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

    OpenAIRE

    Sei, Kiguna; Sasa, Hidenori; Furuya, Kenichi

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  3. Predictors of successful external cephalic version and assessment of success for vaginal delivery.

    Science.gov (United States)

    Salzer, Liat; Nagar, Ran; Melamed, Nir; Wiznitzer, Arnon; Peled, Yoav; Yogev, Yariv

    2015-01-01

    To identify predictors of successful external cephalic version (ECV) and to compare delivery outcome between women who had a successful ECV and women with spontaneous vertex presentation. A retrospective cohort study of all women who underwent ECV in a single tertiary medical center between 2007 and 2011. Delivery outcome was compared between women who underwent a trial of vaginal delivery following successful ECV with that of a control group in a 2:1 ratio. Multivariate analysis was used to identify predictors of successful ECV. Overall 287 were eligible for the study group. Of these 130 (45.3%) had a successful ECV. Polyhydramnios was the strongest factor associated with successful ECV (OR=3.1, 95%-CI 1.4-7.2), followed by transverse lie (versus breech presentation, OR=2.6, 95%-CI 1.2-6.7) and a posterior placenta (OR=1.7, 95%-CI 1.1-3.9), while nulliparity was associated with a lower likelihood of successful ECV (OR=0.4, 95%-CI 0.2-0.6). Women who had a successful ECV and underwent a trial of labor were more likely to deliver by operative vaginal delivery (OVD) (OR=1.8, 95%-CI 1.2-3.6), mainly due to a higher rate of prolonged 2nd, but were not at an increased risk for CS (OR=0.9, 95%-CI 0.4-2.4). Counselling to women prior to ECV should address the likelihood of success based on the predicting factors described above, as well as the increased risk for OVD in the case of successful ECV.

  4. Relationship between fetal station and successful vaginal delivery in nulliparous women.

    Science.gov (United States)

    Segel, Sally Y; Carreño, Carlos A; Weiner, Steven J; Bloom, Steven L; Spong, Catherine Y; Varner, Michael W; Rouse, Dwight J; Caritis, Steve N; Grobman, William A; Sorokin, Yoram; Sciscione, Anthony; Mercer, Brian M; Thorp, John M; Malone, Fergal D; Harper, Margaret; Iams, Jay D

    2012-10-01

    To study the relationship between fetal station and successful vaginal delivery in nulliparous women. This was a secondary analysis from a previously reported trial of pulse oximetry. Vaginal delivery rates were evaluated and compared with respect to the fetal station. Spontaneous labor and induction of labor groups were evaluated separately. Multivariable logistic regression analysis was performed to adjust for confounding factors. Successful vaginal delivery was more frequent with an engaged vertex for spontaneous labor (86.2% versus 78.6%; p = 0.01) and induced labor (87.7% versus 66.1%; p women with induced labor (OR 2.2; 95% CI 0.96 to 5.1; p = 0.06). Among nulliparous women enrolled in the FOX randomized trial in spontaneous labor or for labor induction, an engaged fetal vertex does not affect their vaginal delivery rate. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Phosphorylated IGFBP-1 in predicting successful vaginal delivery in post-term pregnancy.

    Science.gov (United States)

    Kosinska-Kaczynska, Katarzyna; Bomba-Opon, Dorota; Bobrowska, Katarzyna; Kozlowski, Szymon; Brawura-Biskupski-Samaha, Robert; Szymusik, Iwona; Wegrzyn, Piotr; Wielgos, Miroslaw

    2015-07-01

    To estimate whether phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretion in term and post-term pregnancies can predict spontaneous onset of labor or vaginal delivery. A prospective cohort study of 167 women in singleton term and post-term pregnancies, was conducted at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2013 and 2014. phIGFBP-1 test (Actim Partus Medix Biochemica), ultrasound cervix assessment and Bishop score were analyzed in the study group. Spontaneous onset of labor was the primary and vaginal delivery was the secondary outcome. In 32.5 % of patients, spontaneous uterine contractions appeared. 67.5 % of women delivered vaginally, 32.5 % had cesarean section. phIGFBP-1 test predicted spontaneous onset of labor (sensitivity 0.69, specificity of 0.42) and successful vaginal delivery (0.67, 0.48). In the prediction of spontaneous delivery onset ultrasound cervical assessment and phIBFBP-1 had comparable sensitivity and in the prediction of successful vaginal birth all three tests had comparable sensitivity. The time from preinduction to spontaneous onset of delivery was significantly shorter in women with positive phIGFBP-1 test (13.65 ± 6.7 vs 20.75 ± 2.6 h; p = 0.006). A test for phIGFBP1 presence might be an additional tool for predicting both spontaneous onset of labor and successful vaginal delivery in post-term pregnancies.

  6. 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

  7. Attempted and Successful Vacuum-Assisted Vaginal Delivery by Prepregnancy Body Mass Index.

    Science.gov (United States)

    Ramos, Sebastian Z; Waring, Molly E; Leung, Katherine; Amir, Nili S; Bannon, Annika L; Moore Simas, Tiffany A

    2017-02-01

    To examine rates of attempted and successful vacuum-assisted vaginal delivery by prepregnancy body mass index (BMI). We conducted a retrospective cohort study of 2,084 women with singleton gestations needing operative delivery assistance and vacuum-eligible (fully dilated, +2 station or greater, 34 weeks of gestation or greater) using 2006-2014 inpatient records. Prepregnancy BMI was categorized as underweight (less than 18.5), normal weight (18.5 to less than 25), overweight (25 to less than 30), or obese (30 or greater). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of attempted and successful vacuum-assisted vaginal delivery by prepregnancy BMI adjusted for age, race, marital status, parity, diabetes, labor induction-augmentation, episiotomy, gestational age, and neonatal birth weight. Thirty-nine percent of women requiring delivery assistance and eligible for a vacuum were overweight or obese, 79% had vacuum attempts, and 95.3% of attempted vacuum-assisted vaginal deliveries were successful. Compared with women who were normal weight prepregnancy (82.8%), women who were overweight or obese were less likely to have vacuum attempted (75.8%, OR 0.71, 95% CI 0.53-0.96 and 71.2%, OR 0.53, 95% CI 0.39-0.74, respectively). Among women with attempted vacuum-assisted vaginal delivery, successful delivery did not differ by prepregnancy BMI (92.6%, OR 0.54, 95% CI 0.21-1.37 for underweight; 94.5%, OR 1.07, 95% CI 0.57-2.00 for overweight; 96.3%, OR 1.09, 95% CI 0.51-2.33 for obese compared with 95.6% among normal-weight women). Among women in need of operative delivery assistance, prepregnancy obesity was associated with lower likelihood of attempted vacuum-assisted vaginal delivery but, if attempted, success rates were similar to rates among normal-weight women. With significant morbidity of second-stage cesarean delivery in obese women, research should examine whether vacuum-assisted vaginal delivery may be appropriate for

  8. Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean.

    Science.gov (United States)

    Mone, Fionnuala; Harrity, Conor; Toner, Brenda; Mcnally, Aine; Adams, Beverley; Currie, Aoife

    2014-07-01

    To compare the characteristics of women who select elective repeat cesarean rather than trial of labor after cesarean (TOLAC) for delivery, and to determine individual predictors for success and failure within a TOLAC group and observe differences in maternal and neonatal morbidity. The present descriptive, retrospective, observational study was performed in a regional obstetric unit in the United Kingdom. Data were collected from the Northern Ireland Maternity System database on all women who gave birth between April 2010 and April 2012, and had a previous cesarean delivery, and statistical analysis was performed. In total, 893 patients were included in the study: 385 underwent TOLAC and 493 underwent elective repeat cesarean. On comparison, women in the elective repeat cesarean group had a shorter inter-delivery interval and fewer had had a previous vaginal delivery (Psuccess in the TOLAC group included previous vaginal delivery and a longer inter-delivery interval (PSuccessful vaginal birth after cesarean (VBAC) did not have higher rates of maternal morbidity. The majority of patients (56%) chose elective repeat cesarean rather than TOLAC, which has long-term implications both clinically and financially. A validated prediction model might improve patient counseling and identify women with a high likelihood of successful VBAC. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    Siew Cheng Chai

    2015-01-01

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

  11. Prediction of successful trial of labor after cesarean - the benefit of prior vaginal delivery.

    Science.gov (United States)

    Ashwal, Eran; Wertheimer, Avital; Aviram, Amir; Wiznitzer, Arnon; Yogev, Yariv; Hiersch, Liran

    2016-01-01

    To determine predictive factors for vaginal birth after cesarean section (VBAC). A retrospective cohort study of all women with singleton pregnancies and a prior single low transverse cesarean section (CS) who attempted vaginal delivery in a tertiary hospital (2010-2014). Pregnancy outcome of women with VBAC was compared to those who failed vaginal delivery. Sub-analysis for women with no prior vaginal deliveries was performed. Pregnancies with non-cephalic presentation, estimated fetal weight >4000 g and any contraindications for vaginal delivery were excluded. Of the 40 714 deliveries, 1767 women met inclusion criteria. Among them 1563 (88.5%) had a VBAC and 204 (11.5%) failed. There was no significant difference between the groups regarding maternal age, comorbidities and pregnancy complications. Predictors for VBAC were (odds ratio, 95% confidence interval) interval from prior CS (1.13, 1.04-1.22, p=0.004), previous VBAC (2.77, 1.60-4.78, p women with no prior vaginal birth, only birthweight was associated with VBAC (0.99, 0.99-1.00, p = 0.02). While different variables may influence the rate of VBAC, the predictive ability of VBAC for women with no previous vaginal deliveries remains poor.

  12. Transperineal sonographic assessment of angle of progression as a predictor of successful vaginal delivery following induction of labor.

    Science.gov (United States)

    Gillor, M; Vaisbuch, E; Zaks, S; Barak, O; Hagay, Z; Levy, R

    2017-02-01

    To assess whether measurement of the angle of progression (AOP) before induction of labor (IOL) can predict successful vaginal delivery in nulliparous women. This was a prospective, observational study of nulliparous women with a singleton term pregnancy and an indication for IOL. Transperineal sonography was used to measure the AOP before cervical ripening. Since all women enrolled had a low Bishop score, 98.6% of them were induced with either intracervical extra-amniotic balloon catheter or vaginal prostaglandin E-2. The staff in the labor ward were blinded to the AOP measurements. Clinical data were retrieved from computerized medical records. Of the 150 women included in the final analysis, 40 (26.7%) delivered by Cesarean section. The median AOP was narrower in women who had a Cesarean delivery than in those who delivered vaginally (90° (interquartile range (IQR), 84-94.5°) vs 98° (IQR, 90.8-105°); P women who underwent Cesarean delivery for non-progression of labor (n = 27) in the analysis, an AOP of > 92° (derived from a receiver-operating characteristics curve) was associated with a successful vaginal delivery in 94.8% of women. Multivariate stepwise logistic regression analysis including maternal age, body mass index, gestational age, estimated fetal weight, fetal head station, indication for IOL and AOP demonstrated that only AOP was independently associated with the prediction of a successful induction. AOP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at term undergoing IOL; an AOP wider than 92° is associated with a high rate of vaginal delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  13. Comparison of elastosonography and digital examination of cervix for consistency to predict successful vaginal delivery after induction of labor with oxytocin.

    Science.gov (United States)

    Gultekin, Serap; Gultekin, Ismail Burak; Icer, Bilal; Yilmaz, Elif; Alkan, Afra; Kucukozkan, Tuncay

    2017-12-01

    To compare elastosonography and digital examination of cervix for consistency in the prediction of successful vaginal delivery. A total of 64 pregnant women with the indication of induction of labor (IOL) were enrolled to the study. The uterine cervix is evaluated before and after the IOL with elastosonography and digital examination for consistency and sonography for length. Methods were compared in regard to the prediction of successful vaginal delivery. The median of gestational age was 41.00 (IQR = 2.32). Out of 64 participants, 40 (62.5%) had vaginal delivery and 24 (37.5%) had cesarean delivery. The preinduction and postinduction elastosonographic indices were insignificant in delivery groups. The preinduction and postinduction evaluations of cervical consistency with digital examination were significant within vaginal delivery group (p = 0.046), whereas it was insignificant within cesarean delivery group and between the delivery groups. The preinduction and postinduction Bishop scores were significant within vaginal delivery group (p = 0.005), whereas it was insignificant within cesarean delivery group and between the delivery groups. Postinduction Bishop score was significant between the delivery groups. Evaluation of cervix for consistency with either elastosonography or digital examination was found to be insignificant in prediction of successful vaginal delivery after IOL with oxytocin.

  14. 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.)

  15. 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.

  16. Successful pregnancy with a full-term vaginal delivery one year after n-butyl cyanoacrylate embolization of a uterine arteriovenous malformation.

    Science.gov (United States)

    McCormick, Colleen C; Kim, Hyun S

    2006-01-01

    Uterine arteriovenous malformation (AVM) causes significant morbidity with vaginal bleeding. Traditional therapy is a hysterectomy with no potential for future pregnancy. We present a case of successful superselective embolization of uterine AVM using n-butyl cyanoacrylate with subsequent normal term pregnancy and uncomplicated vaginal delivery in 1 year.

  17. A comparison of induction of labor success rates over three time periods in 20 years at a single academic tertiary care center: are we improving vaginal delivery rates?

    Science.gov (United States)

    Fischer, Richard; Machac, Nicole; Hunter, Krystal; Adriance, Lori

    2018-04-01

    To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution. All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared. A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates. Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.

  18. Assisted Vaginal Delivery

    Science.gov (United States)

    ... prescription. If sitting is uncomfortable, sit on a pillow. There also are special cushions that may be ... vagina. Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus. ...

  19. 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.

  20. Vaginal delivery of breech presentation.

    Science.gov (United States)

    Kotaska, Andrew; Menticoglou, Savas; Gagnon, Robert

    2009-06-01

    To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Vaginal breech birth can be associated with a higher risk of perinatal mortality and short-term neonatal morbidity than

  1. Thermosensitive hydrogels a versatile concept adapted to vaginal drug delivery.

    Science.gov (United States)

    Taurin, Sebastien; Almomen, Aliyah A; Pollak, Tatianna; Kim, Sun Jin; Maxwell, John; Peterson, C Matthew; Owen, Shawn C; Janát-Amsbury, Margit M

    2017-11-15

    Vaginal drug delivery represents an attractive strategy for local and systemic delivery of drugs otherwise poorly absorbed after oral administration. The rather dense vascular network, mucus permeability and the physiological phenomenon of the uterine first-pass effect can all be exploited for therapeutic benefit. However, several physiological factors such as an acidic pH, constant secretion, and turnover of mucus as well as varying thickness of the vaginal epithelium can impact sustained drug delivery. In recent years, polymers have been designed to tackle challenges mentioned above. In particular, thermosensitive hydrogels hold great promise due to their stability, biocompatibility, adhesion properties and adjustable drug release kinetics. Here, we discuss the physiological and anatomical uniqueness of the vaginal environment and how it impacts the safe and efficient vaginal delivery and also reviewed several thermosensitive hydrogels deemed suitable for vaginal drug delivery by addressing specific characteristics, which are essential to engage the vaginal environment successfully.

  2. [Frequency of epidural analgesia for vaginal delivery].

    Science.gov (United States)

    Atanassova, M; Nikolov, A

    2011-01-01

    To establish the frequency of epidural analgesia for vaginal delivery. The research includes 51 632 deliveries for 16 years period. Total frequency of vaginal delivery with EA, compared to total number of vaginal deliveries for period is 11.77%. The frequency shows tendency to slowly increase in the beginning of the period, probably because of getting experienced among some of the obstetricians, after then frequency stay relatively constant. Except care of somatic health of mother and foetus, modern obstetrics requires to ensure maximum comfort of parturient, to satisfy requirements of modern women for "painless" delivery and leave a positive memory of birth. That is why more frequently use of EA for vaginal delivery is necessary. EA is an approved method for anesthetizing vaginal delivery. It is established slowly increasing frequency of EA for anesthetizing vaginal delivery. The frequency of EA in University hospital "Maichin dom" is relatively low in comparison with mentioned in literature values, which raises the question of finding ways to further promote and increase the application of EA.

  3. Successful delivery after vaginal occlusion in addition to cerclage in a trachelectomy patient with recurrent second trimester pregnancy loss

    DEFF Research Database (Denmark)

    Sneider, Kirstine; Poulsen, Mette Østergaard; Ottosen, Christian

    2014-01-01

    KEY CLINICAL MESSAGE: Pregnancy outcome after trachelectomy has high risk of complications such as second trimester pregnancy loss and preterm birth. We report beneficial effect of a simple procedure of vaginal occlusion in addition to cerclage in a patient with trachelectomy and two prior second...... trimester pregnancy losses....

  4. Twin vaginal delivery: innovate or abdicate.

    Science.gov (United States)

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

    2017-05-01

    Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; Pinnovation. Without novel provider-focused strategies, we may relinquish passively the requisite skills for not only our patients but also for future generations of obstetricians. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    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 Methods: A prospective cross-sectional study was ...

  6. OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES IN REFERRED CASES

    OpenAIRE

    Prameela; Asha; Prajwal

    2015-01-01

    INTRODUCTION: Instrumental vaginal deliveries are important procedures. Performed in indicated cases and attending to the well laid criterias will reduce the fetal and maternal morbidity. These assisted instrumental vaginal deliveries help in reducing the caesarean sec tion rate. AIMS AND OBJECTIVES: To determine the incidence and indications of instrumental vaginal deliveries. To know the maternal and fetal outcome in ventouse (vaccum assisted vaginal delivery) and...

  7. Stereophotogrammetry of the perineum during vaginal delivery.

    Science.gov (United States)

    Zemčík, Robert; Karbanova, Jaroslava; Kalis, Vladimir; Lobovský, Libor; Jansová, Magdalena; Rusavy, Zdenek

    2012-10-01

    To analyze deformation of the perineum during normal vaginal delivery in order to identify clinical steps that might be beneficial when executing manual perineal protection. The present prospective study at Charles University Hospital, Pilsen, Czech Republic, enrolled 10 primiparous women at term undergoing non-instrumental vaginal delivery assisted by the same obstetrician between September 2009 and September 2010. A modified hands-poised technique performed concurrently with stereophotogrammetry was used to analyze and quantify perineal deformation and strain at the final stage of delivery. The highest tissue strain (mean, 177%; 95% confidence interval [CI], 106.3-248.5) was in a transverse direction and occurred at the level of the fourchette (i.e. 1cm was transversely stretched and deformed to 2.77 cm during the final stage of vaginal delivery). This strain was more than 4 times higher than the maximum anteroposterior strain (mean, 43%; 95% CI, 28.6-57.4). On the basis of these stereophotogrammetry data, a technique of perineal protection executed by fingers of the posterior (right) hand can be proposed. Further experimental and clinical studies are needed to evaluate whether this technique might assist in reducing obstetric perineal trauma. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Mode of delivery of twin gestation with very low birthweight: is vaginal delivery safe?

    Science.gov (United States)

    Barzilay, Eran; Mazaki-Tovi, Shali; Amikam, Uri; de Castro, Hila; Haas, Jigal; Mazkereth, Ram; Sivan, Eyal; Schiff, Eyal; Yinon, Yoav

    2015-08-01

    The purpose of this study was to determine whether planned vaginal delivery is associated with increased risk of perinatal death and morbidity in twin pregnancies that are complicated by a very low birthweight of the second twin. We conducted a retrospective cohort study of twin pregnancies in which the second twin's birthweight was ≤1500 g. One hundred ninety-three twin gestations met the study criteria; patients were classified into 2 groups according to the planned mode of delivery: (1) cesarean delivery (n = 142) and (2) vaginal delivery (n = 51). In the vaginal delivery group, 21 pairs were in cephalic-cephalic presentation at the time of delivery; 28 pairs were cephalic-noncephalic, and 2 pairs were noncephalic-noncephalic. Composite adverse neonatal outcome was defined as the presence of neonatal death, respiratory distress syndrome, sepsis, necrotizing enterocolitis, or intraventricular hemorrhage grade 3-4. Trial of vaginal delivery was successful for both twins in 90.5% of cephalic-cephalic twins and 96.4% in cephalic-noncephalic twins. The rate of intraventricular hemorrhage was significantly higher in the vaginal delivery group (29.4% vs 8.5%, respectively; P = .013; adjusted odds ratio [OR], 3.65; 95% confidence interval [CI], 1.32-10.1). The increased risk of intraventricular hemorrhage in the vaginal delivery groups was evident in both twin A (17.6% vs 7.0%; P = .029) and twin B (15.7% vs 4.9%; P = .014); however, these differences were not significant after adjustment for possible confounders (twin A: adjusted OR, 1.79; 95% CI, 0.58-5.55; twin B: adjusted OR, 2.13; 95% CI, 0.63-7.25). In addition, subgroup analysis revealed that both cephalic-cephalic and cephalic-noncephalic twins who were delivered vaginally had increased risk for intraventricular hemorrhage. There were no significant differences between the cesarean and vaginal delivery groups in the rates of Apgar score <7 at 5 minutes, arterial cord pH <7.1, composite adverse neonatal outcome

  9. 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.

  10. 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 ...

  11. [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, psuccess in patients with a previous cesarean delivery.

  12. Vaginal delivery after previous caesarean section for failure of second stage of labour.

    Science.gov (United States)

    Jongen, V H; Halfwerk, M G; Brouwer, W K

    1998-10-01

    To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery. Retrospective follow up study. Medical Centre Leeuwarden, The Netherlands. All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 19861998. Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour. Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour. In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.

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

    Science.gov (United States)

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

    2017-09-01

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

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

    African Journals Online (AJOL)

    Background : Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings Study design : Labor records on operative vaginal ...

  15. 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 ...

  16. 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

  17. 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.

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

    African Journals Online (AJOL)

    O'SHEHU

    Instrumental vaginal delivery - an assessment of use in a tertiary care centre. Constance E SHEHU. Joel C OMEMBELEDE. Dept of Obstetrics &. Gynaecology, Usmanu. Danfodiyo, University. Teaching Hospital Sokoto. NIGERIA. Author for Correspondence. Constance E SHEHU. Dept of Obstetrics &. Gynaecology, Usmanu.

  19. Is a Vaginal Birth Possible After a Cesarean Delivery?

    Science.gov (United States)

    ... Information Find a Study Resources and Publications Is a vaginal birth possible after a cesarean delivery? Skip sharing on social media links ... delivery necessary and what are the risks? ​​ Related A-Z Topics High-Risk Pregnancy Labor and Delivery ...

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

    African Journals Online (AJOL)

    Results: Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; ...

  1. 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

  2. Twin pregnancy outcomes after increasing rate of vaginal twin delivery: retrospective cohort study in a Hong Kong regional obstetric unit.

    Science.gov (United States)

    Tang, Hiu Tung; Liu, Ah Lai; Chan, Sum Yee; Lau, Chin Ho; Yung, Wai Kuen; Lau, Wai Lam; Leung, Wing Cheong

    2016-01-01

    To determine any change in adverse neonatal/maternal outcomes after increasing the rate of vaginal twin delivery by comparing vaginal twin delivery and caesarean delivery with our previous cohort study. In a retrospective cohort study, all twins booked at a Hong Kong regional obstetrics unit were evaluated during a 3-year period from 1 April 2009 to 31 March 2012. Out of the 269 sets of twins who eventually delivered in our unit, 68 (25.3%) of them were delivered vaginally, compared to 15.8% in our previous cohort study (p = 0.02). For those who were suitable for vaginal delivery, significantly more women attempted vaginal delivery: 93/133 (69.9%) versus 47/100 (47%) (p = 0.0005). The success rate for vaginal delivery and rate of requiring caesarean delivery for the 2nd twin were similar between these two periods. There were significantly more 2nd twins with cord blood pH delivery. Otherwise, there was no significant difference between other neonatal/maternal morbidities. With proper counseling, significantly more women who were suitable for vaginal twin delivery would opt to do so. There was no significant increase in neonatal/maternal morbidities despite the increased rate of vaginal twin delivery.

  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. 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

  5. Operative vaginal deliveries in Zaria, Nigeria

    African Journals Online (AJOL)

    2009-10-05

    Oct 5, 2009 ... Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy .... suction pump was used for vacuum extraction. The subjects reviewed consisted of all .... for their application, more liberal use of caesarean deliveries, lack of skills, ...

  6. 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.

  7. Bakri balloon in vaginal-perineal hematomas complicating vaginal delivery: a new therapeutic approach.

    Science.gov (United States)

    Gizzo, Salvatore; Saccardi, Carlo; Patrelli, Tito Silvio; Di Gangi, Stefania; D'Antona, Donato; Battista Nardelli, Giovanni

    2013-04-01

    The study aimed to evaluate the effectiveness of Bakri balloon as a hemostatic device in severe postpartum hemorrhage due to complicated vaginal-perineal hematoma not responsive to standard surgical treatments. The article discusses an effective and minimally invasive technique for resolving a case of massive vaginal-perineal bleeding after vaginal delivery complicated by ischiorectal fossa hematoma. A 36-year-old primipara white woman, 41 weeks 1 day pregnant, was admitted to our unit for beginning of labor. She experienced a precipitous delivery of a healthy male baby (3.72 kg, 51 cm in length), and spontaneous complete afterbirth of placenta and membranes. The intervention involved positioning of an hemostatic Bakri balloon device in the vagina, to compress the vaginal wall, ensuring that the draining apex was well positioned into the uterine cervix. The patient was discharged after having a puerperal course without further complications. Vaginal hemostatic Bakri balloon device shows hemostatic efficacy immediately assessable, is promptly removable, not interfering with subsequent surgical or radiological procedures, does not increase the risk of infections as other compressive procedures, allows flow of lochia, does not cause pain or discomfort in women, and permits adjustable compression when a drainage is placed during surgery. Despite the high cost, it does not show disadvantages.

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

    African Journals Online (AJOL)

    The complications of prolonged and obstructed labor cause 4-13% of all maternal deaths in developing countries. This results other problems of women like obstetric fistula, Ruptured uterus and obstetric palsy. The use of vacuum assisted vaginal deliveries can reduce these mortalities as well as have impact on the ...

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

    African Journals Online (AJOL)

    Resident trainees (93.4%) applied the instruments and the most common maternal complication was post-partum haemorrhage (11.1%) followed by perineal laceration (5.9%). Few neonates (4.6%)suffered complications. Conclusion: The incidence of instrumental vaginal delivery is low. There is an obvious shift from the ...

  10. 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

  11. 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

  12. Comparison of Breast Crawl Between Infants Delivered by Vaginal Delivery and Cesarean Section.

    Science.gov (United States)

    Heidarzadeh, Mohammad; Hakimi, Sevil; Habibelahi, Abbas; Mohammadi, Marzieh; Shahrak, Shakiba Pourasad

    2016-05-12

    Exclusive breastfeeding is the single most cost-effective intervention to reduce infant mortality. Breast crawl (BC) is deemed a natural way for the baby to behave immediately after delivery. BC is the method that may help initiation of breastfeeding in the most natural way. The aim of this study is to compare successful BC between neonates born through vaginal delivery and those born through cesarean section (CS) and factors associated with a positive outcome. Participants were mothers who delivered their babies during the period of October 2012 to December 2013 in Alzahra Hospital in Tabriz, through cesarean or vaginal delivery. Infants were placed prone on their mothers' abdomen after delivery. Data show that babies delivered through vaginal delivery had significantly more success in BC than babies born through the cesarean delivery (88.01% versus 11.21%). Moreover, babies in the CS group used significantly less time to achieve BC (45 versus 28 minutes). There is a remarkable difference in completion and length of time used to achieve BC between infants with regard to the delivery mode. Encouraging BC in all dyads, especially in cesarean births, may unduly delay the infant's first breastfeed.

  13. After vaginal delivery - in the hospital

    Science.gov (United States)

    ... to be transferred to the neonatal intensive care unit for extra care. However, most new babies stay in the room with their mother. In the first hours after delivery, hold your baby and attempt skin-to-skin ...

  14. [The risk factors for pelvic floor trauma following vaginal delivery].

    Science.gov (United States)

    Michalec, I; Tomanová, M; Navrátilová, M; Šimetka, O; Procházka, M

    2015-01-01

    The evaluation of the risk and protective factors for pelvic floor trauma in relation to vaginal delivery. Review. Department of Obstetrics and Gynecology, University Hospital of Ostrava. The aim was to provide a comprehensive survey of studies focused on risk factors for pelvic floor trauma following vaginal delivery; and to constitute the relationship between the risk and protective factors and levator ani injury. To state the prognosis of the pelvic floor injury before a child delivery is difficult and almost impossible, but it has been assumed that an operative vaginal delivery (obstetrical forceps) represents a significant risk factor for avulsion. The change in obstetric practice can prevent the injury and thus to reduce an adverse effect. Pregnancy and the methods of childbirth are important factors with an impact on pelvic floor injury, potentially contributing to the development of pelvic organ prolapse, and stress and anal incontinence. The recognition of the factors, the proper training of medical staff in the management of labour, and subsequently the proper treatment of perineal tears should prevent pelvic floor injury.

  15. Rupture of an ovarian artery aneurysm following normal vaginal delivery

    Directory of Open Access Journals (Sweden)

    F van Schouwenburg

    2011-06-01

    Full Text Available A 30 year-old woman presented at the casualty department 12 days after having given birth to a healthy baby via normal vaginal delivery. She complained of increasing pain and a mass in her right flank. There were no complaints of nausea, vomiting, dysuria or abnormal bowel habits. On examination, the patient was acutely distressed, in severe pain and was anaemic with an Hb of 5 g/dl. Her blood pressure was 151/71 mmHg and her pulse rate 125/minute. Physical examination revealed a severely distended abdomen with features of peritonitis. An abdominal ultrasound revealed a large abdominal fluid collection and a CT scan was therefore requested. A contrast-enhanced CT scan demonstrated a large homogenous retroperitoneal fluid collection in the right flank, with a 25mm rounded, intensely enhancing focus located close to the inferior border of the collection. The collection displaced the bowel to the left and inferiorly, and the liver, superiorly. The differential diagnosis included a ruptured ovarian artery aneurysm. As soon as the patient was stable, she was taken for ovarian artery embolization that was successfully accomplished. The patient recovered well in the ward.

  16. Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?

    Science.gov (United States)

    Hiersch, Liran; Borovich, Adi; Gabbay-Benziv, Rinat; Maimon-Cohen, Moria; Aviram, Amir; Yogev, Yariv; Ashwal, Eran

    2017-02-01

    Previous studies have suggested that a variety of maternal and obstetrical characteristics may predict successful prostaglandin E2 (PGE2) cervical ripening. However, in most studies women were administered vaginal tablets or gel so scarce is known regarding potential predictors in women administrated slow-release vaginal inserts. We aimed to characterize the response of cervical ripening for labor induction using slow-release PGE2 vaginal insert and to identify predictors for success. A retrospective cohort study in a single center (2013-2015). The association between maternal characteristics at admission and cervical ripening success/failure were explored. Cervical ripening failure was defined as a Bishop's score women met inclusion criteria, of them, 774 (78.56%) succeeded and 212 (21.5%) failed cervical ripening. Cervical ripening success was associated with (OR, 95% CI): nulliparity (0.42, 0.22-0.81, p = 0.009, i.e., nulliparity was negatively associated with successful ripening), gestational age (GA) at delivery (1.29, 1.02-1.61, p success. A prediction model which included the abovementioned characteristics had an AUC of 0.792 (95% CI 0.743-0.840). Overall, basic parameters, such as parity, cervical dilatation at admission and gestational age can predict successful cervical ripening PGE2 vaginal inserts.

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

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2014-07-01

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

  18. 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.

  19. 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.

