50) with abdominal pressure relative to delivery. Conclusion In squirrel monkeys, coccygeus muscles demonstrate the greatest change related to parturition, and parturition-related bladder neck descent seems permanent. PMID:21567260

  10. 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.

  11. Intramuscular oxytocin versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery (LabOR trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Adnan, Nita; Boland, Fiona; Murphy, Deirdre J

    2017-11-15

    Primary postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. The most common cause of primary PPH is uterine atony. Atonic PPH rates are increasing in developed countries despite routine active management of the third stage of labour. In less-developed countries, primary PPH remains the leading cause of maternal death. Although the value of routine oxytocics in the third stage of labour has been well established, there is inconsistent practice in the choice of agent and route of administration. Oxytocin is the preferred agent because it has fewer side effects than other uterotonics with similar efficacy. It can be given intravenously or intramuscularly; however, to date, the most effective route of administering oxytocin has not been established. A double-blind randomised controlled trial is planned. The aim of the study is to compare the effects of an intramuscular bolus of oxytocin (10 IU in 1 mL) and placebo intravenous injection (1 mL 0.9% saline given slowly) with an intravenous bolus of oxytocin (10 IU in 1 mL given slowly over 1 min) and placebo intramuscular injection (1 mL 0.9% saline) at vaginal delivery. The study will recruit 1000 women at term (>36 weeks) with singleton pregnancies who are aiming for a vaginal delivery. The primary outcome will be PPH (measured blood loss ≥ 500 mL). A study involving 1000 women will have 80% power at the 5% two-sided alpha level, to detect differences in the proportion of patients with measured blood loss > 500 ml of 10% vs 5%. Given the increasing trends of atonic PPH it is both important and timely that we evaluate the most effective route of oxytocin administration for the management of the third stage of labour. To date, there has been limited research comparing the efficacy of intramuscular oxytocin vs intravenous oxytocin for the third stage of labour. ISRCTN Registry, ISRCTN14718882 . Registered on 4 January 2016. Pilot commenced 12

  12. Estrogen Vaginal

    Science.gov (United States)

    ... in women who are experiencing or have experienced menopause (change of life; the end of monthly menstrual periods). Femring® brand estradiol vaginal ring is also used to treat hot flushes ... are experiencing menopause. Premarin® brand vaginal cream is also used to ...

  13. 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 ...

  14. Episiotomy in normal deliveries at the University Hospital "La Ribera".

    Directory of Open Access Journals (Sweden)

    Sandra Pérez Valero

    2013-03-01

    Full Text Available Aim: Describe the incidence of episiotomy in normal vaginal delivery and analyze risk factors that affect the performance of the practice by midwife.Material and Methods: Observational, descriptive, cross sectional, retrospective study from January 1 to December 31, 2011 at the University Hospital “La Ribera”. The variables are episiotomy, perineal tears, parity and technique, provided by the hospital itself.Results: The percentage of episiotomy in normal vaginal deliveries performed at the University Hospital "La Ribera" was 33.5% (2011. Statistically significant differences were found for variables perineal injury and mediolateral technique, increased the number of intact perineal and spontaneous tears for women without episiotomy. Among women who underwent episiotomy, there is a higher proportion than those who used a medial to lateral technique. Conclusions: The University Hospital "La Ribera" has a selective episiotomy policy in normal vaginals deliveries that favors humanized birth and helps to preserve the perineum intact.

  15. Progesterone to prevent spontaneous preterm birth

    Science.gov (United States)

    Romero, Roberto; Yeo, Lami; Chaemsaithong, Piya; Chaiworapongsa, Tinnakorn; Hassan, Sonia

    2014-01-01

    Summary Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important healthcare priority. Preterm parturition is one of the ‘great obstetrical syndromes’ and is caused by multiple etiologies. One of the mechanisms of disease is the untimely decline in progesterone action, which can be manifested by a sonographic short cervix in the midtrimester. The detection of a short cervix in the midtrimester is a powerful risk factor for preterm delivery. Vaginal progesterone can reduce the rate of preterm delivery by 45%, and the rate of neonatal morbidity (admission to neonatal intensive care unit, respiratory distress syndrome, need for mechanical ventilation, etc.). To prevent one case of spontaneous preterm birth birth in women with a short cervix both with and without a prior history of preterm birth. In patients with a prior history of preterm birth, vaginal progesterone is as effective as cervical cerclage to prevent preterm delivery. 17α-Hydroxyprogesterone caproate has not been shown to be effective in reducing the rate of spontaneous preterm birth in women with a short cervix. PMID:24315687

  16. Terconazole Vaginal Cream, Vaginal Suppositories

    Science.gov (United States)

    Terconazole comes as a cream and suppository to insert into the vagina. It is usually used daily at bedtime for either 3 or 7 days. ... prescribed by your doctor.To use the vaginal cream or vaginal suppositories, read the instructions provided with ...

  17. [Bacterial vaginosis and spontaneous preterm birth].

    Science.gov (United States)

    Brabant, G

    2016-12-01

    To determine if bacterial vaginosis is a marker for risk of spontaneous preterm delivery and if its detection and treatment can reduce this risk. Consultation of the database Pubmed/Medline, Science Direct, and international guidelines of medical societies. Bacterial vaginosis (BV) is a dysbiosis resulting in an imbalance in the vaginal flora through the multiplication of anaerobic bacteria and jointly of a disappearance of well-known protective Lactobacilli. His diagnosis is based on clinical Amsel criteria and/or a Gram stain with establishment of the Nugent score. The prevalence of the BV extraordinarily varies according to ethnic and/or geographical origin (4-58 %), in France, it is close to 7 % in the first trimester of pregnancy (EL2). The link between BV and spontaneous premature delivery is low with an odds ratio between 1.5 and 2 in the most recent studies (EL3). Metronidazole or clindamycin is effective to treat BV (EL3). It is recommended to prescribe one of these antibiotics in the case of symptomatic BV (Professional Consensus). The testing associated with the treatment of BV in the global population showed no benefit in the prevention of the risk of spontaneous preterm delivery (EL2). Concerning low-risk asymptomatic population (defined by the absence of antecedent of premature delivery), it has been failed profit to track and treat the BV in the prevention of the risk of spontaneous preterm delivery (EL1). Concerning the high-risk population (defined by a history of preterm delivery), it has been failed profit to track and treat the VB in the prevention of the risk of spontaneous preterm delivery (EL3). However, in the sub population of patients with a history of preterm delivery occurred in a context of materno-fetal bacterial infection, there may be a benefit to detect and treat early and systematically genital infection, and in particular the BV (Professional Consensus). The screening and treatment of BV during pregnancy in asymptomatic low

  18. Self medication with vaginal misoprostol in a term pregnancy: case ...

    African Journals Online (AJOL)

    eclampsia at term, who self administered misoprostol by the vaginal route - without its being prescribed - in an attempt to avoid repeat caesarean section, is described. She eventually had vaginal delivery of a live female infant with cardiopulmonary ...

  19. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour.

    Science.gov (United States)

    Soltani, Hora; Poulose, Thomas A; Hutchon, David R

    2011-09-07

    Cord drainage in the third stage of labour involves unclamping the previously clamped and divided umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour following vaginal birth, with or without prophylactic use of uterotonics in the management of the third stage of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010). Randomised controlled trials comparing placental cord draining with no placental cord drainage as part of the management of the third stage of labour. Two review authors independently assessed the quality of trials and extracted data. This was then verified by the third review author who then entered the agreed outcomes to the review. Three studies involving 1257 women met our inclusion criteria. Cord drainage reduced the length of the third stage of labour (mean difference (MD) -2.85 minutes, 95% confidence interval (CI) -4.04 to -1.66; three trials, 1257 women (heterogeneity: T² = 0.87; Chi²P=17.19, I² = 88%)) and reduced the average amount of blood loss (MD -77.00 ml, 95% CI -113.73 to -40.27; one trial, 200 women).No incidence of retained placenta at 30 minutes after birth was observed in the included studies, therefore, it was not possible to compare this outcome. The differences between the cord drainage and the control group were not statistically significant for postpartum haemorrhage or manual removal of the placenta. None of the included studies reported fetomaternal transfusion outcomes and there were no data relating to maternal pain or discomfort during the third stage of labour. There was a small reduction in the length of the third stage of labour and also in the amount of blood loss when cord drainage was applied compared with no cord drainage. The clinical importance of such observed statistically significant reductions

  20. 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

  1. 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 ...

  2. Mode of delivery and Pelvic floor disorder

    International Nuclear Information System (INIS)

    Noor, R.; Neelam, H.; Bashir, M.S.

    2017-01-01

    Objective: To compare pelvic floor dysfunction in non pregnant women who had delivered vaginally versus those with cesarean delivery. Methodology: The prevalence of pelvic floor disorders among non pregnant women was assesses by using a standardized tool pelvic floor distress inventory short form (PFDI-20). Data was collected from Jinnah Hospital Lahore, Pakistan. Results: Total numbers of participants were 278. 47.12% subjects had moderate, 36.69% miner and 16.19% had severe pelvic floor dysfunction. The symptoms of pelvic organ prolapse were more prevalent (mean value is 59.1876) than Urinary Distress (mean value is 40.5426), while the Colorectal-Anal Distress (mean value is 35.9150) were least prevalent. Conclusion: Pelvic floor disorders are very common among females and are strongly associated with mode of delivery. Although spontaneous vaginal birth was extensively associated with pelvic floor disorders the instrumental delivery affects most. (author)

  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. Delivery of a baby with severe combined immunodeficiency at 31 weeks gestation following an extreme preterm prelabour spontaneous rupture of the membranes: a case report

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    Watkinson Sally J

    2009-11-01

    Full Text Available Abstract Introduction If left untreated, severe combined immunodeficiency can lead to an acute susceptibility to infection. The intrauterine environment is sterile until the amniotic membranes rupture. The vaginal flora then ascends into the genital tract, thus increasing the risk of chorioamnionitis. An extremely premature and prolonged membrane rupture is associated with a dismal prognosis for an immunocompetent preterm fetus. There are no case reports to date that detail the outcome of an immunocompromised preterm baby following prolonged rupture of membranes. Case presentation We present the case of a 32-year-old Indian woman who delivered a 31-week gestational baby who had a severe combined immunodeficiency following premature prelabour prolonged rupture of the membranes at the 14th week of gestation. Conclusion Extreme preterm prelabour spontaneous rupture of membranes in an underlying condition of severe combined immunodeficiency does not necessarily lead to an unfavourable outcome.

  5. Comparison Between Use of Oral Misoprostol Versus Vaginal Misoprostol for Induction of Labour at Term.

    Science.gov (United States)

    Prameela; Sharma, Kavya D

    2018-04-01

    In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration-oral (100 μg 4th hourly) and vaginal (25 μg 4th hourly), for induction of labour at term. In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes <12 h were considered for labour induction and were divided into two equal groups. Group A received 100 μg misoprostol orally 4th hourly, and group B received 25 μg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared. In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13 h 43 min and in vaginal group interval is 13 h 26 min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant ( p value -0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant ( p value -0.04). APGAR score at 5 min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group. Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium

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

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    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. 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.

  8. Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - a clinical recommendation

    DEFF Research Database (Denmark)

    Haahr, Thor; Ersbøll, Anne S; Karlsen, Mona A

    2016-01-01

    INTRODUCTION: Bacterial vaginosis (BV) is characterized by a dysbiosis of the vaginal microbiota with a depletion of Lactobacillus spp. In pregnancy, prevalence's between 7 and 30% have been reported depending on the study population and the definition. BV may be associated with an increased risk...

  9. Elevated maternal serum-free β-human chorionic gonadotropin (β-hCG) and reduced risk of spontaneous preterm delivery.

    Science.gov (United States)

    Soni, Shelly; Krantz, David A; Blitz, Matthew J; Vohra, Nidhi; Rochelson, Burton

    2018-04-12

    To evaluate the relationship between first and second trimester maternal serum-free β-hCG and the risk of spontaneous preterm delivery (PTD). This was a case-control study of women evaluated and delivered at our institution from 2011 to 2015. Spontaneous PTD was defined as delivery before 37 weeks due to spontaneous preterm labor or premature rupture of membranes. Patient with multifetal gestation and those with medically indicated term or PTD were excluded. Of 877 women meeting the inclusion criteria, 173 delivered preterm and 704 delivered at term, and 8.1% had high free β-hCG in one or both trimesters. High maternal first and/or second trimester free β-hCG (≥95th percentile) was associated with lower rates of PTD. Thirty-two women with high free β-hCG in both first and second trimesters delivered at term. Gestational age at delivery and birth weights were lower in women who did not have high free β-hCG in any trimester. Low free β-hCG (≤5th percentile) in either trimester was not associated with an increased or decreased likelihood of PTD. Logistic regression demonstrated an independent association of high free β-hCG (≥95th percentile) with a reduced likelihood of PTD. Stratified analysis revealed a stronger impact of this association in women with no prior history of PTD. High free β-hCG, in the absence of risk factors for medically indicated PTD, is associated with a reduced likelihood of spontaneous PTD and may represent a marker indicating lower risk.

  10. Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network.

    Science.gov (United States)

    Boyle, Annelee; Preslar, Jessica P; Hogue, Carol J R; Silver, Robert M; Reddy, Uma M; Goldenberg, Robert L; Stoll, Barbara J; Varner, Michael W; Conway, Deborah L; Saade, George R; Bukowski, Radek; Dudley, Donald J

    2017-04-01

    To describe delivery management of singleton stillbirths in a population-based, multicenter case series. We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented). Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture. Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.

  11. Complete genome sequence and lifestyle of black-pigmented Corynebacterium aurimucosum ATCC 700975 (formerly C. nigricans CN-1 isolated from a vaginal swab of a woman with spontaneous abortion

    Directory of Open Access Journals (Sweden)

    Gartemann Karl-Heinz

    2010-02-01

    Full Text Available Abstract Background Corynebacterium aurimucosum is a slightly yellowish, non-lipophilic, facultative anaerobic member of the genus Corynebacterium and predominantly isolated from human clinical specimens. Unusual black-pigmented variants of C. aurimucosum (originally named as C. nigricans continue to be recovered from the female urogenital tract and they are associated with complications during pregnancy. C. aurimucosum ATCC 700975 (C. nigricans CN-1 was originally isolated from a vaginal swab of a 34-year-old woman who experienced a spontaneous abortion during month six of pregnancy. For a better understanding of the physiology and lifestyle of this potential urogenital pathogen, the complete genome sequence of C. aurimucosum ATCC 700975 was determined. Results Sequencing and assembly of the C. aurimucosum ATCC 700975 genome yielded a circular chromosome of 2,790,189 bp in size and the 29,037-bp plasmid pET44827. Specific gene sets associated with the central metabolism of C. aurimucosum apparently provide enhanced metabolic flexibility and adaptability in aerobic, anaerobic and low-pH environments, including gene clusters for the uptake and degradation of aromatic amines, L-histidine and L-tartrate as well as a gene region for the formation of selenocysteine and its incorporation into formate dehydrogenase. Plasmid pET44827 codes for a non-ribosomal peptide synthetase that plays the pivotal role in the synthesis of the characteristic black pigment of C. aurimucosum ATCC 700975. Conclusions The data obtained by the genome project suggest that C. aurimucosum could be both a resident of the human gut and possibly a pathogen in the female genital tract causing complications during pregnancy. Since hitherto all black-pigmented C. aurimucosum strains have been recovered from female genital source, biosynthesis of the pigment is apparently required for colonization by protecting the bacterial cells against the high hydrogen peroxide concentration in

  12. Sexual function and postpartum depression 6 months after attempted operative vaginal delivery according to fetal head station: A prospective population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Guillaume Ducarme

    Full Text Available To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD, and specifically midpelvic or low aOVD, on female and male sexual function and symptoms of postpartum depression (PPD at 6 months.Prospective population-based cohort study.1,941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital.Symptoms of female sexual dysfunction using the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12, symptoms of PPD using the Edinburgh Postnatal Depression Scale (EPDS score, symptoms of male sexual dysfunction using the International Index of Erectile Function (IIEF-15 and perineal pain were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of female and male sexual function and symptoms of PPD at 6 months using multiple regression and adjusting for demographics, and risk factors of sexual dysfunction, symptoms of PPD and perineal pain with adjusted odds ratios (aORs and 95% confidence intervals (95% CI.The study included 907 women (46.7% who responded to the questionnaire; 18.4% (167/907 had midpelvic aOVD, and 81.6% (740/907 low. Most women (873/907 [96.3%] of those with partners reported sexual activity at 6 months. No significant difference was observed for PISQ-12, EPDS, IIEF-15 scores and perineal pain between mid and low pelvic groups. Compared with low pelvic aOVD, midpelvic aOVD was not significantly associated with either female or male sexual dysfunction (p = 0.89 and p = 0.76, respectively, or maternal symptoms of PPD (p = 0.83. Perineal pain significantly increased the risk of male and female sexual dysfunction and maternal symptoms of PPD at 6 months (p = 0.02, p = 0.006, and p = 0.02, respectively.Midpelvic compared with low pelvic aOVD was not associated with an increase in sexual dysfunction, nor with symptoms of PPD at 6

  13. Brief Report: Cesarean Delivery and Subsequent Fecundability.

    Science.gov (United States)

    Radin, Rose G; Mikkelsen, Ellen M; Rothman, Kenneth J; Hatch, Elizabeth E; Sorensen, Henrik T; Riis, Anders H; Kuohung, Wendy; Wise, Lauren A

    2016-11-01

    Studies have shown that cesarean delivery is associated with fewer subsequent births relative to vaginal delivery, but it is unclear whether confounding by pregnancy intention or indication for surgery explained these results. We evaluated the association between cesarean delivery and subsequent fecundability among 910 primiparous women after singleton live birth. In a cohort of Danish women planning pregnancy (2007-2012), obstetrical history was obtained via registry linkage; time-to-pregnancy and covariate data were collected via questionnaire. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were adjusted for potential confounders. Relative to spontaneous vaginal delivery, emergency cesarean delivery with cephalic presentation showed little association with fecundability (FR = 1.0, 95% CI = 0.83, 1.3), but cesarean delivery with breech presentation (FR = 0.72, 95% CI = 0.53, 0.97) and planned cesarean delivery with cephalic presentation (FR = 0.51, 95% CI = 0.25, 1.0) were associated with reduced fecundability. The cesarean-fecundability association varied by previous fetal presentation and emergency status.

  14. Development of a mucoadhesive delivery system for control release of doxepin with application in vaginal pain relief associated with gynecological surgery.

    Science.gov (United States)

    Sanz, Roser; Clares, Beatriz; Mallandrich, Mireia; Suñer-Carbó, Joaquim; Montes, María Jesús; Calpena, Ana C

    2018-01-15

    The main purpose of this study was to develop a semisolid mucoadhesive formulation for the non-invasive vaginal administration of doxepin (DOX) for relief of pain derived from the scarring process after surgery. An orafix ® platform loading DOX was tested for adequate stability, rheology and vaginal mucoadhesion capacity. The formulation exhibited appropriate pH and was microbiologically stable. The rheological studies confirmed its pseudoplastic and thixotropic nature with prevalence of the elastic behavior component over the viscous one. Appropriate syringeability and spreadability results were also confirmed. Different experiments showed adequate mucoadhesion capacity even in the presence of simulated vaginal fluid. Finally, DOX release, permeation and retention in vaginal mucosa studies were also accomplished with promising results. DOX release kinetics followed the modified Higuchi model and the permeation studies did not render such high values as to suggest potential systemic absorption which could lead to undesirable systemic side effects. Therefore, we can hypostatize that the proposed formulation may assist to fill in the therapeutic gap regarding pure pain relief at local level in vagina. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. MRI of vaginal conditions

    International Nuclear Information System (INIS)

    Lopez, C.; Balogun, M.; Ganesan, R.; Olliff, J.F.

    2005-01-01

    Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies

  16. MRI of vaginal conditions

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, C. [Department of Radiology, Birmingham Women' s Hospital, Birmingham (United Kingdom)]. E-mail: carolina.lopez@bwhct.nhs.uk; Balogun, M. [Department of Radiology, Birmingham Women' s Hospital, Birmingham (United Kingdom); Ganesan, R. [Department of Histopathology, Birmingham Women' s Hospital, Birmingham (United Kingdom); Olliff, J.F. [University Hospital Birmingham, Birmingham (United Kingdom)

    2005-06-01

    Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.