  20. Successful treatment of vaginal malakoplakia in a young cat

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    Ryan P Cattin

    2016-10-01

    Full Text Available Case summary A 3-year-old, female, spayed, domestic shorthair cat presented for dysuria and haematuria, unresponsive to antibiotic treatment. A small, fleshy, erythematous mass protruded from the vaginal vault. Ultrasound identified a vaginal mass effect with mixed echogenicity measuring in excess of 3 cm. Vaginoscopy confirmed an extensive, fleshy, irregular mass that was characterised histologically as pyogranulomatous vaginitis, with periodic acid–Schiff-positive macrophages containing gram-negative bacteria. Fluorescence in situ hybridisation analysis demonstrated invasive intracellular Escherichia coli. Vaginal malakoplakia was diagnosed. Tissue culture and antimicrobial susceptibility of E coli was used to guide treatment. A 6 week course of enrofloxacin 5 mg/kg q24h resulted in complete resolution of the mass and clinical signs. Relevance and novel information Malakoplakia is a rare chronic inflammatory condition that has been previously reported in the bladder of two cats. The pathogenesis of malakoplakia is thought to involve ineffective killing of bacteria (eg. E coli , similar to granulomatous colitis in Boxers and French Bulldogs. The literature on malakoplakia in cats is sparse. This is the first reported feline case with vaginal involvement, intracellular E coli and successful treatment with a fluoroquinolone. Malakoplakia is an important, non-neoplastic differential diagnosis when a mass is identified in the urogenital system of a young cat.

  1. 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.

  2. Multicompartmental Pharmacokinetic Model of Tenofovir Delivery by a Vaginal Gel

    Science.gov (United States)

    Gao, Yajing; Katz, David F.

    2013-01-01

    Background Trials of a vaginal Tenofovir gel for pre-exposure prophylaxis (PrEP) for HIV have given conflicting results. Knowledge of concentrations of Tenofovir and its active form Tenofovir diphosphate, at putative sites of anti-HIV functioning, is central to understanding trial outcomes and design of products and dosage regimens. Topical Tenofovir delivery to the vaginal environment is complex, multivariate and non-linear; determinants relate to drug, vehicle, dosage regimen, and environment. Experimental PK methods cannot yield mechanistic understanding of this process, and have uncontrolled variability in drug sampling. Mechanistic modeling of the process could help delineate its determinants, and be a tool in design and interpretation of products and trials. Methods and Findings We created a four-compartment mass transport model for Tenofovir delivery by a gel: gel, epithelium, stroma, blood. Transport was diffusion-driven in vaginal compartments; blood concentration was time-varying but homogeneous. Parameters for the model derived from in vitro and in vivo PK data, to which model predictions gave good agreement. Steep concentration gradients occurred in stroma ≤8 hours after gel release. Increasing epithelial thickness delayed initial TFV delivery to stroma and its decline: tmax increased but AUC at 24 hours was not significantly altered. At 24 and 48 hours, stromal concentrations were 6.3% and 0.2% of Cmax. Concentrations in simulated biopsies overestimated stromal concentrations, as much as ∼5X, depending upon time of sampling, biopsy thickness and epithelial thickness. Conclusions There was reasonably good agreement of model predictions with clinical PK data. Conversion of TFV to TFV-DP was not included, but PK data suggest a linear relationship between them. Thus contrasts predicted by this model can inform design of gels and dosage regimens in clinical trials, and interpretation of PK data. This mass transport based approach can be extended to TFV

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

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    Hassan Boskabadi

    2014-03-01

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

  4. 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

  5. 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

  6. A novel and multifunctional excipient for vaginal drug delivery

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    Mohd. Aamir Mirza

    2011-12-01

    Full Text Available The present study explores the pharmaceutical potential of a natural organic matter (fulvic acid for sustained release, acid buffering capacity and mucoadhesion in vaginal drug delivery. The antifungal drug, Itraconazole, was first converted into inclusion complexes with fulvic acid (1:1 & 1:2 molar ratio and then characterized by Differential Scanning Calorimetry (DSC, X-Ray Diffraction (XRD, Fourier Transform Infrared Spectroscopy (FT IR and Mass Spectroscopy. Results were also authenticated by conformational analysis. Solubility analysis of complexes yielded different thermodynamic parameters and explained the driving force for solubilisation when the pH was varied in an acidic range. MTT assays were also performed to assess the potential in vitro cell toxicity of the complexes in comparison to the neat drug. The complexes were then formulated into tablets and optimized for hardness, mucoadhesion and release profiles. The optimized tablets presented with satisfactory mucoadhesion, acid buffering and spreading ability. Moreover, the antifungal activity of the formulation was also increased due to improved aqueous solubility of the drug despite the larger size of the complex. The study also indicated the potential use of fulvic acid as a functional excipient in the preparation of a vaginal drug delivery system (VDDS.

  7. Vaginal Delivery under Epidural Analgesia in Pregnant Women with a Diagnosis of Moyamoya Disease.

    Science.gov (United States)

    Sato, Kimitoshi; Yamada, Masaru; Okutomi, Toshiyuki; Kato, Rie; Unno, Nobuya; Fujii, Kiyotaka; Kumabe, Toshihiro

    2015-05-01

    Moyamoya disease more commonly occurs in young people and women, so patients with this disease may experience pregnancy and delivery. Cesarean section (CS) is often chosen as the mode of delivery for these patients in Japan. No appropriate mode of delivery has yet been established for pregnant women with moyamoya disease in terms of stroke prevention. We have used vaginal delivery under epidural analgesia (EA) in such patients unless CS has been indicated for the maternal or fetal reasons. This study retrospectively analyzed our patients with moyamoya disease who gave birth to confirm the safety of vaginal delivery under EA. Twelve consecutive patients diagnosed with moyamoya disease had 14 deliveries at our hospital between September 2004 and January 2013. The incidences of intrapartum stroke were compared between cases of vaginal delivery under EA and CS cases. Ten vaginal deliveries under EA and 4 elective CSs were performed. No intrapartum stroke was observed during either vaginal delivery under EA or CS. Among the patients who underwent vaginal delivery under EA, 1 parturient who experienced 2 deliveries suffered transient ischemic attack during both postpartum periods. All 14 infants were healthy without sequelae. Vaginal delivery under EA is an option for patients with moyamoya disease, provided that close cooperation with neurosurgeons, obstetricians, and anesthesiologists is assured. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. 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 χ2 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/m2 (adjusted odds ratio, 1.53, 95% confidence interval, 1.03-2.27 for a body mass index increase of 2 kg/m2 to women who gained

  9. Anal endosonographic findings in women after vaginal delivery

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-04-15

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

  10. Vaginal ring delivery of selective progesterone receptor modulators for contraception

    Science.gov (United States)

    Jensen, Jeffrey T.

    2013-01-01

    Vaginal ring delivery of selective progesterone receptor modulators (SPRMs) are under development to address limitations of current hormonal methods that affect use and effectiveness. This method would be appropriate for use in women with contraindications to, or preferences to avoid, estrogens. A contraceptive vaginal ring (CVR) also eliminates the need for daily dosing, and therefore might improve the effectiveness of contraception. The principle contraceptive effect of SPRMs is the suppression of ovulation. One limiting factor of chronic SPRM administration is the development of benign endometrial thickening characterized as PRM-associated endometrial changes. Ulipristal acetate is approved for use as an emergency contraceptive pill, but no SPRM is approved for regular contraception. The Population Council is developing an ulipristal acetate CVR for regular contraception. The CVR studied is of a matrix design composed of micronized UPA mixed in a silicone rubber matrix The target product is a ring designed for continuous use over 3 months delivering near steady-state drug levels that will suppress ovulation. Results from Phase 1–2 studies demonstrate that suppression of ovulation occurs with UPA levels above 6–7 ng/mL. PMID:23040126

  11. Failed manual removal of the placenta after vaginal delivery.

    Science.gov (United States)

    Bjurström, Johanna; Collins, Sally; Langhoff-Roos, Jens; Sundberg, Karin; Jørgensen, Annemette; Duvekot, Johannes J; Groenbeck, Lene

    2018-02-01

    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. Members of the European Working group on Abnormally Invasive Placenta (EW-AIP) were invited to report all recent cases of retained placenta that were not antenatally suspected to be abnormally adherent or invasive, but could not be removed manually despite several attempts. The six cases from Denmark, The Netherlands 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 a histopathological diagnosis of increta. Based on these cases we present a flow chart to aid clinical management for future cases. 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 and abnormally adherent placenta. Clinicians need to be aware of the options available to them when confronted by the rare case of a retained placenta that cannot be removed manually in a hemodynamically stable patient.

  12. Clinician attendance and delivery practices at hospital-based vaginal deliveries in Western Kenya.

    Science.gov (United States)

    Patel, Suha J; Bogaert, Kelly; Gachuno, Onesmus W; Kibore, Minnie W; Unger, Jennifer; Walker, Dilys M

    2016-05-01

    To characterize delivery practices and factors associated with respectful, evidence-based care at a referral hospital in Western Kenya. An exploratory observational study used a standardized birth-observation form to record information on patient characteristics and healthcare practitioner behaviors during uncomplicated vaginal deliveries between June 30, 2014 and July 17, 2014. All deliveries were monitored for whether healthcare staff performed six specific evidence-based practices (three maternal and three neonatal practices). In total, 75 vaginal deliveries were observed. In 48 (64%) deliveries, nursing students were the only practitioners present. The mean number of evidence-based practices performed at each delivery was 3.58. The number of evidence-based practices performed by junior practitioners was higher when a nurse educator was assessing their performance (4.47 vs 3.36, Prespectful-care scores were recorded when delivery teams comprised three or more practitioners (1.38; 95% confidence interval 0.93-1.84 vs 2.74; 95% confidence interval 2.16-3.31, P=0.002). The present study found low rates of evidence-based practice and respectful maternity care; this could serve as a deterrent for women seeking care at the study facility. These findings emphasize the need for a comprehensive approach in increasing the quality of patient care to improve maternal and newborn health outcomes. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Urinary incontinence after vaginal delivery or cesarean section

    Directory of Open Access Journals (Sweden)

    João Bosco Ramos Borges

    2010-06-01

    Full Text Available Objective: To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil, and the relation between the type of incontinence and the obstetric history of these women. Methods: A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag. Statistical analysis was carried out using the χ2 test and odds ratio (95%CI. Results: Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%, followed by mixed urinary incontinence (35% and urge incontinence (15%. Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. Conclusions: One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

  14. Enhanced vaginal drug delivery through the use of hypotonic formulations that induce fluid uptake.

    Science.gov (United States)

    Ensign, Laura M; Hoen, Timothy E; Maisel, Katharina; Cone, Richard A; Hanes, Justin S

    2013-09-01

    Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that administration of hypotonic solutions would induce fluid uptake that could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We found that hypotonic formulations markedly increased the rate at which small molecule drugs and mucoinert nanoparticles (mucus-penetrating particles, or MPP), but not conventional mucoadhesive nanoparticles (CP), reached the vaginal epithelial surface in vivo in mice. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that drugs or MPP in isotonic formulations failed to reach efficiently. However, hypotonic formulations caused unencapsulated "free" drugs to be drawn through the epithelium, reducing vaginal retention. In contrast, hypotonic formulations caused MPP to accumulate rapidly and uniformly on vaginal surfaces, ideally positioned for localized sustained drug delivery. Using a mouse model of vaginal genital herpes (HSV-2) infection, we found that hypotonic delivery of free drug led to improved immediate protection, but diminished longer-term protection. In contrast, as we previously demonstrated, hypotonic delivery of drug via MPP led to better long-term retention and protection in the vagina. Importantly, we demonstrate that slightly hypotonic formulations provided rapid and uniform delivery of MPP to the entire vaginal surface, thus enabling formulations with minimal risk of epithelial toxicity. Hypotonic formulations for vaginal drug delivery via MPP may significantly improve prevention and treatment of reproductive tract diseases and disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. VAGINAL DELIVERY OF GIANT FETUS – SHOULDER DYSTOCIA

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    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.

  16. WITHDRAWN: Soft versus rigid vacuum extractor cups for assisted vaginal delivery.

    Science.gov (United States)

    Johanson, Richard; Menon, Vijay

    2010-11-10

    The original cups used for vacuum extraction delivery of the fetus were rigid metal cups. Subsequently, soft cups of flexible materials such as silicone rubber or plastic were introduced. Soft cups are thought to have a poorer success rate than metal cups. However they are also thought to be less likely to be associated with scalp trauma and less likely to injure the mother. The objective of this review was to assess the effects of soft versus rigid vacuum extractor cups on perineal injury, fetal scalp injury and success rate. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: February 2000. Acceptably controlled comparisons of soft versus rigid vacuum extractor cups. Two reviewers assessed trial quality and extracted data. Study authors were contacted for additional information. Nine trials involving 1375 women were included. The trials were of average quality. Soft cups are significantly more likely to fail to achieve vaginal delivery (odds ratio 1.65, 95% confidence interval 1.19 to 2.29). However, they were associated with less scalp injury (odds ratio 0.45, 95% confidence interval 0.15 to 0.60). There was no difference between the two groups in terms of maternal injury. Metal cups appear to be more suitable for 'occipito-posterior', transverse and difficult 'occipito-anterior' position deliveries. The soft cups seem to be appropriate for straightforward deliveries.

  17. 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.

  18. Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases

    Directory of Open Access Journals (Sweden)

    Natalie Kew

    2017-01-01

    Full Text Available Introduction. Our study aims to investigate and evaluate (1 rates of success of ECV for breech presentation at term at the Royal Women’s Hospital in comparison to international standards; (2 mode of delivery following ECV; (3 factors influencing success rates of ECV at the Royal Women’s Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women’s Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women’s Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women’s Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (P<0.05. The only predictor of cephalic vaginal delivery following ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women’s Hospital, Melbourne, is in line with global standards.

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

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    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.

  20. Decision-making for vaginal delivery in the North of Iran: A focused ethnography

    Science.gov (United States)

    Zakerihamidi, Maryam; Roudsari, Robab Latifnejad; Khoei, Effat Merghati; Kazemnejad, Anoshirvan

    2014-01-01

    Background: Many factors have been mentioned to influence decision-making for different kinds of delivery. Decision-making for vaginal delivery is under the influence of culture, perceptions, beliefs, values, attitudes, personalities, and knowledge. The current study aims at exploring the determinants of decision-making for vaginal delivery in the north of Iran from women's perspective. Materials and Methods: A focused ethnographic method with purposeful sampling method has been used. Semi-structured interviews and observation were conducted with 12 pregnant women and 10 delivered women, 7 midwives, 7 gynecologists, and 9 non-pregnant women in Tonekabon clinics. Interviews and observations were recorded and transcribed. The accuracy of the extracted codes and themes was confirmed by restoration of the arranged and coded texts to the participants (member check) and by an expert person from outside the study context. Data were analyzed using thematic analysis and MAXqda software. Results: Five themes were extracted from the data: Economic influencing factors, Cultural values and norms related to normal childbirth, Positive attitudes towards vaginal delivery, Role of important others, and Facilitators of natural birth. Several sub-themes and sub-sub themes also emerged from the data (e.g. safe delivery, forming maternal feelings, painful but tolerable, maternal role facilitator, inexpensive delivery, a process with good outcome and less complications, relief messenger). Conclusions: Giving enough information about vaginal delivery for pregnant women and their family members, training pregnant women to increase tolerance during labor pain, and modifying expenses can increase economic affordability, positive cultural norms and attitudes about vaginal delivery, proper social support, use of normal delivery facilitators, and direct them toward vaginal delivery. PMID:25949250

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

    Science.gov (United States)

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

    2017-04-01

    It is not well-characterized whether attempting operative vaginal delivery is a safe and effective alternative among women who undergo a trial of labor after cesarean delivery who are unable to complete second-stage labor with a spontaneous vaginal delivery. The purpose of this study was to compare maternal and neonatal outcomes that are associated with attempted operative vaginal delivery with those that are associated with second-stage repeat cesarean delivery without an operative vaginal delivery attempt among women who undergo a trial of labor after cesarean delivery. This is a retrospective secondary analysis of data from Cesarean Registry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Women who underwent a trial of labor after cesarean delivery who were at least 36 weeks gestation were eligible for analysis if they had a live, singleton, nonanomalous gestation in cephalic presentation and reached second-stage labor (defined as complete cervical dilation) with a fetal station of at least +2. The data for women who had an attempted operative vaginal delivery with either forceps or vacuum were compared with those of women who underwent second stage repeat cesarean delivery without operative vaginal delivery attempt. Outcomes of maternal and neonatal complications were compared between groups with bivariable and multivariable analyses. Of 1230 women whose cases were eligible for analysis, 945 women (76.8%) had an attempted operative vaginal delivery. Of those who underwent attempted operative vaginal delivery, 914 women (96.7%) achieved a vaginal delivery. Women who attempted operative vaginal delivery had a lower mean body mass index (30.4±6.0 vs 31.8±5.9 kg/m2; P=.001) and gestational age (39.5±1.3 vs 39.8±1.2 weeks; P=.012) at delivery and were more likely to be of non-Hispanic black race (30.0% vs 22.1%; P=.002), to have had a previous vaginal delivery (34.9% vs 20

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

    Science.gov (United States)

    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

    2013-10-03

    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 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison. A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P=0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P=0.49). In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).

  3. Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery.

    Science.gov (United States)

    Muraca, G M; Skoll, A; Lisonkova, S; Sabr, Y; Brant, R; Cundiff, G W; Joseph, K S

    2017-07-10

    To quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery. Population-based, retrospective cohort study. British Columbia, Canada. Term, singleton deliveries (2004-2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress). Multinomial propensity scores and mulitvariable log-binomial regression models were used to estimate adjusted rate ratios (ARR) and 95% confidence intervals (95% CI). Composite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications). Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46-3.07; vacuum ARR 2.71, 95% CI 1.49-3.15; sequential ARR 4.68, 95% CI 3.33-6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05-2.36; vacuum ARR 2.29, 95% CI 1.57-3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04-1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54-3.56). Attempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument. Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery. © 2017 The Authors. BJOG An International Journal of

  4. 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

  5. Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section.

    Science.gov (United States)

    Abdelazim, Ibrahim A; Elbiaa, Assem A M; Al-Kadi, Mohamed; Yehia, Amr H; Sami Nusair, Bassam M; Faza, Mohannad Abu

    2014-01-01

    To detect the maternal and obstetrical factors associated with successful trial of vaginal birth among women with a previous cesarean delivery. A total of 122 women who were eligible for a trial of labor after cesarean section (TOLAC) according to departmental protocol were included in this comparative prospective study. After informed consent, the women included in this study were subjected to a thorough history to detect maternal and obstetric characteristics and a standard examination to estimate fetal weight, engagement of the fetal head, intra-partum features of fetal membranes, and cervical dilatation. After delivery, data on duration of labor, labor augmentation, mode of delivery, birth outcome, and neonatal intensive care (NICU) admission were recorded and analyzed. Trial of labor after cesarean section was successful in 72.13% and was unsuccessful in 27.87%. Body mass index (BMI) was significantly lower in the successful TOLAC group compared to the unsuccessful group (23.8±0.03 versus 26.2±0.02 kg/m(2)), and the number of women with BMI >25 kg/m(2) was significantly high in the unsuccessful group; also, mean gestational age was significantly lower in the successful TOLAC group compared to the unsuccessful group (37.5±0.04 versus 38.5±0.03 weeks), and the number of women admitted in labor with gestation ≥40 weeks was significantly high in the unsuccessful group. The number of women admitted with >2/5 of fetal head palpable abdominally and fetal head station ≥-2 was significantly high in the unsuccessful TOLAC group. In carefully selected cases, TOLAC is safe and often successful. Presence of BMI >25 kg/m(2), gestation ≥40 weeks, and vertex station ≥-2 were risk factors for unsuccessful TOLAC.

  6. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis.

    Science.gov (United States)

    de Hundt, Marcella; Velzel, Joost; de Groot, Christianne J; Mol, Ben W; Kok, Marjolein

    2014-06-01

    To assess the mode of delivery in women after a successful external cephalic version by performing a systematic review and meta-analysis. We searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for studies reporting on the mode of delivery in women after successful external cephalic version at term and women with a spontaneous cephalic-presenting fetus. Two reviewers independently selected studies, extracted data, and assessed study quality. The association between mode of delivery and successful external cephalic version was expressed as a common odds ratio with a 95% confidence interval (CI). We identified three cohort studies and eight case-control studies, reporting on 46,641 women. The average cesarean delivery rate for women with a successful external cephalic version was 21%. Women after successful external cephalic version were at increased risk for cesarean delivery for dystocia (odds ratio [OR] 2.2, 95% CI 1.6-3.0), cesarean delivery for fetal distress (OR 2.2, 95% CI 1.6-2.9), and instrumental vaginal delivery (OR 1.4, 95% CI 1.1-1.7). Women who have had a successful external cephalic version for breech presentation are at increased risk for cesarean delivery and instrumental vaginal delivery as compared with women with a spontaneous cephalic presentation. Nevertheless, with a number needed to treat of three, external cephalic version still remains a very efficient procedure to prevent a cesarean delivery.

  7. Randomized trial of cesarean vs 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; Ruiz, Julio C; Parks, Virginia L; Kuehl, Thomas J; Larsen, Wilma I

    2015-11-01

    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 humanlike pattern of spontaneous age- and parity-associated pelvic organ prolapse. The potential to prevent or diminish these changes with scheduled cesarean delivery (CD) has not been evaluated. In a randomized, controlled trial, we compared female squirrel monkeys undergoing spontaneous vaginal delivery with those undergoing scheduled primary CD for pelvic floor muscle volumes, muscle contrast changes, and dynamic effects on bladder neck position. Levator ani, obturator internus, and coccygeus (COC) 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 postpartum. The position of bladder neck relative to bony reference line also was assessed with abdominal pressure using dynamic magnetic resonance imaging. Baseline measurements of 10 females randomly assigned to scheduled primary CD 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 < .05) in the observation immediately after pregnancy. The COC muscles increased (P < .05) immediately after delivery for females in the spontaneous vaginal delivery group, but not for females in the scheduled CD group. Position of the bladder neck descended (P < .05) by 3 months postpartum in both groups. Scheduled CD diminishes changes in COC muscle volume and contrast reported to be associated with spontaneous vaginal delivery in squirrel monkeys. However, 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. Copyright © 2015 The Authors. Published by Elsevier Inc

  8. Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study.

    Science.gov (United States)

    Jallad, Karl; Steele, Sarah E; Barber, Matthew D

    2016-01-01

    The aim of the study was to estimate risk factors associated with breakdown of perineal laceration repair after vaginal delivery. This is a case-control study of women who sustained a breakdown of perineal laceration repair after vaginal delivery between 2002 and 2015. Cases were patients who sustained a perineal wound breakdown after vaginal delivery and repair of a second-, third-, or fourth-degree laceration. Controls, matched 1:1, were patients who either sustained a second-, third-, or fourth-degree perineal laceration and repair without evidence of breakdown and who delivered on the same day and institution as the case. A total of 104,301 deliveries were assessed for breakdown of perineal laceration. One hundred forty-four met the inclusion criteria. These were matched with 144 controls. Logistic regression analysis demonstrated that smoking is associated with increased risk for breakdown of perineal laceration (adjusted odds ratio [adj. OR], 6.4; 95% confidence interval [CI], 1.2-38.5), whereas a previous vaginal delivery is protective (adj. OR, 0.14; 95% CI, 0.05-0.3). In addition, third- or fourth-degree laceration (adj. OR, 4.0; 95% CI, 1.1-15.7), presence of episiotomy at time of delivery (adj. OR, 11.1; 95% CI, 2.9-48.8), operative delivery (adj. OR, 3.4; 95% CI, 1.2-10.3), midwife performing the laceration repair (adj. OR, 4.7; 95% CI, 1.5-15.8), and use of chromic suture (adj. OR, 3.9; 95% CI, 1.6-9.8) were independent risk factors for breakdown of perineal laceration. Smoking, nulliparity, episiotomy, operative delivery, third- or fourth-degree laceration, repair by a midwife, and use of chromic suture are independent risk factors for breakdown of perineal laceration repair after vaginal delivery.

  9. 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.

  10. Long QT syndrome in pregnancy: are vaginal delivery and use of oxytocin permitted? A case report.

    Science.gov (United States)

    Martillotti, Gabriella; Talajic, Mario; Rey, Eveline; Leduc, Line

    2012-11-01

    Patients with congenital long QT syndrome (LQTS) are at increased risk of ventricular arrhythmia, particularly during labour and the puerperium. A 28-year-old primigravida with known LQTS underwent induction of labour at 41 weeks' gestation using a Foley catheter balloon and IV oxytocin. Vaginal delivery with passive second stage and outlet forceps was undertaken with early epidural analgesia to prevent tachycardia and psychological stress. The patient gave birth to a healthy female, and had an uncomplicated postpartum period under continuous electrocardiogram monitoring. Vaginal delivery with use of oxytocin for the induction of labour can be safely undertaken in patients with LQTS.

  11. Obstetrical trauma to the genital tract following vaginal delivery

    National Research Council Canada - National Science Library

    Khaskheli, Meharunnissa; Baloch, Shahla; Baloch, Aneela Sheeba

    2012-01-01

    .... All women who sustained genital tract trauma during delivery at the study centre and those referred from periphery with the same condition within 40 days of delivery were enrolled in the study...

  12. A rare complication of vaginal delivery: labial adhesion.

    Science.gov (United States)

    Caglayan, E K

    2014-01-01

    Labial adhesions are mostly seen in teenagers and menopausal women, however they may be encountered rarely in the postpartum period. Surgical division under local anesthesia is more effective than topical estrogen. In this article a young women at the age of 23 years, who gave normal vaginal birth 12 months prior and who had difficulty in coitus because of labial sinechia is reported. During physical examination, an adhesion between right and left labia minora approximately three cm in length was observed. The adhesion was seperated under local anesthesia and the patient was discharged from the hospital on the same day. On postoperative seventh day control, she had neither complaints nor complications. Labial adhesions are rarely encountered after normal vaginal childbirth. The most effective treatment of labial sinechia is surgical division under local anesthesia.

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

  14. Vaginal delivery in pregnancy with Moyamoya disease: experience at a single institute.

    Science.gov (United States)

    Tanaka, Hiroaki; Katsuragi, Shinji; Tanaka, Kayo; Miyoshi, Takekazu; Kamiya, Chizuko; Iwanaga, Naoko; Neki, Reiko; Takahashi, Jun C; Ikeda, Tomoaki; Yoshimatsu, Jun

    2015-04-01

    Cesarean section is commonly selected in pregnancy with Moyamoya disease. We consider vaginal delivery with epidural anesthesia a viable alternative in such cases. Mode of delivery and outcomes were examined in 27 pregnancies in 19 women with Moyamoya disease treated at the Department of Perinatology, National Cardiovascular Center, Japan, from 1983 to 2013. Of these 27 pregnancies, 20 were delivered vaginally with epidural anesthesia. The cerebral circulation, mode of delivery, maternal outcome (presence of symptoms due to Moyamoya disease intrapartum) and neonatal outcome (gestational week, birthweight, Apgar score at 5 min and pH of umbilical artery) were investigated. The cerebral circulation was judged to be good in all pregnancies. No symptoms due to Moyamoya disease intrapartum were seen in the vaginal delivery cases. Our findings indicate that vaginal delivery is viable in pregnancy with Moyamoya disease and that unnecessary cesarean section may be avoided. These findings are limited by the retrospective nature of the study. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  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. Caesarean or normal vaginal delivery: overview of physicians' self-preference and suggestion to patients.

    Science.gov (United States)

    Hantoushzadeh, Sedigheh; Rajabzadeh, Alireza; Saadati, Ali; Mahdanian, Abolfazl; Ashrafinia, Narges; Khazardoost, Soghra; Borna, Sedigheh; Maleki, Maryam; Shariat, Mamak

    2009-07-01

    Caesarean delivery in the absence of any medical indications has become a major issue of concern among the women's health professionals. The patients' choice of caesarean is influenced by several factors predominating by their physicians' suggestion. Our objective was to examine factors that may affect the physicians' responses to patients consulting the mode of delivery. Questionnaires were posted to 1,000 female obstetricians and gynaecologists practicing in Tehran in winter 2007. Questionnaires included demographic information of physicians and their history of pregnancy and delivery. Finally, they were asked their preferred mode of delivery and the mode they suggest when being consulted by parturient. From 1,000 physicians, 785 cases (78.5%) responded to the survey. The rate of responses in favour of suggesting normal vaginal delivery, Caesarean Section and painless vaginal delivery was 60.8, 25.6 and 13.6%, respectively. There was a correlation between the suggested and the preferred mode of delivery, it means that the physicians mostly suggested their self-preferred mode of delivery to their patients. Physicians normally suggest to their patients as the safe mode of delivery what they prefer for themselves. This preference and subsequent suggestion is influenced by different factors including their age, marital status, and previous modes of delivery. As conclusion, it is inferred that informing a physician to choose the right mode of delivery for herself leads to better suggestions to the patients.

  17. Vaginal delivery under caudal analgesia after caesarean section and other major uterine surgery.

    Science.gov (United States)

    Meehan, F P; Moolgaoker, A S; Stallworthy, J

    1972-06-24

    In the absence of a recurring indication for caesarean section vaginal delivery in subsequent pregnancy is a "trial of scar," with potentially serious implications for mother and baby. Labour under caudal analgesia was carefully supervised for 75 women with a surgically scarred uterus-due to lower segment section in 72, abdominal hysterotomy in one, and transcavity myomectomy in two. Every caesarean scar was assessed digitally during labour and every uterus was examined after delivery. Caudal analgesia provided a painless labour and delivery and made scar assessment easy. Controlled intravenous Syntocinon infusion was given to 25 patients. One scar dehiscence occurred early in labour and one in the second stage. Seventy mothers had 71 vaginal deliveries with one pair of twins and one breech. There was one stillbirth and no neonatal death. There were five repeat sections.

  18. 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

  19. 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

  20. 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.

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

    Science.gov (United States)

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

    2014-03-01

    [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 the vagina and the transducer was placed transversely on the right side of the body during the Valsalva maneuver. [Results] There were significant differences in the thickness of the transverses abdominis (TrA) between in all the groups rest and the Valsalva maneuver, and there were significant differences in the internus oblique (IO) in the nulliparous group. During the Valsalva maneuver, there were significant differences in the TrA between the nulliparous group and the vaginal delivery group, and there were significant differences in the IO between the nulliparous delivery group and the vaginal delivery group, and between the nulliparous group and the Cesarean section group. Delivery history changed vaginal pressure, and there were significant differences between the nulliparous group and the vaginal delivery group, and between the nulliparous group and the Cesarean delivery group. [Conclusion] Pregnancy and delivery method may affect pelvic floor and abdominal muscles during the Valsalva maneuver.

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

    Directory of Open Access Journals (Sweden)

    Toril Andersen

    2015-01-01

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

  3. Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery.

    Science.gov (United States)

    Fajar, Jonny Karunia; Andalas, Mohd; Harapan, Harapan

    2017-01-01

    The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery. A retrospective study was conducted at Dr. Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5 min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions. A total of 205 (3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52 cases) vaginal and 74% (153 cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1 min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476-16.870], P = 0.0001) and 5 min (OR 95% CI = 7.727 [1.416-42.175], P = 0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18-6.26, P = 0.0001). There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs.