  17. Vaginal prostaglandin gel to induce labour in women with one previous caesarean section.

    LENUS (Irish Health Repository)

    Agnew, G

    2012-02-01

    This retrospective study reviewed the mode of delivery when vaginal prostaglandins were used to induce labour in women with a single previous lower segment caesarean section. Over a 4-year period, PGE 2 gel was used cautiously in low doses in 54 women. Induction with PGE 2 gel was associated with an overall vaginal birth after caesarean section (VBAC) rate of 74%, which compared favourably with the 74% VBAC rate in women who went into spontaneous labour (n = 1969). There were no adverse outcomes recorded after the prostaglandin inductions but the number reported are too small to draw any conclusions about the risks, such as uterine rupture. We report our results because they may be helpful in assessing the chances of a successful VBAC in the uncommon clinical circumstances where prostaglandin induction is being considered.

  18. The impact of a computerized decision aid on empowering pregnant women for choosing vaginal versus cesarean section delivery: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Eslami, Saeid; Aslani, Azam; Tara, Fatemeh; Ghalichi, Leila; Erfanian, Fatemeh; Abu-Hanna, Ameen

    2015-01-01

    Cesarean delivery on maternal request (CDMR) is one of the main reasons for cesarean delivery in Iran, and women often need help in making a decision about the delivery options available to them. The main objective of this study is to evaluate the effect of a computerized decision aid (CDA) system

  19. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Incontinência urinária no puerpério de parto vaginal e cesárea: revisão de literatura = Urinary incontinence in postpartum of vaginal delivery and cesarean: literature review

    Directory of Open Access Journals (Sweden)

    Borba, Alice Rios

    2014-01-01

    Full Text Available Objetivo: O estudo objetivou revisar a literatura quanto à presença de incontinência urinária (IU no puerpério de parto normal e cesárea. Materiais e Métodos: Foi realizada uma pesquisa nos bancos de dados PubMed/MedLine, COCHRANE e EMBASE. Foram selecionados os seguintes tipos de estudo: prospectivo multicêntrico, caso-controle, prospectivo, coorte, multicêntrico prospectivo observacional, randomizado controlado, prospectivo observacional, coorte controlado, transversal, base populacional, publicados no período de 2002 a 2012, nos idiomas inglês e português, em que as palavras-chave estivessem no título ou resumo. As palavras-chave utilizadas foram: “parto vaginal”, “cesárea” e “incontinência urinária”. Resultados: Os 14 estudos analisados, avaliaram a presença de IU no puerpério de parto vaginal e cesárea. Observamos que a cesárea para ter seu papel protetor no aparecimento da IU no puerpério deve ser realizada de maneira eletiva. Os distúrbios do assoalho pélvico estão fortemente ligados com idade materna, fumo, obesidade, parto de fórceps, multiparidade, episiotomia, duração da segunda fase do trabalho de parto, gravidez e constipação crônica. Conclusão: Conclui-se que a segunda fase prolongada do trabalho de parto tem papel significativo na presença da IU no puerpério em ambos modos de parto, e que a cesárea teria o seu valor protetor no desenvolvimento da IU no puerpério apenas se fosse realizada de maneira eletiva. Dos 14 artigos, apenas um estudo foi realizado na população brasileira, mostrando a importância de serem realizados mais estudos sobre IU no puerpério no Brasil

  1. Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature.

    Science.gov (United States)

    Dall'Asta, Andrea; Ghi, Tullio; Pedrazzi, Giuseppe; Frusca, Tiziana

    2016-09-01

    Vacuum extractor has been increasingly used over the last decades and is acknowledged as a risk factor for shoulder dystocia (SD). In this meta-analysis we assess the actual risk of SD following a vacuum delivery compared to spontaneous vaginal delivery (SVD) and forceps. Systematic literature search (English literature only) on MEDLINE, EMBASE, ScienceDirect, the Cochrane library and ClinicalTrials.gov conducted up to May 2015. Key search terms included: Operative/Vacuum/Forceps delivery [Mesh] and shoulder dystocia and subheadings. 2 stage-process study selection. We included only studies where data concerning the occurrence of SD following operative vaginal delivery were reported as adjusted odds ratio (AOR) and no significant difference in confounding factors for SD was recorded. Included trials clustered according to the delivery mode (1) vacuum vs. SVD, (2) forceps vs. vacuum. Methodological quality of each study evaluated with the Newcastle-Ottawa System (NOS). 87 potentially relevant papers. After applying inclusion and exclusion criteria only 7 were selected for the meta-analysis. Vacuum delivery appeared associated with a higher risk of SD than SVD in both fixed and random model (OR 2.87 and 2.98 respectively). No difference in the rate of SD was found between vacuum and forceps (p>0.05). Vacuum extractor carries an increased risk of SD compared with spontaneous vaginal delivery whereas the occurrence of SD does not seem to vary following vacuum or forceps. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Panamanian women׳s experience of vaginal examination in labour: A questionnaire validation.

    Science.gov (United States)

    Bonilla-Escobar, Francisco J; Ortega-Lenis, Delia; Rojas-Mirquez, Johanna C; Ortega-Loubon, Christian

    2016-05-01

    to validate a tool that allows healthcare providers to obtain accurate information regarding Panamanian women׳s thoughts and feelings about vaginal examination during labour that can be used in other Latin-American countries. validation study based on a database from a cross-sectional study carried out in two tertiary care hospitals in Panama City, Panama. Women in the immediate postpartum period who had spontaneous labour onset and uncomplicated deliveries were included in the study from April to August 2008. Researchers used a survey designed by Lewin et al. that included 20 questions related to a patient׳s experience during a vaginal examination. five constructs (factors) related to a patient׳s experience of vaginal examination during labour were identified: Approval (Alpha Cronbach׳s 0.72), Perception (0.67), Rejection (0.40), Consent (0.51), and Stress (0.20). it was demonstrated the validity of the scale and its constructs used to obtain information related to vaginal examination during labour, including patients' experiences with examination and healthcare staff performance. utilisation of the scale will allow institutions to identify items that need improvement and address these areas in order to promote the best care for patients in labour. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain.

    Science.gov (United States)

    Doğan, Bülent; Gün, İsmet; Özdamar, Özkan; Yılmaz, Ali; Muhçu, Murat

    2017-02-01

    To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women. This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ 2 test. Statistical significance was defined as p sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p = 0.001). There were significant differences in sexual desire between groups 1 and 3 (p = 0.005), in arousal and in orgasm between both groups 1 and 2 (p = 0.001 and p = 0.038, respectively) and groups 1 and 3 (p = 0.001 and p = 0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points. Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.

  4. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The relationship between mode of delivery and sexual health outcomes after childbirth.

    Science.gov (United States)

    Faisal-Cury, Alexandre; Menezes, Paulo Rossi; Quayle, Julieta; Matijasevich, Alicia; Diniz, Simone Grilo

    2015-05-01

    Several factors are implicated in the women's sexuality after childbirth. Nevertheless, there is conflicting evidence about the influence of mode of delivery (MD) AIM: To prospectively evaluate the relationship between MD and sexual health outcomes after childbirth A prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The exposure variable was MD: uncomplicated vaginal delivery (spontaneous vaginal delivery without episiotomy or any kind of perineal laceration); complicated vaginal delivery (either forceps or normal, with episiotomy or any kind of perineal laceration) and cesarean delivery. Socio-demographic and obstetric data were obtained through a questionnaire applied during the antenatal and postnatal period. Crude and adjusted risk ratios, with 95% confidence intervals, were calculated using Poisson regression to examine the associations between MD and sexual health outcomes. The three main sexual health outcomes were later resumption of sexual life, self-perception of decline of sexual life (DSL), and presence of sexual desire. One hundred and forty-one women (21.9%) resumed sexual life 3 or more months after delivery. Although 87.1% of women had desire, DSL occurred in 21.1% of the cohort. No associations were found between MD and sexual health outcomes. Women's sexuality after childbirth were not influenced by the type of delivery. Efforts to improve the treatment of sexual problems after childbirth should focus beyond MD. © 2015 International Society for Sexual Medicine.

  6. Targeted Doxorubicin Delivery to Brain Tumors via Minicells: Proof of Principle Using Dogs with Spontaneously Occurring Tumors as a Model.

    Science.gov (United States)

    MacDiarmid, Jennifer A; Langova, Veronika; Bailey, Dale; Pattison, Scott T; Pattison, Stacey L; Christensen, Neil; Armstrong, Luke R; Brahmbhatt, Vatsala N; Smolarczyk, Katarzyna; Harrison, Matthew T; Costa, Marylia; Mugridge, Nancy B; Sedliarou, Ilya; Grimes, Nicholas A; Kiss, Debra L; Stillman, Bruce; Hann, Christine L; Gallia, Gary L; Graham, Robert M; Brahmbhatt, Himanshu

    2016-01-01

    Cytotoxic chemotherapy can be very effective for the treatment of cancer but toxicity on normal tissues often limits patient tolerance and often causes long-term adverse effects. The objective of this study was to assist in the preclinical development of using modified, non-living bacterially-derived minicells to deliver the potent chemotherapeutic doxorubicin via epidermal growth factor receptor (EGFR) targeting. Specifically, this study sought to evaluate the safety and efficacy of EGFR targeted, doxorubicin loaded minicells (designated EGFRminicellsDox) to deliver doxorubicin to spontaneous brain tumors in 17 companion dogs; a comparative oncology model of human brain cancers. EGFRminicellsDox were administered weekly via intravenous injection to 17 dogs with late-stage brain cancers. Biodistribution was assessed using single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Anti-tumor response was determined using MRI, and blood samples were subject to toxicology (hematology, biochemistry) and inflammatory marker analysis. Targeted, doxorubicin-loaded minicells rapidly localized to the core of brain tumors. Complete resolution or marked tumor regression (>90% reduction in tumor volume) were observed in 23.53% of the cohort, with lasting anti-tumor responses characterized by remission in three dogs for more than two years. The median overall survival was 264 days (range 49 to 973). No adverse clinical, hematological or biochemical effects were observed with repeated administration of EGFRminicellsDox (30 to 98 doses administered in 10 of the 17 dogs). Targeted minicells loaded with doxorubicin were safely administered to dogs with late stage brain cancer and clinical activity was observed. These findings demonstrate the strong potential for clinical applications of targeted, doxorubicin-loaded minicells for the effective treatment of patients with brain cancer. On this basis, we have designed a Phase 1 clinical study of EGFR

  7. Targeted Doxorubicin Delivery to Brain Tumors via Minicells: Proof of Principle Using Dogs with Spontaneously Occurring Tumors as a Model.

    Directory of Open Access Journals (Sweden)

    Jennifer A MacDiarmid

    Full Text Available Cytotoxic chemotherapy can be very effective for the treatment of cancer but toxicity on normal tissues often limits patient tolerance and often causes long-term adverse effects. The objective of this study was to assist in the preclinical development of using modified, non-living bacterially-derived minicells to deliver the potent chemotherapeutic doxorubicin via epidermal growth factor receptor (EGFR targeting. Specifically, this study sought to evaluate the safety and efficacy of EGFR targeted, doxorubicin loaded minicells (designated EGFRminicellsDox to deliver doxorubicin to spontaneous brain tumors in 17 companion dogs; a comparative oncology model of human brain cancers.EGFRminicellsDox were administered weekly via intravenous injection to 17 dogs with late-stage brain cancers. Biodistribution was assessed using single-photon emission computed tomography (SPECT and magnetic resonance imaging (MRI. Anti-tumor response was determined using MRI, and blood samples were subject to toxicology (hematology, biochemistry and inflammatory marker analysis. Targeted, doxorubicin-loaded minicells rapidly localized to the core of brain tumors. Complete resolution or marked tumor regression (>90% reduction in tumor volume were observed in 23.53% of the cohort, with lasting anti-tumor responses characterized by remission in three dogs for more than two years. The median overall survival was 264 days (range 49 to 973. No adverse clinical, hematological or biochemical effects were observed with repeated administration of EGFRminicellsDox (30 to 98 doses administered in 10 of the 17 dogs.Targeted minicells loaded with doxorubicin were safely administered to dogs with late stage brain cancer and clinical activity was observed. These findings demonstrate the strong potential for clinical applications of targeted, doxorubicin-loaded minicells for the effective treatment of patients with brain cancer. On this basis, we have designed a Phase 1 clinical study of

  8. Delivery of helium–oxygen mixture during spontaneous breathing: evaluation of three high-concentration face masks.

    Science.gov (United States)

    Roche-Campo, Ferran; Vignaux, Laurence; Galia, Fabrice; Lyazidi, Aissam; Vargas, Frédéric; Texereau, Joëlle; Apiou-Sbirlea, Gabriela; Jolliet, Philippe; Brochard, Laurent

    2011-11-01

    To evaluate the efficacy of delivering a mixture of helium and oxygen gas (He–O2) in spontaneous ventilation. Three high oxygen flow reservoir masks were tested: the Heliox21, specifically designed for helium; the Hi-Ox80 mask, with an inspiratory and an expiratory valve; and a standard high-concentration face mask. This prospective randomized crossover study was performed in six healthy volunteers in a laboratory setting. Volunteers breathed a mixture of 78% He/22% O2 through each of the masks under two different breathing conditions (rest and hyperventilation: minute ventilation of 14.9 ± 6.1 and 26.7 ± 8.7 L min(−1), respectively) and four different He–O2 flow rates (7, 10, 12, and 15 L min(−1)). A nasopharyngeal catheter was used to estimate He pharyngeal concentration (Fp [He]) in the airways in order to determine the percentage of contamination with room air (% air cont) at end-expiration. Under all testing conditions, the Hi-Ox80 mask presented a significantly lower % air cont. During resting breathing pattern, a Fp [He] higher than 50% was achieved in 54% of the tests performed with the Hi-Ox80 mask compared to 29% for the Heliox21 mask and only 17% for the standard mask. At hyperventilation, a Fp [He] higher than 50% was achieved in 17% of the tests performed with the Hi-Ox mask compared to 4% for the other two masks. He–O2 administration via the usual high-concentration reservoir masks results in significant dilution by room air. The Hi-Ox80 mask minimized room air contamination and much more frequently achieved a pharyngeal He concentration higher than 50%.

  9. Vaginal yeast infection

    Science.gov (United States)

    ... are available as creams, ointments, vaginal tablets or suppositories and oral tablets. Most can be bought without ... Medicine for up to 14 days Clotrimazole vaginal suppository or fluconazole pill every week to prevent new ...

  10. Hysterectomy - vaginal - discharge

    Science.gov (United States)

    Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... you are unable to urinate. You have a discharge from your vagina that has a bad odor. You have bleeding ...

  11. Vaginal progesterone combined with cervical pessary: A chance for pregnancies at risk for preterm birth?

    Science.gov (United States)

    Stricker, Nathanael; Timmesfeld, Nina; Kyvernitakis, Ioannis; Goerges, Janina; Arabin, Birgit

    2016-06-01

    Precocious cervical ripening, as defined by cervical shortening on transvaginal sonography, has prompted a broad evaluation of secondary strategies (such as cerclage, vaginal progesterone, or a cervical pessary) to prevent preterm delivery. However, there is still a lack of direct comparisons between individual treatments or their combinations. We sought to compare at-risk patients and screening patients who had been treated with cervical pessary alone with patients who had been treated with pessary plus vaginal progesterone. This is a pre- and postintervention cohort study from a preterm labor clinic where placement of a cervical pessary has been the standard treatment since 2008 for at-risk women defined by (1) a history of spontaneous preterm birth at suppositories) was prescribed in addition to the pessary. Both at-risk patients (n = 55) and screening patients (n = 51) were treated at the time of diagnosis. The primary outcome was the rate of preterm deliveries at <34 weeks of gestation. Secondary outcomes included deliveries at <28, <32, and <37 weeks of gestation, the days from start of therapy until delivery, a composite index of neonatal outcome, and the number of days in the neonatal intensive care unit. Primary and secondary outcomes were compared between groups with the use of multivariable models to adjust for possible confounders. Delivery at <34 weeks of gestation occurred in 17 of 53 patients (32.1%) who were treated with pessary plus progesterone, compared with 13 of 53 patients (24.5%) who were treated with pessary alone (P = .57). Similarly, there was no difference in the rate of preterm delivery at <28, <32, or <37 weeks of gestation. The composite poor neonatal outcome was 15.1% in the pessary group vs 18.9% in the combined group (P = .96). The mean duration of stay in the neonatal intensive care unit was 46.5 days (range, 9-130 days) in the combined vs 52.0 days (range, 3-151 days) in the pessary group (P < .001). In this cohort study

  12. Associação entre a analgesia epidural e o trauma perineal no parto vaginal Asociación entre la analgesia epidural y el trauma perineal en el parto vaginal Association between epidural analgesia and perineal laceration in vaginal delivery

    Directory of Open Access Journals (Sweden)

    Juliana Cristina dos Santos Monteiro

    2009-03-01

    Full Text Available O objetivo deste estudo foi analisar a associação entre a analgesia epidural e a laceração perineal em mulheres submetidas ao parto vaginal. Foi realizado um estudo descritivo e transversal, para o qual foram pesquisados 109 prontuários de mulheres assistidas durante o processo de parturição, em uma maternidade em Ribeirão Preto. Os dados foram coletados nos meses de março e abril de 2003. Para analisar a correlação entre as variáveis foi aplicado o teste qui-quadrado. Foi realizado parto normal em 91,7% (100 das parturientes e fórceps em 8,2% (9. Na análise dos dados, 74,3% da amostra receberam analgesia epidural; destas, 26,5% tiveram algum grau de laceração perineal e 9,1%, períneo íntegro, não sendo possível verificar a associação entre as variáveis mencionadas. Não foi verificada, neste estudo, significância estatística para afirmar que as condições do períneo após o parto vaginal e a utilização da analgesia epidural estão associadas (valor x²4GL= 3,1.El objetivo de esto estudio fue analizar la asociación entre la analgesia epidural y la laceración perineal en mujeres sometidas al parto vaginal. Fue realizado un estudio descriptivo y transversal, para lo cual fueron investigados 109 prontuarios de mujeres asistidas durante el proceso de parturición en una maternidad en Ribeirão Preto. Los datos fueron colectados en marzo y abril de 2003. Para analizar la correlación entre las variables fue aplicado el Teste Chi-Cuadrado. Fue realizado parto normal en 91,7% (100 de las parturientes y en 8,2% (09 parto fórceps. En el análisis de los datos, 74,3% de la muestra recibieron analgesia epidural, y de estas 26,5% tuvieron algún nivel de laceración perineal y 9,1% perineo íntegro. No fue posible verificar la asociación entre las variables aludidas. No fue verificado en esto estudio, significancia estadística para afirmar que las condiciones del perineo después del parto vaginal y el uso de analgesia

  13. Successful term delivery of spontaneous twin pregnancy in a woman with bicorporeal septate uterus: A case report.

    Science.gov (United States)

    Li, Yanfang; Yang, Lilin; Tian, Yuanyuan; Li, Daocheng; Luo, Songping

    2016-08-01

    Herein, we report the first case of successful term delivery of twins in a patient with bicorporeal septate uterus via natural conception. The patient had been diagnosed with complete septate, didelphys and bicornuate uterus during different phases of her three pregnancies. Based on follow-up data at six weeks and then six months post-partum of the last pregnancy, we found that the abnormalities presented in our case did not fit the criteria of any categories following American Fertility Society and European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy classification systems. After comprehensive review of the uterine morphologic characteristics, embryology and pregnancy outcome, we considered 'bicorporeal septate uterus' the most appropriate diagnosis. This case emphasized the atypical changes of uterine shape as twin pregnancy advances and its influence on productive performance and pregnancy outcome in uterine malformation. It also raised concern regarding the usability and comprehensiveness of the two most popular classification systems. © 2016 Japan Society of Obstetrics and Gynecology.

  14. 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.

  15. Is there a role for cervical assessment and uterine artery Doppler in the first trimester of pregnancy as a screening test for spontaneous preterm delivery?

    Science.gov (United States)

    Parra-Cordero, M; Sepúlveda-Martínez, A; Rencoret, G; Valdés, E; Pedraza, D; Muñoz, H

    2014-03-01

    To evaluate the role of cervical length (CL) and uterine artery pulsatility index (UtA-PI) at 11+0 to 13+6 weeks as predictors of spontaneous preterm delivery (sPTD) in a Chilean population. This was a prospective study of asymptomatic women with singleton pregnancies attending for a nuchal translucency scan at 11+0 to 13+6 weeks' gestation and who underwent a transvaginal scan for evaluation of CL and UtA-PI. Exclusion criteria were fetal and pregnancy complications (other than sPTD) and iatrogenic delivery atUtA-PI were adjusted for fetal crown-rump length and maternal characteristics and expressed as multiples of the median (MoM) of the unaffected group. Prediction of sPTD using maternal and pregnancy characteristics was studied using logistic regression analysis. A total of 3480 women were recruited into the study and, after application of exclusion criteria, 3310 were included in the analysis. The rate of sPTD atUtA-PI between pregnancies with and without subsequent sPTD. Logistic regression analysis showed that smoking and previous PTD were significantly associated with sPTD atUtA-PI nor CL during the first trimester was shown to be a useful predictor of early sPTD. However, a combined model that includes smoking and previous PTD predicts approximately one-quarter of those women destined to deliver at<34 weeks, with a false-positive rate of 8%. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

  16. Aerosol delivery during spontaneous breathing with different types of nebulizers- in vitro/ex vivo models evaluation.

    Science.gov (United States)

    Lin, Hui-Ling; Fang, Tien-Pei; Cho, Hui-Sun; Wan, Gwo-Hwa; Hsieh, Meng-Jer; Fink, James B

    2018-02-01

    Nebulizers for spontaneous breathing have been evaluated through different study designs. There are limitations in simulated bench models related to patient and nebulizer factors. The aim of this study was to determine the correlation of inhaled drug mass between in vitro and ex vivo studies by testing aerosol deposition of various types of nebulizers. Ten healthy subjects were recruited to receive aerosol therapy with five nebulizers in random order: 1) a jet nebulizer (JN); 2) a breath-enhanced nebulizer (BEN); 3) a manually triggered nebulizer (MTN), 4) a breath-actuated nebulizer (BAN), and 5) a vibrating mesh nebulizer (VMN) with valved-adapter. A unit dose of salbutamol containing 5 mg in 2.5 mL was placed into the nebulizer and administered for 10 min. For the ex vivo study, minute ventilation of healthy subjects was recorded for 1 min. For the in vitro study a breathing simulator was utilized with adult breathing patterns. Aerosolized drug from the nebulizers and the accessory tubes was captured using inspiratory and expiratory collecting filters. Captured drug was eluted, measured and expressed as inhaled and exhaled mass using spectrophotometry at a wavelength of 276 nm. 10 healthy subjects were recruited, aged 20.8 ± 0.7 years old, with a mean height of 166.2 ± 9.2 cm and weight of 64.7 ± 12.4 kg. There was no significant difference in the inhaled drug dose between the JN and BEN (15.0 ± 1.94% and 17.74 ± 2.65%, respectively, p = .763), yet the inhaled doses were lower than the other three nebulizers (p vivo model (44.0 ± 0.9% and 35.5 ± 6.3% respectively, p = .003), whereas the JN in the ex vivo model resulted in a greater inhaled drug dose (15.0 ± 1.9% for ex vivo vs 11.6 ± 1.6% for in vitro, p = .008). These in vitro/ex vivo model comparisons of nebulizers performance indicated that breath-related nebulizers can be estimated using an in vitro model; however, the JN and VMN delivered

  17. 75 FR 3745 - NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights; Notice

    Science.gov (United States)

    2010-01-22

    ... Conference on Vaginal Birth After Cesarean: New Insights; Notice Notice is hereby given by the National Institutes of Health (NIH) of the ``NIH Consensus Development Conference on Vaginal Birth After Cesarean: New... will be open to the public. Vaginal birth after cesarean (VBAC) is the delivery of a baby through the...

  18. Response to delivery stress is not mediated by beta-endorphin (1-31).

    Science.gov (United States)

    Harbach, Heinz; Antrecht, Kerstin; Boedeker, Rolf-Hasso; Hempelmann, Gunter; Markart, Philipp; Matejec, Reginald; Muehling, Joerg; Welters, Ingeborg; Zygmunt, Marek

    2008-01-01

    The aim of the study was to determine the reaction of the melanotroph and corticotroph-type pituitary proopiomelanocortin (POMC) response to vaginal delivery and caesarean section stress. Furthermore, the relationship between the release of pituitary POMC fragments, gonadotropins and sexual steroids were examined. Blood samples were obtained from 10 women in labour on arrival in the birth room (t(A)), at cervix dilatation of 5 cm (t(B)) and immediately after spontaneous delivery (t(C)) and in 16 patients undergoing elective caesarean section before induction of anaesthesia (t(B)) and immediately after delivery (t(C)). Samples were analysed for cortisol, ACTH, authentic beta-endorphin, beta-endorphin immunoreactive material (IRM), acetyl-N-beta-endorphin IRM (NAC), beta-lipotropin (beta-LPH) IRM, oestradiol (E(2)), progesterone (P), prolactin (PRL), FSH and LH. NAC representing the melanotroph-type pituitary POMC system did not increase during the course of caesarean section or spontaneous labour. In contrast, a significant increase of beta-endorphin IRM, beta-LPH IRM and ACTH were observed, representing an activation of the corticotroph-type POMC system. Highly significant correlations between POMC fragment concentrations during caesarean section and spontaneous labour were also observed. Sexual steroids (E(2) and P) decreased significantly. Except for beta-endorphin IRM and E(2) in course of spontaneous delivery no significant correlation was observed between POMC fragment and gonadotropins or sexual steroids. Caesarean section and spontaneous delivery activated the corticotroph but not the melanotroph POMC system.

  19. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births

    Directory of Open Access Journals (Sweden)

    Khajehei M

    2009-01-01

    Full Text Available Background and Objective: We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births. Materials and Methods: This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum. Results: The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi group was 40 days and in the caesarean section (C/S group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%, sexual dissatisfaction (65%, and vaginal looseness (55%. In the C/S group, the most common problems were vaginal dryness (85%, sexual dissatisfaction (60%, and decreased libido (35%. There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant. Conclusion: Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women′s sexual life and try to improve their quality of life after delivery.

  20. Martius flap and anterior vaginal wall sling for correction of ...

    African Journals Online (AJOL)

    UVF) associated with stress urinary incontinence (SUI) after vaginal delivery. ... Follow-up included history, physical examination, urine analysis and pelvic ultrasonography for the assessment of residual urine. Urodynamic evaluation was ...

  1. 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

  2. TABIQUE VAGINAL TRANSVERSO Y ATRESIA VAGINAL

    OpenAIRE

    Bustos,Paola; Smirnow,Marcia

    2003-01-01

    El tabique vaginal transverso, la atresia vaginal parcial y la atresia vaginal total, son una gama de alteraciones congénitas, en las que se ve afectada la continuidad de la vagina. En conjunto, son malformaciones poco frecuentes del aparato genital. A continuación exponemos la experiencia de nuestro servicio respecto a esta patología, durante 13 años(1989 a 2002), presentando 4 casos clínicos y un análisis del tema basado en la literatura

  3. Successful External Cephalic Version: Factors Predicting Vaginal Birth

    Directory of Open Access Journals (Sweden)

    Pei Shan Lim

    2014-01-01

    Full Text Available Purpose. To determine the maternal and fetal outcomes of successful external cephalic version (ECV as well as factors predicting vaginal birth. Methods. The ECV data over a period of three years at Universiti Kebangsaan Malaysia Medical Centre (UKMMC between 1 September 2008 and 30 September 2010 was reviewed. Sixty-seven patients who had successful ECV were studied and reviewed for maternal, fetal, and labour outcomes. The control group comprised patients with cephalic singletons of matching parity who delivered following the index cases. Results. The mean gestational age at ECV was 263±6.52 days (37.5 weeks ± 6.52 days. Spontaneous labour and transient cardiotocographic (CTG changes were the commonest early adverse effects following ECV. The reversion rate was 7.46%. The mean gestational age at delivery of the two groups was significantly different (P=0.000 with 277.9±8.91 days and 269.9±9.68 days in the study group and control groups, respectively. The study group needed significantly more inductions of labour. They required more operative deliveries, had more blood loss at delivery, a higher incidence of meconium-stained liquor, and more cord around the neck. Previous flexed breeches had a threefold increase in caesarean section rate compared to previous extended breeches (44.1% versus 15.2%, P=0.010. On the contrary, an amniotic fluid index (AFI of 13 or more is significantly associated with a higher rate of vaginal birth (86.8% versus 48.3%, P=0.001. Conclusions. Patients with successful ECV were at higher risk of carrying the pregnancy beyond 40 weeks and needing induction of labour, with a higher rate of caesarean section and higher rates of obstetrics complications. Extended breech and AFI 13 or more were significantly more likely to deliver vaginally postsuccessful ECV. This additional information may be useful to caution a patient with breech that ECV does not bring them to behave exactly like a normal cephalic, so that they

  4. Bioadhesive Controlled Release Clotrimazole Vaginal Tablets | Bhat ...

    African Journals Online (AJOL)

    Conclusion: This study indicates the possible use of suitable mixtures of natural and semi-synthetic cellulosic polymers for the preparation of clotrimazole mucoadhesive tablets for application as a vaginal controlled delivery system. Keywords: Clotrimazole, Swelling, Cellulosic polymers, Guar gum, Bioadhesion, Release ...

  5. Universal cervical length screening for singleton pregnancies with no history of preterm delivery, or the inverse of the Pareto principle.

    Science.gov (United States)

    Rozenberg, P

    2017-06-01

    Ultrasound measurement of cervical length in the general population enables the identification of women at risk for spontaneous preterm delivery. Vaginal progesterone is effective in reducing the risk of preterm delivery in this population. This screening associated with treatment by vaginal progesterone is cost-effective. Universal screening of cervical length can therefore be considered justified. Nonetheless, this screening will not appreciably reduce the preterm birth prevalence: in France or UK, where the preterm delivery rate is around 7.4%, this strategy would make it possible to reduce it only to 7.0%. This small benefit must be set against the considerable effort required in terms of screening ultrasound scans. Universal ultrasound screening of cervical length is the inverse of Pareto's principle: a small benefit against a considerable effort. © 2016 Royal College of Obstetricians and Gynaecologists.

  6. Diástase dos músculos retoabdominais no puerpério imediato de primíparas e multíparas após o parto vaginal Diastasis of rectus abdominis muscle immediately postpartum of primiparous and multiparous after vaginal delivery

    Directory of Open Access Journals (Sweden)

    Mariana Tirolli Rett

    2012-09-01

    Full Text Available O presente estudo comparou a diástase dos músculos retoabdominais (DMRA supra-umbilical (SU e infra-umbilical (IU entre primíparas e multíparas, correlacionou com a paridade, idade materna, índice de massa corporal (IMC e tempo de trabalho de parto (TTP. Foram incluídas 100 primíparas com idade de 21,0±4,4 anos e 100 multíparas com idade de 27,2±6,2 anos submetidas ao parto vaginal. A DMRA foi avaliada nos pontos 4,5 cm acima e abaixo da cicatriz umbilical com o paquímetro. Foram empregados o test t de Student e correlação de Pearson, adotando-se pThe present study compared the diastasis of rectus abdominis muscle (DRAM above and below umbilicus in primiparous and multiparous and correlated these with maternal's age, number of births, body mass index (BMI and labour. Women's submitted to a vaginal delivery were included: 100 primiparous women (aged 21.0±4.4 years and 100 multiparous women (27.2±6.2 years. The DRAM was measurements 4.5 cm above and below de umbilical scar with a caliper. Statistical analysis was conducted by Student's t-test for dependent samples and Pearson´s correlation, considering p<0.05. The DRAM above umbilicus in primiparous was 2.3±1.2 cm and 2.6± 1.4 cm in multiparous and below umbilicus were 1.2±0.9 cm and 1.2±1.0, showing no difference. The DRAM above umbilicus was higher than below in primiparous and multiparous (p<0.0001. It was found a significant association between the DRAM above and below the umbilicus, and DRAM above umbilicus and maternal's age and number of births. No correlations with the BMI and labor were observed. DRAM above umbilicus was significantly greater in both groups, but similar when primiparous and multiparous were compared. A significant correlation was observed among DRAM above and below umbilicus, DRAM above umbilicus and maternal's age and number of births.

  7. [The influence of mode of delivery on the level of catecholamines in umbilical cord blood of neonates].

    Science.gov (United States)

    Wang, Jing-xuan; Zhang, Wei-yuan

    2009-05-19

    To determine whether mode of delivery is associated with the level of catecholamines in umbilical cord blood of neonates. A study was carried out on 150 neonates. Among them 90 were healthy while 60 were diagnosed fetal distress. Then the subjects were first divided into 5 groups according to different modes of delivery: 30 were delivered by spontaneous labor for vaginal delivery without any pain relief; 30 by vaginal delivery with epidural anaesthesia; 30 by caesarean section without labor; 30 by vaginal delivery with low forceps because of fetal distress and 30 by caesarean section of emergency because of fetal distress. After delivery, umbilical cord blood of both artery and vein was collected for determination of norepinephrine (NE), epinephrine (E), and dopamine (DA). (1) The concentration of NE and E of umbilical artery were different in each group (P < 0.01), the group with the highest concentrations of NE and E was the ones delivered by vaginal delivery with low forceps [(73 +/- 6) ng/L, (37.8 +/- 1.8) ng/L] while caesarean section [(35 +/- 5) ng/L, (27.2 +/- 1.2) ng/L] was associated with significantly lower concentrations of NE and E of umbilical artery. The ones delivered by vaginal delivery with low forceps [(33.7 +/- 4.5) ng/L] and caesarean section of emergency [(32.9 +/- 4.5) ng/L] had higher concentrations of DA compared with any other group (P < 0.01). (2) The concentration of NE and E of umbilical vein were different in each group (P < 0.01) just like that of umbilical artery. The ones delivered by vaginal delivery with low forceps and caesarean section of emergency had higher concentrations of DA compared with any other group (P < 0.01). (3) The neonates with fetal distress had higher levels of catecholamine both in umbilical artery and umbilical vein than the healthy ones (P < 0.01); at the same time, the ones with fetal distress got lower Apgar scores 1, 5, 10 min after born contrasted to the healthy ones. If no indication for caesarean section

  8. Vaginal microbiota in menopause

    OpenAIRE

    Martinus Tarina; Wresti Indriatmi; Larisa Paramitha; Evita Halim Effendi; Shannaz Nadia Yusharyahya; Hanny Nilasari

    2016-01-01

    The human vagina together with its resident, microbiota, comprise a dynamic ecosystem. Normal microbiota is dominated by Lactobacillus species, and pathogen microbiota such as Gardnerella species and Bacteroides species can occur due to decrease in Lactobacillus domination. Lactobacillus plays an essential role in keeping normal vaginal microbiota in balance. Vaginal microbiota adapts to pH change and hormonal value. Changes in the vaginal microbiota over a woman’s lifespan will influence the...

  9. Mode of Delivery and Long-Term Health-Related Quality-of-Life Outcomes: A Prospective Population-Based Study.

    Science.gov (United States)

    Petrou, Stavros; Kim, Sung Wook; McParland, Penny; Boyle, Elaine M

    2017-06-01

    Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics. The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32 +0 and 36 +6 weeks' gestation and a sample of term-born controls. Perinatal data were extracted from the mothers' maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes. The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (-0.026; p = 0.038) and among mothers of term-born infants (-0.062; p quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery. © 2016 Wiley Periodicals, Inc.

  10. Opium use during pregnancy and risk of preterm delivery: A population-based cohort study.

    Science.gov (United States)

    Maghsoudlou, Siavash; Cnattingius, Sven; Montgomery, Scott; Aarabi, Mohsen; Semnani, Shahriar; Wikström, Anna-Karin; Bahmanyar, Shahram

    2017-01-01

    Use of narcotic or "recreational" drugs has been associated with adverse pregnancy outcomes such as preterm delivery. However, the associations might be confounded by other factors related to high-risk behaviours. This is the first study to investigate the association between traditional opium use during pregnancy and risk of preterm delivery. We performed a population-based cohort study in the rural areas of the Golestan province, Iran between 2008 and 2010. We randomly selected 920 women who used (usually smoked) opium during pregnancy and 920 women who did not. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the opium use during pregnancy and preterm delivery and adjustment was made for potential confounding factors. This study shows compared with non-use of opium and tobacco, use of only opium during pregnancy was associated with an increased risk of preterm delivery (OR = 1.56; 95% CI 1.05-2.32), and the risk was more than two-fold increased among dual users of opium and tobacco (OR = 2.31; 95% CI 1.37-3.90). We observed that opium use only was associated with a doubled risk for preterm caesarean delivery (OR = 2.05; 95% CI 1.10-3.82) but not for preterm vaginal delivery (OR = 1.25; 95% CI 0.75-2.07). Dual use of opium and tobacco was associated with a substantially increased risk of vaginal preterm delivery (OR = 2.58; 95% CI 1.41-4.71). Opium use during pregnancy among non-tobacco smokers is associated with an increased risk of preterm caesarean delivery, indicating an increased risk of a compromised foetus before or during labour. Women who use both opium and smoked during pregnancy have an increased risk of preterm vaginal delivery, indicating an increased risk of spontaneous preterm delivery.

  11. Parturition pit: the bony imprint of vaginal birth

    International Nuclear Information System (INIS)

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

    2016-01-01

    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. 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. 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 (p < 0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p < 0.0001). No males had pits. Our study indicates that parturition pits are associated with prior vaginal birth 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. (orig.)

  12. Paediatric vaginal discharge

    African Journals Online (AJOL)

    Vaginal discharge in the prepubertal patient is a common symptom, and can be a source of distress for the caregiver and con- cern for the healthcare worker. Several factors predispose these patients to the development of recurrent vaginal discharge. Unless noticed by the caregiver, this problem can persist for long periods ...

  13. 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

  14. 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

  15. 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.

  16. Female sexual outcomes in primiparous women after vaginal ...

    African Journals Online (AJOL)

    Background: Sexual function is an essential component of life and yet very little is known about the relationships between the female sexuality and the mode of delivery. Objective: To compare sexual outcomes after vaginal delivery and cesarean section. Methods: A cross-sectional study was conducted on women in two ...

  17. Female sexual outcomes in primiparous women after vaginal ...

    African Journals Online (AJOL)

    2017-09-03

    Sep 3, 2017 ... Female sexual outcomes evaluated were female Sexual Function Index scores and the time required to resume sexual activities after delivery. Results: Sexual function did not differ significantly among two groups vaginal delivery n=90 and cesarean section n = 113 with regard to duration of marriage, ...

  18. 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.

  19. Vaginitis: Diagnosis and Treatment.

    Science.gov (United States)

    Paladine, Heather L; Desai, Urmi A

    2018-03-01

    Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy; DNA probe testing is also available. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. Treatment of noninfectious vaginitis should be directed at the underlying cause. Atrophic vaginitis is treated with hormonal and nonhormonal therapies. Inflammatory vaginitis may improve with

  20. [Diagnosis of vaginal discharge].

    Science.gov (United States)

    Böcher, Sidsel; Helmig, Rikke Bek; Arpi, Magnus; Bjerrum, Lars

    2018-01-15

    Changes in vaginal discharge are often caused by imbalance in the vaginal microflora, and laboratory testing is usually of little use, as most microbes detected are commensals. In-office diagnosis in general practice using wet mount microscopy and Amsel criteria is helpful and often sufficient to ensure correct diagnosis and treatment. Laboratory testing of vaginal discharge should only be performed, if sexually transmitted disease is suspected, if there is treatment failure or inconclusive wet mount prior to gynaecological surgery, and in pregnant women with recurrent miscarriage or preterm birth.

  1. Myomectomy by vaginal route

    Directory of Open Access Journals (Sweden)

    Milovanović Zagorka

    2004-01-01

    Full Text Available In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique-vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.

  2. Maternal and neonatal complications in term breech delivered vaginally

    International Nuclear Information System (INIS)

    Jadoon, S.; Jadoon, S.M.K.; Shah, R.