  4. Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery

    Science.gov (United States)

    Fajar, Jonny Karunia; Andalas, Mohd; Harapan, Harapan

    2017-01-01

    Objective: The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery. Materials and Methods: A retrospective study was conducted at Dr. Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5 min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions. Results: A total of 205 (3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52 cases) vaginal and 74% (153 cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1 min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476–16.870], P = 0.0001) and 5 min (OR 95% CI = 7.727 [1.416–42.175], P = 0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18–6.26, P = 0.0001). Conclusions: There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs. PMID:28757760

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

    Science.gov (United States)

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

    2015-09-01

    Vaginal delivery of active drugs has been largely studied for local and systemic applications. It is well known that vagina is a complex route, due to physiological and non-physiological changes. Therefore, in order to achieve a prolonged local effect, these variations have to be considered. The aim of this study was to formulate and to characterize a solid system, called sponges, obtained by lyophilization of cellulosic derivative (HEC 250M) hydrogels. These sponges have to meet particular criteria to be adapted for vaginal application: they have to adhere to the vaginal cavity and to be rehydrated by the small amount of vaginal fluids. Moreover, they have to be easily manipulated and to be stable. Three freezing temperatures have been tested to prepare sponges (-15°C, -25°C, -35°C). By SEM analyzes, it was observed that the pores into the sponges were smaller and numerous as the freezing temperature decreases. However, this temperature did not have any influence on the rehydration speed that was rather influenced by the HEC concentration. Viscosity and mucoadhesive strength of hydrogels and corresponding sponges were also measured. It appeared that these parameters are mainly dependent on the HEC concentration. These mucoadhesive sponges can be considered as potential drug delivery systems intended for vaginal application. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Zaman Shakila

    2010-01-01

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

  7. 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 digital vaginal examination (P = .036). 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.

  8. 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.

  9. 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).

  10. Impact of Pregnancy and Vaginal Delivery on the Passive and Active Mechanics of the Rat Vagina

    Science.gov (United States)

    Feola, Andrew; Moalli, Pamela; Alperin, Marianna; Duerr, Robbie; Gandley, Robin E.; Bramowitch, Steven

    2011-01-01

    Remodeling of vaginal extracellular matrix and smooth muscle likely plays a critical role in reducing the risk of maternal injury during vaginal delivery by altering the mechanical properties to increase distension and reduce stress. Long-Evans rats were divided into five groups to examine the passive mechanical and active contractile properties throughout pregnancy and postpartum: virgin (n = 17), mid-pregnant (Day 14–16, n = 12), late-pregnant (Day 20–22, n = 14), immediate postpartum (0–2 h after delivery, n = 14), and 4 week postpartum (n = 15). Longitudinal sections of vaginal tissue were loaded to failure uniaxially for passive mechanical or active contractile properties were examined. For passive mechanics, the tangent modulus decreased 45% by mid-pregnancy and immediately postpartum (p vagina are consistent with what would be expected from a tissue that is remodeling to maximize its ability to distend at the time of vaginal delivery to facilitate passage of the fetus with minimal injury. PMID:20824342

  11. The role of mode of delivery on elastic fiber architecture and vaginal vault elasticity: a rodent model study

    OpenAIRE

    Downing, Keith; Billah, Mubashir; Raparia, Eva; Shah, Anup; Silverstein, Moshe; Ahmad, Amanda; Boutis, Gregory S.

    2013-01-01

    We report on an experimental study of the role of mode of delivery and pregnancy on the architecture of vaginal elastic fibers and vaginal vault elasticity in female Sprague-Dawley rats. In primiparous rats submitted to spontaneous or Cesarean delivery and virgin rats submitted to simulated delivery, the tortuosity of elastic fibers (defined as the ratio of length to end-to-end distance) was observed to decrease when measured two days to two weeks postpartum. In addition, the measured tortuos...

  12. 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

  13. Who wants a caesarean section? A study of women's personal experience of vaginal and caesarean delivery.

    Science.gov (United States)

    Aslam, M F; Gilmour, K; Fawdry, R D S

    2003-07-01

    The Changing Childbirth report, 1999, explicitly endorsed the right of women to be involved in childbirth decisions and to have a choice in childbirth and it has been suggested that maternal requests for a caesarean birth has been a significant factor in the recently observed increases in caesarean section rates. There have been reports of both obstetrician's views and midwives' views regarding the mode of delivery. However, there is a lack of literature reporting the views of women who have experienced personally both a caesarean section and a vaginal delivery. Fifty women in Milton Keynes who had had at least one vaginal delivery and at least one caesarean section were asked for their opinion.

  14. Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases.

    Science.gov (United States)

    Kew, Natalie; DuPlessis, Jacobus; La Paglia, Domenic; Williams, Katherine

    2017-01-01

    Introduction. Our study aims to investigate and evaluate (1) rates of success of ECV for breech presentation at term at the Royal Women's Hospital in comparison to international standards; (2) mode of delivery following ECV; (3) factors influencing success rates of ECV at the Royal Women's Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women's Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women's Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women's Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (P ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women's Hospital, Melbourne, is in line with global standards.

  15. 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 ...

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

    Science.gov (United States)

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

    2016-10-01

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

  17. 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.

  18. Angioembolisation in vaginal vascular malformation.

    Directory of Open Access Journals (Sweden)

    Srivastava D

    2001-01-01

    Full Text Available Vaginal arteriovenous malformations are rare entities and their most common presentation is vaginal haemorrhage. This case report describes a 22-year-old woman who presented at 20 weeks of gestation with slow growing soft and tender swelling at anterior vaginal wall. Diagnosis was confirmed as vaginal vascular malformation on contrast enhanced magnetic resonance imaging. The mass did not subside after delivery and patient developed dyspareunia. It was successfully treated by angioembolisation using polyvinyl alcohol particles. Angioembolisation being safe and effective should be the treatment of first choice for symptomatic vaginal vascular malformation.

  19. 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.

  20. 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.

  1. 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

    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...... deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence....

  2. 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.

  3. Characteristics Associated With Successful Fitting of a Vaginal Bowel Control System for Fecal Incontinence.

    Science.gov (United States)

    Matthews, Catherine A; Varma, Madhulika G; Takase-Sanchez, Michelle M; Hale, Douglas S; Van Drie, Douglas; Muir, Tristi; Wells, Ellen; Jannelli, Mary; Richter, Holly E

    2016-01-01

    We previously showed that management with a novel vaginal bowel control system was efficacious in women with moderate to severe fecal incontinence. The objective of this secondary analysis was to evaluate the clinical characteristics associated with device-fitting success. This is a secondary analysis of an institutional review board-approved, multicenter, prospective, open-label clinical study of women aged 19 to 75 years with 4 or more episodes of fecal incontinence recorded on a 2-week baseline bowel diary. Those successfully fitted with the vaginal bowel control device entered a 1-month treatment period, and efficacy was assessed with a repeat bowel diary. Demographic data, medical and surgical history, and pelvic examination findings were compared across women with successful and unsuccessful completion of the fitting period. Multivariate logistic regression analysis was performed. Six clinical sites in the United States recruited from August 2012 through October 2013. Overall, 110 women underwent attempted fitting, of which 61 (55.5%) of 110 were successful and entered the treatment portion of the study. Multivariate logistic regression analysis revealed that previous prolapse surgery (P = 0.007) and shorter vaginal length (P = 0.041) were independently associated with unsuccessful fitting. Women who have not undergone previous prolapse surgery had 4.7 times the odds (95% confidence interval [CI], 1.53-14.53) of a successful fit. In addition, for every additional centimeter of vaginal length, women had 1.49 times the odds (95% CI, 1.02-2.17) of a successful fit. Shorter vaginal length and previous prolapse surgery were associated with an increased risk of fitting failure. These findings may be used to inform patients regarding their expectation of successful fitting.

  4. Hospital treatment - Is it affordable? A structured cost analysis of vaginal deliveries and planned caesarean sections.

    Science.gov (United States)

    Heer, I M; Kahlert, S; Rummel, S; Kümper, C; Jonat, W; Strauss, A

    2009-11-03

    The analysis of cost effectiveness in hospitals is as difficult as treating the patients properly. We are yet not able to answer the simple question of what costs are caused by a certain diagnosis and its treatment during an average hospital stay. To answer some issues of the global problem of cost effectiveness during hospitalisation, we analysed the costs and the cost structure of a normal obstetrical hospital stay during an uncomplicated vaginal delivery and a planned caesarean section. Cost data was collected and summarized from the patients file, the hospital's computer system gathering all cost centres, known material expenses and expenses of non obstetrical medical services. For vaginal deliveries/planned caesareans we can calculate with a surplus of about 83Euro/1432Euro. About 45% of the summarized costs are calculated on a reliable database. The introduction of the DRG based clearing system in Germany has aggravated the discussion on cost effectiveness. Our meticulous work-up of expenses excluded personal precautionary costs and personnel costs of documentation because no tools are described to depict such costs. If we would add these costs to the known expenses of our study, we strongly suspect that hospital treatment of vaginal deliveries or planned caesarean sections is not cost effective.

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

    Science.gov (United States)

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

    2017-06-01

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

  6. 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 ...

  7. 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 (pprocess 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.

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

    Science.gov (United States)

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

    2009-01-01

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

  9. 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

  10. Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery.

    Science.gov (United States)

    Sentilhes, Loïc; Oppenheimer, Anne; Bouhours, Anne-Charlotte; Normand, Estelle; Haddad, Bassam; Descamps, Philippe; Marpeau, Loïc; Goffinet, François; Kayem, Gilles

    2015-07-01

    The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD). Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression. The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity. A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Is obstetric anal sphincter injury a risk factor for levator ani muscle avulsion in vaginal delivery?

    Science.gov (United States)

    González, M Simó; Garriga, J Cassadó; Capel, C Dosouto; Roda, O Porta; Capó, J Perelló; Saladich, I Gich

    2017-02-01

    To analyze whether women who sustain obstetric anal sphincter injury (OASI) in their first vaginal delivery have a higher incidence of levator ani muscle (LAM) avulsion than do women without OASI. We conducted a prospective observational cohort study of 80 primiparous women who gave birth at our tertiary obstetric unit between September 2011 and July 2013. The women were divided into two groups: women diagnosed with OASI during vaginal delivery (n = 40) and women without OASI (n = 40), matched by mode of delivery and newborn birth weight. Four-dimensional (4D) transperineal ultrasound was performed in all participants at 6-12 months after delivery to assess for integrity or avulsion of the LAM. Ultrasound images were evaluated by two observers who were blinded to group assignment and clinical data. Interobserver agreement was assessed to determine the reproducibility of 4D transperineal ultrasound for diagnosing LAM avulsion. We found no statistically significant differences between the two groups. The incidence of LAM avulsion was 24.3% in the OASI group and 34.2% in the control group (P = 0.448). Interobserver agreement in the diagnosis of LAM avulsion in the study population using 4D transperineal ultrasound was 89.5%, with a kappa index of 0.76. Our findings do not support OASI as a risk factor for LAM avulsion. Prospective studies in larger populations are needed to establish the biomechanical relationships of the pelvic floor structures involved in vaginal delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  12. [German-speaking midwifes prefer vaginal mode of delivery to elective Caesarean].

    Science.gov (United States)

    Harder, U; Reutter, R; Luyben, A; Gross, M M

    2002-04-01

    Increasing ceasarean section rates are a world wide concern in obstetrics. One of the latest contributing factors is the elective caesarean section in uncomplicated singleton pregnancy at term. The preference for this mode of delivery was primarily brought forward by obstetric practitioners (Al Mufty, McCarthy, Fisk 1996). A questionnaire, which mainly aimed to ask germanspeaking midwifes in Austria, Germany and Switzerland about their personal choice of delivery mode, was included in one of the issues of the German-language midwifery journal "Die Hebamme". This questionnaire contained 5 half-closed/half open questions describing specific obstetric occurrences. The midwifes were asked to express their preferred mode of delivery and describe their reason for choosing. 446 questionnaires (12 %) were returned. The majority (100 %) of the german speaking midwifes preferred a normal vaginal delivery in an uncomplicated singleton pregnancy at term with a child in cephalic presentation. The rating was about the same (97 %) in the presence of general risk factors which don't indicate a primary caesarean section. Breech presentation and macrosomia are a matter of concern to the midwifes. Midwifes arguing for a first child in breech presentation or with macrosomia > 4.5 kg vote highly significantly more frequently for elective caesarean section than midwifes arguing for at least the second child. The first-rate reasons for the preference of vaginal delivery concern the natural and physiological way of delivery, the personal experience of delivery, the higher risks of caesarean section and the possibility of a later caesarean section in case of fetal distress during first or second stage of labour. Concerns are expressed about the maintenance of competence amongst practitioners, thus influencing the choice of mode of delivery in obstetrics.

  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. A case report of delayed diagnosis of uterine rupture following vaginal delivery

    Directory of Open Access Journals (Sweden)

    Vanessa Falé Rosado

    2017-08-01

    Full Text Available Introduction: A uterine rupture is still a rare event but its incidence appears to be increasing, even in the unscarred uterus. In our case, the uterine rupture presented itself in an unscarred uterus and after a vaginal delivery. Case report: A 36 years old women with three previous normal deliveries, comes to our hospital for assistance at 32 weeks with a poor pregnancy surveillance. After diagnosing Gestational Diabetes, she is admitted for therapeutic adjustment. She is discharged after achieving metabolic control but comes back a few days later with a stillbirth, born by vaginal delivery. Six days later she presents with: fever and pain; anemia leukocytosis and a heterogeneous image on ultrasound. However, was decided to start intravenous antibiotics before choosing for surgery. Her condition worsens and an exploratory laparotomy is done: a posterior uterine wall rupture that required a hysterectomy. Conclusion: Risk factors for uterine rupture were present (maternal age over 35, higher parity, fetal macrosomia but the absence of any symptom, the normal examination after delivery, and mostly, an unscarred uterus, resulted in a delay in the diagnosis of more than one week, leading to catastrophic consequences: hysterectomy. This case reminds us that uterine rupture happens not only in case of previous uterine surgery, and these cases seem to be increasing because of the increase in other risk factors: advanced maternal age and diabetes with resulting fetal macrosomia.

  15. [Vaginal birth versus Cesarean section on demand - which mode of delivery is preferred by pregnant women?].

    Science.gov (United States)

    Hainer, F; Kowalcek, I

    2011-02-01

    The Cesarean section rate continues to increase across the developed nations since there are still a number possible reasons for this development including medical and non-clinical indications. The aim of this study was to analyse how pregnant women themselves think about Cesarean section and vaginal delivery, and which mode of delivery they prefer. Pregnant women booked for prenatal diagnosis at the University Hospital Schleswig-Holstein, Campus Lübeck between October 2004 and January 2005 were invited to participate in the study. 534 pregnant women completed a questionnaire on their method of choice for delivery and selected background variables. Women favour a natural birth and place high importance on the criteria physiology, active birth experience and personal assistance. Characteristics of the Cesarean section that were viewed negatively include surgery and pain. The rise in Cesarean section rates cannot be explained by the patients' preferences. In terms of patient autonomy, obstetricians should respect a woman's wish for vaginal delivery, avoiding medical intervention if clinically possible. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    Michiel L Houben

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

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

    Science.gov (United States)

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

    2012-09-01

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

  18. Evaluation of the angled Episcissors-60® episiotomy scissors in spontaneous vaginal deliveries

    Directory of Open Access Journals (Sweden)

    Patel RP

    2014-07-01

    Full Text Available Rajnish P Patel,1,2 Sunita M Ubale21Suyog Women's Hospital, 2Rajiv Gandhi Medical College, Thane, IndiaBackground: Obstetric anal sphincter injuries (OASIs are the leading cause of anal incontinence in women. Episiotomies with a postdelivery suture angle of less than 30° to the midline are more likely to injure the anal sphincter directly, while those with a suture angle of more than 60° are associated with increased incidence of OASIs, as they do not relieve the pressure on the perineum. A safe zone of 40°–60° has been proposed. Recently, two new types of episiotomy scissors (Episcissors-60® Straight version and angled version were introduced to ensure a standardized cutting angle of 60° to the midline. We audited our results with the angled Episcissors-60 in spontaneous vaginal deliveries. Materials and methods: Consecutive patients delivering in two private maternity hospitals in Thane, India undergoing clinically indicated episiotomies were included. Only patients delivering spontaneously were included. The scissors were introduced vaginally at crowning, and aligned to orient the guide limb vertically from the posterior fourchette to the anus. While a single cut was preferred, a stagger cut was needed for some women. Postdelivery angles were measured by placing a protractor transparency on the perineum after delivery and marking the angle with an indelible ink pen. Per rectal examination was performed prior to suturing to detect OASIs. Results: A total of 25 women underwent clinically indicated episiotomies. Of these, 16 women were nulliparous, eight women were para 1, and one woman was a para 2. One woman had a vaginal breech delivery (para 2, and the rest were cephalic vertex deliveries. The average age was 27 (range 20–35 years. The median birth weight was 2,800 g (standard deviation 312 g, interquartile range 2,500–3,000 g. The median postdelivery suture angle of the episiotomy was 50° (standard deviation 3.5

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

    Directory of Open Access Journals (Sweden)

    Sthela Maria MURAD-REGADAS

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

  20. Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

    Directory of Open Access Journals (Sweden)

    Arifa Akter Jahan

    2013-07-01

    Full Text Available Background: Over half-a-million women die each year from pregnancy-related causes, and 99 percent of these occur in developing countries. In Bangladesh though maternal mortality rate (MMR declined significantly around 40% in the past decade, still eclampsia accounts for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure is delivery regardless of gestational age. A rational therapy for general management of hypertension and convulsion has been established in Bangladesh by the Eclampsia Working Group. But controversy still exists regarding obstetric management. Objective: To evaluate the feto-maternal outcome in cesarean section compared to vaginal delivery in eclamptic patients. Materials and Methods: This prospective cohort study was conducted in the department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH, from January to December 2011. A total 100 eclamptic women with term pregnancy and live fetus were purposively included in the study (Group I, 50 patients with vaginal delivery and Group II, 50 with cesarean section. Results: Out of these 100 patients 56% were aged ≤20 years, 71% were primigravida and 77% were from low socioeconomic status. Sixteen percent patients from vaginal delivery group and 18% from cesarean section group had no antenatal care. The mean gestational age was about 38 weeks in two groups. No significant difference was found between the two groups regarding blood pressure, proteinuria, consciousness level and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group compared to 6% in cesarean section group. Maternal complications such as postpartum hemorrhage, cerebrovascular accident, renal failure, obstetric shock and abruptio placenta were higher among vaginal delivery group patients (46% than cesarean section patients (16%. Maternal mortality was 6% in the vaginal delivery group and none in the cesarean section group. Regarding

  1. Vaginal Delivery vs. Cesarean Section: A Focused Ethnographic Study of Women's Perceptions in The North of Iran.

    Science.gov (United States)

    Zakerihamidi, Maryam; Latifnejad Roudsari, Robab; Merghati Khoei, Effat

    2015-01-01

    Cesarean section (C-section) in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women's perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women's perceptions towards modes of delivery in the North of Iran. Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. Two major themes emerged from the data including: "vaginal delivery, a facilitator of women's physical and mental health promotion", and "C-section, a surgical intervention associated with decreased labor pain". Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. In the North of Iran, women's justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section.

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

    Science.gov (United States)

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

    2016-12-01

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

  3. High-intensity focused ultrasound treatment of placenta accreta after vaginal delivery: a preliminary study.

    Science.gov (United States)

    Bai, Y; Luo, X; Li, Q; Yin, N; Fu, X; Zhang, H; Qi, H

    2016-04-01

    To evaluate the safety and efficiency of high-intensity focused ultrasound (HIFU) in the treatment of placenta accreta after vaginal delivery. Enrolled into this study between September 2011 and September 2013 were 12 patients who had been diagnosed with placenta accreta following vaginal delivery and who had stable vital signs. All patients were treated using an ultrasound-guided HIFU treatment system. As indication of the effectiveness of the treatment we considered decreased vascular index on color Doppler imaging, decrease in size of residual placenta compared with pretreatment size on assessment by three-dimensional ultrasound with Virtual Organ Computer-aided Analysis, reduced signal intensity and degree of enhancement on magnetic resonance imaging and avoidance of hysterectomy following treatment. To assess the safety of HIFU treatment, we recorded side effects, hemorrhage, infection, sex steroid levels, return of menses and subsequent pregnancy. Patients were followed up in this preliminary study until December 2013. The 12 patients receiving HIFU treatment had an average postpartum hospital stay of 6.8 days and an average period of residual placental involution of 36.9 days. HIFU treatment did not apparently increase the risk of infection or hemorrhage and no patient required hysterectomy. In all patients menstruation recommenced after an average of 80.2 days, and sex steroid levels during the middle luteal phase of the second menstrual cycle were normal. Two patients became pregnant again during the follow-up period. This preliminary study suggests that ultrasound-guided HIFU is a safe and effective non-invasive method to treat placenta accreta patients after vaginal delivery who have stable vital signs and desire to preserve fertility. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  4. A novel ketoconazole bioadhesive effervescent tablet for vaginal delivery: design, in vitro and 'in vivo' evaluation.

    Science.gov (United States)

    Wang, Lei; Tang, Xing

    2008-02-28

    Bioadhesive tablet formulations of ketoconazole for vaginal delivery were studied. Carbomer (Carbopol 974P, Carbopol 934P), hydroxypropylmethyl cellulose (HPMC) and hydroxypropyl cellulose (HPC) were used as candidate bioadhesive polymers. Effervescent was incorporated into the formulations as a disintegration agent. The swelling behavior and bioadhesive strength of the drug-free tablets were investigated. Carbopol 934P was selected as biopolymer in combination with HPMC or HPC at different ratios to develop five drug-loaded formulations. The swellings, tackiness and in vitro release were studied on the tablets. A good sustained effect and a moderate bioadhesion were obtained with the tablets. The formulation containing 100mg of effervescent, with the Carbopol 934P:HPC ratio of 1:9, seemed to be the optimum one for the tablet. In vivo drug residence tests were carried out by administering the preferred formulation to female rats. The results showed that the drug remaining followed a one-order model. Even after 24h of administration in vagina of rats, 17% of the original employed drug was retained on the vaginal tissue. Our study may provide a potential vaginal tablet formulation of ketoconazole against Candida albicans.

  5. Self-testing of vaginal pH to prevent preterm delivery: a controlled trial.

    Science.gov (United States)

    Bitzer, Eva-Maria; Schneider, Andrea; Wenzlaff, Paul; Hoyme, Udo B; Siegmund-Schultze, Elisabeth

    2011-02-01

    From 2004 to 2006, in a model project carried out by four German health insurers, expectant mothers were offered self-testing of vaginal pH in order to prevent preterm delivery. They were given pH test gloves on request so that they could measure their vaginal pH twice a week from the 12(th) to the 32(nd) week of gestation. They were instructed to consult with a gynecologist after any positive result. All further diagnostic or therapeutic decisions were at the discretion of the treating gynecologist. We assessed the effectiveness of the screening intervention, using delivery before the 37th week of gestation as the primary endpoint. In this prospective, controlled trial, we collected data on deliveries from 2004 to 2006 that were covered by the four participating insurers in five German federal states. We compared the outcomes of pregnancy in women who did and did not request test gloves (intervention group, [IG], and control group, [CG]). The data were derived from claims data of the participating insurers, as well as from a nationwide quality assurance auditing program for obstetrics and perinatal care. Propensity score matching and multivariate adjustment were used to control for the expected self-selection bias. The study sample comprised 149 082 deliveries. 13% of the expectant mothers requested test gloves, about half of them up to the 16(th) week of gestation. As expected, women with an elevated risk of preterm birth requested test gloves more often. Delivery before the 37(th) week of gestation was slightly more common in the intervention group than in the control group (IG 7.97%, CG 7.52%, relative risk 1.06, 95% confidence interval 1.00-1.12). This result was of borderline statistical significance in the propensity score matched analysis, but it was not statistically significant in the multivariate model. This trial did not demonstrate the efficacy of self-testing of vaginal pH for the prevention of preterm delivery (< 37 weeks of gestation).

  6. Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss.

    Science.gov (United States)

    Stephenson, Mary D; McQueen, Dana; Winter, Michelle; Kliman, Harvey J

    2017-03-01

    To assess the effectiveness of luteal start vaginal micronized P in a recurrent pregnancy loss (RPL) cohort. Observational cohort study using prospectively collected data. Not applicable. Women seen between 2004 and 2012 with a history of two or more unexplained pregnancy losses pregnancy(ies). Women were excluded if concomitant findings, such as endometritis, maturation delay, or glandular-stromal dyssynchrony, were identified on EB. Vaginal micronized P was prescribed at a dose of 100-200 mg every 12 hours starting 3 days after LH surge (luteal start) if glandular epithelial nuclear cyclin E (nCyclinE) expression was elevated (>20%) in endometrial glands or empirically despite normal nCyclinE (≤20%). Women with normal nCyclinE (≤20%) who did not receive P were used as controls. Pregnancy success was an ongoing pregnancy >10 weeks in size. One hundred sixteen women met the inclusion criteria, of whom 51% (n = 59) had elevated nCyclinE and 49% (n = 57) had normal nCyclinE. Pregnancy success in the 59 women with elevated nCyclinE significantly improved after intervention: 6% (16/255) in prior pregnancies versus 69% (57/83) in subsequent pregnancies. Pregnancy success in subsequent pregnancies was higher in women prescribed vaginal micronized P compared with controls: 68% (86/126) versus 51% (19/37); odds ratio = 2.1 (95% confidence interval, 1.0-4.4). In this study, we found that the use of luteal start vaginal micronized P was associated with improved pregnancy success in a strictly defined cohort of women with RPL. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Non-aqueous silicone elastomer gels as a vaginal microbicide delivery system for the HIV-1 entry inhibitor maraviroc

    Science.gov (United States)

    Forbes, Claire J.; Lowry, Deborah; Geer, Leslie; Veazey, Ronald S.; Shattock, Robin J.; Klasse, Per Johan; Mitchnick, Mark; Goldman, Laurie; Doyle, Lara A.; Muldoon, Brendan C.O.; Woolfson, A. David; Moore, John P.; Malcolm, R. Karl

    2011-01-01

    Aqueous semi-solid polymeric gels, such as those based on hydroxyethylcellulose (HEC) and polyacrylic acid (e.g. Carbopol®), have a long history of use in vaginal drug delivery. However, despite their ubiquity, they often provide sub-optimal clinical performance, due to poor mucosal retention and limited solubility for poorly water-soluble actives. These issues are particularly pertinent for vaginal HIV microbicides, since many lead candidates are poorly water-soluble and where a major goal is the development of a coitally independent, once daily gel product. In this study, we report the use of a non-aqueous silicone elastomer gel for vaginal delivery of the HIV-1 entry inhibitor maraviroc. In vitro rheological, syringeability and retention studies demonstrated enhanced performance for silicone gels compared with a conventional aqueous HEC gel, while testing of the gels in the slug model confirmed a lack of mucosal irritancy. Pharmacokinetic studies following single dose vaginal administration of a maraviroc silicone gel in rhesus macaques showed higher and sustained MVC levels in vaginal fluid, vaginal tissue and plasma compared with a HEC gel containing the same maraviroc loading. The results demonstrate that non-aqueous silicone gels have potential as a formulation platform for coitally independent vaginal HIV microbicides. PMID:21864598

  8. Decreased neonatal pain response after vaginal-operative delivery with Kiwi OmniCup versus metal ventouse.

    Science.gov (United States)

    Huhn, E A; Visca, E; Vogt, D R; von Felten, S; Tinner Oehler, E M; Bührer, C; Surbek, D; Zimmermann, R; Hoesli, I

    2017-01-31

    Vaginal delivery, especially operative assisted vaginal delivery, seems to be a major stressor for the neonate. The objective of this study was to evaluate the stress response after metal cup versus Kiwi Omnicup® ventouse delivery. The study was a secondary observational analysis of data from a former prospective randomised placebo controlled multicentre study on the analgesic effect of acetaminophen in neonates after operative vaginal delivery and took place at three Swiss tertiary hospitals. Healthy pregnant women ≥35 weeks of gestation with an estimated fetal birth weight above 2000 g were recruited after admission to the labour ward. Pain reaction was analysed by pain expression score EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) directly after delivery. For measurement of the biochemical stress response, salivary cortisol as well as the Bernese Pain Scale of Newborns (BPSN) were evaluated before and after an acute pain stimulus (the standard heel prick for metabolic testing (Guthrie test)) at 48-72 h. Infants born by vaginal operative delivery displayed a lower pain response after plastic cup than metal cup ventouse delivery (p Kiwi OmniCup® versus metal cup ventouse. Trial was registered under under NCT00488540 on 19th June 2007.

  9. Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery.

    Science.gov (United States)

    Reinhard, Joscha; Sänger, Nicole; Hanker, Lars; Reichenbach, Lena; Yuan, Juping; Herrmann, Eva; Louwen, Frank

    2013-04-01

    To examine the delivery mode and neonatal outcome after a trial of external cephalic version (ECV) procedures. This is an interim analysis of an ongoing larger prospective off-centre randomised trial, which compares a clinical hypnosis intervention against neuro-linguistic programming (NLP) of women with a singleton breech foetus at or after 37(0/7) (259 days) weeks of gestation and normal amniotic fluid index. Main outcome measures were delivery mode and neonatal outcome. On the same day after the ECV procedure two patients (2 %), who had unsuccessful ECVs, had Caesarean sections (one due to vaginal bleeding and one due to pathological CTG). After the ECV procedure 40.4 % of women had cephalic presentation (n = 38) and 58.5 % (n = 55) remained breech presentation. One patient remained transverse presentation (n = 1; 1.1 %). Vaginal delivery was observed by 73.7 % of cephalic presentation (n = 28), whereas 26.3 % (n = 10) had in-labour Caesarean sections. Of those, who selected a trial of vaginal breech delivery, 42.4 % (n = 14) delivered vaginally and 57.6 % (n = 19) delivered via Caesarean section. There is a statistically significant difference between the rate of vaginal birth between cephalic presentation and trial of vaginal breech delivery (p = 0.009), however, no difference in neonatal outcome was observed. ECV is a safe procedure and can reduce not only the rate of elective Caesarean sections due to breech presentation but also the rate of in-labour Caesarean sections even if a trial of vaginal breech delivery is attempted.

  10. The role of mode of delivery on elastic fiber architecture and vaginal vault elasticity: a rodent model study.

    Science.gov (United States)

    Downing, Keith T; Billah, Mubashir; Raparia, Eva; Shah, Anup; Silverstein, Moshe C; Ahmad, Amanda; Boutis, Gregory S

    2014-01-01

    We report on an experimental study of the role of mode of delivery and pregnancy on the architecture of vaginal elastic fibers and vaginal vault elasticity in female Sprague-Dawley rats. In primiparous rats submitted to spontaneous or Cesarean delivery and virgin rats submitted to simulated delivery, the tortuosity of elastic fibers (defined as the ratio of length to end-to-end distance) was observed to decrease when measured from two days to two weeks postpartum. In addition, the measured tortuosity of elastic fibers in multiparous rats was greater than that of virgin rats. The tortuosity of elastic fibers of all rats measured at two days postpartum was found to be similar to that of multiparous rats. At two weeks postpartum the measured tortuosity of vaginal elastic fibers was indistinguishable from virgin rats, regardless of the delivery method. Borrowing from the field of polymer physics, a model is suggested that connects elastic fiber tortuosity to the resulting tension under an applied stress; fibers having high tortuosity are expected to provide less structural support than more linear, low tortuosity fibers. To probe the macroscopic effects in elasticity due to architectural changes observed in elastic fibers, we have measured the stiffness of the vaginal vault in each cohort using a pressure-infusion system. The vaginal vault stiffness of all primiparous rats measured two weeks postpartum was greater than that measured two days postpartum. In addition, the vaginal vault of virgin rats was stiffer than that of multiparous rats. These observations confirmed that vaginal vault elastic fibers undergo significant remodeling due to pregnancy and parturition, and that the complex remodeling may be a significant contributor to tissue elasticity. Remarkably, regardless of the mode of delivery or simulated tissue trauma, elastic fiber tortuosity is observed to decrease from two days to two weeks postpartum indicating the onset of repair and recovery of tissue

  11. 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...... trial (PREDICT study), in which women with twin pregnancies were randomized to daily treatment with progesterone or placebo pessaries from 20-24 weeks until 34 weeks' gestation. This subpopulation consisted of high-risk pregnancies, defined by the finding of cervical length ≤ 10th centile at 20-24 weeks...... (10.6%) of the 677 women participating in the PREDICT study, the pregnancy was considered to be high-risk, including 47 with cervical length ≤ 10th centile, 28 with a history of preterm delivery or late miscarriage and three fulfilling both criteria. Baseline characteristics for progesterone...