    2008-01-01

    To evaluate the maternal and neonatal complications in terms of genital tract trauma to mother, perinatal mortality. Apgar score at 5 minutes and neonatal trauma in all singleton term breech cases delivered vaginally. A 100 consecutive patients with singleton breech presentation, whether booked or unbooked, were admitted and delivered vaginally in hospital during the study period. They were studied for maternal and neonatal complications. Maternal complication included any genital tract trauma during delivery while neonatal complications were perinatal mortality, low Apgar score (less than eight at 5 minutes) and birth trauma. There were a total 3977 deliveries during this study period, 145 breech presentation (incidence 3.6%). Out of those, 100 were included in the study. All were unbooked cases, 87% were multigravida while 13% were primigravida. An Apgar score of eight was recorded in 87% babies while 10% had an Apgar score of less than eight after 5 minutes. There were 3 still births and one neonatal death. Aggregated perinatal mortality rate was 40/1000 live births. Only one baby had birth trauma (Erbs paralysis) during vaginal breech delivery. Ninety seven (97%) mothers had no complications while only 3 (3%) had complications. Out of these, one had cervical tear and 2 had vaginal tears. Offering a trial of vaginal breech delivery to strictly selected and well-counselled patients remains an appropriate option without compromising perinatal and maternal outcome. It also decreases the rate of operative delivery for this malpresentation. (author)

  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

    OBJECTIVE: A new method for induction of labour--balloon catheter with extra-amniotic saline infusion (BCEAS)--is evaluated in randomised comparison with prostaglandin E2 (PGE2) in vaginal pessaries. STUDY GROUP: One-hundred and nine pregnant women with unfavourable cervices. MAJOR OUTCOME MEASURES......: 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

  4. Vaginal contraception--an update.

    Science.gov (United States)

    Edelman, D A; Thompson, S

    1982-04-01

    not yet available. A non-fitted, spermicide-releasing diaphragm is now being tested that obviates the need for a separate spermicidal supply. The diaphragm has been designed to be a 1-use only product. There has been an increasing demand for cervical caps in the U.S. The cervical caps now used are only available in a limited number of sizes. A custom-fitted cervical cap has been developed to overcome some of the disadvantages of the cervical caps available. An improved model of the cap is now being evaluated by the IFRP in a limited phase 2 multiclinic trial. This trial should give lower pregnancy rates because of the improvements that have been made in the design and fabrication of the caps. The newly developed vaginal contraceptives, such as the sponges and custom-fitted cervical cap, appear to offer several significant advantages over the available vaginal contraceptives. These advantages, such as their ease of use and potential not to interfere with the spontaneity of intercourse, will probably result in further increases in the numbers of women who choose to use vaginal contraceptives as their only contraceptive method. An additional benefit of the use of spermicides is that they provide a high degree of protection against some of the sexually transmitted diseases.

  5. 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.

  6. 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. PMID:26203286

  7. Vaginal bleeding between periods

    Science.gov (United States)

    ... varicose veins) IUD use (may cause occasional spotting) Ectopic pregnancy Miscarriage Other pregnancy complications Vaginal dryness due to ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for ...

  8. Can Vaginitis Be Prevented?

    Science.gov (United States)

    ... examples of safe sex. 1 Centers for Disease Control and Prevention. (2010). Self-study STD module—vaginitis . ... Halvorson New Chief of Gynecologic Health and Disease Branch Division of Epidemiology, Statistics, ...

  9. Vaginal and Vulvar Cancer

    Science.gov (United States)

    ... find more information about vaginal, vulvar, and other gynecologic cancers? Centers for Disease Control and Prevention: 800-CDC-INFO or www. cdc. gov/ cancer/ gynecologic National Cancer Institute: 800-4-CANCER or www. ...

  10. 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 ... repair; Urinary incontinence - vaginal wall repair Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  11. Vaginal Diseases - Multiple Languages

    Science.gov (United States)

    ... 简体中文) Expand Section Colposcopy - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Vaginal Infection - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual ...

  12. [Physicopharmaceutical characteristics of ulinastatin vaginal suppositories prepared in a hospital].

    Science.gov (United States)

    Satake, Kiyoshi; Nakajima, Takanori; Iwata, Masanori; Fujikake, Yoshio; Kimura, Masayuki

    2011-01-01

    We studied a locally applied vaginal preparation (vaginal suppositories) of ulinastatin (urinary trypsin inhibitor, UTI), designed to threatened premature delivery and maintain pregnancy. Witepsol S55 was chosen as the basic component of the vaginal suppositories based on the physical pharmaceutical characteristics of three kinds of hard fats. The average particle size of the UTI aqueous injection was approximately 70% as compared with that of the UTI lyophilized product, used as the base material for the preparation of UTI vaginal suppositories. We compared the physical pharmaceutical properties of UTI vaginal suppositories with water contents of 2.5%, 5.0%, and 7.5%, respectively. Preparation strength negatively correlated with the water content. The coefficient of viscosity positively correlated with the water content of the preparation. UTI vaginal suppositories with a water content of 5.0% had the highest average drug release rate on moment analysis. A comprehensive evaluation of the properties of UTI vaginal suppositories, including high strength due to disintegration resistance, the coefficient of viscosity and its influence on local retention, and drug release and its influence on the duration of effect, indicated that a 5.0% UTI aqueous solution for injection combined with Witepsol S55 as the base was the optimal formulation for the hospital preparation of vaginal suppositories.

  13. Pelvic floor functional disorders in vaginally delivered primiparae

    OpenAIRE

    Antolic, Andrea

    2011-01-01

    In this study we examined pelvic floor functional disorders in primiparae with single pregnancies, cephalic presentation at term at the Charité delivery department before and during pregnancy as well as after vaginal delivery by means of questionnaire in relation to maternal, neonatal and obstetric risk factors. The pathophysiology of pelvic floor disorders is still not statisfyingly resolved. During pregnancy 74% of primiparae knew about the interrelation between delivery and sexual disorde...

  14. Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose.

    Science.gov (United States)

    Carlson, Nicole S; Corwin, Elizabeth J; Lowe, Nancy K

    2017-07-01

    Synthetic oxytocin, the primary tool for labor augmentation, is less effective among obese women, leading to more unplanned cesarean deliveries for slow labor progress. It is not known if obese women require higher doses of oxytocin due to maternal, fetal, or labor factors related to maternal obesity. This study had two main objectives: (1) examine the influence of maternal body mass index (BMI) on hourly doses of oxytocin from augmentation initiation until vaginal delivery in obese women; and (2) examine the influence of other maternal, fetal, and labor factors on hourly doses of oxytocin in obese women. Longitudinal study of a cohort ( N = 136) of healthy, nulliparous, spontaneously laboring obese women (BMI ≥ 30 kg/m 2 ) who received oxytocin augmentation and achieved vaginal delivery. We performed iterative multilevel analyses to examine the influence of maternal BMI and other factors on hourly oxytocin doses. Maternal BMI explained 16.56% (95% confidence interval [CI] = [13.7, 20.04], p multilevel model controlling for influence of maternal, fetal, and labor characteristics. Maternal age, gestational age, status of amniotic membranes at hospital admission, and admission cervical dilation examination were not significant; however, neonatal birthweight and cervical dilation at oxytocin initiation were significant predictors of hourly oxytocin dose in these women ( p response to oxytocin used for augmentation.

  15. Editorial: Operative vaginal delivery | Petro | Obstetrics and ...

    African Journals Online (AJOL)

    Obstetrics and Gynaecology Forum. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 17, No 4 (2007) >. Log in or Register to get access to full text downloads.

  16. Operative vaginal deliveries in Zaria, Nigeria

    African Journals Online (AJOL)

    2009-10-05

    Oct 5, 2009 ... Zaria, Nigéria, ont été analysés quant aux mode de livraison, indication pour dispositif livraison vaginale, utilisation de l'anesthésie, score ... Il y n'avait aucune différence significative dans l'utilisation de l'anesthésie entre les ..... syntocinon, upright posture for the parturient with use of the birth cushion, ...

  17. After vaginal delivery - in the hospital

    Science.gov (United States)

    ... feel that it makes up for the long journey of pregnancy and the pain and discomfort of ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  18. Pregnancy's stronghold on the vaginal microbiome.

    Directory of Open Access Journals (Sweden)

    Marina R S Walther-António

    Full Text Available To assess the vaginal microbiome throughout full-term uncomplicated pregnancy.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.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.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 investigating the role of the microbiome in

  19. Effect of delivery modalities on the physiologic inhibition system of coagulation of the neonate.

    Science.gov (United States)

    Franzoi, Malida; Simioni, Paolo; Luni, Sonia; Zerbinati, Patrizia; Girolami, Antonio; Zanardo, Vincenzo

    2002-01-01

    The perinatal period is associated with an increased incidence of thromboembolic complications, which may occur in both the maternal and fetal circulation in otherwise normal and healthy adults and fetuses, and this may be related to the activation of the coagulation system at the time of parturition. The risk of these complications is generally much higher in neonates, who have decreased activity of the physiologic inhibition system of coagulation (PISC), including protein C, protein S and antithrombin, in comparison with adults. Therefore, any additional obstetric iatrogenic factors could predispose the neonate to an increased risk of thromboembolic complications. The aim of this study was to evaluate the influence of modality of delivery (spontaneous vaginal delivery vs. elective caesarian section) on the neonatal PISC factor (protein C, protein S and antithrombin) levels and the fibrinolytic system (plasminogen and fibrinogen levels). We studied 41 consecutive healthy newborns, 18 delivered vaginally (mean gestational age 39.7 +/- 0.8) and 23 by elective caesarian section (mean gestational age 38.5 +/- 0.7). Plasma samples were collected from the umbilical cord at birth. AT activity, protein C antigen and activity, total and free protein S antigen, fibrinogen concentration and plasminogen activity were tested. Among PISC factors studied in cord blood of infants born after vaginal delivery, protein C antigen levels and antithrombin activity were statistically higher (41.3 +/- 9.4 vs. 33.9 +/- 7.2 and 58.5 +/- 10.0 vs. 48.4 +/- 12.7, respectively; Plabor stress of vaginal delivery may play a role in influencing the levels of some PISC factors in the cord blood of full-term neonates. In newborns with coagulation disorders, separate reference ranges in coagulation screening tests should be possibly needed depending on the delivery modality.

  20. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study.

    Science.gov (United States)

    MacArthur, C; Glazener, C; Lancashire, R; Herbison, P; Wilson, D

    2011-07-01

    To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries. Twelve-year longitudinal study. Maternity units in Aberdeen, Birmingham and Dunedin. Women who returned postal questionnaires 3 months and 12 years after index birth. Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth. Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth. Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37-0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89-1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66-1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73-1.54). Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  1. Candidate gene analysis of spontaneous preterm delivery: New insights from re-analysis of a case-control study using case-parent triads and control-mother dyads

    Directory of Open Access Journals (Sweden)

    Myking Solveig

    2011-12-01

    Full Text Available Abstract Background Spontaneous preterm delivery (PTD has a multifactorial etiology with evidence of a genetic contribution to its pathogenesis. A number of candidate gene case-control studies have been performed on spontaneous PTD, but the results have been inconsistent, and do not fully assess the role of how two genotypes can impact outcome. To elucidate this latter point we re-analyzed data from a previously published case-control candidate gene study, using a case-parent triad design and a hybrid design combining case-parent triads and control-mother dyads. These methods offer a robust approach to genetic association studies for PTD compared to traditional case-control designs. Methods The study participants were obtained from the Norwegian Mother and Child Cohort Study (MoBa. A total of 196 case triads and 211 control dyads were selected for the analysis. A case-parent triad design as well as a hybrid design was used to analyze 1,326 SNPs from 159 candidate genes. We compared our results to those from a previous case-control study on the same samples. Haplotypes were analyzed using a sliding window of three SNPs and a pathway analysis was performed to gain biological insight into the pathophysiology of preterm delivery. Results The most consistent significant fetal gene across all analyses was COL5A2. The functionally similar COL5A1 was significant when combining fetal and maternal genotypes. PON1 was significant with analytical approaches for single locus association of fetal genes alone, but was possibly confounded by maternal effects. Focal adhesion (hsa04510, Cell Communication (hsa01430 and ECM receptor interaction (hsa04512 were the most constant significant pathways. Conclusion This study suggests a fetal association of COL5A2 and a combined fetal-maternal association of COL5A1 with spontaneous PTD. In addition, the pathway analysis implied interactions of genes affecting cell communication and extracellular matrix.

  2. Spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Davari R

    1996-07-01

    Full Text Available A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

  3. Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA.

    Science.gov (United States)

    Kjerulff, Kristen H; Attanasio, Laura B; Edmonds, Joyce K; Kozhimannil, Katy B; Repke, John T

    2017-09-01

    Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery-the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors-including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97-2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications. © 2017 Wiley Periodicals, Inc.

  4. Vaginal microbiota in menopause

    Directory of Open Access Journals (Sweden)

    Martinus Tarina

    2016-12-01

    Full Text Available The human vagina together with its resident, microbiota, comprise a dynamic ecosystem. Normal microbiota is dominated by Lactobacillus species, and pathogen microbiota such as Gardnerella species and Bacteroides species can occur due to decrease in Lactobacillus domination. Lactobacillus plays an essential role in keeping normal vaginal microbiota in balance. Vaginal microbiota adapts to pH change and hormonal value. Changes in the vaginal microbiota over a woman’s lifespan will influence the colonization of pathogenic microbes. They include changes in child, puberty, reproductive state, menopause, and postmenopause. Estrogen levels change will affect the colonization of pathogenic microbium, leading to genitourinary syndrome of menopause. Vulvovaginal atrophy is often found in postmenopausal women, and dominated by L. iners, Anaerococcus sp, Peptoniphilus sp, Prevotella sp, and Streptococcus sp. The normal vaginal microbiota’s imbalance in menopause will cause diseases such as bacterial vaginosis, and recurrent vulvovaginal candidiasis due to hormonal therapies. Changes in the vaginal microbiota due to bacterial vaginosis are characterized by decrease in H2O2-producing Lactobacillus. They are also caused by the increase in numbers and concentration of Gardnerella vaginalis, Mycoplasma hominis, and other anaerob species such as Peptostreptococci, Prevotella spp, and Mobiluncus spp.

  5. The vaginal microflora in relation to gingivitis

    Science.gov (United States)

    2009-01-01

    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 gingivitis had higher counts of Prevotella bivia (p 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p 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. PMID:19161595

  6. 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...... 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....

  7. Incidence of fetal distress in 6 hourly vaginally administered 3 doses, of misoprostol versus dinoprostone for labour induction: a comparative study

    International Nuclear Information System (INIS)

    Rashid, N.; Hanif, A.

    2013-01-01

    Background: Artificial labor pain always poses the risk of fetal distress and is more painful than spontaneous labour. The pharmacological agents that are involved in stimulating uterine contraction may initiate a chain of processes that may lead the baby to suffocate, being deficient of essential oxygen and suffer from distress. The accelerated efforts to adapt safe and advanced measures are inevitable to make the labour induction easier and more secure for both lives involved. Objective: The objective of this study was to compare the incidence of fetal distress in 6 hourly vaginally administered 3 doses, of misoprostol versus dinoprostone for labour induction. Methods: This observational type of comparative study was conducted in Obstetrics Ward Lady Aitchison Hospital Lahore. A total of 200 postdate primigravidas undergoing induction of labour at 41 weeks were selected for this study. They were randomly divided into misoprostol and dinoprostone group, each containing 100 patients. The dose of misoprostol was 50 microgram each time up to a maximum of 150 microgram (3 doses) and dose of dinoprostone was 2 mg and only 2 doses of dinoprostone were used with an interval of 6 hours. Continuous fetal heart rate monitoring was done after induction. Signs of fetal distress like meconium staining of liquor after rupture of membranes and CTG changes were noted. After delivery of baby Apgar score at 5 minutes was taken and any resuscitation required or need for keeping the baby in nursery was noted. Results: The mean age of the patients in misoprostol group was 25.4+-4.5 years and in dinoprostone group was 23.3+-3.4 years. The mean duration of induction to delivery interval in misoprostol group was 16.4+-6.4 hours and in dinoprostone group was 13.1+-4.6 hours. In misoprostol group, 40 (40%) patients delivered with LSCS and 60 (60%) patients delivered with spontaneous vaginal delivery. In dinoprostone group, 36 (36%) patients delivered with LSCS and 64 (64%) patients

  8. Vaginal itching and discharge - child

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003159.htm Vaginal itching and discharge - child To use the sharing features on this ... problem in girls before the age of puberty. Vaginal discharge may also be present. The color, smell, and ...

  9. Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings

    Directory of Open Access Journals (Sweden)

    Dixson George R

    2006-10-01

    Full Text Available Abstract Objective To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. Materials and methods A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. Results Chest tubes were required in several (but not all hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. Conclusion Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.

  10. Vaginitis: Beyond the Basics.

    Science.gov (United States)

    Mills, Benjie Brown

    2017-06-01

    Vaginal complaints are one of the most common reasons women seek the advice of a health care provider. Uncomplicated infections such as vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis are easy to diagnose and treat. However, about 8% of patients will have a more complicated course with failure to respond to treatment or rapid recurrence of symptoms. Understanding the need for a methodical, diagnostic approach to help these women with recurrent or refractory cases of vaginal symptoms will aid the clinician achieve successful patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 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.

  12. MANAGEMENT OF VAGINAL DISCHARGE

    African Journals Online (AJOL)

    Enrique

    , an oral antifungal should be used weekly, e.g. 100 mg flucona- zole.7. The discharge of candidiasis is curd- like and adherent due to direct hyphal invasion of epithelial tissues resulting in erythema of the vaginal epithelium. Clinical diagnosis ...

  13. 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.

  14. 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.

  15. 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

  16. [Prevalence of 7 microorganisms in abnormal vaginal secretions (vaginitis)].

    Science.gov (United States)

    Roupas, A; Wyss, R; Anner, R

    1985-10-19

    Seven microorganisms (N. gonorrhoeae, C. albicans, T. vaginalis, G. vaginalis, M. hominis, U. urealyticum and Streptococcus of group B) have been assayed in genital samplings of 164 asymptomatic women (control group) and of 374 women suffering from abnormal vaginal secretions (vaginitis group). All these bacteria except group B Streptococci were isolated in the vaginitis group more frequently than in the control group (p less than 0.01). The proportion of negative cultures for all tested bacteria was 39% in the control group and 6.4% in the vaginitis group (p less than 0.01). This shows an association of these bacteria with 70% of the patients of the vaginitis group and with only 26% of the women of the control group (p less than 0.01). It is to be noted that the pH values are higher in the group of women with vaginitis than in the control group (p less than 0.01). Comparison of the microbial flora during "specific" an "non-specific" vaginitis indicates that G. vaginalis is isolated more frequently in patients with non-specific vaginitis than among those with specific vaginitis (p less than 0.01). Likewise, M. hominis is isolated more frequently in groups of women with either non-specific vaginitis or T. vaginalis vaginitis, than in groups of patients with a C. albicans vaginitis (p less than 0,01). The results of this study indicate that there is a causal relationship between vaginitis and the presence of T. vaginalis. C. albicans, G. vaginalis, M. hominis or N. gonorrhoeae, either as a single or a mixed infection, and that there is a relationship between increased pH values and abnormal vaginal secretions.

  17. The Analysis of TRICARE Navy Obstetric Delivery Costs within Continental United States Military Treatment Facilities

    Science.gov (United States)

    2009-12-01

    MTFs DESCRIPTION DRG CESAREAN SECTION W CC 370 CESAREAN SECTION W/O CC 371 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 372 VAGINAL DELIVERY W/O...with complicated vaginal deliveries and cesarean sections , there was a large variation in costs associated with complicated deliveries. Thus, for...outside of the catchment area associated with the MTF. In 2006 at NHCL, there were 157 PC Cesarean Sections without Complications (DRG 371) with an

  18. [Pelvic organ prolapse during pregnancy: treatment with vaginal pessary. A report of two cases].

    Science.gov (United States)

    Arango-Buitrago, V; Restrepo-Moreno, M; Echavarría-Restrepo, L G; Gómez-Londoño, M

    2016-09-01

    Pelvic organ prolapse during pregnancy is a rare condition that may be associated with maternal and fetal complications. To describe the experience of two cases of pelvic organ prolapse during pregnancy managed with vaginal pessary. The cases of two patients with grade 4 vaginal prolapse during pregnancy managed with vaginal pessary until the time of delivery are presented. The patients had improvement of their symptoms without complications related to prolapse or pessary use. Early recognition, monitoring and management of this condition are essential. The vaginal pessary is a good option for transient treatment and is associated with few complications.

  19. Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin.

    Science.gov (United States)

    Maier, Josefine T; Metz, Melanie; Watermann, Nina; Li, Linna; Schalinski, Elisabeth; Gauger, Ulrich; Rath, Werner; Hellmeyer, Lars

    2018-04-25

    Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture. This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0-5) and 3 (0-5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher's exact test, the Kruskal-Wallis rank sum test and Pearson's chi-squared test were utilized. Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively). This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.

  20. VAGINAL PROGESTERONE IN WOMEN WITH AN ASYMPTOMATIC SONOGRAPHIC SHORT CERVIX IN THE MIDTRIMESTER DECREASES PRETERM DELIVERY AND NEONATAL MORBIDITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INDIVIDUAL PATIENT DATA

    Science.gov (United States)

    ROMERO, Roberto; NICOLAIDES, Kypros; CONDE-AGUDELO, Agustin; TABOR, Ann; O’BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; KLEIN, Katharina; RODE, Line; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

    2012-01-01

    OBJECTIVE To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix in the mid-trimester reduces the risk of preterm birth and improves neonatal morbidity and mortality. STUDY DESIGN Individual patient data meta-analysis of randomized controlled trials. RESULTS Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (RR 0.58, 95% CI 0.42–0.80), <35 weeks (RR 0.69, 95% CI 0.55–0.88) and <28 weeks (RR 0.50, 95% CI 0.30–0.81), respiratory distress syndrome (RR 0.48, 95% CI 0.30–0.76), composite neonatal morbidity and mortality (RR 0.57, 95% CI 0.40–0.81), birth weight <1500 g (RR 0.55, 95% CI 0.38–0.80), admission to NICU (RR 0.75, 95% CI 0.59–0.94), and requirement for mechanical ventilation (RR 0.66, 95% CI 0.44–0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies. CONCLUSION Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality. PMID:22284156

  1. Vaginal rings for menopausal symptom relief.

    Science.gov (United States)

    Ballagh, Susan A

    2004-01-01

    The vagina is an alternative delivery site of sex steroids for menopausal women. New ring technology provides continuous and consistent delivery of steroids for up to 3 months. Rings rest on the pelvic floor muscles in a nearly horizontal position and are usually imperceptible. Steroid is delivered directly into the systemic circulation which may result in less alteration of coagulation/fibrinolysis pathways as seen with transdermal hormone therapy. Fewer adverse effects are noted when progesterone is applied vaginally, possibly due to lower serum levels of metabolites such as alloprenanolone. Women often switch to a ring for the longer dosing interval but also appreciate the reduced messiness. Over 5700 healthy US women who evaluated an unmedicated ring as a drug delivery platform found it very acceptable independent of age or prior use of barrier contraceptives. Marketed rings in the US include: (i) a ring for systemic and vaginal menopausal therapy that provides average serum estradiol levels of 40.6 pg/mL for the 0.05 mg and 76 pg/mL for the 0.1 mg dose; (ii) a ring for urogenital menopausal symptoms only that minimally elevates serum estradiol, usually within the menopausal range, treating atrophic vaginitis and urethritis; and (iii) a ring labelled for contraception that provides ethinyl estradiol 15 microg and etonogestrel 120 microg appropriate for nonsmoking perimenopausal women. A ring for combination hormone therapy and another releasing progesterone for contraception in lactating women have been reported in the literature, but are not yet available commercially. These may offer future options for hormone therapy. Women with a uterus receiving estrogen, even in low doses, should be given progestogen to prevent endometrial hyperplasia or carcinoma. Even women who have had an endometrial ablation are likely to have some endometrial tissue remaining since long-term amenorrhoea is uncommon. Since no marketed combination ring product is available, other forms

  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. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Outcomes in women attempting vaginal birth after caesarean section ...

    African Journals Online (AJOL)

    A successful vaginal delivery was associated with lower NICU admissions and higher APGAR scores in the neonate than those delivered by caesarean section but there was no statistically significant difference between the groups for APGAR scores <7. There were 3 cases of uterine rupture discovered at caesarean section ...

  4. Living with vesico-vaginal fistula: experiences of women awaiting ...

    African Journals Online (AJOL)

    Vesico-vaginal fistula (VVF) is one of maternal health problems confronting public health workers in Nigeria today. Information on how women suffering from this condition cope is important in that it can inform the design and delivery of programmes and interventions to address the challenges that face victims of VVF.

  5. Comparison of vaginal and oral misoprostol, for the induction of ...

    African Journals Online (AJOL)

    Comparison of vaginal and oral misoprostol, for the induction of labour in women with intra-uterine foetal death. ... It is a tertiary institution serving predominantly black indigenous population. Main outcome measures: The primary outcome measure was the induction to delivery time, and secondary outcome measures were ...

  6. Factors contributing to uterine rupture in women having vaginal ...

    African Journals Online (AJOL)

    Conclusion: The study shows socio economic factors, dependency on family decisions and belief in supernatural powers as major reasons our women chose unorthodox delivery despite prior caesarean section and recommend ways of preventing it. Keywords: vaginal birth after caesarean section, uterine rupture. Tropical ...

  7. Bladder And Uterine Rupture At Vaginal Birth After Cesarean Section

    African Journals Online (AJOL)

    Rupture of the uterus is still a major obstetric problem in developing countries. The urinary bladder is often affected especially when a lower segment Caesarean scar ruptures. We present a case of bladder rupture associated with uterine rupture in a patient who was attempting vaginal delivery after two previous Caesarean ...

  8. [The use of progestatives for the prevention of spontaneous preterm birth].

    Science.gov (United States)

    Azria, E

    2016-12-01

    To identify clinical situations in which progestatives used to reduce the risk of spontaneous preterm delivery and/or reduced adverse neonatal outcomes have been evaluated and identify situations in which 17OHPC or vaginal progesterone might be recommended. Bibliographic searches were performed in the Medline and Cochrane databases with the use of a combination of keywords and text words related to "progesterone", "tocolysis", and "preterm labor" from 1956 through July 2016. 17OHPC administrated after 16 weeks gestational age is not associated with an increased risk of birth defect (LE3). Because of discrepancies on the risk associated with first trimester utilization, it is recommended not to use it before 16 weeks (grade C). Utilization of 17OHPC and vaginal progesterone during both second and third trimester is not associated with an increased risk of congenital abnormalities and developmental adverse outcomes (LE3). Utilization of progestatives is not associated with an increased risk of intrahepatic cholestasis of pregnancy (LE3) and gestational diabetes (LE3). 17OHPC is not recommended as a primary prevention of preterm delivery in a population of women with monofetal pregnancy without history of preterm delivery (grade C). Although systematic screening of short cervix is not recommended (Professional consensus), the discovery of a short cervix (<20mm) between 16 and 24 weeks in an asymptomatic woman with monofetal pregnancy without history of preterm delivery indicates the daily administration of vaginal progesterone until 36 weeks gestational age (grade B). In a randomized controlled trial, 17OHPC is associated with a decreased risk of preterm delivery before 34 weeks gestationnal age (LE2) and with a reduction of neonatal morbidity (LE3) in women with at least one previous preterm delivery before 34 weeks gestationnal age. It is not possible to recommend the systematic use of 17OHPC on the basis of this sole trial with limited external validity

  9. 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

    2018-04-01

    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.

  10. Vaginal rugae: measurement and significance.

    Science.gov (United States)

    Whiteside, J L; Barber, M D; Paraiso, M F; Walters, M D

    2005-03-01

    To devise a validated measure of vaginal rugae and assess the relationships between vaginal rugae and important clinical parameters. Two techniques of assessing vaginal rugae were developed and their inter-/intra-observer variability assessed. Examination variability was assessed using intraclass correlation and by way of an analysis of the absolute difference between the two rugal quantitations. After validating the assessment technique, the rugal quantitations of 88 women were compared to clinical parameters such as age, estrogen status, stage of prolapse, parity, history of anterior vaginal wall surgery, and body mass index. Linear regression analysis was used to assess the relationships between vaginal rugae score and these clinical parameters. The mean age and body mass index of the subjects were 56 years (standard deviation (SD) +/- 13.8 years) and 30.4 kg/m2 (SD +/- 7.5 kg/m2), respectively. The median parity was 2 (range 0-11). A history of anterior vaginal wall surgery was present in 29% of subjects and 46% were estrogen-deficient. Scores for the two techniques to quantitate vaginal rugae were normally distributed. Both techniques demonstrated satisfactory interexaminer reliability. Increasing age and deficient estrogen status were found to be independent predictors of less vaginal rugae. Vaginal rugae can be reliably quantitated. Loss of vaginal rugae is associated with estrogen deficiency and advancing age.

  11. Revisiting the mode of delivery and outcome of singleton breech ...

    African Journals Online (AJOL)

    There was an increased rate of special care baby unit admission in the group that had assisted vaginal breech delivery than in those that had elective caesarean section. There was no difference in terms of birth injury, neonatal death and maternal morbidities between those that had assisted vaginal breech delivery and ...

  12. Spontaneous deregulation

    NARCIS (Netherlands)

    Edelman, Benjamin; Geradin, Damien

    Platform businesses such as Airbnb and Uber have risen to success partly by sidestepping laws and regulations that encumber their traditional competitors. Such rule flouting is what the authors call “spontaneous private deregulation,” and it’s happening in a growing number of industries. The authors

  13. Brazilian multicentre study on preterm birth (EMIP: prevalence and factors associated with spontaneous preterm birth.

    Directory of Open Access Journals (Sweden)

    Renato Passini

    Full Text Available BACKGROUND: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. METHODS AND FINDINGS: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43, multiple pregnancy (ORadj = 29.06, 8.43-100.2, cervical insufficiency (ORadj = 2.93, 1.07-8.05, foetal malformation (ORadj = 2.63, 1.43-4.85, polyhydramnios (ORadj = 2.30, 1.17-4.54, vaginal bleeding (ORadj = 2.16, 1.50-3.11, and previous abortion (ORadj = 1.39, 1.08-1.78. High BMI (ORadj = 0.94, 0.91-0.97 and weight gain during gestation (ORadj = 0.92, 0.89-0.95 were found to be protective factors. CONCLUSIONS: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births

  14. Spontaneous Severe Haemoperitoneum in the Third Trimester Leading to Intrauterine Death: Case Report

    Directory of Open Access Journals (Sweden)

    Harriet Williamson

    2011-01-01

    Full Text Available Spontaneous haemoperitoneum during pregnancy is a rare but potentially catastrophic cause of acute abdominal pain. A healthy 37-year-old primigravida presented with acute abdominal pain and hypovolaemic shock at 37-weeks gestation. An emergency caesarean section was indicated on the clinical suspicion of placental abruption. However, an ultrasound scan confirmed the absence of a fetal heartbeat, and, in light of the mother’s haemodynamic stability, a vaginal delivery was deemed most appropriate. Subsequent imaging, due to deterioration over the following 24-hours, revealed a large heterogenous haematoma within the pelvic cavity, which was later found to be caused by severe pelvic endometriosis. Despite fertility problems associated with severe endometriosis, advanced assisted reproductive technology enables more of these patients to become pregnant, highlighting the need to be aware of this rare complication in pregnancy.

  15. Comparison of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion.

    Science.gov (United States)

    Huang, Ming-Chao; Hsieh, Ching-Hung; Huang, Jian-Pei; Tsai, Hsiu-Ting; Lee, Maw-Sheng

    2017-06-01

    To evaluate the effects of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. From January 2006 to December 2011, 173 women received an 800-μg vaginal loading dose of misoprostol. After the loading dose, 103 patients received 800 mg of misoprostol vaginally and 70 patients received 400 mg of misoprostol sublingually every 12 h until the delivery of the fetus. In the vaginal group, the average abortion time was 1.07 ± 1.29 days; that was 0.82 ± 0.66 days in the sublingual group. Sequential sublingual misoprostol after a vaginal loading dose of 800 mg with an administration interval of 12 h had a similar abortion rate and time to abortion. In addition, this protocol reduced unnecessary digital pelvic examinations and speculum examinations. This sequential sublingual misoprostol regimen might be a suitable regimen for mid-trimester abortion. Copyright © 2017. Published by Elsevier B.V.

  16. 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

  17. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    Roya Kokabi

    2017-08-01

    Conclusion: Vaginal delivery is associated with a twofold increased risk of postpartum SUI in primipara women compared with elective cesarean section. Age and birth weight are the main risk factors of postpartum SUI in both modes of delivery. Tool-assisted delivery and episiotomy were determined as the risk factors of postpartum SUI in vaginal delivery.

  18. What is normal vaginal flora?

    OpenAIRE

    Priestley, C J; Jones, B M; Dhar, J; Goodwin, L

    1997-01-01

    OBJECTIVE: To observe the composition of the vaginal flora of healthy women over time, and in relation to hormonal changes, sexual activity, and hygiene habits. DESIGN: A longitudinal surveillance of the vaginal flora over an eight week period. SUBJECTS: 26 female health care workers in local genitourinary medicine clinics. METHODS: The participants were anonymised. They filled in diary cards daily. Blind vaginal swabs were self-taken two-seven times weekly. A smear was air-dried for later Gr...

  19. Vaginitis in the adolescent patient.

    Science.gov (United States)

    Nyirjesy, P

    1999-08-01

    For any clinician involved in the health care of women, vaginitis remains an unavoidable problem. Vaginitis accounts for an estimated 10 million office visits each year, and it remains the most common reason for patient visits to obstetrician-gynecologists. Despite extensive self-diagnosis and self-treatment for vaginal symptoms in all age groups, important questions persist about the accuracy of such an approach. This article addresses these questions and approaches.

  20. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

    Science.gov (United States)

    Haas, David M; Morgan, Sarah; Contreras, Karenrose

    2014-12-21

    Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 December 2014). We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. We independently assessed eligibility and quality of the studies. Seven trials randomizing 2816 women (2635 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 8.3% in control groups to 4.3% in vaginal cleansing groups (average risk ratio (RR) 0.45, 95% confidence interval (CI) 0.25 to 0.81, seven trials, 2635 women). The risk reduction was particularly strong for women who were already in labor at the time of the cesarean delivery (7.4% in the vaginal cleansing group versus 13.0% in the control group; RR 0.56, 95% CI 0.34 to 0.95, three trials, 523 women) and for women with ruptured membranes (4.3% in the vaginal cleansing group versus 17.9% in the control group; RR 0.24, 95% CI 0.10 to 0.55, three trials, 272 women). No other outcomes realized statistically significant

  1. Vaginal Discharge: What's Normal, What's Not

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Vaginal Discharge: What's Normal, What's Not KidsHealth / For Teens / Vaginal Discharge: What's Normal, What's Not Print Normal vaginal discharge ...

  2. [Vaginal fibromas (author's transl)].

    Science.gov (United States)

    Marinetti, C; Comiti, J

    1980-05-01

    The author describes the characteristics of vaginal fibromas, as observed in one personal case and after a rview of the published literature. These tumors, which affect women during the period of genital activity, are not of frequent occurrence, and the principal signs are dyspareunia and metrorrhagia. The histological appearance of the tumours is very similar to that of uterine fibromas, but their pathogenicity appears to be different, and they progress in a similar manner to that of benign tumors. Because of the existence of a cleavage line they can be easily enucleated, the main therapeutic problem being the choice of the surgical approach to be employed.

  3. Red herring vaginal discharge.

    Science.gov (United States)

    Lee, Jun Hee; Pringle, Kirsty; Rajimwale, Ashok

    2013-09-18

    Labial hair tourniquet syndrome is a rare condition that can be easily misdiagnosed and ultimately lead to irreversible damage. An 11-year-old premenarche girl presented with a 5-day history of pain and swelling in the labia with associated vaginal discharge. The general practitioner treated her with clotrimazole without improvement. On examination, there was an oedematous swelling of the right labia with a proximal hair tourniquet. Local anaesthetic was applied and the hair removed with forceps. There was instant relief of pain and the discharge stopped within 24 h. The patient was sent home with a course of antibiotics.

  4. Spontaneous Uterine Rupture at 15 Weeks' Gestation in a Patient with a History of Cesarean Delivery after Removal of Shirodkar Cerclage

    Directory of Open Access Journals (Sweden)

    Serika Kanao

    2014-05-01

    Full Text Available A pregnant woman presented with acute upper abdominal pain and nausea at 15 weeks' gestation. She had a history of cesarean delivery for abruption after the removal of a Shirodkar cerclage that was placed because of cervical shortening caused by conization. She became pregnant again 14 months later. Ultrasonography revealed no significant findings, and a single intrauterine pregnancy with positive fetal heart activity was confirmed. An intestinal obstruction was suspected because abdominal radiography showed multiple air–fluid levels in the colon. Over the 3 hours following admission, her symptoms gradually worsened, and plain abdominal computed tomography (CT showed a large hemorrhage in the abdominal cavity, but the uterine wall appeared intact at this time. Subsequently, dynamic CT revealed discontinuity of the uterine muscle layer. During laparotomy, uterine rupture with complete opening of the uterine wall at the site of the previous transverse scar was identified. A dead fetus was located within the amniotic sac in a blood-filled abdominal cavity. She received a total of 10 units of packed red blood cells and 6 units of fresh frozen plasma for the resuscitation. She was discharged on the eighth postoperative day without any complications.

  5. Diástase dos músculos retoabdominais no puerpério imediato de primíparas e multíparas após o parto vaginal Diastasis of rectus abdominis muscle immediately postpartum of primiparous and multiparous after vaginal delivery

    OpenAIRE

    Mariana Tirolli Rett; Fabiane Ramos de Araújo; Isabela Rocha; Rosemery Augusta da Silva

    2012-01-01

    O presente estudo comparou a diástase dos músculos retoabdominais (DMRA) supra-umbilical (SU) e infra-umbilical (IU) entre primíparas e multíparas, correlacionou com a paridade, idade materna, índice de massa corporal (IMC) e tempo de trabalho de parto (TTP). Foram incluídas 100 primíparas com idade de 21,0±4,4 anos e 100 multíparas com idade de 27,2±6,2 anos submetidas ao parto vaginal. A DMRA foi avaliada nos pontos 4,5 cm acima e abaixo da cicatriz umbilical com o paquímetro. Foram emprega...

  6. Maternal Factors Associated With Early Spontaneous Singleton ...

    African Journals Online (AJOL)

    Background: Knowledge of the maternal factors predisposing to preterm deliveries should affect the anticipatory care of mothers at risk of delivering preterm babies and improve perinatal outcome. Objective: To determine the maternal socio-biological characteristics associated with the delivery of early spontaneous ...

  7. 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.

  8. 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.

  9. Vacuum Delivery in Jos University Teaching Hospital, Jos, Nigeria ...

    African Journals Online (AJOL)

    Obstetric practice continues to change, particularly assisted vaginal delivery. Vacuum delivery is a mode of delivery technique in Jos University Teaching Hospital (JUTH) in the maternity unit. The objective of the study was to determine the rate of ventouse delivery, its indications, and maternal and fetal morbidity in our ...

  10. Preterm Delivery in the Setting of Left Calyceal Rupture

    Directory of Open Access Journals (Sweden)

    Brent Hanson

    2015-01-01

    Full Text Available Spontaneous rupture of the renal collecting system is a rare but serious complication of pregnancy. We report a case of nontraumatic left renal calyceal rupture in a pregnancy which ultimately progressed to preterm delivery. A 29-year-old primigravida with a remote history of urolithiasis presented with left flank pain, suprapubic pain, and signs of preterm labor at 33 weeks of gestation. The patient was believed to have urolithiasis, although initial renal ultrasound failed to demonstrate definitive calculi. After a temporary improvement in flank pain with medication, the patient experienced acute worsening of her left flank pain. Urology was consulted and further imaging was obtained. Magnetic resonance imaging (MRI was consistent with bilateral hydronephrosis and rupture of the left renal calyx. Given the patient’s worsening pain in the setting of left calyceal rupture, the urology team planned for placement of a left ureteral stent. However, before the patient could receive her stent, she progressed to active labor and delivered a viable female infant vaginally. Following delivery, the patient’s flank pain resolved rapidly and spontaneously, so no surgical intervention was performed. A summary of the literature and the details of this specific clinical situation are provided.

  11. 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.

  12. The relationship of Candida colonization of the oral and vaginal mucosae of mothers and oral mucosae of their newborns at birth.