  12. Safety and efficacy of airbag midwifery in promoting normal vaginal delivery and reducing caesarean section.

    Science.gov (United States)

    Ma, Jianting; Shao, Huajiang; Lu, Xingren; Zhang, Bo; Zhang, Guanger

    2012-11-01

    Balloon bionic midwifery has been applied in clinical obstetrics in China for 10 years, although played a certain role in controlling and improving the quality of obstetrics and caesarean section rate, but some questions have not been resolved. The aim of this study was to investigate the efficacy and safety of airbag midwifery. Primiparas (2410 cases) with various medical conditions were randomly divided into airbag and control groups undergoing the same obstetrical treatments, but airbag midwifery as a birthing option was chosen twice when the cervix was dilated to 2-4 cm during labor. The duration of the first and second stages, as well as the total delivery process, of the airbag group was shorter than that for the controls. The natural delivery rate of the airbag group was higher than that of the control group. The forcep delivery rate, cesarean section rate, amount of vaginal bleeding within 2 h after delivery, rate of postpartum hemorrhage, fetal distress, and pitocin use in the airbag group were all lower than those in the control group. No significant difference in the rate of maternal and fetal complications was observed in the two groups. The bionic airbag midwifery approach did not contribute to the incidence rate of urine retention, leukocyte count, neutrophil proportion, and level of creactive protein and IL-6 24 h after delivery. Airbag midwifery skill is a simple, effective, and safe procedure.

  13. 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

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

    Science.gov (United States)

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

    2013-01-01

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

  15. [Successful postponement of delivery in twin pregnancy].

    Science.gov (United States)

    Binder, T; Parízek, A; Hájek, Z; Dokoupilová, M

    2003-10-01

    Description of twin pregnancy after IVF preterm rupture of membranes of fetus A in 22nd gestational week. Abortion of fetus A and successful delayed delivery of twin B. Case report. Obstetrics and Gynecology Department, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Obstetrics and Gynecology Department, 1st Medical Faculty Charles University and General Faculty Hospital, Prague. Patient A. S. 34 years old, admitted to the hospital in 23rd gestational week with preterm rupture of membranes of fetus A, after appearing spontaneous uterine contractions terminated the abortion of fetus A. The uterine contractions stopped with toxolytics and after one week of expectation interval the cerclage suture of cervix was performed. The following course of pregnancy was protected with antibiotics and 48 hours toxolysis with beta mimetics. The pregnancy continued without any serious complications till 37th gestational week, when infectious markers elevated. Cerclage suture was taken away and after 12 hours interval the labor started. The labor was terminated with s.c. because of imminent fetal hypoxia. After the abortion of twin A we succeeded to delay delivery interval for 4 months. The borderline mature neonate was born in good clinical condition and survived without any serious complications.

  16. Fetal heart rate changes observed on the CTG trace during instrumental vaginal delivery.

    Science.gov (United States)

    Xie, Wanying; Archer, Abigail; Li, Chao; Cui, Hongyan; Chandraharan, Edwin

    2017-09-10

    Instrumental vaginal delivery (IVD) helps expedite delivery during second stage of labour so as to avoid a second stage caesarean section. However, due to mechanical effects on the fetal head, vacuum and forceps may cause cardiotocograph (CTG) abnormalities due to vigal stimulation as well as increased intracranial pressure. To determine the features observed on the CTG during IVD in term pregnancy and correlate them to perinatal outcomes. A retrospective analysis of 445 cases who had vacuum deliveries (227) and forceps deliveries (218) at St. George's University Hospitals NHS Foundation Trust during a 12-month period was performed. CTG features were analysed at 10 minutes prior to and immediately after applications of the chosen instrument till delivery. Specific abnormalities were correlated to Apgar score and umbilical blood pH. Specific CTG abnormalities after applications of vacuum and forceps were: tachycardia (99 (43.61%) versus 88 (40.37%)), increased baseline fetal heart rate (FHR) [14 (6.17%) versus 4 (1.83%) p = .0204], baro-receptor-mediated "variable" deceleration (101 (44.49%) versus 85 (38.99%)), chemoreceptor-mediated "late" deceleration (62 (27.31%) versus 76 (34.86%)), prolonged deceleration (32 (14.10%) versus 24 (11.01%)), saltatory pattern [35 (15.42%) versus 76 (34.86%) p 7.20). After application of instruments, 90% of CTG traces showed abnormal features. Tachycardia, baro- and chemoreceptor-mediated decelerations, and saltatory patterns were the most common abnormalities. Increased baseline FHR during vacuum as compared to forceps delivery was possibly secondary to pain/pressure and resultant sympathetic overactivity. The saltatory pattern was more common in forceps deliveries, possibly secondary to increased intracranial pressure and resultant autonomic instability. Despite these CTG abnormalities, the perinatal outcomes were good.

  17. Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies: secondary analysis of a placebo-controlled randomized trial and meta-analysis

    DEFF Research Database (Denmark)

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

    2011-01-01

    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.......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....

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

    Directory of Open Access Journals (Sweden)

    Reetu Hooda

    2016-01-01

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

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

    Science.gov (United States)

    Maharlouei, Najmeh; Rezaianzadeh, Abbas; Hesami, Elham; Moradi, Fariba; Mazloomi, Ezat; Joulaei, Hassan; Khodayari, Mohammad; Lankarani, Kamran B.

    2013-01-01

    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 20th to 30th 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. PMID:24523780

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

    Directory of Open Access Journals (Sweden)

    Najmeh Maharlouei

    2013-01-01

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

  1. The effect of adding hyoscine to vaginal misoprostol on abortion induction success rate

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    Tehranian A

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate. "n"nMethods: In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 µg/4h, vaginal (n=37 or misoprostol (400 µg/4h, vaginal plus hyoscine (20 mg IV (n=37. Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding, decline in hemoglobin more than 3 g/dl, need for blood transfusion and failure of treatment according to the failure of induction of labor or cervical opening in 24 hours after starting treatment and the total duration of hospitalization were compared between groups. "n"nResults: There were no significant differences between groups regarding the rate of side effects like nausea, abdominal pain and vaginal bleeding. In misoprostol plus hyoscine group, the success rate in abortion was significantly higher (40

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

    Science.gov (United States)

    Veltman, Larry

    2014-01-01

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

  3. Vaginal Delivery vs. Cesarean Section: A Focused Ethnographic Study of Women’s Perceptions in The North of Iran

    Science.gov (United States)

    Zakerihamidi, Maryam; Latifnejad Roudsari, Robab; Merghati Khoei, Effat

    2015-01-01

    Background: Cesarean section (C-section) in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women’s perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women’s perceptions towards modes of delivery in the North of Iran. Methods: Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. Results: Two major themes emerged from the data including: “vaginal delivery, a facilitator of women’s physical and mental health promotion”, and “C-section, a surgical intervention associated with decreased labor pain”. Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. Conclusion: In the North of Iran, women’s justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section. PMID:25553333

  4. Vaginal distribution and retention of a multiparticulate drug delivery system, assessed by gamma scintigraphy and magnetic resonance imaging.

    Science.gov (United States)

    Mehta, Samata; Verstraelen, Hans; Peremans, Kathelijne; Villeirs, Geert; Vermeire, Simon; De Vos, Filip; Mehuys, Els; Remon, Jean Paul; Vervaet, Chris

    2012-04-15

    promising novel vaginal drug delivery system, resulting in complete coverage of the vaginal mucosa and long retention time. Copyright © 2012 Elsevier B.V. All rights reserved.

  5. Factors influencing the likelihood of instrumental delivery success.

    Science.gov (United States)

    Aiken, Catherine E; Aiken, Abigail R; Brockelsby, Jeremy C; Scott, James G

    2014-04-01

    To evaluate risk factors for unsuccessful instrumental delivery when variability between individual obstetricians is taken into account. We conducted a retrospective cohort study of attempted instrumental deliveries over a 5-year period (2008-2012 inclusive) in a tertiary United Kingdom center. To account for interobstetrician variability, we matched unsuccessful deliveries (case group) with successful deliveries (control group) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful instrumental deliveries. Three thousand seven hundred ninety-eight instrumental deliveries of vertex-presenting, single, term newborns were attempted, of which 246 were unsuccessful (6.5%). Increased birth weight (odds ratio [OR] 1.11; Pinstrument selection and decision to rotate were no longer associated with instrumental delivery success. More senior obstetricians had higher rates of unsuccessful deliveries (12% compared with 5%; Pinstrumental delivery was associated with higher birth weight (OR 1.07; Pinstrumental delivery, whereas the influence of instrument selection and rotational delivery appear to be operator-dependent. Risk factors for lack of instrumental delivery success are distinct from risk factors for requiring instrumental delivery, and these should not be conflated in clinical practice.

  6. Long term effect of vaginal delivery and cesarean section on female sexual function in primipara mothers.

    Science.gov (United States)

    Ghorat, Fereshteh; Esfehani, Reza Jafarzadeh; Sharifzadeh, Masoumeh; Tabarraei, Yaser; Aghahosseini, Shima Sadat

    2017-03-01

    Pregnancy and birth giving are two of the most important and common effective factors influencing female sexual function. Sexual dysfunction can affect women's quality of life and marriage. This research tried to determine the relation between labor type and long term sexual function in primipara women of Sabzevar, Iran. This cross-sectional study took place in Sabzevar healthcare system in 2014. Study population was chosen by random sampling from every primipara woman who had delivered 2 years ago, in Sabzevar Hospitals. A total number of 177 primipara women were enrolled in this study after signing an informed contest. Sexual function of mothers was determined by validated Persian version of female sexual function index (FSFI). SPSS statistical software version 19 and descriptive and inferential statistics such as percentage, mean, standard deviation, Chi square, student t-test and fisher exact test were used to analyze data. Among the study population, 69.5% had natural vaginal delivery (NVD) and 30.5% had caesarean section (C/S). The overall FSFI score was not significantly different in women undergoing NVD or C/S (p=0.23). Also, no significant relation was found between delivery method and urinary (p=0.07) and fecal incontinency (p=0.6). Female sexual function was prominent in women with urinary (p=0.015) and fecal incontinency (p=0.018). The results of present study showed that delivery method has no long-term effect on female sexual function and appropriate education about the sexual issues after delivery and effect of birth giving on sexual function are necessary for this group of society.

  7. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  9. 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.

  10. 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 digital palpation and use of a perineometer (tau = 0.82; p digital palpation may be used in clinical practice because of its expressive correlation with use of a perineometer.

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

    Directory of Open Access Journals (Sweden)

    Lin-miao ZENG

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Safieh Kanani

    2015-03-01

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

  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. 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...... 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...

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

    Science.gov (United States)

    Nappi, Rossella E

    2013-12-01

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

  16. Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot Referral Hospital, Northwest Ethiopia: a retrospective record review

    Directory of Open Access Journals (Sweden)

    Abebe Eyowas F

    2016-07-01

    Full Text Available Fantu Abebe Eyowas,1 Ashebir Kidane Negasi,1 Gizachew Eyassu Aynalem,1 Abebaw Gebeyehu Worku2 1International NGO, Strengthening Human Resource for Health, Bahir Dar, 2Institute of Public Health, University of Gondar, Gondar, Ethiopia Introduction: Some studies favor elective cesarean delivery, and other surveys benefit vaginal delivery, while others emphasize that the quality of care during labor, birth, and immediate postpartum period plays a great role than the route of delivery. However, little information is locally available regarding the incidences of adverse birth outcome with respect to the route of delivery. Methods: This study was a retrospective analysis of eligible patient records that included 3,003 pregnant women who had undergone either cesarean or vaginal delivery from July 1, 2012, to June 31, 2013. Pretested questionnaire was used to collect the data. The completeness and consistency of the data were checked, cleaned, and double entered to EPI-INFO 3.5.2 and analyzed with SPSS V20. Independent sample t-test and chi-square test were conducted to compare the outcome of vaginal delivery and cesarean section (CS using index variables. Significance was taken at P<0.05. Results: Among the enrolled women, 760 mothers had CS delivery and the remaining 2,243 mothers delivered vaginally. Children born through CS (mean =6.83, standard deviation =1.31 had a significantly lower first-minute Apgar score than those in the vaginal delivery group (mean =7.19, standard deviation =1.18, P=0.001. Similarly, the observed respiratory distress syndrome (c2=0.09, P=0.793 and neonatal transfer rate to neonatal intensive care unit (c2=0.086, P=0.766 were more in neonates delivered by CS than those in the vaginally delivered group. Besides, the observed neonatal death (c2=0.675, P=0.411 and maternal death (c2= 8.878, P=0.003 were higher among CS deliveries compared with vaginal deliveries. Conclusion: Neonatal and maternal morbidity and mortality appear

  17. Native tissue repairs in anterior vaginal prolapse surgery: examining definitions of surgical success in the mesh era.

    Science.gov (United States)

    Lee, Una; Wolff, Erika M; Kobashi, Kathleen C

    2012-07-01

    Native tissue repair of the anterior vaginal wall was thought to have a poor success rate based on anatomic outcome. This high rate of anatomic failure was often quoted as the underlying reason for performing mesh-augmented prolapse repair. The purpose of this article is to review the outcomes of native tissue repair of anterior vaginal prolapse repair in the mesh era. Success in pelvic organ prolapse surgery has been redefined. The contemporary definition of success includes the absence of symptoms associated with a vaginal bulge, which correlates best with a patient's perception of success. When this concept is applied to 12 randomized controlled trials that compared native tissue anterior colporrhaphy and mesh repairs for anterior vaginal wall prolapse, it is apparent that although mesh repair had superior anatomic success (38-93 vs. 27-71%), both mesh and native tissue repair had excellent rates of symptomatic success (75-96 and 62-100%, respectively). Taken together, the overall reoperation rate for native tissue repair was 5.0% compared with 9.0% for mesh-augmented repair. Although anatomic stage 0 results are not achieved in many cases, patients do experience symptomatic relief and improvement in their quality of life, only seeking retreatment in a small proportion of cases with anatomic recurrence. Thus, the definition of success must include subjective symptom-based outcome in addition to anatomic outcome. In addition, the degree of later complications, including additional surgeries, must also be taken into account when defining success based on patient satisfaction.

  18. The relationship between ultrasonic findings of postpartum uterus after normal vaginal delivery and the duration of lochia discharge

    Directory of Open Access Journals (Sweden)

    Soghra Khazardoost

    2017-06-01

    Full Text Available Background: Lochia is the slight vaginal bleeding between 24 hour to 12 week after delivery. There isn't any standard definition for difference between normal and abnormal lochia in post-partum period. The aim of this study was to determine the relationship between ultrasonic findings of the postpartum uterus after normal vaginal delivery with the duration of lochia discharge. Methods: In this cross-sectional study was done in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2015. In this study 160 women with non-complicated vaginal delivery were entered. Inclusion criteria were: Term pregnancy with gestational age > 37, singleton fetus with cephalic presentation. Exclusion criteria were pre-term pregnancies, previous Cesarean section or other uterine surgeries and twin fetuses. Transvaginal ultrasound was done in first 48 hours after delivery, endometrial thickness echogenicity and uterine size was evaluated. Maternal age, parity, duration of labor and neonatal weight were evaluated. Then the mothers were followed for 6 weeks. The quality and the quantity of lochia discharge were asked by the phone. Results: Lochial discharge last more than 6 weeks in 96 out of 160 (60%. One had less than 4 weeks. The uterus length, thickness, height and endometrial length did not show any relationship with the duration of lochial discharge, but endometrial strip thickness significantly correlated with the duration of lochial discharge period (P=0.04. None of clinical variables like the number of gravidity, parity, live birth or child birth weight, were correlated to the duration of lochia discharge period, but the labor time was correlated to the duration of lochia discharge period (P=0.04. Although both endometrial thickness and labor time in univariate analysis were correlated to the lochia duration time but this was true just for endometrial thickness in multivariate analysis. Conclusion: The endometrial

  19. User preferences in a carrageenan-based vaginal drug delivery system.

    Directory of Open Access Journals (Sweden)

    Bangde Li

    Full Text Available Topical microbicides are a promising solution to address the global threat of HIV and other sexually transmitted infections. To be successful, a microbicide not only needs to be biologically functional but also highly acceptable to users. User acceptability of microbicides can be incorporated early in the product formulation and design process. Previous qualitative research revealed women had strong preferences regarding product shape, while preferences related to size and firmness were less clear. Here, we explored the effect of size and firmness on the acceptability of semisolid ovoid microbicide prototypes intended for vaginal use. Sexually active women (n = 74 were randomized to one of two conditions: with and without applicator. Nine different prototypes were evaluated; they were formulated to low, medium and high firmness using mixtures of kappa and iota carrageenan and potassium chloride. Three sizes were produced at each firmness level. Women manipulated all nine prototypes, rating them for perceived effectiveness, imagined ease-of-insertion and willingness-to-try on visual analog scales. The influence of size and firmness on these three outcome measures were assessed using ANOVA and response surface models. Results indicated size and firmness both influenced the outcome measures, but firmness was more influential than size. Also, the specific effects of size and firmness depended strongly on presence or absence of an applicator. Generally, women in the without applicator condition wanted a larger, firmer product. Collectively, these data suggest efforts to rationally design of microbicides for enhanced user acceptability must consider factors like size and firmness. Also, the decision to include or forego an applicator should be addressed early in the design process, as it strongly influences other design decisions.

  20. User Preferences in a Carrageenan-Based Vaginal Drug Delivery System

    Science.gov (United States)

    Li, Bangde; Zaveri, Toral; Ziegler, Gregory R.; Hayes, John E.

    2013-01-01

    Topical microbicides are a promising solution to address the global threat of HIV and other sexually transmitted infections. To be successful, a microbicide not only needs to be biologically functional but also highly acceptable to users. User acceptability of microbicides can be incorporated early in the product formulation and design process. Previous qualitative research revealed women had strong preferences regarding product shape, while preferences related to size and firmness were less clear. Here, we explored the effect of size and firmness on the acceptability of semisolid ovoid microbicide prototypes intended for vaginal use. Sexually active women (n = 74) were randomized to one of two conditions: with and without applicator. Nine different prototypes were evaluated; they were formulated to low, medium and high firmness using mixtures of kappa and iota carrageenan and potassium chloride. Three sizes were produced at each firmness level. Women manipulated all nine prototypes, rating them for perceived effectiveness, imagined ease-of-insertion and willingness-to-try on visual analog scales. The influence of size and firmness on these three outcome measures were assessed using ANOVA and response surface models. Results indicated size and firmness both influenced the outcome measures, but firmess was more influential than size. Also, the specific effects of size and firmness depended strongly on presence or absence of an applicator. Generally, women in the without applicator condition wanted a larger, firmer product. Collectively, these data suggest efforts to rationally design of microbicides for enhanced user acceptability must consider factors like size and firmness. Also, the decision to include or forego an applicator should be addressed early in the design process, as it strongly influences other design decisions. PMID:23358688

  1. 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.

  2. Mode of delivery following successful external cephalic version: comparison with spontaneous cephalic presentations at delivery.

    Science.gov (United States)

    Kuppens, Simone M I; Hutton, Eileen K; Hasaart, Tom H M; Aichi, Nassira; Wijnen, Henrica A; Pop, Victor J M

    2013-10-01

    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). We conducted a retrospective matched cohort study in a teaching hospital in the Netherlands. Delivery outcomes of women with a successful ECV were compared with those of women with spontaneously occurring cephalic presentations, controlling for maternal age, parity, gestational age at delivery, and onset of labour (spontaneous or induced). Exclusion criteria were a history of Caesarean section, delivery at Women who had a successful ECV had a significantly higher Caesarean section rate than the women in the control group (33/220 [15%] vs. 62/1030 [6.0 %]; P women in the cases group showed that nulliparity, induction of labour, and occiput posterior presentation were associated with Caesarean section and instrumental deliveries. Compared with delivery of spontaneous cephalic presenta-tions, delivery of cephalic presenting babies following successful ECV is associated with an increased rate of Caesarean section, especially in nulliparous women and women whose labour is induced.

  3. [Maternal care after vaginal delivery and management of complications in immediate post-partum--Guidelines for clinical practice].

    Science.gov (United States)

    Simon, E-G; Laffon, M

    2015-12-01

    To provide recommendations on maternal care after vaginal delivery, and management of complications in immediate post-partum period. Bibliographic research from the Pubmed database and recommendations issued by the main scientific societies, and assignment of a level of evidence and a recommendation grade. After a vaginal delivery, monitoring of blood pressure, heart rate, bleeding, uterine involution, genital pain, urination, temperature, transit and signs of phlebitis is recommended (professional consensus). Post-partum Anemia is defined by a hemoglobinmagnesium sulfate are the same as in prenatal period (professional consensus). Oral NSAIDs are effective for perineal pain and uterine involution (EL2). In case of broken down perineal wounds following childbirth, there is no argument in favor of suturing or not suturing, however the suturing is to be preferred for large dehisced perineal wounds (professional consensus). Infection of perineal scar justifies an oral broad-spectrum antibiotics, in addition to local nursing (professional consensus). In case of obstetric anal sphincter injuries, an antibiotic prophylaxis is recommended (grade B). Hygiene advice should be given to all women who had an episiotomy or a perineal tear (professional consensus). The only etiological treatment of post-dural puncture headache is the blood patch (EL2). It must not be carried out before 48 hours (professional consensus). Thromboembolic risk after a vaginal birth is about 1‰ (EL2). The prescription of thromboprophylaxis with LMWH and graduated compression stockings should be based on risk factors (professional consensus). During the immediate post-partum period, complications may be unrecognized or confused with the natural post-partum evolution, which implies a strong vigilance from practitioners. This vigilance is all the more necessary that the maternal residence durations are shortened. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. 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.

  5. 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.

  6. Mode of delivery in a subsequent pregnancy following previous instrumental delivery.

    Science.gov (United States)

    Lurie, Samuel; Steinberg, Netanel; Tannus, Samer; Golan, Abraham; Sadan, Oscar

    2013-05-01

    To assess mode of subsequent delivery in women with previous instrumental vaginal delivery. In this retrospective longitudinal study we followed women who underwent instrumental delivery. The study group included all consecutive parturient women who underwent an instrumental vaginal delivery during a 24-month period (1996-1999). We then identified women who had a subsequent delivery in our center until the end of the year 2010. The control group included women who had a spontaneous vaginal delivery from the same time. During the index period we had 349 consecutive successful instrumental vaginal deliveries. Of those, 125 women had a subsequent delivery in our center (35.8%). In subsequent pregnancies, the spontaneous vaginal delivery rate was 76.8% and 90.4%; the instrumental delivery rate was 8.8% and 1.6%; and the cesarean rate was 14.4% and 8.0%, in the instrumental delivery, and spontaneous vaginal delivery groups, respectively (Pinstrumental delivery or a cesarean after having an instrumental delivery in a previous pregnancy was 2.8 (95% confidence interval 1.4-5.9, Pinstrumental delivery are at an increased risk of requiring either an instrumental delivery or a cesarean section in a subsequent pregnancy compared with women with a previous spontaneous vaginal delivery.

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

    Directory of Open Access Journals (Sweden)

    Seyedeh Zahra Masoumi

    2016-12-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  9. 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...

  10. 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

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

    2014-01-01

    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

  12. 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.

  13. 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

  14. 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.

  15. Early skin-to-skin contact for healthy full-term infants after vaginal and caesarean delivery : A qualitative study on clinician perspectives

    NARCIS (Netherlands)

    Koopman, Inez; Callaghan-Koru, Jennifer A.; Alaofin, Oluwatope; Argani, Cynthia H.; Farzin, Azadeh

    2016-01-01

    Aims and objectives: This study aims to provide insight into key factors from a clinician's perspective that influence uninterrupted early skin-to-skin contact after vaginal and caesarean delivery of healthy full-term infants. Background: Early skin-to-skin contact of healthy full-term infants

  16. 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.

  17. Acceptability of vaginal film, soft-gel capsule, and tablet as potential microbicide delivery methods among African women.

    Science.gov (United States)

    Nel, Annalene M; Mitchnick, Lynne B; Risha, Peter; Muungo, Lungwani Tyson Makoye; Norick, Pamela M

    2011-08-01

    Vaginal microbicides are in development for the prevention of HIV transmission to women via sexual intercourse. Acceptability of the microbicide delivery method in the targeted population is important to product adherence and, therefore, product effectiveness. It is anticipated that multiple delivery methods will be required to satisfy personal preferences among future microbicide users. A total of 526 sexually active women aged 18-30 years participated in a consumer product preference study in Burkina Faso, Tanzania, and Zambia. Screened women who had given consent were instructed to use each of the three products (placebo formulations of a vaginal tablet, film, and soft-gel capsule) once daily for 7 consecutive days for a total of 21 days. Women were interviewed about their impressions of the product at the completion of each 7-day trial period. Over 80% of women reported they liked using each dosage form, and over 85% said they would definitely use it. The film and soft-gel capsule were chosen significantly more often than the tablet as the preferred dosage form (39% and 37% vs. 25%, respectively) mainly because of faster dissolving time and easier insertion. Women in Burkina Faso and Tanzania preferred the soft-gel capsule (42%-46%), whereas Zambian women preferred the film (51%). Age, socioeconomic status, and marital status did not significantly affect product preference. All three dosage forms were acceptable to the women surveyed. Preferred dosage forms varied by country. These data suggest that the availability of microbicides in multiple dosage forms may increase acceptability, adherence, and, therefore, effectiveness.

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  19. 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

    2017-04-25

    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.

  20. 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

  1. Predictive Factors for Delivery within 7 Days after Successful 48-Hour Treatment of Threatened Preterm Labor

    NARCIS (Netherlands)

    Roos, Carolien; Schuit, Ewoud; Scheepers, Hubertina C J; Bloemenkamp, Kitty W M; Bolte, Antoinette C; Duvekot, Hans J J; van Eyck, Jim; Kok, Joke H; Kwee, Anneke; Merién, Ashley E R; Opmeer, Brent C; Oudijk, Martijn A; van Pampus, Mariëlle G; Papatsonis, Dimitri N M; Porath, Martina M; Sollie, Krystyna M; Spaanderman, Marc E A; Vijgen, Sylvia M C; Willekes, Christine; Lotgering, Fred K; van der Post, Joris A M; Mol, Ben Willem J

    2015-01-01

    Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance

  2. Predictive Factors for Delivery within 7 Days after Successful 48-Hour Treatment of Threatened Preterm Labor

    NARCIS (Netherlands)

    Roos, C.; Schuit, E.; Scheepers, H.C.; Bloemenkamp, K.W.; Bolte, A.C.; Duvekot, H.J.; Eyck, J. van; Kok, J.H.; Kwee, A.; Merien, A.E.; Opmeer, B.C.; Oudijk, M.A.; Pampus, M.G. van; Papatsonis, D.N.; Porath, M.M.; Sollie, K.M.; Spaanderman, M.E.; Vijgen, S.M.; Willekes, C.; Lotgering, F.K.; Post, J.A. van der; Mol, B.W.

    2015-01-01

    Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance

  3. Predictive Factors for Delivery within 7 Days after Successful 48-Hour Treatment of Threatened Preterm Labor.

    NARCIS (Netherlands)

    Roos, Carolien; Schuit, Ewoud; Scheepers, Hubertina C J; Bloemenkamp, Kitty W M; Bolte, Antoinette C; Duvekot, Hans J J; van Eyck, Jim; Kok, Joke H; Kwee, Anneke; Merién, Ashley E R; Opmeer, Brent C; Oudijk, Martijn A; van Pampus, Mariëlle G; Papatsonis, Dimitri N M; Porath, Martina M; Sollie, Krystyna M; Spaanderman, Marc E A; Vijgen, Sylvia M C; Willekes, Christine; Lotgering, Fred K; van der Post, Joris A M; Mol, Ben Willem J

    2015-01-01

    Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance

  4. 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.

  5. Lactogenesis failure following successful delivery of advanced abdominal pregnancy.

    Science.gov (United States)

    Pieh-Holder, Kelly L; Scardo, James A; Costello, Deborah H

    2012-12-01

    Abdominal pregnancy is a rare condition with significant risk of maternal and fetal morbidity and mortality. Because of the vascular involvement, the placenta is often left in situ. Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation. We present a case of failure of lactogenesis II following the successful delivery of an advanced abdominal pregnancy in which the placenta was left in situ. This is the first report to discuss the effects on lactation of leaving the placenta in situ as a conservative management option in advanced abdominal pregnancy.

  6. [An updated overview on the anatomy and function of the female pelvic floor, with emphasis on the effect of vaginal delivery].

    Science.gov (United States)

    Jóźwik, Maciej; Jóźwik, Marcin; Adamkiewicz, Maciej; Szymanowski, Paweł; Jóźwik, Michał

    2013-01-01

    Phylogenetically, the pelvic floor is a relatively old group of skeletal muscles which, along the acquisition of the erect posture by the human, gained a number of new important roles or were subjected to adaptation of some other roles performed earlier. The functional tasks of the pelvic floor in women (mostly of its prominent representatives - the levator ani muscles) include: supporting the contents of the abdominal cavity at the upright position, participation in the volitional and reflex compression of the urethra, narrowing the transverse dimension of the vagina and urogenital hiatus, involvement in sexual functions, and securing the terminal portion of the alimentary tract. The aim of this overview was to briefly review the information on the latest understanding of the anatomy of the pelvic floor, delineate its nomenclature recommended by the Federative Committee on Anatomical Terminology, and emphasize an array of physiological findings related to the contractility of these important muscles. The functional specialization of striated muscle fiber types and the anatomical basis of the relationship between vaginal delivery at term and postpartum urinary incontinence have been underlined. Nowadays, some intrapartum injuries to the pelvic floor can be successfully detected with ultrasound in the immediate postpartum period. This updated information should be part of a basic professional knowledge for obstetrician-gynecologist.

  7. Development and in vivo safety assessment of tenofovir-loaded nanoparticles-in-film as a novel vaginal microbicide delivery system.

    Science.gov (United States)

    Machado, Alexandra; Cunha-Reis, Cassilda; Araújo, Francisca; Nunes, Rute; Seabra, Vítor; Ferreira, Domingos; das Neves, José; Sarmento, Bruno

    2016-10-15

    Topical pre-exposure prophylaxis (PrEP) with antiretroviral drugs holds promise in preventing vaginal transmission of HIV. However, significant biomedical and social issues found in multiple past clinical trials still need to be addressed in order to optimize protection and users' adherence. One approach may be the development of improved microbicide products. A novel delivery platform comprising drug-loaded nanoparticles (NPs) incorporated into a thin polymeric film base (NPs-in-film) was developed in order to allow the vaginal administration of the microbicide drug candidate tenofovir. The system was optimized for relevant physicochemical features and characterized for biological properties, namely cytotoxicity and safety in a mouse model. Tenofovir-loaded poly(lactic-co-glycolic acid) (PLGA)/stearylamine (SA) composite NPs with mean diameter of 127nm were obtained with drug association efficiency above 50%, and further incorporated into an approximately 115μm thick, hydroxypropyl methylcellulose/poly(vinyl alcohol)-based film. The system was shown to possess suitable mechanical properties for vaginal administration and to quickly disintegrate in approximately 9min upon contact with a simulated vaginal fluid (SVF). The original osmolarity and pH of SVF was not affected by the film. Tenofovir was also released in a biphasic fashion (around 30% of the drug in 15min, followed by sustained release up to 24h). The incorporation of NPs further improved the adhesive potential of the film to ex vivo pig vaginal mucosa. Cytotoxicity of NPs and film was significantly increased by the incorporation of SA, but remained at levels considered tolerable for vaginal delivery of tenofovir. Moreover, histological analysis of genital tissues and cytokine/chemokine levels in vaginal lavages upon 14days of daily vaginal administration to mice confirmed that tenofovir-loaded NPs-in-film was safe and did not induce any apparent histological changes or pro-inflammatory response. Overall

  8. 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.

  9. Freeze-dried, mucoadhesive system for vaginal delivery of the HIV microbicide, dapivirine: optimisation by an artificial neural network.

    Science.gov (United States)

    Woolfson, A David; Umrethia, Manish L; Kett, Victoria L; Malcolm, R Karl

    2010-03-30

    Dapivirine mucoadhesive gels and freeze-dried tablets were prepared using a 3x3x2 factorial design. An artificial neural network (ANN) with multi-layer perception was used to investigate the effect of hydroxypropyl-methylcellulose (HPMC): polyvinylpyrrolidone (PVP) ratio (X1), mucoadhesive concentration (X2) and delivery system (gel or freeze-dried mucoadhesive tablet, X3) on response variables; cumulative release of dapivirine at 24h (Q(24)), mucoadhesive force (F(max)) and zero-rate viscosity. Optimisation was performed by minimising the error between the experimental and predicted values of responses by ANN. The method was validated using check point analysis by preparing six formulations of gels and their corresponding freeze-dried tablets randomly selected from within the design space of contour plots. Experimental and predicted values of response variables were not significantly different (p>0.05, two-sided paired t-test). For gels, Q(24) values were higher than their corresponding freeze-dried tablets. F(max) values for freeze-dried tablets were significantly different (2-4 times greater, p>0.05, two-sided paired t-test) compared to equivalent gels. Freeze-dried tablets having lower values for X1 and higher values for X2 components offered the best compromise between effective dapivirine release, mucoadhesion and viscosity such that increased vaginal residence time was likely to be achieved. Copyright (c) 2009 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Emilia Szymańska

    2016-09-01

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

  11. 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.

  12. 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.

  13. Successful delivery of RRT in Ebola virus disease.

    Science.gov (United States)

    Connor, Michael J; Kraft, Colleen; Mehta, Aneesh K; Varkey, Jay B; Lyon, G Marshall; Crozier, Ian; Ströher, Ute; Ribner, Bruce S; Franch, Harold A

    2015-01-01

    AKI has been observed in cases of Ebola virus disease. We describe the protocol for the first known successful delivery of RRT with subsequent renal recovery in a patient with Ebola virus disease treated at Emory University Hospital, in Atlanta, Georgia. Providing RRT in Ebola virus disease is complex and requires meticulous attention to safety for the patient, healthcare workers, and the community. We specifically describe measures to decrease the risk of transmission of Ebola virus disease and report pilot data demonstrating no detectable Ebola virus genetic material in the spent RRT effluent waste. This article also proposes clinical practice guidelines for acute RRT in Ebola virus disease. Copyright © 2015 by the American Society of Nephrology.

  14. The effect of a first vaginal delivery on the integrity of the pelvic floor musculature.

    Science.gov (United States)

    Marshall, K; Walsh, D M; Baxter, G D

    2002-11-01

    To assess the specific effect of delivery of the first child on the integrity of the pelvic floor musculature. A prospective study of two groups of females with no symptoms of urinary incontinence. Physiotherapy Department, Rotunda Lying In Hospital, Dublin. Two groups of healthy female physiotherapists (age range 20-28 years) were recruited for the study: group 1 consisted of nulliparous females (n = 10) and group 2 consisted of primiparous females who were 9-10 months post delivery (n = 10). Assessment of the pelvic floor musculature was performed by digital assessment, electromyography and perineometry. For all data, the nulliparous group showed evidence of greater pelvic floor strength and endurance. Analysis of anterior and posterior electromyography data showed significantly stronger contractions in the nulliparous group (p = 0.0001 and 0.044). During a maximum contraction of the pelvic floor muscles, the anterior resting EMG activity increased by 9 +/- 6 microV (mean +/- SD) in the primiparous group compared with an increment of 22.3 +/- 4.74 microV in the nulliparous group. Posterior EMG resting activity increased by 19.7 +/- 7.65 microV (mean +/- SD) in the nulliparous group compared with 13.8 +/- 8.19 microV in the primiparous group. There were significant differences between the two groups for the four types of digital muscle assessment (p readings in the nulliparous group (increment = 5.6 +/- 2.5, mean +/- SD) compared with the primiparous group (increment = 3.1 +/- 0.9; mean +/- SD). This study suggests that irrespective of lack of symptoms of urinary incontinence, it would appear advisable that all women should undertake a prescribed programme of pelvic floor rehabilitation exercises after childbirth.

  15. The impact of the time interval between two successive deliveries in an obstetric unit in terms of the mode of each delivery and the rate of perinatal mortality.

    Science.gov (United States)

    Stein, Werner; Hawighorst, Thomas; Wenzlaff, Paul; Emons, Günter

    2012-01-01

    To analyze the relationship of the time interval between two deliveries, done by one obstetric team, on the delivery mode of the subsequent birth; to define the length of this interval; and to evaluate this time interval as a risk factor for increased perinatal mortality in a population-based cohort. All singleton deliveries at ≥ 24 weeks' gestation in Lower Saxony, Germany, between 2001 and 2005 (a total of 317,663 deliveries including 402 cases of perinatal mortality) were analyzed. The mode of the previous and the subsequent delivery, the time interval between the two deliveries, the time of birth, the hospital volume, and the existence of an affiliated neonatal ward were investigated. When the first vaginal delivery was <45 min, there was a reduced probability that the subsequent birth would be a cesarean section. In case of a previous cesarean section, the cesarean rate of the following birth was influenced up to 165 min. In a multivariate analysis, vaginal deliveries following an earlier vaginal birth and occurring within <45 min were associated with increased perinatal mortality. Repeated cesarean sections within <165 min were associated with increased perinatal mortality when occurring at night or on weekends. A short time interval between two deliveries in an obstetric unit constitutes an independent risk factor for perinatal mortality.

  16. Vaginal cysts

    Science.gov (United States)

    ... of tissue. It can be filled with air, fluid, pus, or other material. A vaginal cyst occurs on or under the vaginal lining. ... There are several types of vaginal cysts. Vaginal inclusion cysts ... may collect fluid and develop into a vaginal wall cyst later ...

  17. Vaginal Atrophy

    Science.gov (United States)

    ... urinary signs and symptoms: Vaginal dryness Vaginal burning Vaginal discharge Genital itching Burning with urination Urgency with urination More urinary tract infections Urinary incontinence Light bleeding after intercourse Discomfort with ...

  18. Pelvic floor muscle functions are improved after successful transobturator vaginal mesh procedures.

    Science.gov (United States)

    Huang, Wen-Chen; Yang, Shwu-Huey; Yang, Jenn-Ming

    2017-02-01

    To explore functional changes of pelvic floor muscle (PFM) after successful Perigee procedures. We retrospectively analyzed information from 145 women having achieved anatomic success, defined as pelvic organ prolapse quantification (POP-Q) system. The investigated data included results from the POP-Q system and four-dimensional ultrasound at the preoperative and 12-month postoperative evaluations. The involuntary and voluntary PFM functions were, respectively, investigated during coughing and squeezing using the ultrasound parameters of the bladder neck distance (BND), bladder neck angle (BNA), genitohiatal distance (GHD), and genitohiatal angle. Postoperatively more women displayed normal involuntary PFM function in maintaining a stable bladder neck (preoperative vs. postoperative: 4.8% vs. 22.8%, P < 0.001) and genitohiatal (preoperative vs. postoperative: 16.6% vs. 30.3%, P = 0.008) locations upon coughing and could perform voluntary PFM contractions (preoperative vs. postoperative: 49.7% vs. 64.1%, P = 0.018). Compared with preoperative manifestations, less caudal displacement of the bladder neck indicated by smaller ranges of dynamic changes in BNA following coughing (preoperative vs. postoperative: 28° vs. 12°, P < 0.001), more cranial movement of the bladder neck indicated by larger values of changes in BND following squeezing (-0.26 vs. 0.06 cm, P < 0.001), and less reduction of genitohiatal size indicated by larger values of changes in GHD following squeezing (preoperative vs. postoperative: -0.95 vs. -0.63 cm, P = 0.027) were demonstrated postoperatively. Involuntary and voluntary PFM functions are improved after successful Perigee procedures. Neurourol. Urodynam. 36:380-384, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  19. Uroflowmetric changes, success rate and complications following Tension-free Vaginal Tape Obturator (TVT-O) operation in obese females.

    Science.gov (United States)

    Fouad, Reham; El-Faissal, Yahia M; Hashem, Ahmed T; Gad Allah, Sherine H

    2017-07-01

    The goal of this study was to evaluate the outcome of Tension-free Vaginal Tape Obturator (TVT-O) operation in the treatment of urodynamic stress incontinence (USI) in obese females, with respect to uroflowmetric changes, success rate and postoperative complications. This prospective observational study included 26 patients with USI at the Obstetrics & Gynecology department-Cairo University hospital during the year 2015. The participants had body mass index (BMI)≥30. Patients underwent TVT-O operation. Follow up of the patients was performed by cough test and uroflowmetry after one week, one month, three months and six months. Postoperative complications such as groin pain, sense of incomplete emptying, need to strain to complete micturition and urinary tract infection were recorded. Comparisons between groups were done using Chi square, Phi-Cramer test for categorical variables. The mean age for the subjects was 43.58±9.01years. The mean BMI was 33.4±2.1. The success rate of TVT-O operation was 21 out of 26 patients (≈81%). Normal maximum flow rate was in 88% of patients at week one and was normal in 100% of patients at months three and six (p=0.101 & 0.101). Postoperative groin pain was the main complaint during the first week after operation and decreased significantly from week one to the 1st month postoperative (84.62% & 65.38%, P=0.041). TVT-O operation showed a high success rate in treatment of USI in obese patients without affecting the voiding function of the bladder as proven by the uroflowmetry. The main postoperative complaint was the groin pain which significantly improved after one month. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Differentials in health-related quality of life of employed and unemployed women with normal vaginal delivery.

    Science.gov (United States)

    Chinweuba, Anthonia U; Okoronkwo, Ijeoma L; Anarado, Agnes N; Agbapuonwu, Noreen E; Ogbonnaya, Ngozi P; Ihudiebube-Splendor, Chikaodili N

    2018-01-10

    The combination of child care and domestic work demands on both housewives and the employed (hired) women may impact their health-related quality-of-life. There is paucity of studies to ascertain this. This study investigated the differences in health-related quality of life of employed and unemployed women with normal vaginal delivery and associated socio-demographic variables. This longitudinal study was done from March, 2012 to June, 2013. Modified SF-36v2™ health-related quality of life questionnaire was administered to 234 newly delivered women drawn from six selected hospitals in Enugu, Southeast Nigeria at 6, 12 and 18 weeks postpartum. Respondents were reached for data collection through personal contacts initially at the hospitals of delivery, and subsequently by visits to their homes/workplaces or cell-phone calls. Women were asked to indicate how each of 36 items applied to them at each of the three times. Data collection lasted for six calendar months and 17 days (from September 3rd 2012 to 20th March, 2013). All the women had their best HrQoL at 12 weeks postpartum. Employed women reported lower health-related quality-of-life than the unemployed at the three time-points, the lowest mean score being at 18 weeks postpartum (Mean = 73.9). Multiple comparison of scores of the two groups using Tukey HSD Repeated Mean showed significant variation on the eight subscales of the health-related quality-of-life. Physical functioning (p = 0.045), Physical role limitation (p = 0.000), bodily pain (p = 0.000), social functioning (p = 0.000) and general health (p = 0.000) were unequal guaranteeing type 1 error. Women with higher education and personal income reported higher health-related quality-of-life (p quality-of-life post-partum. The traditionally accepted paid 3 months maternity leave should be elongated by extra months to help women balance their daily work with baby care. Gender sensitive employment opportunities in favour of

  1. 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.

  2. The success of microneedle-mediated vaccine delivery into skin

    OpenAIRE

    Marshall, Sarah; Laura J. Sahm; Moore, Anne C.

    2016-01-01

    Microneedles (MNs) are designed to specifically target the outermost, skin barrier layer, the stratum corneum, creating transient pathways for minimally invasive transcutaneous delivery. It is reported that MNs can facilitate delivery without stimulating the pain receptors or damaging blood vessels that lie beneath, thus being perceived as painless and associated with reduced bleeding. This immunocompetence of the skin, coupled with its ease of access, makes this organ an attractive vaccinati...

  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. Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study.

    Science.gov (United States)

    Dohbit, Julius Sama; Foumane, Pascal; Tochie, Joel Noutakdie; Mamoudou, Fadimatou; Temgoua, Mazou N; Tankeu, Ronni; Aletum, Veronica; Mboudou, Emile

    2017-11-22

    Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. A retrospective cohort study. A tertiary hospital in Yaounde, Cameroon. Cases of VBD of newborns weighing 2500-3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500-3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  5. Intraoral Vacuum of Breast-Feeding Newborns Within the First 24 Hr: Cesarean Section Versus Vaginal Delivery.

    Science.gov (United States)

    Zhang, Feng; Xia, Haiou; Li, Xia; Qin, Ling; Gu, Hongmei; Xu, Xujuan; Shen, Meiyun

    2016-07-01

    To explore whether newborns born via Cesarean section have a weaker intraoral vacuum compared with those born vaginally and to determine whether a weaker intraoral vacuum is related to a delayed onset of lactation. For this prospective cohort study, 71 mother-infant dyads were enrolled and divided into birthing groups, vaginal or Cesarean. The newborn intraoral vacuum was measured via a tube placed alongside the nipple and connected to a pressure sensor during a breast-feeding session within the first 24 hr after birth. Onset of lactation was confirmed by maternal perception of breast fullness. The intraoral vacuum and its relationship with the onset of lactation were analyzed. After adjustment for confounding factors, the peak intraoral vacuum was -19.50 kPa in the vaginal group, which was significantly stronger than the -13.78 kPa in the Cesarean group (p = .005). Additionally, the baseline intraoral vacuum in the vaginal group (-2.35 kPa) was significantly stronger than that in the Cesarean group (-1.18 kPa; p = .022). Strength of the newborn intraoral vacuum was associated with the time of onset of maternal lactation. Cesarean section may weaken newborns' intraoral vacuum within the first 24 hr after birth. Stronger intraoral vacuum was related to earlier onset of lactation. Early intervention aimed at the weaker intraoral vacuum should be provided to promote the onset of lactation. © The Author(s) 2016.

  6. 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.

  7. Pregnancy and delivery in a parturient with liver transplant

    Directory of Open Access Journals (Sweden)

    A V Pyregov

    2013-01-01

    Full Text Available The article presents a case of successful spontaneous vaginal delivery with the use of epidural analgesia in a patient with orthotopic liver transplant. The importance of the multidisciplinary approach is highlighted in management of such cases.

  8. A "See and Treat" Office Procedure for Retained Products of Conception Removal After Normal Vaginal Delivery Using Manual Vacuum Aspiration: Preliminary Efficacy and Reproductive Outcomes.

    Science.gov (United States)

    Karavani, Gilad; Bahar, Raz; Herzberg, Shmuel; Yanai, Nili

    To compare the efficacy and reproductive outcomes of an ultrasound-guided manual vacuum aspiration (MVA) procedure with the widely accepted operative hysteroscopic (OH) procedure in the removal of retained products of conception (RPOCs) after normal vaginal delivery. A retrospective cohort study (Canadian Task Force classification II-2). A university-affiliated tertiary medical center. Eighty-six patients after normal vaginal delivery diagnosed with RPOCs from 2005 through 2015. This study was approved by the local institutional review board. Treatment with either MVA or OH for patients diagnosed with RPOCs. Of 86 patients, 23 underwent remnant removal by ultrasound-guided MVA using a 6- to 7-mm catheter in a "see and treat" office procedure. Sixty-three patients underwent remnant removal using the OH procedure. Follow-up included sonographic examination 3 to 5 weeks after the procedure and long-term follow-up on complications and reproductive outcomes. Successful remnant evacuation and the overall complications rates were similar when comparing the MVA group and the OH group (95.7% vs 96.8% and 4.3% vs 4.7%, respectively). Conception rates and miscarriage rates were comparable in the MVA and OH groups (78.6% vs 72.2% and 9.1% vs 14.8%, respectively). Preliminary results from 23 patients suggest that MVA is an efficient procedure with low complication rates and satisfactory reproductive outcomes. It does not require anesthesia or operating room facilities, allowing an immediate and inexpensive "see and treat" option for RPOCs. Further larger controlled trials are required. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-01-10

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-01

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

  11. The success of microneedle-mediated vaccine delivery into skin.

    Science.gov (United States)

    Marshall, Sarah; Sahm, Laura J; Moore, Anne C

    2016-11-01

    Microneedles (MNs) are designed to specifically target the outermost, skin barrier layer, the stratum corneum, creating transient pathways for minimally invasive transcutaneous delivery. It is reported that MNs can facilitate delivery without stimulating the pain receptors or damaging blood vessels that lie beneath, thus being perceived as painless and associated with reduced bleeding. This immunocompetence of the skin, coupled with its ease of access, makes this organ an attractive vaccination site. The purpose of this review was to collate primary scientific literature pertaining to MN-mediated in vivo vaccination programmes. A total of 62 original research articles are presented, compiling vaccination strategies in 6 different models (mouse, rat, guinea pig, rabbit, pig, macaque and human). Vaccines tested span a wide range of viral, bacterial and protozoan pathogens and includes 7 of the 13 vaccine-preventable diseases, as defined by the WHO. This review highlights the paucity of available clinical trial data. MN-delivered vaccines have demonstrated safety and immunogenicity in pre-clinical models and boast desirable attributes such as painless administration, thermostability, dose-sparing capacity and the potential for self-administration. These advantages should contribute to enhanced global vaccine access.

  12. 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

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

    Science.gov (United States)

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

    2017-08-04

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

  14. 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.

  15. Comparison of preoperative and postoperative pressure transmission ratio and urethral pressure profilometry in patients with successful outcome following the vaginal wall patch sling technique.

    Science.gov (United States)

    Mikhail, Magdy S; Rosa, Hector; Palan, Prabhudas; Anderson, Patrick

    2005-01-01

    We studied preoperative and postoperative pressure transmission ratio (PTR) and urethral pressure profilometry in patients undergoing the vaginal wall patch sling technique as a first surgical approach for genuine stress incontinence (GSI) with urethral hypermobility. The specific aims were to determine the exact urodynamic parameters, if any, that may be improved postoperatively and to report the urodynamic outcome of the vaginal wall patch sling technique in successful cases. Preoperatively, all patients had a positive standing stress test, urethral hypermobility on Q-tip testing, and normal postvoid residual volume. On urodynamics, all patients had equalization of maximum urethral closure pressure (MUCP) on cough profilometry, and absence of detrusor contractions on subtracted cystometry. The PTR for each cough was calculated. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length (FUL). Urethral pressure profilometry was performed at bladder capacity in the sitting position. All urodynamic tests were repeated 3-6 months postoperatively. A two-tailed t-test was used for statistical analysis. Forty-eight patients demonstrated successful outcome at initial follow up and constituted the study population. There was a statistically significant increase in MUCP at stress as well as a statistical increase in PTR in the first, second, and third quartiles of the FUL postoperatively. The vaginal patch sling technique appears to restore continence both by buttressing the urethra at times of stress as well as repositioning the proximal urethra into the intra-abdominal pressure zone, thus, enhancing pressure transmission to the proximal urethra.

  16. Online, Instructional Television and Traditional Delivery: Student Characteristics and Success Factors in Business Statistics

    Science.gov (United States)

    Dotterweich, Douglas P.; Rochelle, Carolyn F.

    2012-01-01

    Distance education has surged in recent years while research on student characteristics and factors leading to successful outcomes has not kept pace. This study examined characteristics of regional university students in undergraduate Business Statistics and factors linked to their success based on three modes of delivery - Online, Instructional…

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

    Science.gov (United States)

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

    2014-07-01

    Nevirapine (NVP) was loaded in polycaprolactone (PCL) matrices to produce vaginal inserts with the aim of preventing HIV transmission. NVP dispersions in PCL were prepared, at 10% (w/w) theoretical loading, measured with respect to the PCL content of the matrices, in the form of (1) NVP only, (2) a physical mixture of NVP with polyethylene glycol (PEG) 6000 or (c) a solid dispersion (SD) with PEG produced by co-dissolution in ethanol. Characterisation of SD by differential scanning calorimetry and attenuated total reflectance-Fourier transform infrared spectroscopy suggested transformation of the crystalline structure of NVP to an amorphous form which consequently increased the dissolution rate of drug. A low-loading efficiency of 13% was obtained for NVP-loaded matrices and less than 20% for matrices prepared using physical mixtures of drug and PEG. The loading efficiency was improved significantly to around 40% when a 1:4 NVP-PEG SD was used for matrix production. After 30 days, 40% of the drug content was released from NVP-loaded matrices, 55% from matrices containing 1:4 NVP-PEG physical mixtures and 60% from matrices loaded with 1:4 NVP-PEG SDs. The in vitro anti-viral activity of released NVP was assessed using a luciferase reporter gene assay following the infection of HeLa cells with pseudo-typed HIV-1. NVP released from PCL matrices in simulated vaginal fluid retained over 75% anti-HIV activity compared with the non-formulated NVP control. In conclusion, 1:4 NVP-PEG SDs when loaded in PCL matrices increase drug loading efficiency and improve release behaviour. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

  18. Successful Pregnancy and Delivery in a Woman With Panhypopituitarism

    Directory of Open Access Journals (Sweden)

    Barton D

    2007-01-01

    Full Text Available To The Editor: Pregnancy after a complete loss of hypophyseal function is rare. Lack of growth hormone (GH, adrenocorticotropin (ACTH and thyroid-stimulating hormone (TSH in childhood may result in malfunction of different organ systems, affecting fertility. Complete lack of ovarian stimulation by FSH and LH results in anovulation and ovarian atrophy. We present a patient with panhypopituitarism who has achieved pregnancy and delivered through in vitro fertilization (IVF and embryo transfer (ET. This 35 year-old woman underwent four trans-sphenoidal hypophysectomies at 12, 13, 23 and 26 years of age, for recurrent neuroectodermal cysts (embryonic remnant. Her second operation was complicated by panhypopituitarism with severe diabetes insipidus, treated with adequate doses of hydrocortisone, L-thyroxine and desmopressin. At age 21, cyclic substitution therapy with estrogen and progesterone was given for primary amenorrhea. Two years later, GH therapy was added. At age 33, she requested fertility treatment. GH, cyclic estrogen, and progesterone therapy were stopped, and she underwent ovulation induction, with gonadotropins, followed by IVF and ET, resulting in a successful dichorionic twin pregnancy. She was followed regularly at a combined antenatal clinic. No changes in steroid, desmopressin, or thyroxine doses were required, and the antenatal period was uneventful. An elective caesarean section was performed at 37 weeks gestation, and healthy twin boys (weighing 3.0 and 3.14 kg were delivered. Clinical course during puerperium was normal.Conception and uncomplicated pregnancy in patients with hypopituitiarism are rare [1,2]. Well-timed substitution of missing hormones enables normal physical development. Stimulation therapy with gonadotropins can induce adequate follicular maturation. IVF-ET may be a useful treatment for infertility in patients with hypopituitarism as it may reduce the incidence of multiple pregnancies associated with higher

  19. 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 ...

  20. Label-free analysis of tenofovir delivery to vaginal tissue using co-registered confocal Raman spectroscopy and optical coherence tomography.

    Directory of Open Access Journals (Sweden)

    Oranat Chuchuen

    Full Text Available Vaginally applied microbicide products offer a female-controlled strategy for preventing sexual transmission of HIV. Microbicide transport processes are central to their functioning, and there is a clear need for a better understanding of them. To contribute to that end, we developed an assay to analyze mass transport rates of microbicide molecules within the epithelial and stromal layers of polarized vaginal mucosal tissue during contact with a gel vehicle. The assay utilizes a new diffusion chamber mounted in a custom instrument that combines confocal Raman spectroscopy and optical coherence tomography. This measures depth-resolved microbicide concentration distributions within epithelium and stroma. Data for a tenofovir gel were fitted with a compartmental diffusion model to obtain fundamental transport properties: the molecular diffusion and partition coefficients in different compartments. Diffusion coefficients in epithelium and stroma were computed to be 6.10 ± 2.12 x 10-8 and 4.52 ± 1.86 x 10-7 cm2/sec, respectively. The partition coefficients between epithelium and gel and between stroma and epithelium were found to be 0.53 ± 0.15 and 1.17 ± 0.16, respectively. These drug transport parameters are salient in governing the drug delivery performance of different drug and gel vehicle systems. They can be used to contrast drugs and vehicles during product design, development and screening. They are critical inputs to deterministic transport models that predict the gels' pharmacokinetic performance, which can guide improved design of products and optimization of their dosing regimens.

  1. Evaluation of psychosocial and biological parameters in women seeking for a caesarean section and women who are aiming for vaginal delivery: a cross-sectional study.

    Science.gov (United States)

    Tuschy, Benjamin; Berlit, Sebastian; Stützer, Paul; Lis, Stefanie; Schmahl, Christian; Baumgärtner, Ulf; Sütterlin, Marc

    2018-01-17

    To investigate psychosocial and biological parameters that may influence decision-making concerning the mode of delivery in women with caesarean section on maternal request (CSMR). Two hundred and two women were enrolled prospectively. The study sample (n = 93) consisted of women who aimed for CSMR, the control sample were women who seeked for vaginal delivery (n = 109). Parturients of both samples were enrolled during the pre-birth counselling at the delivery room at the University Medical Centre Mannheim, University Heidelberg, Germany. Women completed standardised questionnaires regarding psychosocial burden (SCL-R 90), fear of childbirth (W-DEQ) and anxiety (STAI), personality structure (HEXACO-Pi-R), and ambiguity tolerance (PFI, PNS, and NFC), social support (F-SozU) as well as one questionnaire assessing demographic parameters and further factors potentially influencing their choice of the mode of delivery. Hair cortisol concentration as a marker for chronic psychological stress and pressure pain threshold with a pressure algometer was assessed. Women in the CSMR sample had less social support (F-SozU: 2.99 ± 0.52 vs. 3.12 ± 0.32; p = 0.043) and were less educated (high school or university degree: 37 vs. 71%, p = 0.001) compared to parturients of the control sample. Women who underwent CSMR were less open-minded (HEXACO-Pi-R: 3.08 ± 0.57 vs. 3.26 ± 0.50; p = 0.016) and less extroverted (HEXACO-Pi-R: 3.34 ± 0.36 vs. 3.46 ± 0.41; p = 0.041). The control collective showed higher scores in negative appraisal of the birth ('W-DEQ-negative appraisal': 2.5 ± 0.8 vs. 2.2 ± 0.9; p = 0.006), whereas "lack of positive anticipation" was higher in the study collective ('W-DEQ-lack of positive anticipation': 3.2 ± 1.2 vs. 2.8 ± 0.8; p = 0.015). The study collective had higher pressure pain threshold values (5.07 ± 2.06 vs. 4.35 ± 1.38; p = 0.007), while no significant differences were observed in hair cortisol

  2. 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.

  3. 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

  4. 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

  5. Government e-service delivery:identification of success factors from citizens' perspective

    OpenAIRE

    Saha, Parmita

    2008-01-01

    The successful adoption of new technologies helps governments achieve efficiency in their implementation and delivery of public services to citizens. The objective behind various e-government initiatives has shifted in recent years towards establishing services that cater more to citizens' needs and offer greater accessibility. As a result, it is necessary to develop a well-founded theoretical framework to measure the success of such initiatives. The purpose of this thesis is to identify the ...

  6. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery

    OpenAIRE

    Manisco, Gianfranco; Pot??, Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-01-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pre...

  7. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis

    NARCIS (Netherlands)

    de Hundt, Marcella; Velzel, Joost; de Groot, Christianne J.; Mol, Ben W.; Kok, Marjolein

    2014-01-01

    To assess the mode of delivery in women after a successful external cephalic version by performing a systematic review and meta-analysis. We searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for studies reporting on the

  8. Successful Developmental Math Students in Traditional Format and Online Delivery: A Comparative Study

    Science.gov (United States)

    Thomas, Jeremy Lloyd

    2016-01-01

    The purpose of this study was to compare student performance in online and traditional classroom based developmental math courses at Texas community colleges. This study specifically examined: (a) student performance in both delivery methods, (b) students who successfully completed the developmental math course, and (c) student performance in the…

  9. Vaginal evisceration

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Y.C.; Lindenauer, S.M. (Michigan Univ., Ann Arbor (USA) Dept. of Obstetrics and Gynaecology)

    1981-08-01

    A patient with vaginal evisceration due to prior radiation treatment of cervical carcinoma is presented, together with a review to reported cases. The salient features, predisposing causes and management of this unusual problem are discussed.

  10. 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 ...

  11. Metronidazole Vaginal

    Science.gov (United States)

    Metronidazole is used to treat vaginal infections such as bacterial vaginosis (an infection caused from too much of certain bacteria in the vagina). Metronidazole is in a class of medications called nitroimidazole ...

  12. Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases.

    Science.gov (United States)

    Chen, Liang-Kuang; Yang, Bi-Li; Chen, Kuo-Chang; Tsai, Yieh-Loong

    2016-01-01

    Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

  13. Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases

    OpenAIRE

    Chen, Liang-Kuang; Yang, Bi-Li; Chen, Kuo-Chang; Tsai, Yieh-Loong

    2016-01-01

    Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 3...

  14. Vaginal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lesavoy, M.A.

    1985-05-01

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.

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

    Science.gov (United States)

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

    2016-01-01

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

  16. Usefulness of anorectal and endovaginal 3D ultrasound in the evaluation of sphincter and pubovisceral muscle defects using a new scoring system in women with fecal incontinence after vaginal delivery.

    Science.gov (United States)

    Murad-Regadas, Sthela M; da S Fernandes, Graziela Olivia; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Filho, Francisco Sergio Pinheiro Regadas; Dealcanfreitas, Iris Daiana; da Silva Vilarinho, Adjra; da Cruz, Mariana Murad

    2017-04-01

    This study aims to evaluate pubovisceral muscle and anal sphincter defects in women with previous vaginal delivery and fecal incontinence and to correlate the findings with the severity of symptoms using the combined anorectal and endovaginal 3D ultrasonography with a new ultrasound scoring system. Consecutive female patients with previous vaginal delivery and fecal incontinence symptoms were screened. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale, and the extent of defects was assessed by an ultrasound score based on results of anorectal and endovaginal 3D ultrasound. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale. Of 84 women with previous vaginal delivery and fecal incontinence, 21 (25%) had intact pubovisceral muscles and anal sphincters; 63 (75%) had a pubovisceral muscle or anal sphincter defect, or both. Twenty-eight (33%) had a pubovisceral muscle defect [23% with an external anal sphincter (EAS) defect or combined EAS/internal anal sphincter defects; 11% with intact anal sphincters]. Thirty-five (42%) had intact pubovisceral muscles and an anal sphincter defect. Compared with women with intact pubovisceral muscles/anal sphincter defects, patients with pubovisceral muscle defects had significantly higher incontinence scores and significantly higher ultrasound scores indicating more extensive defects. Incontinence symptoms correlated positively with the ultrasound score, measurements of sphincter defects, and area of the levator hiatus. Evaluation of both pubovisceral muscles and anal sphincters is important to identify defects and determine treatment for women with fecal incontinence after vaginal delivery. The severity of fecal incontinence symptoms is significantly related to the extent of defects of the pubovisceral muscles and anal sphincters.