    Science.gov (United States)

    Al-Rusan, Rund M; Darwazeh, Azmi M G; Lataifeh, Isam M

    2017-04-01

    Vaginal Candida colonization is common during pregnancy. Vaginal Candida may transmit vertically to the mouth of newborns during labor. The aim of this study was to assess and compare oral Candida colonization between vaginally born newborns and cesarean-born newborns and to investigate the association of the mother's vaginal and oral Candida colonization and the newborn's oral colonization at the time of delivery. Culture swabs were collected from the oral and vaginal mucosae of 100 pregnant women and from the oral mucosa of their 100 full-term newborns. Fifty (50%) of the mothers gave birth vaginally and the other 50 (50%) by cesarean section. The prevalence of oral and vaginal Candida in pregnant mothers was 49% and 40%, respectively. Oral Candida colonization in newborns was 7%. Oral Candida was isolated from 5 of 50 (10%) in the vaginally born group and from 2 of 50 (4%) in the cesarean-born group (P = .44). In vaginally born group, oral Candida was isolated from 5 of 20 (25%) in those born to mothers with vaginal colonization of Candida, and 0 of 30 (0.0%) in mothers without vaginal colonization of Candida (P = .007). The mother's vaginal Candida may constitute an important source of oral Candida in the newborns, particularly in those delivered vaginally. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. 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...

  14. Constructing predictive models for vaginal surgery in patients with noninvasive gynecological conditions.

    Science.gov (United States)

    Yuan, Lei; Zhou, Hong; Zhang, Hao; Tang, Haosha; Chen, Mo; Liu, Xishi; Xu, Congjian; Yao, Liangqing

    2014-09-01

    To develop predictive models for vaginal operative route selection based on clinical variables that can be easily assessed preoperatively in patients with noninvasive gynecological conditions. Retrospective study. University Hospital. Women with routine gynecological surgeries via different approaches. The medical records of 315 women without prolapse and undergoing hysterectomy, adnexal cystectomy or myomectomy were reviewed. Multiple logistic regression analysis was used to identify factors associated with the vaginal approach for each procedure. Predictive models were generated and optimal cut-off points were identified using the receiver operating characteristic curve. Predictive models for different vaginal surgical procedures. For hysterectomy, the patient's body mass index, dysmenorrheal complaints and uterine size were identified as negative predictors for vaginal hysterectomy, whereas previous vaginal delivery was positive. For adnexal cystectomy, adnexal pathology was a negative predictor, whereas previous vaginal delivery and ovarian cyst size were positive. For myomectomy, the body mass index and number of fibroids were negative predictors while previous vaginal delivery was positive. All three models were able to predict the vaginal procedures undergone by women and the areas under the curve were 0.88, 0.95 and 0.92, respectively. Each optimal model cut-off value (logit(p) = 0.53, 0.36, 0.73) resulted in good sensitivity (92.3%, 100% and 87.5%, respectively) and specificity (77.8%, 88.6% and 90.9%, respectively). These predictive models, which used clinical variables that can be easily assessed preoperatively, may help surgeons to select candidates for different vaginal procedures. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  15. 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.

  16. 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

  17. Impact of delivery mode on the colostrum microbiota composition.

    Science.gov (United States)

    Toscano, Marco; De Grandi, Roberta; Peroni, Diego Giampietro; Grossi, Enzo; Facchin, Valentina; Comberiati, Pasquale; Drago, Lorenzo

    2017-09-25

    Breast milk is a rich nutrient with a temporally dynamic nature. In particular, numerous alterations in the nutritional, immunological and microbiological content occur during the transition from colostrum to mature milk. The objective of our study was to evaluate the potential impact of delivery mode on the microbiota of colostrum, at both the quantitative and qualitative levels (bacterial abundance and microbiota network). Twenty-nine Italian mothers (15 vaginal deliveries vs 14 Cesarean sections) were enrolled in the study. The microbiota of colostrum samples was analyzed by next generation sequencing (Ion Torrent Personal Genome Machine). The colostrum microbiota network associated with Cesarean section and vaginal delivery was evaluated by means of the Auto Contractive Map (AutoCM), a mathematical methodology based on Artificial Neural Network (ANN) architecture. Numerous differences between Cesarean section and vaginal delivery colostrum were observed. Vaginal delivery colostrum had a significant lower abundance of Pseudomonas spp., Staphylococcus spp. and Prevotella spp. when compared to Cesarean section colostrum samples. Furthermore, the mode of delivery had a strong influence on the microbiota network, as Cesarean section colostrum showed a higher number of bacterial hubs if compared to vaginal delivery, sharing only 5 hubs. Interestingly, the colostrum of mothers who had a Cesarean section was richer in environmental bacteria than mothers who underwent vaginal delivery. Finally, both Cesarean section and vaginal delivery colostrum contained a greater number of anaerobic bacteria genera. The mode of delivery had a large impact on the microbiota composition of colostrum. Further studies are needed to better define the meaning of the differences we observed between Cesarean section and vaginal delivery colostrum microbiota.

  18. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried ... vaginal sling; Transobturator sling; Midurethral sling Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  19. 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.

  20. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... of regular ovulation (anovulation). Doctors call the problem abnormal uterine bleeding (AUB) . AUB is more common in teenagers and ...

  1. Desquamative Inflammatory Vaginitis: The Unknown

    OpenAIRE

    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. It is an entity little known by clinicians, leading to a delay in diagnosis and the consequent alteration of the patients’ quality of life. The aim in this manuscript is to analyze DIV through the review of a case and the scientific literature. Case presentation: We report the case ...

  2. 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.

  3. Recurrent vaginal discharge in children.

    Science.gov (United States)

    McGreal, Sharon; Wood, Paul

    2013-08-01

    Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time. Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length: A Randomized Clinical Trial.

    Science.gov (United States)

    Saccone, Gabriele; Maruotti, Giuseppe Maria; Giudicepietro, Antonia; Martinelli, Pasquale

    2017-12-19

    Spontaneous preterm birth is a major cause of perinatal morbidity and mortality. It is unclear if a cervical pessary can reduce the risk of spontaneous preterm delivery. To test whether in asymptomatic women with singleton pregnancies and no prior spontaneous preterm birth but with short cervical length on transvaginal ultrasound, use of a cervical pessary would reduce the rate of spontaneous preterm birth at less than 34 weeks of gestation. Parallel-group, nonblinded, randomized clinical trial conducted from March 1, 2016, to May 25, 2017, at a single center in Italy. Asymptomatic women with singleton gestations, no previous spontaneous preterm births, and cervical lengths of 25 mm or less at 18 weeks 0 days to 23 weeks 6 days of gestation were eligible. Patients were randomized 1:1 to receive either cervical pessary (n = 150) or no pessary (n = 150). The pessary was removed between 37 weeks 0 days and 37 weeks 6 days of gestation or earlier if clinically indicated. The control group received standard care. For cervical length of 20 mm or shorter, women in both groups were prescribed vaginal progesterone, 200 mg/d, until 36 weeks 6 days of gestation. No bed rest or activity restriction was recommended. The primary end point was spontaneous preterm birth at less than 34 weeks of gestation. Secondary outcomes were adverse events. Among 300 women who were randomized (mean age, 29 [SD, 6.3] years; mean gestational age, 22 [SD, 1.3] weeks), 100% completed the trial. The primary end point occurred in 11 women (7.3%) in the pessary group and 23 women (15.3%) in the control group (between-group difference, -8.0% [95% CI, -15.7% to -0.4]; relative risk, 0.48 [95% CI, 0.24-0.95]). During follow-up, the pessary group had a higher rate of increased or new vaginal discharge (86.7% vs 46.0%; between-group difference, +40.7% [95% CI, +30.1%-+50.3%]; relative risk, 1.88 [95% CI, 1.57-2.27]). Among women without prior spontaneous preterm birth who had asymptomatic

  6. [Breech delivery and scarred uterus: a special obstetrical situation?].

    Science.gov (United States)

    Bourtembourg, A; Mangin, M; Ramanah, R; Maillet, R; Riethmuller, D

    2013-06-01

    The management of breech delivery in patients with a history of caesarean section is a special situation requiring to anticipate the delivery route if the usual prerequisites for the acceptance of vaginal breech delivery are present. Does a history of caesarean section imply a systematic refusal of vaginal delivery in case of breech presentation or an alternative to an iterative caesarean still exists? An observational study was undertaken in our level III labour ward from January 1st 1994 to June 30th 2010 on 91 patients with a history of caesarean section and who had breech deliveries of singleton pregnancies at more than 35weeks of amenorrhea. Maternal, obstetrical and neonatal parameters were collected. Patients were divided into three groups: vaginal delivery, caesarean section after an accepted vaginal birth trial, elective caesarean section. The rate of an accepted vaginal birth trial was 24.2% (22 cases) with a 36.4% (eight patients) success rate in this group. There were two (2.9%) unplanned vaginal births. Fourteen patients (15.4%) had caesarian sections after an accepted vaginal birth trial: ten before labour and four during labour for dynamic dystocia or non-reassuring fetal status. Most caesarean sections before labour in case of an accepted vaginal birth trial were justified by an intercurrent factor requiring induction of labour. Neonatal factors did not show any increased morbidity or mortality in the vaginal birth group. No Apgar score was found to be less than or equal to 7 at 5minutes. Umbilical arterial pH and lactate measured as from 2001 were similar between the groups. Indeed, the mean arterial pH after vaginal birth was 7.19 as compared to 7.22 in case of caesarean section after an accepted vaginal birth trial, and 7.26 after elective caesarean section. Likewise, the mean lactate measurement was at 4.71mmol/L after vaginal birth versus 4.54 and 3.07 in the other two groups. Only neonates born after elective caesarean sections were

  7. [Safe delivery of term breech presentation].

    Science.gov (United States)

    Krebs, Lone

    2011-01-17

    It is well-documented from descriptive studies and a large randomized and controlled trial that planned vaginal delivery of term breech infants is associated with a risk of perinatal mortality and morbidity. However, in a modern setting with careful case selection and labour management, complication rates are low. When informed of the risks, the majority of women will choose Caesarean delivery. This paper provides the basis for informing women with term breech so that they may make an informed choice. Recommendations on selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth are proposed.

  8. Breech at term--mode of delivery?

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, T

    1995-01-01

    : Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS: A total...... of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores......) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS: Register data on singleton term breech deliveries imply...

  9. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy.

    Science.gov (United States)

    Wang, Xiu; Yang, Aijun; Ma, Qingyong; Li, Xuelan; Qin, Li; He, Tongqiang

    2016-09-01

    To evaluate effectiveness and safety of titrated oral misoprostol solution (OMS) in comparison with vaginal dinoprostone for cervix ripening and labor induction in term pregnant women. A multicenter randomized controlled trial of women with term singleton pregnancy with indications for labor induction; 481 participants were allocated to receive titrated OMS with different doses by hourly administration according to the procedure or insert vaginal dinoprostone for cervix ripening and labor induction to compare maternal outcomes including indication of labor induction, mode of outcome of delivery, maternal morbidity, and neonatal outcomes between two groups for evaluating the efficacy and safety of titrated oral misoprostol induction. Proportion of delivery within 12 h of titrated oral misoprostol is significantly less than vaginal dinoprostone (p = 0.03), but no difference of total vaginal delivery rate (p = 0.93); the mean time of first treatment to vaginal delivery was longer in OMS group (21.3 ± 14.5 h) compared with the vaginal dinoprostone group (15.7 ± 9.6 h). Although the proportion of cesarean section between the two groups showed no statistically significant difference, OMS group showed significantly lower frequency of uterine hyperstimulation, hypertonus, partus precipitatus and non-reassuring fetal heart rate than dinoprostone group. Neonatal outcomes were similar evaluating from Apgar score and NICU admission. Our study also showed that labor induction of women with cervix Bishop score ≤3 needed increased dosage of misoprostol solution. Titrated OMS is as effective as vaginal dinoprostone in labor induction for term pregnant women, with safer effect for its lower rate of adverse effect for women.

  10. 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...

  11. What is normal vaginal flora?

    Science.gov (United States)

    Priestley, C J; Jones, B M; Dhar, J; Goodwin, L

    1997-02-01

    To observe the composition of the vaginal flora of healthy women over time, and in relation to hormonal changes, sexual activity, and hygiene habits. A longitudinal surveillance of the vaginal flora over an eight week period. 26 female health care workers in local genitourinary medicine clinics. The participants were anonymised. They filled in diary cards daily. Blind vaginal swabs were self-taken two-seven times weekly. A smear was air-dried for later Gram staining. The swabs were also cultured for Candida spp, Gardnerella vaginalis, anaerobes, Mycoplasma hominis and Ureaplasma urealyticum. Of 26 subjects, only four had normal vaginal microbiology throughout. One woman, who was not sexually active, had bacterial vaginosis (BV) throughout and nine (35%) had intermittent BV. Candidiasis was found intermittently in eight women (31%), and eight had normal microscopy. U urealyticum was isolated intermittently in 40% of women with BV, 25% with candida, and 50% with normal microscopy. Many women were symptomatic, but symptoms correlated poorly with microbiological findings. All but two women were sexually active; however, more women with BV were exposed to semen. BV seemed to be related to frequent use of scented soap, and there appeared to be an additive effect of clothing and hygiene factors. Our study raises doubts about what should be regarded as normal vaginal flora. It calls into question the significance of finding BV or U urealyticum on a single occasion in asymptomatic women, or of finding normal flora in symptomatic women. The effect of external factors on the vaginal flora deserve further study.

  12. Vaginitis: MedlinePlus Health Topic

    Science.gov (United States)

    ... of this page: https://medlineplus.gov/vaginitis.html Vaginitis On this page Basics Summary Start Here Symptoms Diagnosis and Tests Prevention and Risk Factors Treatments and Therapies Learn More Specifics See, Play and ...

  13. Delivery outcomes at term after one previous cesarean section.

    Science.gov (United States)

    Yamani-Zamzami, Tarik Y

    2007-12-01

    To determine the maternal and perinatal outcomes at term in women with one previous cesarean delivery and with no history of vaginal birth. This is a case-control study conducted at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, between January 1, 1999 and December 31, 2002. One hundred sixty-two women with one previous cesarean delivery and with no previous vaginal birth were compared with 324 control women. The cesarean section rate was higher in the study group 40 (24.7%) versus 23 (7.1%) in the control group and was statistically significant (phistory of vaginal delivery are considered less favorable, the vaginal birth after cesarean section success rate may be even lower if the indication for previous primary cesarean delivery was failure to progress, and may be associated with increased risk of uterine rupture. Further study is required to confirm our findings.

  14. 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.

  15. Lactobacillus-deficient vaginal microbiota dominate post-partum women in rural Malawi.

    Science.gov (United States)

    Doyle, Ronan; Gondwe, Austridia; Fan, Yue-Mei; Maleta, Kenneth; Ashorn, Per; Klein, Nigel; Harris, Kathryn

    2018-01-05

    The bacterial community found in the vagina is an important determinant of a woman's health and disease. A healthy vaginal microbiota is associated with a lower species richness and high proportions of one of a number of different Lactobacillus spp.. When disrupted the resulting abnormal vaginal microbiota is associated with a number of disease states and poor pregnancy outcomes. Studies up until now have concentrated on relatively small numbers of American and European populations which may not capture the full complexity of the community, nor adequately predict what constitutes a healthy microbiota in all populations. In this study we sampled and characterised the vaginal microbiota from a cohort of 1107 women in rural Malawi found on vaginal swabs taken post-partum. We found a population dominated by Gardnerella vaginalis and devoid of the most common vaginal Lactobacillus species, even if the vagina was sampled over a year post-partum. The Lactobacillus -deficient anaerobic community commonly labelled community state type (CST) 4 could be sub-divided into four further communities. A Lactobacillus iners dominated vaginal microbiota became more common the longer after delivery the vagina was sampled, but G. vaginalis remained the dominant organism. These results outline the difficulty in all-encompassing definitions of what a healthy or abnormal vaginal microbiota is post-partum. Previous identification of community state types and associations between bacterial species, bacterial vaginosis and adverse birth outcomes may not represent the complex heterogeneity of the microbiota present. Importance A bacterial community in the vaginal tract that is dominated by small number of bacterial Lactobacillus species and when they are not present, there is a greater incidence of inflammatory conditions and adverse birth outcomes. A switch to a vaginal bacterial community lacking in Lactobacillus species is common after pregnancy. In this study we characterised the vaginal

  16. 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

  17. Vaginal foreign body: Successful management with vaginoscopy

    OpenAIRE

    Yıldız, Şükrü; Ekin, Murat; Cengiz, Hüseyin; Dağdeviren, Hediye; Kaya, Cihan

    2013-01-01

    The etiology of chronic vaginal discharge in children varies and can be seen as infection, sexual abuse, congenital malformations, vulvar skin disease, vaginal neoplasms and a foreign body. A vaginal foreign body is not a common problem in childhood but it should always be considered when a little girl consults a physician with a chronic vaginal discharge problem. We present the diagnosis and treatment management via vaginoscopy applied to a 6 year old girl who complained of a foul smelling v...

  18. 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.

  19. Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section

    Directory of Open Access Journals (Sweden)

    Balvinder Sagoo

    2015-01-01

    Full Text Available We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.

  20. 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

  1. A new method to measure vaginal sensibility

    NARCIS (Netherlands)

    Lakeman, M. M. E.; Laan, E.; Vaart, C. H.; Roovers, J. P.

    2010-01-01

    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. To develop a new method to measure vaginal sensibility. We developed a technique to measure the

  2. Characterisation of the vaginal microflora of human ...

    African Journals Online (AJOL)

    Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+) and HIV negative (HIV-) women at different phases during menstrual cycle ...

  3. Characterisation of the vaginal microflora of human ...

    African Journals Online (AJOL)

    Teresa kiama

    2014-02-26

    Feb 26, 2014 ... Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+) and HIV negative (HIV-) women at different phases during.

  4. Optimal delivery for preterm breech fetuses: is there any consensus?

    Science.gov (United States)

    To, William W K

    2013-06-01

    The optimal route for delivery of preterm breech-presenting fetuses remains a clinical dilemma. Available data from the literature are largely based on retrospective cohort studies, and randomised controlled trials are considered impossible to conduct. Consistently however, large population-based surveys have shown that planned caesarean sections for these fetuses were associated with better neonatal outcomes compared with those following vaginal delivery. Nevertheless, the increased surgical risks for the mother having caesarean delivery of an early preterm breech fetus must be balanced with the probable neonatal survival benefits. Planned caesarean section should probably be limited to gestations with at least a fair chance of independent neonatal survival, where vaginal delivery is not imminent, and in the absence of other maternal risk factors. Vaginal delivery would probably include those fetuses that are of marginal viability, and that additional protection from abdominal delivery was unlikely to be beneficial to neonatal outcome.

  5. Role of Lactobacillus Species in the Intermediate Vaginal Flora in Early Pregnancy: A Retrospective Cohort Study.

    Science.gov (United States)

    Farr, Alex; Kiss, Herbert; Hagmann, Michael; Machal, Susanne; Holzer, Iris; Kueronya, Verena; Husslein, Peter Wolf; Petricevic, Ljubomir

    2015-01-01

    Poor obstetrical outcomes are associated with imbalances in the vaginal flora. The present study evaluated the role of vaginal Lactobacillus species in women with intermediate vaginal flora with regard to obstetrical outcomes. We retrospectively analysed data from all women with singleton pregnancies who had undergone routine screening for asymptomatic vaginal infections at our tertiary referral centre between 2005 and 2014. Vaginal smears were Gram-stained and classified according to the Nugent scoring system as normal flora (score 0-3), intermediate vaginal flora (4-6), or bacterial vaginosis (7-10). Only women with intermediate vaginal flora were investigated. Women with a Nugent score of 4 were categorised into those with and without Lactobacilli. Follow-up smears were obtained 4-6 weeks after the initial smears. Descriptive data analysis, the Welch's t-test, the Fisher's exact test, and multiple regression analysis with adjustment for confounders were performed. Gestational age at delivery and birth weight were the outcome measures. At antenatal screening, 529/8421 women presented with intermediate vaginal flora. Amongst these, 349/529 (66%) had a Nugent score of 4, 94/529 (17.8%) a Nugent score of 5, and 86/529 (16.2%) a Nugent score of 6. Amongst those with a Nugent score of 4, 232/349 (66.5%) women were in the Lactobacilli group and 117/349 (33.5%) in the Non-Lactobacilli group. The preterm delivery rate was significantly lower in the Lactobacilli than in the Non-Lactobacilli group (OR 0.34, CI 0.21-0.55; pflora in early pregnancy.

  6. MRI in distal vaginal atresia

    International Nuclear Information System (INIS)

    Hugosson, C.; Jorulf, H.; Bakri, Y.