  17. Successful interviewing and selection strategies for patient-centered care delivery.

    Science.gov (United States)

    Dann, D; Miller, B; Hobbs, M; Gentzsch, P; Pierson, C

    1995-03-01

    St. Jude Medical Center, a Sisters of St. Joseph Health System Corporation in Fullerton California, in their efforts at work redesign, realized that the success of a patient-centered care delivery system largely depended upon successful selection of the most suitable team members. The interviewing and selection process used at St. Jude Medical Center includes a structured interview process with integration of both situational and behavioral styles in conjunction with objective rating scales and values driven questions. A common thread woven into the hiring criteria for all levels of personnel in the patient-centered care delivery model was creativity, adaptability, interpersonal skills and compatibility of values. Additionally, the clinical competence of the caregiver within the scope of practice/responsibility was essential for their expanded role. Management and leadership abilities for the managers are also addressed in the interview and selection process to provide the best team members for the overall success of the patient-care redesign.

  18. Obstructed labour caused by rare congenital anomaly of foetus: managed by foetal abdominal tapping leading to successful vaginal delivery

    OpenAIRE

    Neelam Swaroop; Priya Sharma; Kalpana Kumari; Shikha Seth

    2015-01-01

    Obstructed labour with high maternal morbidity and mortality is still prevalent in the developing world. The common causes of obstructed labour include contracted pelvis, uterine abnormalities, maternal pelvic tumours, foetal malpresentation, and congenital foetal abnormalities like hydrocephalus, polycystic kidneys/hydronephrosis or locked twins. Here we present a case of rare congenital anomaly of foetus, Prune belly syndrome causing obstructed labour in its course and managed by foetal abd...

  19. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery

    Science.gov (United States)

    Manisco, Gianfranco; Potì’, Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-01-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well. PMID:26034591

  20. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery.

    Science.gov (United States)

    Manisco, Gianfranco; Potì', Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-06-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well.

  1. Pelvimetry by three-dimensional computed tomography in non-pregnant multiparous women who delivered vaginally

    OpenAIRE

    Salk, Ismail; Cetin, Ali; Salk, Sultan; CETIN, Meral

    2016-01-01

    Summary Background We assessed retrospectively the reference values of pelvic dimensions by 3D CT performed for non-obstetrical indications in non-pregnant multiparous women with a successful vaginal delivery. We further aimed to evaluate the impact of maternal short stature on these parameters. Material/Methods The 3D CT pelvimetry was performed retrospectively in 203 non-pregnant women selected consecutively if they had at least one singleton term delivery with head presentation and if ther...

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

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Prolungatti Cesar

    2011-06-01

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

  3. Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery.

    Science.gov (United States)

    Yardley, Sarah; Cottrell, Elizabeth; Rees, Eliot; Protheroe, Joanne

    2015-02-25

    People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked 'what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?' This realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis. The final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering

  4. 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.

  5. Early amniotomy after vaginal misoprostol for induction of labor: a randomized clinical trial.

    Science.gov (United States)

    Makarem, Mohamed H; Zahran, Kamal M; Abdellah, Mohamad S; Karen, Mohamed A

    2013-08-01

    To test the effectiveness and safety of early amniotomy after vaginal misoprostol for the induction of labor. A randomized clinical trial that included 320 women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, amniotomy group and control group. Each participant received vaginal misoprostol 50 μg every 6 h for induction of labor. In amniotomy group, amniotomy was done in the early active phase of labor while in the control group, the membranes were left to rupture spontaneously or as judged by the senior resident in the duty. More subjects in the amniotomy group achieved vaginal delivery within 24 h than in the control group [117 (73.13 %) vs. 105 (65.63 %)]. Subjects in the amniotomy group reported shorter induction to delivery interval (09.72 ± 4.61 h vs. 13.61 ± 5.61, P = .002), and better neonatal outcome compared to the control group. There were no statistically significant differences between both group with regard to number of doses of misoprostol, need for oxytocin, Cesarean Section indication and maternal side effects. Early amniotomy after vaginal misoprostol for labor induction is associated with higher successful vaginal delivery rate, shorter labor duration and better neonatal outcome.

  6. 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.

  7. 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

  8. Comparación de la atención del parto normal en los sistemas hospitalario y tradicional A comparison of vaginal delivery care between hospital and traditional systems

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    Rosa María Méndez-González

    2002-04-01

    Full Text Available Objetivo. Comparar la atención del parto por vía vaginal entre los sistemas hospitalario y tradicional, para identificar recursos y procedimientos utilizados, y la aparición de complicaciones maternas y neonatales derivadas del tipo de atención. Material y métodos. Estudio transversal realizado en tres hospitales de la ciudad de Mérida y cuatro municipios del estado de Yucatán, México, entre 1989 y 1990. La muestra estuvo constituida por 205 mujeres que tuvieron parto por vía vaginal. Se observó la atención del parto y, a los 15 días posparto, se les entrevistó para detectar complicaciones maternas y neonatales. Se calcularon proporciones y se aplicó ji cuadrada para compararlas. Resultados. Se presentaron complicaciones en ambos sistemas. Sin embargo, en el hospitalario predominaron las maternas y en el tradicional, las neonatales. El número total de complicaciones fue similar. Conclusiones. La calidad de la atención fue similar en ambos servicios. Las complicaciones observadas pueden atribuirse a los recursos y acciones utilizados en cada sistema. Se requieren más estudios de este tipo para contar con evaluaciones objetivas de las ventajas y desventajas de ambos sistemas y contribuir a mejorar la calidad de la atención materno-infantil.Objective. To compare vaginal delivery hospital and traditional care systems to identify resources and practices, as well as maternal and neonatal complications related to each system. Material and Methods. Between 1989 and 1990, a cross-sectional study was conducted in three hospitals of Merida City and four municipalities of the state of Yucatan. The study sample consisted of 205 women who had a normal vaginal delivery. Delivery procedures were observed and a questionnaire to identify complications was applied 15 days after childbirth. Data analysis consisted in comparison of proportions with the chi-squared test. Results. Maternal and neonatal complications were identified in both systems

  9. 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

  10. Vaginoscopic resection of vaginal septum.

    Science.gov (United States)

    Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmed Toufic; Ghulmiyyah, Labib

    2012-12-01

    We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect.

  11. Gastro-retentive drug delivery systems and their in vivo success: A recent update

    Directory of Open Access Journals (Sweden)

    Uttam Kumar Mandal

    2016-10-01

    Full Text Available Gastro-retentive drug delivery system (GRDDS has gained immense popularity in the field of oral drug delivery recently. It is a widely employed approach to retain the dosage form in the stomach for an extended period of time and release the drug slowly that can address many challenges associated with conventional oral delivery, including poor bioavailability. Different innovative approaches like magnetic field assisted gastro-retention, plug type swelling system, muco-adhesion technique, floating system with or without effervescence are being applied to fabricate GRDDS. Apart from in vitro characterization, successful GRDDS development demands well designed in vivo study to establish enhanced gastro-retention and prolonged drug release. Gama scintigraphy and MRI are popular techniques to evaluate in vivo gastric residence time. However, checking of their overall in-vivo efficacy still remains a major challenge for this kind of dosage form, especially in small animals like mice or rat. Reported in vivo studies with beagle dogs, rabbits, and human subjects are only a handful in spite of a large number of encouraging in vitro results. In spite of the many advantages, high subject variations in gastrointestinal physiological condition, effect of food, and variable rate of gastric emptying time are the challenges that limit the number of available GRDDS in the market. This review article highlights the in vivo works of GRDDS carried out in the recent past, including their limitations and challenges that need to be overcome in the near future.

  12. 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.

  13. Vaginal sponge and spermicides

    Science.gov (United States)

    ... counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... Spermicides and vaginal sponges do not work as well at preventing pregnancy as some other forms of birth control. However, using a spermicide ...

  14. Vaginitis test - wet mount

    Science.gov (United States)

    Wet prep - vaginitis; Vaginosis - wet mount; Trichomoniasis - wet mount; Vaginal candida - wet mount ... a rash, painful intercourse, or odor after intercourse. Trichomoniasis , a sexually transmitted disease. Vaginal yeast infection .

  15. 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.

  16. Delivery through perineal body and severed external anal sphincter with an intact vaginal orifice during a precipitous labor: a case report.

    Science.gov (United States)

    Ismail, Khadijah Irfah; McDonnell, Brendan; O'Coigligh, Seosamh

    2015-05-01

    We present the case of a patient who delivered her baby through the perineal body with an intact vaginal introitus. Damage to the perineal body through its connection to the external anal sphincter can involve the rectovaginal septum with increased morbidity and thought to be linked to rectocele development.

  17. Contraceptive vaginal rings: a review.

    Science.gov (United States)

    Brache, Vivian; Faundes, Anibal

    2010-11-01

    Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Vaginal vault prolapse.

    Science.gov (United States)

    Uzoma, Azubuike; Farag, K A

    2009-01-01

    Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward

  19. Thermosensitive bioadhesive gels for the vaginal delivery of sildenafil citrate: in vitro characterization and clinical evaluation in women using clomiphene citrate for induction of ovulation.

    Science.gov (United States)

    Soliman, Ghareb M; Fetih, Gihan; Abbas, Ahmed M

    2017-03-01

    The objective of this study is to develop and characterize in situ thermosensitive gels for the vaginal administration of sildenafil as a potential treatment of endometrial thinning occurring as a result of using clomiphene citrate for ovulation induction in women with type II eugonadotrophic anovulation. While sildenafil has shown promising results in the treatment of infertility in women, the lack of vaginal pharmaceutical preparation and the side effects associated with oral sildenafil limit its clinical effectiveness. Sildenafil citrate in situ forming gels were prepared using different grades of Pluronic® (PF-68 and PF-127). Mucoadhesive polymers as sodium alginate and hydroxyethyl cellulose were added to the gels in different concentrations and the effect on gel properties was studied. The formulations were evaluated in terms of viscosity, gelation temperature (Tsol-gel), mucoadhesion properties, and in vitro drug release characteristics. Selected formulations were evaluated in women with clomiphene citrate failure due to thin endometrium (Clinicaltrial.gov identifier NCT02766725). The Tsol-gel decreased with increasing PF-127 concentration and it was modulated by addition of PF-68 to be within the acceptable range of 28-37 °C. Increasing Pluronic® concentration increased gel viscosity and mucoadhesive force but decreased drug release rate. Clinical results showed that the in situ sildenafil vaginal gel significantly increased endometrial thickness and uterine blood flow with no reported side effects. Further, these results were achieved at lower frequency and duration of drug administration. Sildenafil thermosensitive vaginal gels might result in improved potential of pregnancy in anovulatory patients with clomiphene citrate failure due to thin endometrium.

  20. Large-volume paracentesis, up to 27 L, with adjuvant vaginal cabergoline in the case of severe ovarian hyperstimulation syndrome with successful pregnancy outcome: A case report

    Directory of Open Access Journals (Sweden)

    Nupur Agarwal

    2017-01-01

    Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is a potentially life-threatening complication of assisted reproductive technology. Herein, we report the case of an infertile couple, with the husband being azoospermic, who underwent in-vitro fertilisation and intracytoplasmic sperm injection at our institute. The woman presented with late OHSS 7 days after embryo transfer. Inpatient management was performed with intensive surveillance. Oral cabergoline was started prophylactically but was replaced by the vaginal route due to intolerance. Transvaginal paracentesis was performed five times over 20 days, and a total of 27 L of ascitic fluid was drained. The patient improved substantially and had a further uneventful pregnancy course. This case report helped us theorise that large-volume paracentesis is safe and efficacious in the management of severe OHSS. In addition, the vaginal route of cabergoline administration is more favourable than the oral route in view of lesser side effects and better patient compliance.

  1. Synthesis of the project leadership staffing needs for successful development of alternative delivery programs.

    Science.gov (United States)

    2017-08-01

    This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

  2. Failure to perform assisted deliveries is resulting in an increased ...

    African Journals Online (AJOL)

    The need to perform assisted vaginal delivery has been regarded as self-evident. Textbooks state: 'Assisted vaginal ... in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is .... delivery[20] states that blood-borne viral infections of the mother are no contraindication to operative ...

  3. Critical success factor (CSF) service delivery for tahfiz institution teaching & learning environment

    Science.gov (United States)

    Ridza, B. H.; Jalil, R. A.; Sipan, I.; Nukman, Y.

    2017-11-01

    The exceptional existence of tahfiz institutions (TI) by a government and the private sector in Malaysia indicates that tahfiz education at par to fill mainstream education. Nevertheless, the level of TI facilities management (FM) provided is unstandardized since its infrastructure and establishment is initiated by the varied background of TI organizer. Thus, the effectiveness of TI education system is immeasurable. The significance of this research is to explore the critical success factor (CSF) of service delivery for TI teaching and learning environment. This research adopts both qualitative and quantitative method through survey instrument in order to review and analyze to achieve the research goal. The findings showed several important criteria for a transformation of TI education teaching and learning environment such top management of TI needs to be more responsible in providing better FM practice to achieve efficiency of manpower in providing a conducive learning environment for students for producing excellent huffaz. Thus, TI education system needs to have clear standard guidelines in operating their activities in producing huffaz that capable implement Islamic knowledge to the development of the country.

  4. [Multipurpose treatment of vaginal infections].

    Science.gov (United States)

    Nikolov, A; Masseva, A; Shopova, E; Georgiev, S

    2012-01-01

    Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone.

  5. 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.

  6. Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Azubuike Uzoma

    2009-01-01

    Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

  7. 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.

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

    African Journals Online (AJOL)

    The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage, premature rupture of the membranes (PROM) and puerperal sepsis. Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention ...

  9. Vaginal breech births in a hospital where caesarean section is ...

    African Journals Online (AJOL)

    SCIENTIFIC LETTER. Objectives. Caesarean section has become the preferred delivery method for breech presentation at Chris Hani Baragwanath Academic ... This study has shown that vaginal breech births continue to occur as unexpected events. ... descriptive study was to understand why and how vaginal breech.

  10. Low-activity waste feed delivery -- Minimum duration between successive batches

    Energy Technology Data Exchange (ETDEWEB)

    Peters, B.B.

    1998-08-25

    The purpose of this study is to develop a defensible basis for establishing what ``minimum duration`` will provide acceptable risk mitigation for low-activity waste feed delivery to the privatization vendors. The study establishes a probabilistic-based duration for staging of low-activity waste feed batches. A comparison is made of the durations with current feed delivery plans and potential privatization vendor facility throughput rates.

  11. SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience.

    Science.gov (United States)

    Crawford, Jessica; Larsen-Cooper, Erin; Jezman, Zachariah; Cunningham, Stacey C; Bancroft, Emily

    2014-02-01

    To determine the difference in delivery success of health messages delivered through pushed SMS, pushed voice messages sent to personal phones, and voice messages retrieved from a community phone ("retrieved voice messaging"), as well as the difference in quality of the user experience. We analyzed the project's electronic monitoring data between September 2011 and June 2013, including demographics, enrollment data, and messages sent and successfully delivered. We also collected and analyzed information from quarterly phone-based surveys with users to assess quality of the user experience, including acceptability, comprehension, new information learned, and reported behavior change. More than half of subscribers enrolled in the retrieved voice messaging service while nearly one-third enrolled in the pushed SMS service and less than 10% in pushed voice messaging. Message delivery success was highest among pushed SMS subscribers and lowest among retrieved voice subscribers. Overall, 99% of survey respondents reported trusting messages they received, and about 75% of respondents recalled the last message they received and learned something new. Almost 75% of respondents reported that they had already changed or intended to change their behavior based on received messages. Intended or actual behavior change was significantly higher among pushed SMS enrollees than among pushed or retrieved voice messaging enrollees (P = .01). All message modalities led to high levels of satisfaction, comprehension, and new information learned. Due to lower cost, higher delivery success, and higher levels of intended or actual behavior change, SMS is the preferred delivery modality. However, the majority of users included in this study did not have access to a personal phone, and retrieved voice messages provided an opportunity to access a population that otherwise could not be served. Providing multiple methods by which users could access the service was crucial in extending reach

  12. Recent advances in bacteriophage therapy: how delivery routes, formulation, concentration and timing influence the success of phage therapy.

    Science.gov (United States)

    Ryan, Elizabeth M; Gorman, Sean P; Donnelly, Ryan F; Gilmore, Brendan F

    2011-10-01

    Bacteriophages are bacteria-specific viruses that infect and, in the case of obligately lytic phages, destroy their host bacteria. Phage therapy has been used therapeutically to combat bacterial infections since their discovery. This paper reviewed recent in-vivo phage therapy studies, with a distinct focus on the effect of delivery routes, phage concentration and timing of administration on the success of the therapy. It was found that the most successful route of administration for the treatment of systemic infections was via the parenteral route. Oral delivery is mainly used to treat gastrointestinal infections. However, in some cases phages can also reach the systemic circulation. Local delivery (skin, ears, teeth) has proved extremely successful in the treatment of topical infections, as has the inhalation of phages for the treatment of lung infections. The ability of phages to prevent biofilm formation on medical devices has received much attention, mainly in the area of catheter coatings. This review also highlights areas in which phage therapy needs substantial development. Many papers were lacking in formulation details, with crude phage stocks being used in most cases. No phage stability data were included in any of the papers. The review concluded that although phage therapy is an excellent alternative for the treatment of bacterial infections, optimisation of formulations and long-term stability data is required before it can be widely used within a clinical setting. © 2011 The Authors. JPP © 2011 Royal Pharmaceutical Society.

  13. Ecosystem service delivery in restoration projects: the effect of ecological succession on the benefits of tidal marsh restoration

    Directory of Open Access Journals (Sweden)

    Annelies Boerema

    2016-06-01

    Full Text Available Long-term assessment of ecosystem restoration projects is complex because of ecological processes such as succession, particularly in highly dynamic ecosystems such as estuaries. Restoration of intertidal flats and marshes on formerly embanked land, often called managed coastal realignment (MR, became popular in estuarine management. In our study, biophysical and monetary data were collected to calculate the value of 15 (subecosystem services (ES delivered by a large tidal marsh restoration project in the Schelde estuary in Belgium and the Netherlands. We hypothesized that ES delivery changes over time due to ecological succession and hence the long-term benefits are subject to this phenomenon and need to be taken into consideration. A marsh sediment accretion model (MARSED was used to simulate potential marsh succession scenarios. In this way, the temporal evolution of ES delivery caused by ecological succession could be evaluated. Our study shows that benefits during successional marsh stages could actually be higher than for marshes in equilibrium. This finding does not suggest that ecosystems in transition always have a higher value than systems in equilibrium, but emphasizes the need to consider long-term ecological dynamics, such as succession, in a benefit assessment for restoration projects.

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

    African Journals Online (AJOL)

    Ninteen (76.0%) were of low social class. Various reasons for attempting vaginal delivery at TBA's or spiritual churches included lack of funds 9(37.5%) husbands or close relative not available to take decision for hospital delivery 6(25.0%), not appreciating the need for hospital delivery 3(12.5%) and no reason 1(4.2%).

  15. Successful pregnancy and delivery in a woman with propionic acidemia from the Amish community.

    Science.gov (United States)

    Scott Schwoerer, Jessica; van Calcar, Sandra; Rice, Gregory M; Deline, James

    2016-09-01

    Propionic acidemia (PA) is an inborn error of protein metabolism with a variable clinical presentation ranging from neonatal encephalopathy to seemingly asymptomatic individuals who present with cardiomyopathy or sudden death. PA is recognized in the Amish population, often with an early asymptomatic course and eventual cardiac complications. Thus, Amish women with PA may reach reproductive age without clinical sequelae, but are at increased risk for metabolic decompensation during pregnancy, delivery and postpartum period. We describe the care of an Amish woman with PA during her first pregnancy and delivery.

  16. Successful pregnancy and delivery in a woman with propionic acidemia from the Amish community

    Directory of Open Access Journals (Sweden)

    Jessica Scott Schwoerer

    2016-09-01

    Full Text Available Propionic acidemia (PA is an inborn error of protein metabolism with a variable clinical presentation ranging from neonatal encephalopathy to seemingly asymptomatic individuals who present with cardiomyopathy or sudden death. PA is recognized in the Amish population, often with an early asymptomatic course and eventual cardiac complications. Thus, Amish women with PA may reach reproductive age without clinical sequelae, but are at increased risk for metabolic decompensation during pregnancy, delivery and postpartum period. We describe the care of an Amish woman with PA during her first pregnancy and delivery.

  17. 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

  18. Online Delivery as a Course Adjunct Promotes Active Learning and Student Success

    Science.gov (United States)

    Lewis, J. Scott; Harrison, Marissa A.

    2012-01-01

    Chickering and Gamson's notable summary of the best practices of undergraduate teaching include promoting active learning, cooperation, and student-faculty contact. The present study hypothesized that online delivery of lecture prior to course meetings allows more in-class time to achieve these goals. Students in a control group received a…

  19. Serum β-hCG concentration is a predictive factor for successful early medical abortion with vaginal misoprostol within 24 hours

    OpenAIRE

    Kim, Jung In; Park, In Yang; Yim, Jung Mi; Cheon, Ju Young; Yun, Hang Goo; Kwon, Ji Young

    2017-01-01

    Objective To evaluate the predictive factors associated with the success of medical abortion by misoprostol monotherapy within 24 hours in the first trimester of pregnancy. Methods The records of 228 women with miscarriage up to 11 weeks of gestational age who underwent medical abortion by intravaginal misoprostol monotherapy were reviewed. Success of abortion was defined as complete expulsion of the conceptus without the need for surgical intervention. Outcomes of interest were success of ab...

  20. Challenges and Successes Using Nanomedicines for Aerosol Delivery to the Airways.

    Science.gov (United States)

    Resnier, P; Mottais, A; Sibiril, Y; Le Gall, T; Montier, T

    2016-01-01

    Numerous diseases affect the respiratory tract and the aerosol administration has been widely considered as an adapted and non-invasive method for local delivery. This pathway induces a lung concentration and thus also limits, systemic side effects. However, aerosol delivery of active pharmaceutical ingredients represents a real challenge, due to numerous obstacles such as the specific respiratory movement, the presence of mucus or surfactant, and the mucociliary clearance. Nanomedicines, such as liposomes, micelles or nanoparticles, offer the possibility to increase bioavailability and favor intracellular penetration of specific drugs into lung tissue. This review focuses on the description of aerosol formulations and cellular barriers including design, characteristics and progressive adaptation to airways anatomy. Then, aerosolized formulations currently clinically approved, or in clinical trial are summarized according to the encapsulated drug. In a final section, promising aerosol formulations in pre-clinical studies are detailed.

  1. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    Science.gov (United States)

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  2. 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.

  3. Breastfeeding After Cesarean Delivery

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Breastfeeding After Cesarean Delivery Page Content Article Body A ... delivered vaginally. It is especially important to begin breastfeeding as soon as you are able and to ...

  4. A Path to Successful Energy Retrofits: Early Collaboration through Integrated Project Delivery Teams

    Energy Technology Data Exchange (ETDEWEB)

    Parrish, Kristen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-10-01

    This document guides you through a process for the early design phases of retrofit projects to help you mitigate frustrations commonly experienced by building owners and designers. It outlines the value of forming an integrated project delivery team and developing a communication and information-sharing infrastructure that fosters collaboration. This guide does not present a complete process for designing an energy retrofit for a building. Instead, it focuses on the early design phase tasks related to developing and selecting energy efficiency measures (EEMs) that benefit from collaboration, and highlights the resulting advantages.

  5. 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 ...

  6. 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

    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...

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. Microfinance Institutions' Successful Delivery Of Micronutrient Powders: A Randomized Trial In Rural Haiti.

    Science.gov (United States)

    Baum, Aaron; Elize, Wesly; Jean-Louis, Florence

    2017-11-01

    Globally, two-thirds of child deaths could be prevented by increased provision of health interventions such as vaccines, micronutrient supplements, and water purification tablets. We report the results from a randomized controlled trial in Haiti during 2012 that tested whether microfinance institutions-which reach 200 million households worldwide-can effectively deliver health products. These institutions provide loans to underserved entrepreneurs, primarily poor women in rural areas. In the intervention group, micronutrient powders to improve the nutrition of young children were distributed at regularly occurring microfinance meetings by a trained borrower. In both the control and the intervention groups, nurses led seminars on nutrition and extended breastfeeding during microfinance meetings. At three-month follow-up, the mean difference in hemoglobin concentration between children in the intervention group and those in the control group was 0.28 grams per deciliter (g/dL)-with a subsample of younger children (under two years of age) showing greater relative improvement (0.46 g/dL)-and the odds ratio for children in the intervention group meeting the diagnostic criteria for anemia was 0.64. The results are similar to those of previous studies that evaluated micronutrient powder distribution through dedicated health institutions. Our findings suggest that microfinance institutions are a promising platform for the large-scale delivery of health products in low-income countries.

  13. 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

  14. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Osman Köse

    2013-01-01

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

  16. Non-viral nanovectors for gene delivery: factors that govern successful therapeutics.

    Science.gov (United States)

    Viola, Joana R; El-Andaloussi, Samir; Oprea, Iulian I; Smith, C I Edvard

    2010-06-01

    Gene therapy is regarded as one of the most promising therapeutic approaches, as it has the potential to treat disorders by correcting malformations at the nucleic acids. Some of the most recent developments in the process of plasmid DNA vector design and formulation are reviewed with a special focus on: different formulations of nanovectors and a summary of successful cases reported; requirements for systemic administration; and functionalization of the nanocarriers by use of targeting entities. An understanding of the different physiological barriers and a comprehensive review of the recent strategies used to overcome these obstacles. Particular attention is given to formulations for intravenous administration, colloidal stability properties and different targeting entities used. Overall, vector formulation must take into account the administration route and inherent physiological barriers. Critical parameters for the success of pDNA nanovectors are: particles size, colloidal stability of the formulation and interaction between the carrier and plasmid DNA. Highly relevant is the fact that this interaction should be balanced to offer protection to degradation as well as allow dissociation of the therapeutic nucleic acid for obtaining maximal activity.

  17. Vaginal and Vulvar Cancer

    Science.gov (United States)

    ... Facts About Gynecologic Cancer campaign. The campaign helps women get the facts about gynecologic cancer, providing important “inside knowledge” about their bodies and health. What are vaginal and vulvar cancers? Cancer is ...

  18. 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 ...

  19. Vaginal Yeast Infections

    Science.gov (United States)

    ... Yeast Infections Print A A A en español Infecciones vaginales por hongos What Are Vaginal Yeast Infections? ... keep the amount in a person's body under control. But yeast in the vagina can sometimes "overgrow" ...

  20. Vaginal birth - slideshow

    Science.gov (United States)

    ... ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  1. Vaginal bleeding between periods

    Science.gov (United States)

    ... Inflammation or infection of the cervix (cervicitis) or uterus (endometritis) Injury or disease of the vaginal opening (caused by intercourse, trauma, infection, polyp, genital warts , ulcer, or varicose veins) ...

  2. Yeast Infection (Vaginal)

    Science.gov (United States)

    ... vaginal discharge with a cottage cheese appearance Complicated yeast infection You might have a complicated yeast infection ... have an uncomplicated or a complicated infection. Uncomplicated yeast infection For mild to moderate symptoms and infrequent ...

  3. Successful delivery of adjuvant external beam radiotherapy for ependymoma in a patient with Ondine's curse

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mehee [Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL (United States); Thoma, Miranda; Tolekidis, George [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States); Byrne, Richard W. [Department of Neurosurgery, Rush University Medical Center, Chicago, IL (United States); Diaz, Aidnag Z., E-mail: aidnag_diaz@rush.edu [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States); Department of Neurosurgery, Rush University Medical Center, Chicago, IL (United States)

    2015-01-01

    Ondine's curse is a rare, potentially life-threatening disorder characterized by loss of automatic breathing during sleep and preserved voluntary breathing. It is seldom encountered in the radiotherapy clinic but can pose significant technical challenges and safety concerns in the delivery of a prescribed radiation course. We report a unique case of successful delivery of radiotherapy for ependymoma in a patient with Ondine's curse. A 53-year-old gentleman presented with vertigo when lying down. Brain magnetic resonance imaging revealed an enhancing mass in the floor of the fourth ventricle. He underwent maximal safe resection. Pathology revealed ependymoma. The patient was referred for radiotherapy. Computed tomography simulation was performed in supine position with 3-point thermoplastic mask immobilization. Sequential TomoTherapy plans were developed. At first scheduled treatment, shortly after mask placement, his arms went limp and he was unresponsive. Vitals showed oxygen saturation 83%, pulse 127, and blood pressure 172/97 mm Hg. He was diagnosed with Ondine's curse thought secondary to previous brainstem damage; the combination of lying flat and pressure from the mask was causing him to go into respiratory arrest. As supine positioning did not seem clinically advisable, he was simulated in prone position. A RapidArc plan and a back-up conformal plan were developed. Prescriptions were modified to meet conservative organs-at-risk constraints. Several strategies were used to minimize uncertainties in set-up reproducibility associated with prone positioning. He tolerated prone RapidArc treatments well. The report highlights the importance of applying practical patient safety and treatment planning/delivery strategies in the management of this challenging case.

  4. Technology for efficient and successful delivery of vermicompost colonized bioinoculants in Pogostemon cablin (patchouli) Benth.

    Science.gov (United States)

    Singh, Rakshapal; Divya, S; Awasthi, Ashutosh; Kalra, Alok

    2012-01-01

    The usefulness of vermicompost as a supporting media for growth of bioinoculants was evaluated for successful transfer of sufficient propagules of bioinoculants into the organic fields. The rooted plants after 50 days were pot and field tested for their growth and yield performances when transplanted along with rooting medium into pots/organic fields. The rooting medium, 50 days of inoculation, contained sufficient population of bioinoculants and arbuscular mycorrhizal (AM) fungi. Treatment with bioinoculants (except Trichoderma harzianum) substantially improved the root and shoot biomass of nursery raised rooted cuttings particularly in treatments containing Azotobacter chroococcum (150 and 91.67%, respectively), Glomus intraradices (117 and 91.67%, respectively) and Pseudomonas fluorescens (117 and 83%, respectively). The transplanted rooted plants in pots, over two harvests, yielded higher shoot biomass when rooting medium contained A. chroococcum (147%), G. intraradices (139%) and P. fluorescencs (139%). Although the treatments did not affect the content of essential oil, the quality of essential oil as measured by the content of patchouli alcohol improved with Glomus aggregatum (18%). Similar trends were observed in field trials with significantly higher biomass yield achieved with A. chroococcum (51%), G. intraradices (46%) and P. fluorescencs (17%) compared to control (un-inoculated) plots. Increased in herb yield was found to be related with increased nutrient uptake. The population of bioinoculants in the rhizosphere was observed to be considerably higher in plots receiving vermicompost enriched with bioinoculants. This technology can be a successful way of delivering sufficient propagules of bioinoculants along with vermicompost especially in organic fields.

  5. 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

    National Research Council Canada - National Science Library

    Verstraelen, Hans; Vervaet, Chris; Remon, Jean-Paul

    2016-01-01

    .... 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...

  6. Transient gestational diabetes insipidus diagnosed in successive pregnancies: review of pathophysiology, diagnosis, treatment, and management of delivery.

    Science.gov (United States)

    Kalelioglu, Ibrahim; Kubat Uzum, Ayse; Yildirim, Alkan; Ozkan, Tulay; Gungor, Funda; Has, Recep

    2007-01-01

    Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-D: -arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.

  7. Trial of labour after caesarean (TOLAC) is associated with increased risk for instrumental delivery.

    Science.gov (United States)

    Inbar, Rotem; Mazaaki, Shali; Kalter, Anat; Gat, Itai; Sivan, Eyal; Schiff, Eyal; Hendler, Israel

    2017-01-01

    We compared the rates of instrumental delivery in a cohort of nulliparous women at term (n = 19,416), to primiparous women who attempted labour after prior caesarean (TOLAC) (n = 1747). The rate of instrumental deliveries was higher in the TOLAC group compared to nulliparous gravidas (17.3 vs. 15% respectively, p = 0.001). The difference was more prominent for women who eventually had successful vaginal delivery (TOLAC: 23.9% vs. 17.1%, p < 0.0001 respectively). Based on our results, previous caesarean whether urgent or elective was associated with an increased risk of instrumental delivery in the subsequent pregnancy.