    1991-01-01

    Magnetric resonance imaging in two young females with abdominal pain revealed vaginal atresia with massive hematocolpos but a normal cervix and uterine body. Information obtained with MRI was superior to ultrasound and CT and is suggested as the examination of choice prior to surgical correction. (orig.)

  7. Asymptomatic Vaginal Disease In Pregnancy

    African Journals Online (AJOL)

    1974-04-17

    Apr 17, 1974 ... Clinical features, such as pruritus and the appearance of a discharge, were ... fashion. The clinical findings were not made known to the microbiologist or to the cytologist. The media used for culture were: blood agar (for identi- fication and isolation .... comparing the appearance of the vaginal secretion with.

  8. 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.

  9. Influence of the delivery modus on subpopulations and replication of lymphocytes in mothers and newborns.

    Science.gov (United States)

    Almanzar, Giovanni; Schönlaub, Jörn; Hammerer-Lercher, Angelika; Koppelstaetter, Christian; Bernhard, David; Prelog, Martina

    2015-12-01

    Several studies reported that the mode of delivery may induce changes to the immune system. Our hypothesis was that the delivery mode may influence mainly the naive T cell subpopulation. Particular focus was set on the proportions and peripheral replicative history of naive T cells and cord blood serum concentrations of IL-7, a cytokine involved in peripheral naive T cell homeostasis. In a prospective cohort study, proportions of lymphocyte populations were measured in mothers and newborns delivered by spontaneous vaginal delivery (SD), vacuum extraction (VE), primary (PCS) and secondary Cesarean sections (SCS) by flow cytometry. T-cell-receptor-excision-circles (TRECs) and relative telomere lengths (RTLs) were used to estimate the replicative history of peripheral naive T cells. The cytokine profile was assessed by ELISA. The study demonstrated that leukocytes, neutrophils and NK cells were increased in spontaneously delivered newborns compared to PCS, whereas circulating T cells were relatively lower. TRECs and RTLs were not significantly influenced by the delivery mode. IL-2, IL-8 and IFN-γ were increased in VD. IL-7 production tends to be increased in more stress-associated delivery modes, such as VE and SCS. Our results demonstrate proportional changes in newborns delivered by PCS and diminished cytokine production. It has to be proven whether these alterations may be of disadvantage regarding early defense of infectious diseases. Understanding the physiological role of these changes may help to find preventive strategies for neonatal infectious risks and the development of atopy or other immune diseases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. 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.

  11. Mode of delivery affects the bacterial community in the newborn gut.

    Science.gov (United States)

    Biasucci, Giacomo; Rubini, Monica; Riboni, Sara; Morelli, Lorenzo; Bessi, Elena; Retetangos, Cristiana

    2010-07-01

    The first colonisation of the intestine is one of the most profound immunological exposures faced by the newborn and it is influenced by external and internal factors. The early composition of human microbiota could have long-lasting metabolic effects and the initial composition of human intestinal bacteria is also known to affect postnatal immune system development, as we are already aware that reduced microbial stimulation during infancy would result in slower postnatal maturation of the immune system and development of an optimal balance between TH1 and TH2-like immunity. Mode of delivery has a major role on the composition of intestinal microbiota in early infancy, as it has been shown that infants born by Caesarean section (CS) have lower numbers of Bifidobacteria and Bacteroides compared with vaginally born infants. We designed a study to investigate the influence of mode of delivery (CS vs. vaginal delivery) on intestinal microbial composition on day 3 of life using PCR-denaturing gradient gel electrophoresis (DGGE) and PCR-temperature gradient gel electrophoresis (TGGE). Both DGGE and TGGE analyses have been used, together with the specific amplifications for 10 Bifidobacterium sp., 3 Ruminococcus sp., and Bacteroides that all have a highly relevant physiological role in the intestinal ecosystem of the newborn. A total of 46 term infants were enrolled in the study, consecutively recruiting all the CS-delivered babies (n=23; 8 males and 15 females) and the immediately following spontaneously delivered babies (n=23; 11 males and 12 females). DGGE analysis carried out with Bifidobacterium-specific primers revealed the presence of this genus in 13 of 23 (56.5%) samples derived from vaginally delivered newborns but in none of the samples obtained from newborns delivered by CS. PCR analysis with Bifidobacterium-species-specific primers showed that naturally delivered infants had a large number of bifidobacterial species, whereas in CS-delivered babies only two

  12. Influence of mode of delivery at term on the neonatal respiratory morbidity

    International Nuclear Information System (INIS)

    Dehdashtian, M.

    2008-01-01

    Respiratory morbidity is an important complication of elective cesarean section. Our objective was to find out the incidence of respiratory distress in term neonates delivered by elective cesarean section and compare it with neonates delivered vaginally. We evaluated one thousands infants delivered by elective cesarean section and normal vaginal delivery for respiratory distress. Among 500 cesarean done, 27 (5.4%) neonates had respiratory distress and among 500 vaginal delivery infants, 8(1.6%) developed respiratory Distress (P<0.001). The odd ratio for neonatal respiratory distress was 3.38, almost threefold higher in cesarean section group than those delivered vaginally. (author)

  13. 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...... and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP...... 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....

  14. Uterine perforation by a cystoperitoneal shunt, an unusual cause of recurrent vaginal discharge.

    Science.gov (United States)

    Poilblanc, Mathieu; Sentilhes, Loïc; Mercier, Philippe; Lefèbvre, Céline; Descamps, Philippe

    2012-01-01

    We describe the first reported case of uterine perforation by a cystoperitoneal shunt. The mechanism of this unusual complication is unclear. A 17-year-old patient had a cystoperitoneal shunt for a porencephalic cyst. She presented with recurrent watery vaginal discharge. A pelvic ultrasound examination showed that the uterus had been perforated by the distal tip of the shunt. The cystoperitoneal shunt was converted to a ventriculo-atrial shunt, and the vaginal discharge subsequently resolved. The appearance of light and clear vaginal discharge in a patient with a cystoperitoneal shunt raises the possibility of uterine perforation. This can be confirmed by ultrasound and analysis of the discharge. Removal of the shunt leads to spontaneous closure of the uterine defect.

  15. The effects of hyaluronic acid vaginal gel on the vaginal epithelium of ovariectomized rats.

    Science.gov (United States)

    Liu, Shuai-Bin; Liu, Shao-Li; Gan, Xiao-Ling; Zhou, Qin; Hu, Li-Na

    2015-03-01

    Hyaluronic acid is one of the best materials of water retention which can be used in vaginal atrophy. This study is to evaluate the role and mechanism of the hyaluronic acid vaginal gel (Hyalofemme) in the vaginal epithelium of ovariectomized rats. Sixty SD rats were randomly divided into control group (Sham ovariectomy, Sham-OVX), tendency group (ovariectomy, OVX), and experiment group (ovariectomy+Hyalofemme, OVX+Hyalofemme). The hyaluronic acid vaginal gel was administered local vaginal therapy to the experiment group with cytologicaly confirmed vaginal atrophy. The doses were adjusted by animal weight according to human dosage. After daily treatment for 14 days, VEGF and P-AKT activations were detected by Western blot in the experiment group. The hyaluronic acid vaginal gel proved to be very effective in the cytological reversal of vaginal atrophy but did not increase uterine weight. Vaginal microecosystem indicators were negative in the control group and the experiment group. By contrast, the indicators were positive in the tendency group. Hyaluronic acid vaginal gel is effective in the reversal of vaginal atrophy and is beneficial for improving vaginal microecosystem in the postmenopausal rat model. The hyaluronic acid vaginal gel can also improve the repair capacity of the vaginal epithelium.

  16. Short and inflamed cervix predicts spontaneous preterm birth (COLIBRI study).

    Science.gov (United States)

    Raiche, Evelyne; Ouellet, Annie; Berthiaume, Maryse; Rousseau, Éric; Pasquier, Jean-Charles

    2014-07-01

    To develop a new strategy of predicting spontaneous preterm birth (sPTB) by combination of transvaginal ultrasound (TVUS) assessment and inflammatory proteins detection in vaginal secretions. Prospective study of 87 women referred for cervical length assessment with a standardized TVUS combined to vaginal secretions sampling. Samples were analyzed for presence of 10 cytokines. Main outcome was sPTB (cervix (cervix and IL-8 in vaginal secretions were independently associated with sPTB (OR 3.58 (95%CI 1.02; 12.61) and 14.55 (95%CI 1.64; 128.83), respectively) as their combination (OR 4.33 (95%CI 1.25; 14.95)). By categorizing cervical length by presence of IL-8, sPTB occurred in 55.6% of women with a short inflamed cervix. COLIBRI study used a novel, single-step method of vaginal secretions sampling during TVUS and demonstrated that combination of short cervix and IL-8 in vaginal secretions is a promising sPTB predictive test.

  17. Toward an ethically responsible approach to vaginal birth after cesarean.

    Science.gov (United States)

    Lyerly, Anne Drapkin; Little, Margaret Olivia

    2010-10-01

    Determining approach to delivery after a previous cesarean is among the most contentious areas of obstetrics. We present a framework for ethically responsible guidelines and practice regarding vaginal birth after cesarean. We describe ethical complexities of 3 key issues that mark the debate: the cesarean delivery rate, safety, and patient autonomy. We then describe a taxonomy of considerations that should inform a responsible framework for guideline development and highlight critical distinctions between types of guidelines that have been blurred in the past. We then forward 2 central claims. First, in otherwise uncomplicated birth after a single previous cesarean, both vaginal birth after cesarean and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach. Second, in complicated cases, providers and policymakers should carefully calibrate the strength of evidence to ensure differential risk and cost are adequate to justify directive guidelines given important variations in values women bring to childbirth. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor.

    Science.gov (United States)

    Mayer, Richard Bernhard; Oppelt, Peter; Shebl, Omar; Pömer, Joachim; Allerstorfer, Christina; Weiss, Christoph

    2016-05-01

    Only one phase III trial has been published to date on the efficacy and safety of misoprostol vaginal inserts for inducing labor. The aim of this study was to compare misoprostol inserts with dinoprostone inserts. This retrospective cohort study evaluated the reduction in time to vaginal delivery and delivery within 24h, in routine clinical work, in 119 labor inductions using a 200-μg misoprostol vaginal insert (Misodel(®); June-October 2014) in comparison with 124 inductions using a 10-mg dinoprostone insert (Propess(®); December 2013-April 2014). Vaginal delivery within 24h occurred in 77.3% (n=92) of the misoprostol cohort and 74.2% (n=92) of the dinoprostone cohort (P=0.654). Time from insert application to vaginal delivery (min) was 761.76 (±409.44, cohort M) versus 805.17 (±473.00, cohort D) (P=0.817). Cesarean delivery was performed in 10.1% (n=12) versus 10.5% (n=13) in the misoprostol and dinoprostone cohorts, respectively (P≥0.999). The modified Bishop scores were 2.0 versus 3.0 (P=0.001), mean body mass index (BMI) was 24.72 versus 23.95 (P=0.033), and fetal scalp blood testing was required in 12.6% (n=15) versus 3.2% (n=4; P=0.008). No differences were observed with regard to the rates of transfer to the neonatal unit or any type of fetal acidosis. The groups thus had similar results for rates of vaginal delivery within 24h, cesarean delivery and fetal outcomes. The misoprostol group had lower modified Bishop scores, higher BMIs, and a higher rate of fetal scalp blood testing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. A new method to measure vaginal sensibility.

    Science.gov (United States)

    Lakeman, M M E; Laan, E; Vaart, C H; Roovers, J P

    2010-06-01

    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. To develop a new method to measure vaginal sensibility. We developed a technique to measure the sensibility of the vaginal wall consisting of a St Marks electrode on a gloved index finger, with a stimulating electrode mounted at the tip. Measurements were performed in four different target areas (caudal and cranial, posterior and anterior) by two independent female researchers in a random order. Subjects were 12 healthy women. The intra-observer reproducibility of both researchers was almost perfect (Pearsons-Rho correlation coefficient 0.77-0.96 sensibility in the cranial posterior vaginal wall relative to the cranial anterior vaginal wall, but for all measurements, researcher 2 obtained higher sensibility ratings than researcher 1. In addition, researcher 2 found a decreased sensibility in the cranial anterior vaginal wall for women not using oral contraceptives. Phase of the menstrual cycle did not influence vaginal sensibility. We developed a new instrument to measure vaginal sensibility. The instrument has excellent intra-observer reproducibility. This method is sufficiently sensitive so as to differentiate between anterior and posterior cranial vaginal wall sensibility, but outcome differs as a function of researcher. Further evaluation of the clinical use of this method is needed, provided that measurements are performed by the same researcher. (c) 2010 Wiley-Liss, Inc.

  20. Spontaneous pneumothorax in weightlifters.

    Science.gov (United States)

    Marnejon, T; Sarac, S; Cropp, A J

    1995-06-01

    Spontaneous pneumothorax is infrequently caused by strenuous exertion. To our knowledge there has only been one case of spontaneous pneumothorax associated with weightlifting reported in the medical literature. We describe three consecutive cases of spontaneous pneumothorax associated with weightlifting. We postulate that spontaneous pneumothorax in these patients may be secondary to improper breathing techniques. It is important that physicians and weight trainers be aware of the association between weight lifting and spontaneous pneumothorax and assure that proper instruction is given to athletes who work with weights.

  1. Evaluation of vaginal fluid squamous cell carcinoma antigen test in diagnosis of premature rupture of membranes.

    Science.gov (United States)

    Koike, Natsuki; Oi, Hidekazu; Naruse, Katsuhiko; Tsunemi, Taihei; Akasaka, Juria; Sado, Toshiyuki; Kobayashi, Hiroshi

    2017-02-01

    Previous studies have reported that concentrations of squamous cell carcinoma (SCC) antigen in amniotic fluid are extremely higher than that in the maternal serum. The aim of this study was to assess the potential clinical utility of vaginal fluid SCC level as a marker for diagnosing premature rupture of membranes (PROM). A case-control study was performed using patients admitted to Nara Medical University Hospital, delivery ward, from January 2011 to December 2012. The discriminatory potential of SCC assay was determined using 54 PROM and 108 gestational age-matched control vaginal fluid samples, in a 1:2 ratio. Levels of vaginal fluid SCC in patients with PROM and control pregnant women were quantified by an enzyme-linked immunosorbent assay. The statistical results showed no correlation between gestational age and vaginal fluid SCC levels. There was no significant difference in vaginal fluid SCC levels between patients with PROM and those with control pregnant women (16156.5 ± 10495.8 ng/mL versus 15471.9 ± 11362.2 ng/mL, p = 0.467). We conclude that SCC could not be regarded as a potential marker for diagnosis of PROM. SCC may be a physiologic constituent of the vaginal fluid during pregnancy.

  2. [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.

  3. [Prevention of spontaneous preterm birth (excluding preterm premature rupture of membranes): Guidelines for clinical practice - Text of the Guidelines (short text)].

    Science.gov (United States)

    Sentilhes, L; Sénat, M-V; Ancel, P-Y; Azria, E; Benoist, G; Blanc, J; Brabant, G; Bretelle, F; Brun, S; Doret, M; Ducroux-Schouwey, C; Evrard, A; Kayem, G; Maisonneuve, E; Marcellin, L; Marret, S; Mottet, N; Paysant, S; Riethmuller, D; Rozenberg, P; Schmitz, T; Torchin, H; Langer, B

    2016-12-01

    To determine the measures to prevent spontaneous preterm birth (excluding preterm premature rupture of membranes)and its consequences. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. In France, premature birth concerns 60,000 neonates every year (7.4 %), half of them are delivered after spontaneous onset of labor. Among preventable risk factors of spontaneous prematurity, only cessation of smoking is associated to a decrease of prematurity (level of evidence [LE] 1). This is therefore recommended (grade A). Routine screening and treatment of vaginal bacteriosis in general population is not recommended (grade A). Asymptomatic women with single pregnancy without history of preterm delivery and a short cervix between 16 and 24 weeks is the only population in which vaginal progesterone is recommended (grade B). A history-indicated cerclage is not recommended in case of only past history of conisation (grade C), uterine malformation (Professional consensus), isolated history of pretem delivery (grade B) or twin pregnancies in primary (grade B) or secondary (grade C) prevention of preterm birth. A history-indicated cerclage is recommended for single pregnancy with a history of at least 3 late miscarriages or preterm deliveries (grade A).). In case of past history of a single pregnancy delivery before 34 weeks gestation (WG), ultrasound cervical length screening is recommended between 16 and 22 WG in order to propose a cerclage in case of lengthpremature rupture of membranes. Maintenance tocolysis is not recomended (grade B). Antenatal corticosteroid administration is recommended to every woman at risk of preterm delivery before 34 weeks of gestation (grade A). After 34 weeks, evidences are not consistent enough to recommend systematic antenatal corticosteroid treatment (grade B), however, a course might be indicated in the clinical situations associated with the

  4. Mode of delivery and the probability of subsequent childbearing: a population-based register study.

    Science.gov (United States)

    Elvander, C; Dahlberg, J; Andersson, G; Cnattingius, S

    2015-11-01

    To investigate the relationship between mode of first delivery and probability of subsequent childbearing. Population-based study. Nationwide study in Sweden. A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010. Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs). Probability of having a second and third child; interpregnancy interval. Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95-0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84-0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80-0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability. A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

  5. Concurrent chemoradiation for vaginal cancer.

    Directory of Open Access Journals (Sweden)

    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.

  6. Lactobacillus for Vaginal Microflora Correction

    Directory of Open Access Journals (Sweden)

    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. Vaginal absorption of hexachlorophene during labor.

    Science.gov (United States)

    Strickland, D M; Leonard, R G; Stavchansky, S; Benoit, T; Wilson, R T

    1983-12-01

    Surgical soap that contains hexachlorophene is used as an antiseptic lubricant for vaginal examinations during labor in some centers. Theoretically, hexachlorophene can be absorbed from the vaginal mucosa and be potentially toxic to the fetus and neonate. To evaluate vaginal absorption and placental transfer of hexachlorophene, we measured levels in mixed arterial/venous cord serum and postpartum maternal serum in 28 women whose vaginal examinations were lubricated with pHisoHex during labor. The serum of 12 women had detectable levels of hexachlorophene, with a high level of 942 ng/ml. Cord serum had detectable levels in nine neonates, with a high level of 617 ng/ml. The conclusion is that hexachlorophene from vaginal lubricants is variably absorbed from the vaginal mucosa, and appreciable amounts can be detected in maternal and cord serum. Because of the potential for neonatal hexachlorophene toxicity, we recommend the use of alternative lubricants for pelvic examinations during labor.

  8. Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women

    NARCIS (Netherlands)

    van de Wijgert, Janneke H. H. M.; Morrison, Charles S.; Cornelisse, Peter G. A.; Munjoma, Marshall; Moncada, Jeanne; Awio, Peter; Wang, Jing; van der Pol, Barbara; Chipato, Tsungai; Salata, Robert A.; Padian, Nancy S.

    2008-01-01

    OBJECTIVE: To evaluate interrelationships between bacterial vaginosis (BV), vaginal yeast, vaginal practices (cleansing and drying/tightening), mucosal inflammation, and HIV acquisition. METHODS: A multicenter, prospective, observational cohort study was conducted, enrolling 4531 HIV-negative women

  9. Vaginal cuff dehiscence after vaginal cuff brachytherapy for uterine cancer. A case report

    OpenAIRE

    Cattaneo, Richard; Bellon, Maria; Elshaikh, Mohamed A.

    2013-01-01

    Vaginal cuff dehiscence is a rare, but potentially serious complication after total hysterectomy. We report a case of vaginal cuff dehiscence after vaginal cuff brachytherapy. A 62 year old female underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and was found to have International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB endometrioid adenocarcinoma of the uterus. The patient was referred for adjuvant vaginal cuff brachytherapy. D...