  8. Diabetic Foot Ulcers and Epidermal Growth Factor: Revisiting the Local Delivery Route for a Successful Outcome

    Directory of Open Access Journals (Sweden)

    Jorge Berlanga-Acosta

    2017-01-01

    Full Text Available Soon after epidermal growth factor (EGF discovery, some in vivo models appeared demonstrating its property to enhance cutaneous wound healing. EGF was the first growth factor (GF introduced in the clinical arena as a healing enhancer, exerting its mitogenic effects on epithelial, fibroblastoid, and endothelial cells via a tyrosine kinase membrane receptor. Compelling evidences from the 90s documented that, for EGF, locally prolonged bioavailability and hourly interaction with the receptor were necessary for a successful tissue response. Eventually, the enthusiasm on the clinical use of EGF to steer the healing process was wiped out as the topical route to deliver proteins started to be questioned. The simultaneous in vivo experiments, emphasizing the impact of the parenterally administered EGF on epithelial and nonepithelial organs in terms of mitogenesis and cytoprotection, rendered the theoretical fundamentals for the injectable use of EGF and shaped the hypothesis that locally infiltrating the diabetic ulcers would lead to an effective healing. Although the diabetic chronic wounds microenvironment is hostile for local GFs bioavailability, EGF local infiltration circumvented the limitations of its topical application, thus expanding its therapeutic prospect. Our clinical pharmacovigilance and basic studies attest the significance of the GF local infiltration for chronic wounds healing.

  9. Aerobic vaginal pathogens and their sensitivity pattern.

    Science.gov (United States)

    Mumtaz, Shamim; Ahmad, Mumtaz; Aftab, Irum; Akhtar, Naeem; ul Hassan, Masood; Hamid, Abdul

    2008-01-01

    The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years (April 2004-March 2006). One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection (39.5%) was observed at 31-40 years followed by 41-50 years (35.8%). About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs & with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor (35%) as well as outdoor (41.6%) patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity (> 80%) against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to

  10. INTRODUCTION OF SUCCESSFUL BREASTFEEDING PRINCIPLES TO THE SYSTEM OF MEDICAL CARE DELIVERY TO PREMATURE INFANTS

    Directory of Open Access Journals (Sweden)

    I. A. Belyaeva

    2014-01-01

    Full Text Available Optimal feeding in the early postnatal ontogenesis is especially important for premature infants with overlapping perinatal pathologies. As is known, unique properties of breast milk ensure adequate physical and neuropsychic development of children, as well as balanced development of metabolism; this is especially important for premature infants. The article presents the main stages of securing priority of breastfeeding for healthy infants: the history of development of the commonly known “ten steps” of breastfeeding for obstetric institutions and the objective impediments to implementation of these steps at neonatal resuscitation and intensive care units (NRICUs and neonatal pathology units. A group of experts of the World Health Organization summarized experience of several neonatal inpatient hospitals in the framework of the Baby Friendly Hospital Initiative and formulated the basic principles of breastfeeding support for implementation at NRICUs. The experts emphasize utmost importance of a long-lasting contact with the mother (skin-to-skin and teaching lactation preservation methods to mothers for the support of breastfeeding of premature infants. An attitude toward withdrawal from other feeding methods, rubber teats and pacifiers, as well as organization of breastfeeding “upon request” from premature infants is restricted due to peculiarities of health status and physiological maturity of such children. The experts state that mothers must remain with premature infants around the clock and the necessity of contact with other family members. They also emphasize the importance of preparation of parents to breastfeeding maintenance after discharge from hospital. Implementation of these modified approaches is expected to contribute to successful prolonged breastfeeding of premature infants. 

  11. 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

  12. Worksheet of Exogenous Variables that Impact the Success of Validation Stage of Product Delivery of a Project

    Directory of Open Access Journals (Sweden)

    Altino José Mentzingen de Moraes

    2015-02-01

    building a solution that complies with the expectations presented by Stakeholders in the Project Result (which, as already said, are recorded in the Discipline of Scope in accordance with the Planning Stage and should meet the intended requirements of compliance in Product Delivery (which, as already said, are recorded in the Discipline of Quality in accordance with Validation Stage. In the execution of Validation Stage of Product Delivery structured in the Discipline of Quality, which occurs immediately as predecessor of the placement of the solution built in Operational Phase Production is used, as reference to parameterize the expected quality, the degree of compliance with the requirements (Essential and/or Desirable specified in the Planning Stage of Project Result structured in the Discipline of Scope. Independently of the nature of the Project (if this is to execute a solution for the Civil Construction, Software Development, Product Implementation or others Areas, may be perceived some Exogenous Variables that interfere with the achievement with success of Validation Stage of Product Delivery structured in the Discipline of Quality. The perception of these Exogenous Variables, which can interfere with Deadlines and Costs initially planned for the implementation of Validation Stage of Product Delivery, is the result of the accumulation of experiences throughout the professional career of more than 40 (forty years of author this work in projects of various types, besides their additional Technical Certifications in the field of Project Management (PMP© - Project Management Professional/PMI© - Project Management Institute and System Testing (CTFL© - Certified Tester Foundation Level/ISTQB© - International Software Testing Qualifications Board. As result of their assessments and surveys in this theme, the author identified and classified the Exogenous Variables perceived between 2 (two Aspects, which are, the Circumstantial Aspects of the Project and the Specific

  13. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

    Energy Technology Data Exchange (ETDEWEB)

    Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp; Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp; Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp; Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp; Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp; Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan); Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp [Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan); Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp; Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan)

    2016-08-15

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  14. Management of Cesarean Deliveries and Cesarean Scars With Osteopathic Manipulative Treatment: A Brief Report.

    Science.gov (United States)

    Martingano, Daniel

    2016-07-01

    Cesarean scars pose a unique set of risks for women who have had previous cesarean deliveries. Between 1996 and 2007, the rate of trial of labor after previous cesarean delivery increased, along with reported rates of uterine rupture and other complications. Consequently, trial of labor after previous cesarean delivery and resultant vaginal birth after cesarean delivery have decreased and cesarean delivery has increased. With nearly one-third of women having cesarean delivery, the rate of rare complications such as cesarean scar ectopic pregnancy has also increased. An integration of osteopathic manipulative treatment techniques into the management of cesarean deliveries and cesarean scars has yet to be defined. The author presents 4 cases of cesarean delivery in which osteopathic manipulative treatment was integrated with successful outcomes.

  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. The art of performing a safe forceps delivery: a skill to revitalise.

    Science.gov (United States)

    Rather, Henna; Muglu, Javaid; Veluthar, Luxmi; Sivanesan, K

    2016-04-01

    The number of forceps deliveries is globally falling possibly due to Obstetricians gaining more experience and competence in the use of Ventouse deliveries. The declining use of traction forceps can increase the rate of second stage caesarean sections, which may have a long-term impact on the overall rate of vaginal births, despite the efforts of improving uptake of vaginal births after caesarean sections. The failures in forceps deliveries are commonly related to inaccurate assessment of the foetal position and station, which can be addressed by gaining sound clinical experience and applying intra-partum scanning to determine the fetal head position in the second stage, and should be part of the core curriculum in obstetric training. The alternate techniques of rotation, like digital and manual rotation, should be taught and encouraged in cases where rotation is required, which will significantly increase the success rate of instrumental deliveries. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. 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

  18. Assemblies for in vitro measurement of bioadhesive strength and retention characteristics in simulated vaginal environment.

    Science.gov (United States)

    Vermani, Kavita; Garg, Sanjay; Zaneveld, Lourens J D

    2002-10-01

    The vaginal route of administration offers a promising option for local and systemic delivery of drugs. Conventional vaginal formulations are associated with limitations of poor retention, leakage, and messiness, thereby causing inconvenience to users. To overcome these limitations, formulations that adhere to the vaginal mucosa for a sufficient period of time need to be developed. Bioadhesion and retention are desirable characteristics of a vaginal formulation to achieve desired efficacy. These properties can be built in during formulation development by the use of bioadhesive polymers. In the present study, assemblies for in vitro measurement of bioadhesive strength and retention characteristics of vaginal formulations have been developed. A modified simulated vaginal fluid (SVFM) was used to simulate vaginal conditions for bioadhesion studies. Cellophane hydrated with SVFM and isolated sheep vaginal mucosa were used as model membranes. The bioadhesive potential of various polymers and their combinations was evaluated. Among the polymers evaluated, xanthan gum (XG), sodium alginate (SA), Polycarbophil (PC), and their combinations (XG + SA and XG + PC) were found to possess significant bioadhesive strength. In retention experiments, XG, SA, and combinations (XG + SA and XG + PC) were retained in isolated sheep vaginal tissue, while PC exhibited poor retention under experimental conditions. Based on the results of the study conducted, XG, SA, and combinations (XG + SA and XG + PC) have been proposed as potential candidates for developing bioadhesive vaginal drug delivery systems.

  19. Chronic Uterine Inversion Presenting as a Painless Vaginal Mass at 6 Months Post Partum: A Case Report.

    Science.gov (United States)

    Ali, Eram; Kumar, Manisha

    2016-05-01

    Uterine inversion is an abnormal protrusion of internal surface of relaxed uterus through the vaginal orifice. Its causes can be broadly classified as puerperal and non-puerperal with puerperal uterine inversion more common than non-puerperal uterine inversion. Acute inversions occurring immediately, or within 24 hours post-partum are the most common type. Chronic Uterine Inversions (CUI) occurring more than four weeks after the delivery are rare identities. There differential diagnosis includes prolapsed fibroids and endometrial polyp. Chronic nature of these inversions makes the restoration of the normal position of the uterus per vaginal difficult contrary to acute inversions which can be reposited more easily. We hereby present a case of 28-year-old lady who presented with a painless vaginal mass at 6 months post-partum. She was diagnosed as a case of CUI based on clinical and sonographic examination. Inverted uterus was successfully restored through per abdominal approach. The presentation of CUI as a painless vaginal mass at delayed post-partum period is rare and therefore reported.

  20. Difficulty in the management of pregnancy after vaginal radical trachelectomy.

    Science.gov (United States)

    Takada, Sakura; Ishioka, Shin-Ichi; Endo, Toshiaki; Baba, Tsuyoshi; Morishita, Miyuki; Akashi, Yushi; Mizuuchi, Masahito; Adachi, Hidefumi; Kim, Miseon; Saito, Tsuyoshi

    2013-12-01

    We have performed 26 vaginal radical trachelectomies (RTs) for patients with early invasive uterine cervical cancer since 2003 and, to date, have experienced 8 deliveries. The procedure has a high risk for preterm labor and the subsequent occurrence of preterm premature rupture of membranes (pPROM). We report the present situation and the limits of follow-up of pregnancy after vaginal RT. Our operative procedure is based on that of Dargent et al. We usually amputate the cervix approximately 10 mm below the isthmus. To remove the parametrium, we cut at the level of type II hysterectomy. Pregnancy courses after vaginal RT were studied in 8 patients with respect to symptoms, cervical length, and several infectious signs. We recommended that patients enter hospital early in their second trimester, and prophylactic daily vaginal disinfection with povidone-iodine and an ulinastatin vaginal suppository were administered. Careful checking for vaginal infectious signs, as well as cervical length and abdominal tension of patients was also performed. Four patients followed up with this modality were able to continue their pregnancies until late in the third trimester. However, this follow-up modality was not effective for patients who showed cervical incompetence due to slack cervical cerclage. They suffered from pPROM at 26 and 19 weeks of gestation. We need a new approach for the management of pregnant patients after vaginal RT with cervical incompetence due to slack cervical cerclage to prevent cervical infection.

  1. MANAGEMENT OF VAGINAL DISCHARGE

    African Journals Online (AJOL)

    Enrique

    Northern Branch. He has conducted numerous clinical trials and has a research interest in infectious diseases with special emphasis on sexually transmitted infections. He is a recipi- ent of the NRFs grant for research in sexually transmitted diseases and is also the principal investigator for a phase III vaginal microbicide.

  2. Vaginal rejuvenation: current perspectives

    Directory of Open Access Journals (Sweden)

    Barbara G

    2017-07-01

    Full Text Available Giussy Barbara,1 Federica Facchin,2 Laura Buggio,3 Daniela Alberico,3 Maria Pina Frattaruolo,3 Alessandra Kustermann1 1Department of Obstetrics and Gynecology, Service for Sexual and Domestic Violence (SVSeD, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 2Faculty of Psychology, Catholic University of Milan, 3Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Abstract: Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed. Keywords: vaginal rejuvenation, female genital cosmetic surgery, vaginoplasty 

  3. Impact of Delivery Modality, Student GPA, and Time-Lapse since High School on Successful Completion of College-Level Math after Taking Developmental Math

    Science.gov (United States)

    Acosta, Diane; North, Teresa Lynn; Avella, John

    2016-01-01

    This study considered whether delivery modality, student GPA, or time since high school affected whether 290 students who had completed a developmental math series as a community college were able to successfully complete college-level math. The data used in the study was comprised of a 4-year period historical student data from Odessa College…

  4. Elementary Principal and Teacher Perceptions of the Effectiveness of Kotter's Strategies Used to Change Teacher Instructional Delivery to Improve Student Success in Algebra 1

    Science.gov (United States)

    From-Friesen, Bendta S.

    2012-01-01

    Purpose: The purpose of this study was twofold: (a) Identify and describe principal and teacher perceptions of the effectiveness of Kotter's strategies used to facilitate change in instructional delivery to improve student success in Algebra 1; (b) identify and describe which strategies used by principals and teachers were perceived as most…

  5. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Kelly L. Pieh-Holder

    2014-01-01

    Full Text Available Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.

  6. [Instrumental delivery with perineum-fetal head distance >55 MM on ultrasound].

    Science.gov (United States)

    Magnard, C; Perrot, M; Fanget, C; Paviot-Trombert, B; Raia-Barjat, T; Chauleur, C

    2016-02-01

    Compare the issue of an operative vaginal delivery associated to the fetal presentation diagnosed by transperineal ultrasound. Three groups were formed: ≥55 mm, between 45 and 55 mm, and <45 mm. A monocentric prospective study on 108 patients has been conducted between April 2011 and August 2014. The distance between perinea and skull has been analyzed to compare the success of operative vaginal delivery considering the level of the fetal presentation in the pelvic cavity. The failed operative vaginal deliveries are more frequent while the fetal head is above 55 mm (16.7%) or while the fetal head is between 45 and 55 mm (9.1%) than while the fetal skull is under 45 mm (1.8%) (P=0.04). However there is no significant difference for the fetal shoulder dystocia (5.6% vs 3.0% vs 3.5%, P=0.5), nor for the newborn outcomes (16.7 vs 15.2 vs 14; P=0.9). Despite the high rate of failed operative vaginal delivery above 55 mm, it should be considered not to prohibit but send free to the obstetrician appreciation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. [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.

  8. The impact of maternal body mass index on external cephalic version success.

    Science.gov (United States)

    Chaudhary, Shahrukh; Contag, Stephen; Yao, Ruofan

    2018-01-21

    The purpose of this study is to determine the association between body mass index (BMI) and success of ECV. This is a cross-sectional analysis of singleton live births in the USA from 2010 to 2014 using birth certificate data. Patients were assigned a BMI category according to standard WHO classification. Comparisons of success of ECV between the BMI categories were made using chi-square analysis with normal BMI as the reference group. Cochran-Armitage test was performed to look for a trend of decreasing success of ECV as BMI increased. The odds for successful ECV were estimated using multivariate logistic regression analysis, adjusting for possible confounders. A total of 51,002 patients with documented ECV were available for analysis. There was a decreased success rate for ECV as BMI increased (p success rate of ECV; women with a normal BMI had 65.0% success rate of ECV. Multivariate analyses demonstrated significant decrease in success of ECV in women with BMI of 40 kg/m 2 or greater (OR 0.621, CI 0.542-0.712). Among women with BMI of 40 kg/m 2 or greater with successful ECV, 59.5% delivered vaginally. In contrast, 81.0% of women with normal BMI and successful ECV delivered vaginally. Morbidly obese women have decreased success rate of ECV as BMI increases and decreased vaginal delivery rates after successful ECV.

  9. Delivery Outcomes after Term Induction of Labor in Small-for-Gestational Age Fetuses.

    Science.gov (United States)

    Rhoades, Janine S; Rampersad, Roxane M; Tuuli, Methodius G; Macones, George A; Cahill, Alison G; Stout, Molly J

    2017-05-01

    Objective The objective of this study was to estimate the delivery outcomes after induction of labor (IOL) at term in patients with small-for-gestational age (SGA) fetuses. Study Design A secondary analysis of a prospective cohort study of all term, singleton deliveries from 2010 to 2014. Patients who underwent an IOL for any indication were included. Delivery outcomes were compared between patients with and without SGA fetuses (defined as birth weight < 10th percentile for gestational age). Analysis was stratified by parity. Indication for cesarean was compared between the two groups for those who did not achieve vaginal delivery. Logistic regression was used to adjust for confounders. Results Of 3,787 patients who underwent an IOL, 644 patients had SGA fetuses and 3,143 were included in the non-SGA group. There was no significant difference in rate of successful vaginal delivery for patients with and without SGA fetuses (77.2 vs. 72.0% [adjusted odds ratio: 1.22, 95% confidence interval 1.00-1.50]). Of the patients who were delivered by cesarean, women with SGA fetuses were more likely to undergo cesarean for nonreassuring fetal status and less likely for arrest disorders than women without an SGA fetus. Conclusion Term patients undergoing IOL with SGA fetuses are as likely to achieve a vaginal delivery as patients with non-SGA fetuses. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. [Prolapse surgery. With abdominal or vaginal meshes?].

    Science.gov (United States)

    Loertzer, H; Schneider, P; Thelen, P; Ringert, R H; Strauß, A

    2012-09-01

    In prolapse surgery several surgical techniques are available. The different open, laparoscopic and vaginal approaches are distinguished by distinct success and relapse rates and operation-specific complications. A safe and optimal therapeutic pelvic floor surgery should be based on the three support levels according to DeLancy and be individually adjusted for every patient. The vaginal approach may be used for all kinds of female genital prolapse and is a comparatively less invasive technique with a short time of convalescence. Apart from stress incontinence there is no need for synthetic meshes in primary approaches and excellent results with low complication and relapse rates can be achieved. An uncritical application of synthetic material is to be avoided in vaginal repair at all times. Abdominal surgical techniques, both open and laparoscopic, present their strengths in the therapeutic approach to level 1 defects or stress incontinence. They provide excellent functional and anatomical corrections and low relapse rates. Abdominally inserted meshes have lower complication rates than vaginal ones.

  11. 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.

  12. Uterine artery embolisation in the management of recurrent vaginal ...

    African Journals Online (AJOL)

    We report a rare case of primary postpartum haemorrhage due to a traumatic cause following spontaneous vaginal delivery in which surgical intervention failed. ... haematomas in which surgical intervention fails to control bleeding is still under-reported. ... In the recovery room after 1 hour her blood pressure dropped to ...

  13. Qualitative and quantitative intravaginal targeting: Key to anti-HIV-1 microbicide delivery from test tube to in vivo success

    CSIR Research Space (South Africa)

    Pillay, V

    2012-06-01

    Full Text Available The past decade has seen several effective anti-HIV-1 agent discoveries, yet microbicides continue to disappoint clinically. Our review expounds the view that unsatisfactory microbicide failures may be a result of inefficient delivery systems...

  14. Quantitative analyses of variability in normal vaginal shape and dimension on MR images

    Science.gov (United States)

    Luo, Jiajia; Betschart, Cornelia; Ashton-Miller, James A.; DeLancey, John O. L.

    2016-01-01

    Introduction and hypothesis We present a technique for quantifying inter-individual variability in normal vaginal shape, axis, and dimension, and report findings in healthy women. Methods Eighty women (age: 28~70 years) with normal pelvic organ support underwent supine, multi-planar proton-density MRI. Vaginal width was assessed at five evenly-spaced locations, and vaginal axis, length, and surface area were quantified via ImageJ and MATLAB. Results The mid-sagittal plane angles, relative to the horizontal, of three vaginal axes were 90± 11, 72± 21, and 41± 22° (caudal to cranial, p < 0.001). The mean (± SD) vaginal widths were 17± 5, 24± 4, 30± 7, 41± 9, and 45± 12 mm at the five locations (caudal to cranial, p < 0.001). Mid-sagittal lengths for anterior and posterior vaginal walls were 63± 9 and 98 ± 18 mm respectively. The vaginal surface area was 72 ± 21 cm2 (range: 34 ~ 164 cm2). The coefficient of determination between any demographic variable and any vaginal dimension did not exceed 0.16. Conclusions Large variations in normal vaginal shape, axis, and dimensions were not explained by body size or other demographic variables. This variation has implications for reconstructive surgery, intravaginal and surgical product design, and vaginal drug delivery. PMID:26811115

  15. 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

  16. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision

    Directory of Open Access Journals (Sweden)

    Ridhima Gupta

    2015-01-01

    Full Text Available Background. A transverse vaginal septum (TVS is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation.

  17. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision.

    Science.gov (United States)

    Gupta, Ridhima; Bozzay, Joseph D; Williams, David L; DePond, Robert T; Gantt, Pickens A

    2015-01-01

    Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation.

  18. Vaginitis: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Vulvovaginitis - overview (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginitis updates by ... Vaginitis test - wet mount Vulvovaginitis - overview Related Health Topics Trichomoniasis Vaginal Diseases Yeast Infections Other Languages Find ...

  19. Bladder perforation and development of a vesico - vaginal fistula ...

    African Journals Online (AJOL)

    Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible ...

  20. Pregnant women’s preference for vaginal or caesarean childbirth

    Directory of Open Access Journals (Sweden)

    Lígia Ebner Melchiori

    2009-10-01

    Full Text Available The study investigated the preference for delivery in 40 pregnant women using a semi-structured interview. Most women (75% reported a preference for vaginal delivery, mainly because they believe it will result in a speedy recovery and be better for them and/or their babies. Of the women interviewed, 15% preferred a caesarean section because they considered it be less painful. These preferences, in general, were influenced by friends. Most women said they had fear of parturition due to: feelings of pain/suffering, concern of something happening to them or their babies and because the situation is unknown or assessed in a negative fashion. The presence of trusted people, like one’s husband, mother or doctor, could minimize this fear. These results reinforce the contributions of health professionals, such as psychologists, in answering the psychosocial needs of pregnant women in situations of delivery and birth.   Keywords: vaginal birth; caesarean section; pregnancy; health psychology.

  1. Cervicovaginal aerobic microflora of women with spontaneous abortion or preterm delivery in Araraquara-Brazil Microbiota aeróbica cérvico-vaginal de mulheres com aborto espontâneo ou prematuridade fetal em Araraquara - Brasil

    Directory of Open Access Journals (Sweden)

    Maria Stella G. Raddi

    1998-10-01

    Full Text Available Microbiological routine exams of endocervix and vaginal specimens of 22 women with clinical history of recent spontaneous abortion or premature rupture of membranes were accomplished. Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus agalactiae, Candida sp and Gardnerella vaginalis were recovered from 54.5% (12 of the women. Ureaplasma urealyticum was frequently isolated (45.5% but 5 out of 22 had U. urealyticum only. Our report stands for the importance of quantitative as well as qualitative investigation on genital microflora in pregnant women, since it is likely to influence on pregnancy outcome.Rotina bacteriológica do conteúdo vaginal e cervical de 22 mulheres com histórico de aborto recente ou ruptura precoce das membranas foi realizada. Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus agalactiae, Candida sp e Gardnerella vaginalis foram isolados em 54,5% (12 das pacientes. Apesar de Ureaplasma urealyticum ter sido frequentemente encontrado (45,5%, somente em 5 das 22 mulheres foi o único microrganismo presente nos materiais analisados. Esses resultados chamam a atenção para a importância de investigação quantitativa bem como qualitativa da microbiota genital em gestantes, tendo em vista ter consequências na gestação.

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

    African Journals Online (AJOL)

    Assisted vaginal breech delivery was associated wilh high rate of low Apgar score (score <7) at the 5th minute when compared 10 elective caesarean section (p = 0,000088). 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 ...

  3. 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.

  4. Submicron Matrices Embedded in a Polymeric Caplet for Extended Intravaginal Delivery of Zidovudine.

    Science.gov (United States)

    Mashingaidze, Felix; Choonara, Yahya E; Kumar, Pradeep; du Toit, Lisa C; Maharaj, Vinesh; Buchmann, Eckhart; Pillay, Viness

    2017-11-01

    In this study, an intravaginal delivery system able to deliver an anti-HIV-1 agent for the purpose of potentially reducing HIV-1 transmission acting over an extended duration was successfully formulated. This delivery system was a composite polymeric caplet comprising zidovudine-loaded polyethylene glycol enclatherated pectin-mucin submicron matrices embedded within a poly (D,L-lactide), magnesium stearate, Kollidon® SR, and Carbopol® 974P NF-based polymeric caplet matrix. A three-factor and three-level Box-Behnken statistical design was utilized to optimize the polymeric caplet. The optimized directly compressed composite polymeric caplet hardness was 22.1 ± 0.3 N and the matrix resilience was 62.4 ± 0.6%. The swelling- and diffusion-controlled fractional zidovudine (AZT) release from the optimized caplet was 0.74 ± 0.01 in simulated vaginal fluid (SVF), which increased to 0.81 ± 0.21 in phosphate-buffered saline (PBS) simulating seminal fluid, over 30 days. Caplet matrix swelling was directly related to the percentage Carbopol 974P NF composition. An intravaginal system for AZT delivery was tested in the pig model over 28 days. X-ray analysis depicted delivery system swelling with matrix contrast fading over time as vaginal fluid permeated the matrix core. Plasma, vaginal fluid swab eluates, and tissue AZT concentrations were measured by gradient ultra-performance liquid chromatography (UPLC)-tandem photodiode array detection. Vaginal tissue and vaginal fluid swab eluate AZT concentrations remained above effective levels over 28 days and were higher than plasma AZT concentrations, availing a system with reduced systemic toxicity and more effective inhibition of viral replication at the site of entry.

  5. 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.......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...... 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...

  6. Transient swelling, spreading, and drug delivery by a dissolved anti-HIV microbicide-bearing film

    Science.gov (United States)

    Tasoglu, Savas; Rohan, Lisa C.; Katz, David F.; Szeri, Andrew J.

    2013-03-01

    There is a widespread agreement that more effective drug delivery vehicles with more alternatives, as well as better active pharmaceutical ingredients (APIs), must be developed to improve the efficacy of microbicide products. For instance, in tropical regions, films are more appropriate than gels due to better stability of drugs at extremes of moisture and temperature. Here, we apply fundamental fluid mechanical and physicochemical transport theory to help better understand how successful microbicide API delivery depends upon properties of a film and the human reproductive tract environment. Several critical components of successful drug delivery are addressed. Among these are: elastohydrodynamic flow of a dissolved non-Newtonian film; mass transfer due to inhomogeneous dilution of the film by vaginal fluid contacting it along a moving boundary (the locally deforming vaginal epithelial surface); and drug absorption by the epithelium. Local rheological properties of the film are dependent on local volume fraction of the vaginal fluid. We evaluated this experimentally, delineating the way that constitutive parameters of a shear-thinning dissolved film are modified by dilution. To develop the mathematical model, we integrate the Reynolds lubrication equation with a mass conservation equation to model diluting fluid movement across the moving vaginal epithelial surface and into the film. This is a complex physicochemical phenomenon that is not well understood. We explore time- and space-varying boundary flux model based upon osmotic gradients. Results show that the model produces fluxes that are comparable to experimental data. Further experimental characterization of the vaginal wall is required for a more precise set of parameters and a more sophisticated theoretical treatment of epithelium.

  7. 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.

  8. Vaginal microbicides: An overview

    Directory of Open Access Journals (Sweden)

    Hany Abdel-Aleem

    2011-03-01

    Full Text Available It is estimated that more than 340 million new cases of curable sexually transmitted infections occur every year throughout the world in men and women age (15–49years. Women bear an increasing burden of the epidemic as both caregivers for the ill and because of their heightened risk of infection due to biological, economic and social vulnerabilities. There is an urgent need for new prevention strategies that women can use themselves and initiate. A vaginal microbicide defined as substances intended to reduce or prevent transmission of HIV and/or other sexually transmitted infections (STIs when applied topically to genital mucosal surfaces, provides a woman-controlled method applied before sex that could kill, neutralize, or block HIV and other sexually transmitted diseases.

  9. Cytology for the detection of early recurrence of gynecologic cancer in the vaginal vault.

    Science.gov (United States)

    Lara, Lucia A S; de Andrade, Jurandyr M; Dos Reis, Francisco J C

    2014-01-01

    The real benefit of follow-up cervical cytology in women treated for gynecological cancer is unclear. This study was designed to assess the rate of success of cytological examinations in the detection of early vaginal recurrence of gynecological cancer in women found by other methods to have vaginal recurrence of cervical and endometrial cancer. Records of cytological examinations. Thirty-three women treated for early and invasive cervical and endometrial cancer with recurrence in the vaginal vault were retrospectively analyzed. Records from 1979 to 2010. Sixteen women (48.5%) had symptomatic vaginal recurrence associated with distant metastases, whereas 17 (51.5%) had vaginal recurrence only. Cytology was negative in 12 women (36.4%) with both symptomatic and asymptomatic recurrence and positive in the other 21 (63.6%). In 9 of these 21 women (42.9%), the disease was limited to the vaginal vault, whereas the remaining 12 (57.1%) presented with vaginal lesions associated with distant metastases. Cytology was positive in 9 of the 17 (52.9%) women whose recurrence was limited to the vaginal vault and negative in 8 (47.1%). Vaginal cytology yielded false-negative results in almost half of the women with vaginal recurrence of gynecological cancer. Patents of methods used for early diagnosis and detection of immortalization of cervical cancer are also reviewed in this article.

  10. Temporal structure of first-year courses and success at course exams: comparison of traditional continual and block delivery of anatomy and chemistry courses.

    LENUS (Irish Health Repository)

    Salopek, Daniela

    2012-01-31

    AIM: To evaluate students\\' academic success at delivered in a traditional continual course, spread over the two semesters, or in alternating course blocks. METHOD: We analyzed the data on exam grades for Anatomy and Chemistry courses in the first year of the curriculum for academic year 2001\\/02, with the traditional continual delivery of the courses (n=253 for chemistry and n=243 for anatomy), and academic year 2003\\/04, with block delivery of the courses (n=255 for Chemistry and n=260 for Anatomy). Grades from the final examination were analyzed only for students who sat the exam at the first available exam term and passed the course. For the Anatomy block course, grades at 2 interim written tests and 2 parts of the final exam (practical stage exam and oral exam) in each block were analyzed for students who passed all interim tests and the final exam. RESULTS: There were no differences between two types of course delivery in the number of students passing the final examination at first attempt. There was a decrease in passing percentage for the two Anatomy block course student groups in 2003\\/04 (56% passing students in block 1 vs 40% in block 2, P=0.014). There was an increase in the average grades from 2001\\/02 to 2003\\/04 academic year due to an increase in Chemistry grades (F1,399=18.4, P<0.001, 2 x 2 ANOVA). There was no effect of the sequence of their delivery (F1,206=1.8, P=0.182, 2 x 2 ANOVA). There was also a significant difference in grades on interim assessments of Anatomy when it was delivered in the block format (F3,85=28.8, P<0.001, between-within subjects 2 x 4 ANOVA). CONCLUSIONS: The type of course delivery was not associated with significant differences in student academic success in Anatomy and Chemistry courses in the medical curriculum. Students can successfully pass these courses when they are delivered either in a continual, whole year format or in a condensed time format of a course block, regardless of the number and type of

  11. Quality service delivery for the community, by the community: an innovative Eastern Cape infrastructure and job creation success

    CSIR Research Space (South Africa)

    Wall, K

    2013-10-01

    Full Text Available A number of pilot projects in the Eastern Cape have demonstrated how the institutionally innovative and very practical social franchising partnership approach can successfully be used for the routine maintenance of low-technology water...