  10. Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

    Science.gov (United States)

    Hsia, Renee Y; Akosa Antwi, Yaa; Weber, Ellerie

    2014-01-01

    Objective To examine the between-hospital variation of charges and discounted prices for uncomplicated vaginal and caesarean section deliveries, and to determine the institutional and market-level characteristics that influence adjusted charges. Design, setting and participants Using data from the California Office of Statewide Health Planning and Development (OSHPD), we conducted a cross-sectional study of all privately insured patients admitted to California hospitals in 2011 for uncomplicated vaginal delivery (diagnosis-related group (DRG) 775) or uncomplicated caesarean section (DRG 766). Outcome measures Hospital charges and discounted prices adjusted for each patient's clinical and demographic characteristics. Results We analysed 76 766 vaginal deliveries and 32 660 caesarean sections in California in 2011. After adjusting for patient demographic and clinical characteristics, we found that the average California woman could be charged as little as US$3296 or as much as US$37 227 for a vaginal delivery, and US$8312–US$70 908 for a caesarean section depending on which hospital she was admitted to. The discounted prices were, on an average, 37% of the charges. We found that hospitals in markets with middling competition had significantly lower adjusted charges for vaginal deliveries, while hospitals with higher wage indices and casemixes, as well as for-profit hospitals, had higher adjusted charges. Hospitals in markets with higher uninsurance rates charged significantly less for caesarean sections, while for-profit hospitals and hospitals with higher wage indices charged more. However, the institutional and market-level factors included in our models explained only 35–36% of the between-hospital variation in charges. Conclusions These results indicate that charges and discounted prices for two common, relatively homogeneous diagnosis groups—uncomplicated vaginal delivery and caesarean section—vary widely between hospitals and are not well

  11. Evaluation of common organisms causing vaginal discharge.

    Science.gov (United States)

    Khan, Shazia A; Amir, Fauzia; Altaf, Shagufta; Tanveer, Raazia

    2009-01-01

    Vaginal discharge is very common problem among females. Alteration in balance of normal vaginal organisms can cause the overgrowth of the bacteria that creates vaginal discharge. It is common among sexually active women yet there still remain gaps in our knowledge of this infectious disorder. To evaluate the frequency of bacterial vaginosis (BV), vaginal candidiasis (VC), vaginal trichomoniasis and Group B streptococcus in women complaining of vaginal discharge in our setup. A total of 100 women of reproductive age group with the complaint of vaginal discharge were included in the study. After filling proforma patients were examined by speculum examination and two high vaginal swabs (HVS) were collected aseptically from each patient. One swab was used for making wet mount for clue cells, pus cells and for motility of Trichomonas vaginalis. The other swab was used to check pH and Amine test. The growth was confirmed by Gram staining in each case. Gardnerrella vaginalis were isolated in 28%, Group B streptococcus in 5% and T. vaginolis in 4% of women. Gardnerella vaginalis causing BV is the most common cause of vaginal discharge in otherwise healthy women of reproductive age group in our setup.

  12. Awareness and perceptions of Turkish women towards delivery methods

    Directory of Open Access Journals (Sweden)

    Şükrü Yıldız

    2014-06-01

    Full Text Available Objective: Our aim is to identify the causes of the women’s preferences of vaginal delivery vs. cesarean section and their attitudes for an elective cesarean section. Methods: 400 healthy woman who had applied for antenatal care were included in the study. A questionnaire which is consisted of 21 questions, focused on preference toward mode of delivery and the etiology of these preferences was conducted as a face to face interview. According to history of delivery methods, women have separated into three groups as; women have never given birth/nulliparous (group 1, women who had only vaginal deliveries (group 2, and women who had at least one cesarean deliveries/previous cesarean section (group 3. Results: Of the 400 women questioned, 348 (%87 opted for vaginal delivery, whereas only 52 (%13 opted for an elective caesarean delivery. Ratios of cesarean delivery preference is high in group 3 (%47.5 than group 1( %26 and 2 (%2.7 . Main reasons for vaginal delivery preference: feeling of less pain, fast and easy recovery and less bleeding and infection risc for mothers were the most common preference reasons among all 3 groups. The most common reasons for choosing caesarean delivery were: ‘more comfortable and easy’ in group 1 and ‘tubal ligation demand’ in group 3. ‘Less pain’ and ‘fear of tearing (episiotomy’ also other common reasons for choosing cesarean delivery among all 3 groups. Conclusion: In order to reduce the rate of implemented cesarean section, it is substantially important to encourage educated women and those who have experienced advanced maternal age for increasing the rate of vaginal delivery. J Clin Exp Invest 2014; 5 (2: 173-178

  13. Occurrence and predictors of vacuum and forceps used sequentially for vaginal birth.

    Science.gov (United States)

    Xie, Ri-Hua; Cao, Huiling; Hong, Bo; Sprague, Ann E; Walker, Mark; Wu Wen, Shi

    2013-04-01

    Sequential use of vacuum and obstetric forceps for vaginal delivery is associated with increased risks of adverse maternal and infant outcomes. We conducted a retrospective cohort study to estimate the frequency of sequential use of vacuum and forceps for planned vaginal delivery and to identify predictors, using data collected in Ontario between 2004 and 2007. Multivariate logistic regression models were used to estimate the adjusted odds ratios and 95% confidence intervals of predictors of sequential use of vacuum and forceps. Of 186 988 pregnant women with a singleton, vertex presentation at term and a planned vaginal birth, 1062 (0.57%) required the sequential use of vacuum and forceps for delivery. The major predictors for sequential use of vacuum and forceps were mother's primary language being other than English or French, nulliparity, a history of Caesarean section, dystocia, use of epidural or other pain relief, labour induction, labour augmentation, fetal macrosomia, and advanced gestational age. In this population-based study we found that 0.57% of planned vaginal births were delivered with sequential use of vacuum and obstetric forceps. Abnormal labour, fetal macrosomia, language barriers, and advanced gestational age are significant predictors of requiring this sequential use.

  14. 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

  15. Massive Fetal Ascites: Vaginal Delivery After Trans- Abdominal Fetal ...

    African Journals Online (AJOL)

    We report a care of acute fetal acites diagnosed by ultrasonograhy at 29 weeks gestation in a primigravida who used herbel fertility drugs for conception and through the fist 8 weeks of gestation. Under ultrasound guidance the fetal peritoneal cavity was canulated via the material abdomen with an 18G intravenous canular.

  16. Instrumental vaginal delivery - an assessment of use in a tertiary ...

    African Journals Online (AJOL)

    O'SHEHU

    to the breakdown of the vacuum machine. The rate was fairly constant over the years under study and it is similar to that observed in Scotland and Australia unlike in USA where it is declining: most probably due to litigations.23. Primigravidae 77%, adolescents and young adults (mean age 23.4years) made up the bulk.

  17. Ruptured heterotopic pregnancy and subsequent vaginal delivery at ...

    African Journals Online (AJOL)

    Background: Heterotopic pregnancy is the co- existence of intrauterine and extrauterine gestation at the same time. The condition is life threatening when the ectopic pregnancy ruptures and it is unrecognized. Objective: To report the first successfully managed case of heterotopic pregnancy in a woman without obvious risk ...

  18. Vaginal delivery after hemipelvectomy and pelvic radiotherapy for chondrosarcoma

    NARCIS (Netherlands)

    Browne, J. L.; Oudijk, M. A.; Holtslag, H. R.; Schreuder, H. W. R.

    2014-01-01

    Chondosarcoma of the proximal femur is a rare malignant disorder in women of (pre-) childbearing age, for which a radical resection through a hemipelvectomy could be indicated. We describe a case of a 36-year-old primigravida with a hemipelvectomy (2004) who had a history of radiotherapy of the

  19. [Management of severe or persistent postpartum hemorrhage after vaginal delivery].

    Science.gov (United States)

    Morel, O; Perdriolle-Galet, E; Mézan de Malartic, C; Gauchotte, E; Moncollin, M; Patte, C; Chabot-Lecoanet, A-C

    2014-12-01

    This chapter is an update of the 2004 recommendations for the management of persistent or severe postpartum hemorrhage (PPH) after natural childbirth. Severe PPH is defined by estimated blood loss greater than 1000mL (gradeC). Persistent bleeding within 15 to 30minutes after diagnosis and initial treatment (gradeC) or abundant immediately (professional consensus) should lead to a further management. A systematic review of the literature concerning the management of persistent or severe PPH was conducted on Medline and Cochrane Database, with no specified time period. The initial clinical evaluation is the same whatever initial severity. Each possible cause of bleeding must be evaluated: uterine vacuity must be checked and birth canal lesions must be researched and repaired (gradeC). Sulprostone is effective for the treatment of severe or persistent PPH (EL4) and its use is recommended for the management of PPH resistant to oxytocin administration (grade B). In the current state of the literature, there is no argument for replacing sulprostone in France by dinoprostone or prostaglandins F2α (professional consensus). If oxytocin has been administered, it is not recommended to use misoprostol (EL1) as adjuvant treatment because there is no evidence of benefit in this indication (grade A). Balloon intra-uterine tamponade appears to be an efficient mechanical treatment of uterine atony in case of failure of the initial management by sulprostone. Tamponade allows avoiding the need for further interventional radiology or surgery in most cases (EL4). Intra-uterine tamponade may be offered in case of failure of sulprostone and prior to surgical management or interventional radiology (professional consensus). Its use is left to the discretion of the practitioner. Tamponade should not delay the implementation of further invasive procedures. Copyright © 2014. Published by Elsevier Masson SAS.

  20. Ventral hernia with uterine rupture after vaginal delivery

    Directory of Open Access Journals (Sweden)

    Jung Mi Byun

    2014-09-01

    Conclusion: If a patient has hernia-related symptoms or complications, the diagnosis and management of the hernia should be performed as soon as possible, regardless of the onset, to decrease maternal and fetal mortality.

  1. Factors Influencing The Use Of Episiotomy During Vaginal Delivery ...

    African Journals Online (AJOL)

    Background: Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many ...

  2. 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.

  3. ANAL SPHINCTER INJURIES (OASIS AT DELIVERY

    Directory of Open Access Journals (Sweden)

    Katja Jakopič

    2018-02-01

    feel the pressure but cannot hold bowel contents for long. IAS injury leads to complete inability to control passing of bowel contents. Perineal tears are classified to four degrees depending on tear depth. With first degree tear only vaginal mucosa is torn, second degree perineal muscles are damaged, third degree describes any tearing of anal sphincter and fourth of rectal mucosa. New guidelines recom- mend further classification of 3rd degree tears: 3a = 50 % EAS ruptured 3c = IAS rupture Ultrasound with anal plug is nowadays considered to be the golden standard for diagnosis and follow-up of anal sphincter injuries. Entire length of anal sphincter muscle is shown from U shaped puborectalis muscle to anus. IAS appears as hypo-echoic homogenous circle around rectal mucosa, while EAS appears as outer hyper- echoic heterogenous circle. Dur- ing voluntary contraction distance between ruptured ends of EAS enlarges. 3D ultrasound shows promising results but is not yet standardized. Anal sphincter manometry, pudendal nerve latency and EMG of anal sphincter also contribute valuable information on anal sphincter function and injuries. Risk factors are: fetal weight over 3500g, forceps delivery (but not vacuum extraction occipito-posterior presentation, shoulder dystocia, prolonged second stage of delivery, median episiotomy, previous anorectal surgery and maternal age over 35 years at first delivery are described as risk factors. Caesarean section prevents anal sphincter injuries. Studies show that restrictive use of mediolateral episiotomy in comparison to spontaneous delivery prevents anal sphincter injuries. Rectal examination prior to suturing perineal tears is essential for timely recognition of anal sphincter injuries. EAS appears more read while IAS smooth muscle has a lighter colour (white meat. Sphincter continuity can be palpated between index finger and thumb (pill-rolling motion and voluntary contraction felt. Immediately after delivery voluntary contraction can

  4. [Spontaneous antepartal RhD alloimmunization].

    Science.gov (United States)

    Studničková, M; Holusková, I; Durdová, V; Kratochvílová, T; Strašilová, P; Marková, I; Lubušký, M

    2015-12-01

    Assess the incidence of spontaneous antepartal RhD alloimmunization in RhD negative pregnant women with an RhD positive fetus. Clinical study. Department of Obstetrics and Gynecology, Medical School and University Hospital Olomouc. A total of 906 RhD negative women with an RhD positive fetus and without the presence of anti-Dalloantibodies at the beginning of pregnancy were examined. Always it was a singleton pregnancy, RhD blood group of the pregnant women was assessed in the 1st trimester of pregnancy, RhD status of the fetus was determined after delivery. Screening for irregular antierythrocyte antibodies was performed in all women in the 1st trimester of pregnancy, at 28-32 weeks gestation and immediately prior to delivery at 38-42 weeks gestation. Screening for irregular antierythrocyte antibodies was performed also at 6 months following delivery in all cases of positive antibodies before delivery. Antibody screening was performed using the indirect antiglobulin (LISS/NAT) and enzyme (papain) test with their subsequent identification using a panel of reference erythrocytes by column agglutination method Dia-Med. After delivery, the volume of fetomaternal hemorrhage was assesed in all RhD negative women and RhD alloimmunization prophylaxis was performed by administering the necessary IgG anti-D dose; none of the women were administered IgG anti-D antepartally. During screening for irregular antierythrocyte antibodies at 28-32 weeks gestation, anti-D alloantibodies were diagnosed in 0.2% of the women (2/906); immediately prior to the delivery at 38-42 weeks gestation, anti-D alloantibodies were diagnosed in 2.3% of the women (21/906) and repeatedly even at 6 months following delivery (21/157). In 82.7% of the women (749/906), examination at 6 months following delivery was not performed, therefore in these women spontaneous antepartal RhD alloimmunization cannot reliably be ruled out. Alloimmunization may not be diagnosed yet at term of delivery. If anti

  5. Mucoadhesive drug delivery systems

    Directory of Open Access Journals (Sweden)

    Rahamatullah Shaikh

    2011-01-01

    Full Text Available Mucoadhesion is commonly defined as the adhesion between two materials, at least one of which is a mucosal surface. Over the past few decades, mucosal drug delivery has received a great deal of attention. Mucoadhesive dosage forms may be designed to enable prolonged retention at the site of application, providing a controlled rate of drug release for improved therapeutic outcome. Application of dosage forms to mucosal surfaces may be of benefit to drug molecules not amenable to the oral route, such as those that undergo acid degradation or extensive first-pass metabolism. The mucoadhesive ability of a dosage form is dependent upon a variety of factors, including the nature of the mucosal tissue and the physicochemical properties of the polymeric formulation. This review article aims to provide an overview of the various aspects of mucoadhesion, mucoadhesive materials, factors affecting mucoadhesion, evaluating methods, and finally various mucoadhesive drug delivery systems (buccal, nasal, ocular, gastro, vaginal, and rectal.

  6. [Clinical study on vaginal birth after cesarean].

    Science.gov (United States)

    He, L; Chen, M; He, G L; Liu, X X

    2016-08-25

    To investigate the incidence and pregnant outcome on vaginal birth after cesarean (VBAC). From January 2005 to December 2015, clinical data of 507 cases with VBAC in West China Second Hospital were studied retrospectively. There were 370 cases of VBAC from January 2013 to December 2015 as study group (VBAC group), in contrast, 740 cases of elective repeat cesarean section (ERCS group) and 740 primiparas of vaginal delivery without history of cesarean section as control groups, the pregnancy outcome were analyzed between the study group and control groups respectively. (1) There were 76 547 total births from January 2005 to December 2015. Among these, 10 178 (13.296%, 10 178/76 547) patients had a single prior low transverse cesarean section, of which 4.981% (507/10 178) had VBAC. The incidence of VBAC was rising from 1.020%-3.704% during 2005-2012 to 6.028%-7.662% during 2013-2015. The rate of scared uterus during 2013-2015 was 18.269% (5 539/30 319), of which 9.26% (513/5 539) chose trial of labor after cesarean section (TOLAC). Successful VBAC occurred in 72.12% (370/513) of patients with TOLAC, and 27.88% (143/513) delivered by emergency cesarean. (2) The following parameters of the successful group and the unsuccessful VBAC group were compared, maternal age (29±4) versus (34±4) years, body mass index at prenatal visit (22.2±1.4) versus (22.6±1.4) kg/m(2), gestational age (38.7±0.9) versus (39.6±1.3) weeks, birth weight (3 326±317) versus (3 404±285) g, and the rate of induction of labor 0 (0/370) and 6.29% (9/143), there were significant differences (all Pdelivery without history of cesarean section was compared, (10.3±1.8) versus (11.5±2.0) hours, there was significant difference (P0.05). (4) The postpartum hemorrhage and hospitalization duration in VBAC group incidence were respectively (194±34) ml and (2.32±0.49) days, and the indexes of the ERCS group were respectively (419±57) ml and (4.14±0.78) days, there were significant differences (all P

  7. Antimicrobial prophylaxis in caesarean section delivery

    OpenAIRE

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-01-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A pros...

  8. Obstructed hemivagina with pyocolpos: An unusual presentation after delivery

    Directory of Open Access Journals (Sweden)

    A.S. El-Agwany

    2016-06-01

    Case report: We describe a case of mullerian anomaly that was presented 9 years after menarche. Patient presented after delivery with offensive vaginal discharge and pelvic pressure 7 month after delivery without fever. She was diagnosed with bicornuate uterus, septate cervix along with obstructed hemivagina with pus collection and ipsilateral renal agenesis. She was successfully managed by transvaginal septum resection and drainage of pus.

  9. Current Practice of Forceps and Vacuum Deliveries by Nigerian ...

    African Journals Online (AJOL)

    Obstetricians should be competent and confident in the use of both the forceps and vacuum extractor to assist vaginal delivery. Objective : To asses the current practice of forceps and vacuum deliveries by Nigerian Obstetricians. Methodology: A self administered questionnaire survey of 57 Obstetricians that attended the 6th ...

  10. Iatrogenic encephalocele : a rare complication of vacuum extraction delivery

    NARCIS (Netherlands)

    Jeltema, Hanne-Rinck; Hoving, Eelco

    2011-01-01

    Vacuum extraction is a frequently used form of assisted vaginal delivery. Here we describe a child who was born by vacuum extraction delivery. Days after the birth, a frontal swelling, which was thought to be a caput succedaneum, enlarged. Imaging revealed an iatrogenic encephalocele with a large

  11. Cesarean Delivery for a Life‑threatening Preterm Placental Abruption

    African Journals Online (AJOL)

    Following a failed induction of labor with a deteriorating maternal condition despite resuscitation, emergency cesarean delivery was offered with good maternal outcome. Cesarean delivery could avert further disease progression and possible maternal death in cases of severe preterm placental abruption where vaginal ...

  12. Management of preterm delivery in women with abnormal fetal presentation

    NARCIS (Netherlands)

    Bergenhenegouwen, L.A.

    2015-01-01

    The aim of the thesis was to answer the following questions. 1. What is the optimal mode of delivery in preterm breech presentation? 2. Does an intended caesarean section reduce the risk of perinatal mortality and morbidity as compared to intended vaginal delivery in preterm breech presentation? 3.

  13. Caesarean Delivery: Why The Aversion? | Ezechi | Tropical Journal ...

    African Journals Online (AJOL)

    While only 28.9% will accept caesarean section on doctor\\'s advice, 71.1% will not accept caesarean delivery for any reason. 26.8% of the patients that have had previous caesarean section prefer to die while attempting vaginal delivery than to have a repeat caesarean section. Reasons for refusing caesarean section were ...

  14. Alcohol consumption at the time of conception and spontaneous abortion

    DEFF Research Database (Denmark)

    Henriksen, T.B.; Hjollund, N.H.; Jensen, Tina Kold

    2004-01-01

    The authors studied the association between female and male alcohol intakes at the time of conception and the risk of spontaneous abortion, including early pregnancy loss detected by urinary human chorionic gonadotropin. After a nationwide mailing to about 50,000 members of four trade unions....... Women collected morning urine for 10 days from the first day of vaginal bleeding in each cycle. The authors detected 186 pregnancies: 131 resulted in childbirth, and 55 resulted in spontaneous abortion (34 detected by urinary human chorionic gonadotropin). Depending on the intake in the cycle...... of conception and the adjustment factors, female alcohol intake was associated with 2-3 times the adjusted risk of spontaneous abortion compared with no intake, and male alcohol intake was associated with 2-5 times the adjusted risk. Only the adjusted relative risks for 10 or more drinks/week compared...

  15. VULVO-VAGINAL CANDIDIASIS ASSOCIATED WITH ACITRETIN

    NARCIS (Netherlands)

    STURKENBOOM, MCJM; MIDDELBEEK, A; VANDENBERG, LTWD; VANDENBERG, PB; STRICKER, BHC; WESSELING, H

    The aim of this study was to estimate the risk of vulvo-vaginal candidiasis among the users of acitretin. The incidence rate ratio of vulvo-vaginal candidiasis was estimated in a cohort of acitretin users by using prescription sequence analysis. Study subjects were 196 women between 15 and 45 years