  12. Vaginal cuff dehiscence resulting in small-bowel evisceration. A case report.

    Science.gov (United States)

    Percalli, Luigi; Pricolo, Renato; Passalia, Luigi; Croce, Paolo; Ricco', Matteo; Berretta, Roberto; Marchesi, Federico

    2016-09-13

    Vaginal cuff dehiscence is a rare complication of hysterectomies which seems to be more frequent after surgery with laparoscopic suture of the cuff. We present a clinical case of evisceration of the small bowel emerging from vaginal cuff dehiscence, successfully repaired by positioning a low profile polypropylene ePTFE mesh*.

  13. Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum-assisted closure and split thickness skin graft: a case report.

    Science.gov (United States)

    Aydın, Serdar; Aydın, Çağrı Arıoğlu; Uğurlucan, Funda Güngör; Yaşa, Cenk; Dural, Özlem

    2015-04-01

    We describe the case of a 32-year-old woman (gravidity: 4; parity: 2) who underwent cesarean delivery at 37 weeks of gestation and presented with dehiscence and infection of the surgical wound. She had a history of wound infection and dehiscence of the scar from a previous cesarean delivery and dehiscence in the dorsal side of her left hand at the site of intravenous catheterization. The patient was initially diagnosed with a skin infection and later with pyoderma gangrenosum. No evidence of any underlying disease was found. The lesions were treated with systemic corticosteroids and azathioprine, but the lesions were unresponsive to treatment. This complicated case of pyoderma gangrenosum after cesarean delivery, which initially mimicked wound infection, was successfully treated with vacuum-assisted closure and split-thickness skin graft. This synergistic approach with vacuum-assisted closure could be an important treatment option for aggressive and slow-healing lesions. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  14. 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.

  15. 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 ...

  16. 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.

  17. Vaginal itching and discharge - child

    Science.gov (United States)

    ... Images Female reproductive anatomy Causes of vaginal itching Uterus References Davis AJ, Katz VL. Pediatric and adolescent gynecology: gynecologic examination, infections, trauma, pelvic mass, precocious puberty. In: Lentz GM, Lobo ...

  18. VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.

    Science.gov (United States)

    Seffah, J D; Adu-Bonsaffoh, K

    2014-01-01

    an inverse trend between the annual caesarean sections rates and the proportion of women with one previous CS scheduled for TOLAC. There was a statistically significant difference between women who had successful or failed VBAC regarding maternal age, parity, number of ANC visits, gestational age at delivery, birth weight, Apgar score at 1 min and Apgar score at 5 min. Birth weights of less than 1.5kg, and 3.5Kg or greater were associated significantly with higher incidence failed TOLAC and emergency repeat CS. However, birth weights ranging from 2.0 to 3.49kg were associated with significantly lower incidence of failed TOLAC and emergency repeat CS. Birth weight of 2.5-2.99kg was associated with the lowest incidence of failed TOLAC and repeat CS. . There is a significantly high vaginal birth after caesarian section (VBAC) success rate among carefully selected women undergoing trial of scar in Ghana although a decreasing trend towards trial of labor after caesarian section (TOLAC) and a rising CS rate were determined. TOLAC remains a viable option for child birth in low resource settings like West Africa even though there are specific clinical and management related challenges to overcome. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remains the cornerstone to achieving high VBAC success rate with minimal adverse outcomes in such settings.

  19. 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

  20. Social success of in-stream habitat improvement: from fisheries enhancement to the delivery of multiple ecosystem services

    Directory of Open Access Journals (Sweden)

    Maare Marttila

    2016-03-01

    Full Text Available Stream restoration often aims to enhance fisheries by improving stream conditions for target fish species. However, river restoration has a potential impact on a variety of ecosystem services. Among stakeholders, the emerging expectations about restoration attain different priorities. How well these expectations are met influences social perceptions of success or failure. Although public support for restoration is known to have a significant impact on the sustainability and overall success of restoration, social aspects are rarely considered in this context. To address these issues, we conducted a questionnaire study among the residents and fishermen of three recently restored rivers in Finland. Results indicate that both user groups highly supported the restoration goals, but they were not always satisfied with the restoration outcomes. The changes in landscape value and amenity and fish provisioning had the highest influence on the user groups' attitudes. Restoration-induced changes in ecosystem services showed clear variation between the different locations, but the differences in the perceptions of the two user groups were less evident. Comparing perceptions between the user groups and locations and applying the ecosystem services approach are a novel contribution to the debate on restoration success. Our study highlights the importance of perspective, social-ecological context, and adequate communication for success.

  1. Predictors of the vaginal microflora.

    Science.gov (United States)

    Newton, E R; Piper, J M; Shain, R N; Perdue, S T; Peairs, W

    2001-04-01

    Our purpose was to define influences on the patterns of the vaginal microflora. We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to a behavioral intervention or standard counseling regarding sexually transmitted disease. We reevaluated 508 (82%) and 549 (89%) women at 6 and 12 months, respectively. A comprehensive survey of lower genital tract organisms was conducted at baseline and at 6 and 12 months. Behavioral and microbiologic associations were screened by bivariate analysis. All variables associated with an organism at P 3 times a week, and cunnilingus, fellatio, and anal intercourse at the last sexual encounter. M hominis (but not Ureaplasma urealyticum ), Gardnerella vaginalis, and Lactobacillus species were associated with bacterial vaginosis. Lactobacillus species appeared to protect against bacterial vaginosis and infection with G vaginalis. Sexually transmitted diseases (caused by M hominis, N gonorrhoeae, C trachomatis, and T vaginalis ) were associated with each other. In contrast, hormonal status, vaginal blood, and foreign bodies had little effect. The presence of other microorganisms and race have a more consistent association with the presence or absence of a cervical-vaginal organism than sexual behavior, hormonal status, vaginal devices, or the presence of abnormal vaginal bleeding.

  2. Analysis of Risk Factors for Post-Hysterectomy Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Mahmut Kuntay kuntay Kokanali

    2015-03-01

    Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000: 63-71

  3. Knowledge of blood loss at delivery among postpartum patients

    Directory of Open Access Journals (Sweden)

    Michaela K. Farber

    2016-08-01

    Full Text Available Background Postpartum hemorrhage (PPH is a leading cause of obstetric morbidity. There is limited understanding of patients’ knowledge about blood loss at delivery, PPH, and PPH-related morbidities, including transfusion and anemia. Methods We surveyed 100 healthy postpartum patients who underwent vaginal or cesarean delivery about blood loss, and whether they received information about transfusion and peripartum hemoglobin (Hb testing. Responses were compared between women undergoing vaginal delivery vs. cesarean delivery; P < 0.05 considered as statistically significant. Results In our cohort, 49 women underwent vaginal delivery and 51 women underwent cesarean delivery. Only 29 (29% of women provided blood loss estimates for their delivery. Women who underwent cesarean delivery were more likely to receive clear information about transfusion therapy than those undergoing vaginal delivery (43.1% vs. 20.4% respectively; P = 0.04. Women who underwent vaginal delivery were more likely to receive results of postpartum Hb tests compared to those undergoing cesarean delivery (49% vs. 29.4%; P = 0.02. Conclusion Our findings suggest that women are poorly informed about the magnitude of blood loss at delivery. Hematologic information given to patients varies according to mode of delivery. Further research is needed to better understand the clinical implications of patients’ knowledge gaps about PPH, transfusion and postpartum anemia.

  4. Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route.

    Science.gov (United States)

    Parikh, Laura I; Grantz, Katherine L; Iqbal, Sara N; Huang, Chun-Chih; Landy, Helain J; Fries, Melissa H; Reddy, Uma M

    2017-10-01

    cardiac anomalies underwent attempted vaginal delivery. Among patients who underwent attempted vaginal delivery, 66.1% had a successful vaginal delivery. Women with a fetal cardiac anomaly diagnosed prenatally were more likely to have a planned cesarean delivery than women with a postnatal diagnosis (31.7 vs 22.8%; P anomalies. Most fetal cardiac anomalies were diagnosed postnatally and associated with increased rates of neonatal morbidity. Planned cesarean delivery for prenatally diagnosed cardiac anomalies was not associated with less neonatal morbidity. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Vaginal estrogens for the treatment of dyspareunia.

    Science.gov (United States)

    Krychman, Michael L

    2011-03-01

    Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens play a key role in maintaining vaginal health; women with low serum estradiol are more likely to experience vaginal dryness, dyspareunia, and reduced sexual activity compared with women who have higher estradiol levels. The purpose of this review is to assess the prevalence and impact of dyspareunia, a symptom of vaginal atrophy, on the health of postmenopausal women and to evaluate treatment options using vaginal estrogens (U.S. Food and Drug Administration [FDA] approved). Relevant published literature was identified by searching Index Medicus using the PubMed online database. The search terms dyspareunia, vaginal estrogen, vaginal hormone therapy, vaginal atrophy, and atrophic vaginitis were the focus of the literature review. Current treatment guidelines for vaginal atrophy recommend the use of minimally absorbed local vaginal estrogens, along with non-hormonal lubricants or moisturizers, coupled with maintenance of sexual activity. Vaginal estrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal or vulvar atrophy. Vaginal tablets, rings, and creams are indicated for the treatment of vaginal atrophy, and the FDA has recently approved a low-dose regimen of conjugated estrogens cream to treat moderate-to-severe postmenopausal dyspareunia. The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining, and no significant differences have been seen among vaginal preparations in terms of endometrial safety. Women should be informed of the potential benefits and risks of the treatment options available, and with the help of their healthcare provider, choose an intervention that is most suitable to their individual needs and circumstances. © 2010

  6. Vesico vaginal fistula (VVF): a shift in epidemiology in northeastern ...

    African Journals Online (AJOL)

    Prolonged obstructed labour was the leading cause in 90% and most were in social class IV and V ( using standard occupational classification, OPCS.). Seventy five percent had successful repair, while about 50% were either divorced or neglected by their husbands. Conclusion: Vesico-vaginal fistula remains one ...

  7. Vaginal fluid pH and buffer capacity for predicting false preterm labor in Japanese women.

    Science.gov (United States)

    Noguchi, Taketoshi; Sado, Toshiyuki; Naruse, Katsuhiko; Kobayashi, Hiroshi

    2016-07-01

    To determine the relationship between preterm labor and delivery, and the pH and buffer capacity of vaginal secretions. Between January 1, 2009 and March 31, 2012, two cohorts of patients at 22-36weeks of pregnancy were enrolled in a prospective cohort study at Nara Medical University Hospital, Japan. Patients experiencing preterm contractions and a control group of patients experiencing normal pregnancies were included. The pH and buffer capacity of vaginal secretions were measured and compared. Of the 237 patients enrolled, 48 (20.3%) were experiencing symptoms of preterm labor and 189 (79.7%) were included in the control group. The pH was higher (Pbuffer capacity was lower (P=0.0135) in the vaginal secretions of the patients experiencing preterm contractions compared with the control group. There was no difference in the pH and buffer capacity of the vaginal secretions of symptomatic patients who would experience preterm delivery and those who would not. Receiver operating characteristic curve analyses demonstrated that vaginal-secretion pH and buffer capacity could differentiate between patients experiencing preterm contractions and those not, but could not differentiate between patients who would experience preterm delivery and those who would not. Vaginal-secretion pH and buffer capacity could be useful in diagnosing preterm labor; further studies are needed to determine potential practical diagnostic criteria. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Design for success: Identifying a process for transitioning to an intensive online course delivery model in health professions education.

    Science.gov (United States)

    McDonald, Paige L; Harwood, Kenneth J; Butler, Joan T; Schlumpf, Karen S; Eschmann, Carson W; Drago, Daniela

    2018-12-01

    Intensive courses (ICs), or accelerated courses, are gaining popularity in medical and health professions education, particularly as programs adopt e-learning models to negotiate challenges of flexibility, space, cost, and time. In 2014, the Department of Clinical Research and Leadership (CRL) at the George Washington University School of Medicine and Health Sciences began the process of transitioning two online 15-week graduate programs to an IC model. Within a year, a third program also transitioned to this model. A literature review yielded little guidance on the process of transitioning from 15-week, traditional models of delivery to IC models, particularly in online learning environments. Correspondingly, this paper describes the process by which CRL transitioned three online graduate programs to an IC model and details best practices for course design and facilitation resulting from our iterative redesign process. Finally, we present lessons-learned for the benefit of other medical and health professions' programs contemplating similar transitions. CRL: Department of Clinical Research and Leadership; HSCI: Health Sciences; IC: Intensive course; PD: Program director; QM: Quality Matters.

  9. Elective cesarean delivery for term breech

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens

    2003-01-01

    and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women...... with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more...... often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery...

  10. Freeze-dried mucoadhesive polymeric system containing pegylated lipoplexes: Towards a vaginal sustained released system for siRNA.

    Science.gov (United States)

    Furst, Tania; Dakwar, George R; Zagato, Elisa; Lechanteur, Anna; Remaut, Katrien; Evrard, Brigitte; Braeckmans, Kevin; Piel, Geraldine

    2016-08-28

    Topical vaginal sustained delivery of siRNA presents a significant challenge due to the short residence time of formulations. Therefore, a drug delivery system capable to adhere to the vaginal mucosa is desirable, as it could allow a prolonged delivery and increase the effectiveness of the therapy. The aim of this project is to develop a polymeric solid mucoadhesive system, loaded with lipoplexes, able to be progressively rehydrated by the vaginal fluids to form a hydrogel and to deliver siRNA to vaginal tissues. To minimize adhesive interactions with vaginal mucus components, lipoplexes were coated with different derivatives of polyethylene glycol: DPSE-PEG2000, DPSE-PEG750 and ceramide-PEG2000. Based on stability and diffusion properties in simulated vaginal fluids, lipoplexes containing DSPE-PEG2000 were selected and incorporated in hydroxyethyl cellulose (HEC) hydrogels. Solid systems, called sponges, were then obtained by freeze-drying. Sponges meet acceptable mechanical characteristics and their hardness, deformability and mucoadhesive properties are not influenced by the presence of lipoplexes. Finally, mobility and stability of lipoplexes inside sponges rehydrated with vaginal mucus, mimicking in situ conditions, were evaluated by advanced fluorescence microscopy. The release rate was found to be influenced by the HEC concentration and consequently by the viscosity after rehydration. This study demonstrates the feasibility of entrapping pegylated lipoplexes into a solid matrix system for a prolonged delivery of siRNA into the vagina. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. [Vaginal and postpregnancy inflamations, risks of their treatment for fetus].

    Science.gov (United States)

    Manaková, E; Hubicková Heringová, L

    2008-10-01

    Paper describes risks of gynaecological inflamations and their treatment for the successful course of pregnancy. Review. Czech Teratology Information Service, 3. LF UK, Praha. The article refers the most common types of vaginal inflamation and gives recommendation for the appropriate treatment that is safe for embryo or fetus according to advice of Teratology Information Service. Vaginal inflamation during pregnancy represents risks of abortion, miscarriage or prematurity. For the treatment, we have to take in consideration the age of pregnancy and we should use the drugs, that are safe during this period. It is necessary always to compare risks resulting from disorder and from drugs used.

  12. Anterior vaginal compartment surgery.

    Science.gov (United States)

    Maher, Christopher

    2013-11-01

    To review the safety and efficacy of anterior vaginal compartment pelvic organ prolapse surgery. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and the Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. A grade C recommendation usually depends on level studies or "majority evidence" from level 2/3 studies or Delphi processed expert opinion. A grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Absorbable mesh augmentation of anterior compartment native tissue repair improves the anatomical outcome compared with native tissue repair alone with no increased complication rate in meta-analysis of 2 RCTS (grade B). Biological grafts in meta-analysis have improved anatomical outcomes with no change in subjective outcomes compared with native tissue repairs (grade B). There is conflicting level 1 evidence to support porcine dermis and a single RCT to support small intestine submucosa as graft agents in anterior compartment prolapse surgery (grade B). Consistent level 1 data support a superior anatomical outcome for polypropylene mesh compared with a biological graft in the anterior compartment. Mesh exposure rate was

  13. Foreign Body in Vagina: An Uncommon Cause of Vaginitis in Children

    African Journals Online (AJOL)

    Woei Wang and colleagues[12] have noted that continuous flow vaginoscopy can be used to detect an intra‑vaginal foreign body, which may then be removed successfully by hysteroscopy. They concluded that hysteroscopy is safe, convenient, ...

  14. Developmental Origin of Vaginal Epithelium

    Science.gov (United States)

    Kurita, Takeshi

    2010-01-01

    The developmental origin of vaginal epithelium has been controversial for nearly a century, with speculation that vaginal epithelium originates from the Müllerian duct, Wolffian duct, and/or urogenital sinus. None of these possibilities has been definitively proven or disproven by direct scientific data. To define precisely the origin of vaginal epithelium, epithelial cells of the Müllerian duct, Wolffian duct, or urogenital sinus were fluorescently labeled in mouse embryos by crossing tdTomato-EGFP dual-reporter transgenic mice with transgenic mouse lines that express Cre recombinase in each type of epithelium. In embryos and newborn mice, the vagina consisted of fused Müllerian ducts plus the sinus vagina of urogenital sinus origin. However, the proportion of the sinus vagina was significantly reduced as the Müllerian vagina grew caudally. By postpartum day 7, the Müllerian vagina extended to the caudal end of the body, whereas the sinus vagina remained only at the junction between the vagina and perineal skin. As the vagina opened in puberty, urogenital sinus epithelium was detected only in the vulva, but not in the vagina. Additionally, from embryo to adult stages, residual Wolffian duct epithelium was present in the dorsolateral stromal wall of the vagina, but not within vaginal or vulvar epithelium. In conclusion, adult mouse vaginal epithelium is derived solely from Müllerian duct epithelium. PMID:20638775

  15. Vaginohysteroscopy for the diagnosis and treatment of vaginal lesions.

    Science.gov (United States)

    Di Spiezio Sardo, Attilio; Zizolfi, Brunella; Calagna, Gloria; Florio, Pasquale; Nappi, Carmine; Di Carlo, Costantino

    2016-05-01

    The vaginoscopic approach for hysteroscopy allows detailed endoscopic evaluation of the vaginal walls, fornices, and exocervix. To review the feasibility and efficacy of vaginohysteroscopy in the diagnosis and treatment of vaginal lesions. A systematic review was performed of PubMed/Medline, Embase, Google Scholar, and the Cochrane Database to identify papers published in English. The search terms were "hysteroscopy," "vaginoscopy," "vagino-hysteroscopy," and "vaginal lesion." The last review was performed on January 31, 2015. Studies in which the diagnosis and treatment of vaginal lesions used the vaginoscopic approach and hysteroscopic instrumentation were reviewed. Data were extracted from the identified studies and then analyzed. Thirteen studies were reviewed. Eleven described one case; one reported observations from two patients, and one study reported a case series. All vaginohysteroscopies reported were performed successfully and without significant complications. Vaginohysteroscopy is an easy way to gain access to the cervical canal and an important tool with which to diagnose and treat vaginal lesions. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Successful delivery in a pregnant woman with lupus anticoagulant positive systemic lupus erythematosus treated with double filtration plasmapheresis.

    Science.gov (United States)

    Takeshita, Y; Turumi, Y; Touma, S; Takagi, N

    2001-02-01

    The case was a 29 year old female who has suffered from systemic lupus erythematosus (SLE) since 15 years of age. The activity of SLE was low, and she took prednisolone orally. Her first pregnancy failed after 14 weeks. In the second pregnancy, she had thrombocytopenia, prolonged activated partial thromboplastin time (APTT), positive lupus anticoagulant (LAC) and thus was diagnosed with antiphospholipid antibody syndrome (APS). Combination therapy with steroids and aspirin was started, and she underwent treatment of double filtration plasmapheresis (DFPP) in the early stage of pregnancy. Her platelet count increased, and the value of APTT has normalized with DFPP treatment. She delivered successfully on the 32nd week of pregnancy. We think that DFPP is an effective and safe treatment in patients with an LAC positive pregnancy.

  17. High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems

    Directory of Open Access Journals (Sweden)

    Heylen Elsa

    2011-10-01

    Full Text Available Abstract Background The massive scale-up of antiretroviral treatment (ART access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India. Methods Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months. In addition, CD4 count and viral load (VL were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml. Results A total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center. Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p Conclusions Adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can

  18. 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...

  19. 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.

  20. Successful term pregnancy after selective arterial embolization of symptomatic arteriovenous malformation in the setting of gestational trophoblastic tumor.

    Science.gov (United States)

    Garner, Elizabeth I O; Meyerovitz, Michael; Goldstein, Donald P; Berkowitz, Ross S

    2003-01-01

    Patients with arteriovenous malformations (AVMs) are at risk for significant vaginal hemorrhage, and are traditionally managed surgically. In the patient desiring future fertility, conservative management via selective arterial embolization is a reasonable option. Only a few cases have been previously reported of successful pregnancy after this procedure in the setting of gestational trophoblastic disease (GTD). A 31-year-old gravida 1 para 0 was treated for persistent gestational trophoblastic tumor after a complete mole in 1997. She presented with heavy vaginal bleeding, and arteriogram demonstrated a large uterine AVM. The patient underwent selective uterine artery embolization with complete resolution of bleeding, as well as arteriographic cessation of flow through the AVM. After two first-trimester spontaneous abortions, the patient successfully completed a normal pregnancy, resulting in the forceps-assisted delivery of a healthy female infant. Successful term pregnancy can occur after selective uterine artery embolization in women hemorrhaging from symptomatic GTD-associated AVM.

  1. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull.

    Science.gov (United States)

    Chang, Won Seok; Jung, Hyun Ho; Zadicario, Eyal; Rachmilevitch, Itay; Tlusty, Tal; Vitek, Shuki; Chang, Jin Woo

    2016-02-01

    Magnetic resonance-guided focused ultrasound surgery (MRgFUS) was recently introduced as treatment for movement disorders such as essential tremor and advanced Parkinson's disease (PD). Although deep brain target lesions are successfully generated in most patients, the target area temperature fails to increase in some cases. The skull is one of the greatest barriers to ultrasonic energy transmission. The authors analyzed the skull-related factors that may have prevented an increase in target area temperatures in patients who underwent MRgFUS. The authors retrospectively reviewed data from clinical trials that involved MRgFUS for essential tremor, idiopathic PD, and obsessive-compulsive disorder. Data from 25 patients were included. The relationships between the maximal temperature during treatment and other factors, including sex, age, skull area of the sonication field, number of elements used, skull volume of the sonication field, and skull density ratio (SDR), were determined. Among the various factors, skull volume and SDR exhibited relationships with the maximum temperature. Skull volume was negatively correlated with maximal temperature (p = 0.023, r(2) = 0.206, y = 64.156 - 0.028x, whereas SDR was positively correlated with maximal temperature (p = 0.009, r(2) = 0.263, y = 49.643 + 11.832x). The other factors correlate with the maximal temperature, although some factors showed a tendency to correlate. Some skull-related factors correlated with the maximal target area temperature. Although the number of patients in the present study was relatively small, the results offer information that could guide the selection of MRgFUS candidates.

  2. Self-Efficacy of Choosing Delivery Method and Labor Among Pregnant Women in Pars-Abad City

    Directory of Open Access Journals (Sweden)

    Safieh Kanani

    2014-09-01

    Full Text Available Introduction: Self-efficacy is a person’s belief on his or her own ability to successfully perform a task. It is one’s own ability to cope with stressful situations and implement necessary actions, especially in labor. The aim of this study was to investigate the effect of self-efficacy on choosing delivery method and labor among women. Materials and Methods: This was a cross-sectional and descriptive study. The non-probability sample consisted of 200 primiparous and multipara women in the third trimester of pregnancy recruited from five urban health care centers in Pars-Abad city, Ardebil province, Iran, in 2014. The standard and self-administered questionnaires were used for data collection including demographic variables and self-efficacy of choosing natural vaginal delivery and labor via self-report method. Data analysis was performed using SPSS-21 software by chi-square, Fisher exact test and independent T-test. Results: The mean age of all participants was 25.19 (±4.48. A significant difference was found between spouse education levels, having supplemental insurance and employment status with choosing the delivery method (P < 0.05. Self-efficacy to choose natural vaginal delivery and self-efficacy of labor were associated with parity and choosing the delivery method (P<0.001 the average two types of self-efficacy were higher in multipara women and those who selected natural delivery method. Conclusion: Self-efficacy to choose natural vaginal delivery and labor determies choosing the delivery method and is related to parity. Therefore, it is suggested to focus on self-efficacy in educational interventions to reduce fear of childbirth, especially in primiparous women.

  3. Vaginal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... bleeding in pregnancy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginal Bleeding updates ... late pregnancy Vaginal bleeding in pregnancy Related Health Topics Menstruation Disclaimers MedlinePlus links to health information from ...

  4. Vaginitis: current microbiologic and clinical concepts.

    Science.gov (United States)

    Hill, L V; Embil, J A

    1986-02-15

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed.

  5. Effects of vaginal prolapse surgery and ageing on vaginal vascularization

    NARCIS (Netherlands)

    Weber, M.A.

    2016-01-01

    Ageing affects pelvic floor anatomy and function, resulting in several disorders like pelvic organ prolapse (POP), lower urinary tract symptoms and vaginal atrophy (VA). In this thesis we searched for methods to link the function of pelvic organs to physiological changes. The effects of POP and

  6. POSTOPERATIVE URINARY RETENTION AND EARLY REPOSITION OF TENSION-FREE VAGINAL TAPE

    Directory of Open Access Journals (Sweden)

    Marijan Lužnik

    2003-12-01

    Full Text Available Background. The purpose of this article is to show a possible method of treatment of postoperative urinary retention after an initial tension-free vaginal tape.Methods. From December 1999 to May 2003 we performed one hundred TVT procedures at our department, among them five women had postoperative urinary retention evaluated with catheterization. Revision and reposition of tension-free vaginal tape were performed if retention of urine was over 100 ml.Results. Urinary retention after an initial tension-free vaginal tape was successfully treated by early reposition of tension-free vaginal tape. This resulted in immediate residualfree voiding and continence, which remained unchanged at 6 week and 3 month follow-up.Conclusions. Postoperative urinary retention may be treated by reposition instead of dissection or elongation of the tension-free vaginal tape.

  7. Vaginitis: current microbiologic and clinical concepts.

    OpenAIRE

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a suf...

  8. Risk Factors for Cesarean Delivery following Labor Induction in Multiparous Women

    Directory of Open Access Journals (Sweden)

    Corine J. Verhoeven

    2013-01-01

    Full Text Available Objective. To identify potential risk factors for cesarean delivery following labor induction in multiparous women at term. Methods. We conducted a retrospective case-control study. Cases were parous women in whom the induction of labor had resulted in a cesarean delivery. For each case, we used the data of two successful inductions as controls. Successful induction was defined as a vaginal delivery after the induction of labor. The study was limited to term singleton pregnancies with a child in cephalic position. Results. Between 1995 and 2010, labor was induced in 2548 parous women, of whom 80 had a cesarean delivery (3%. These 80 cases were compared to the data of 160 parous women with a successful induction of labor. In the multivariate analysis history of preterm delivery (odds ratio (OR 5.3 (95% CI 1.1 to 25, maternal height (OR 0.87 (95% CI 0.80 to 0.95 and dilatation at the start of induction (OR 0.43 (95% CI 0.19 to 0.98 were associated with failed induction. Conclusion. In multiparous women, the risk of cesarean delivery following labor induction increases with previous preterm delivery, short maternal height, and limited dilatation at the start of induction.

  9. Factors associated with successful induction of labor.

    Science.gov (United States)

    Al-Shaikh, Ghadeer K; Wahabi, Hayfaa A; Fayed, Amel A; Esmaeil, Samia A; Al-Malki, Ghada A

    2012-03-01

    To evaluate the prevalence, indications, and factors associated with successful induction of labor (IOL), and maternal and neonatal outcomes. All women booked for IOL at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia from April 2010 to March 2011 were included. The characteristics of women who had successful IOL were compared to those who delivered by cesarean section (CS). A multivariable logistic regression analysis was performed to evaluate the factors associated with successful IOL. During the study period, 564 women had IOL. The prevalence rate of IOL was 16%. Vaginal delivery was achieved in 472 (84%) women. The most common indications for IOL were post-term pregnancy in 174 (31%), and diabetes mellitus in 131 (23.2%) of the participants. Maternal characteristics associated with risk of CS were nulliparity (odds ratio: 1.58; 95% confidence interval: 1.09-2.320; p=0.01), and high maternal body mass index (p=0.01). Neonates of women with successful IOL had significantly higher APGAR scores (p=0.04), and more frequent pH more than or equal to 7.1 at delivery (p=0.02). There was no difference in the rate of post-partum hemorrhage, CS, or ruptured uterus between the women who had IOL, and those who went into spontaneous labor. Nulliparity and maternal weight are the main determinants of the outcome of IOL. Case selection for IOL is vital for achieving outcomes similar to spontaneous labor.

  10. 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 ...

  11. Decreased beta-carotene levels in exfoliated vaginal epithelial cells in women with vaginal candidiasis.

    Science.gov (United States)

    Mikhail, M S; Palan, P R; Basu, J; Anyaegbunam, A; Romney, S L

    1994-10-01

    Women are more susceptible to vaginal candidiasis when the host immune response is suppressed. The antioxidant nutrient beta-carotene is postulated to possess immunoenhancing properties. The purpose of this study was to investigate beta-carotene concentrations in exfoliated vaginal epithelial (EVE) cells in women with vaginal candidiasis. Beta-carotene levels in EVE cells, collected by a saline lavage technique from 22 women with vaginal candidiasis and 20 normal controls, were analyzed. The diagnosis of vaginal candidiasis was established by the presence of pruritus, white cheesy vaginal discharge, and a positive potassium hydroxide preparation. Beta-carotene levels were assayed using high pressure liquid chromatography. Vaginal cell concentrations of beta-carotene were significantly decreased in women with vaginal candidiasis (P < 0.001). Decreased beta-carotene levels, and possibly other antioxidants, may alter the local immune response resulting in disturbances in the vaginal flora, overgrowth of candida, and the development of vaginal candidiasis.

  12. Long-term psychosexual and anatomical outcome after vaginal dilation or vaginoplasty: a comparative study.

    Science.gov (United States)

    Callens, Nina; De Cuypere, Griet; Wolffenbuttel, Katja P; Beerendonk, Catharina C M; van der Zwan, Yvonne G; van den Berg, Marjan; Monstrey, Stan; Van Kuyk, Maaike E; De Sutter, Petra; Dessens, Arianne B; Cools, Martine

    2012-07-01

    In patients with disorders of sex development requiring creation of a neovagina, a number of techniques are available, including surgical vaginoplasty and self-dilation therapy. Vaginal dilation therapy has been recommended as a first-line treatment because of its less invasive character and high success rate. However, no data exist on long-term psychosexual functioning after vaginal dilation as compared with that after vaginal surgery. The aim of this study is to compare the psychosexual and anatomical outcome of women with congenital vaginal hypoplasia followed in the same clinical setting after vaginoplasty with that after vaginal dilation. The sexual quality of life of 35 women at least 2 years after vaginoplasty (N = 15), vaginal dilation therapy (N = 8), or coital dilation/no treatment (N = 12) was investigated and compared with the Dutch test validation population (as control). Psychosexual functioning was assessed with the female sexual Function index, the female sexual distress scale-revised, and a semi-structured interview. A gynecological examination was performed to determine the anatomical outcome after both vaginal treatment regimens. After either treatment, 26% of these women had a shortened vaginal length of less than 6.6 cm, i.e., more than two standard deviations below the published mean value (9.6 ± 1.5 cm). Irrespective of the treatment, 47% of the patients had (a) sexual dysfunction(s) and experienced sexual distress. However, after vaginoplasty, patients reported significantly more problems with lubrication (P = 0.025) than after self-dilation therapy. Both psychological and physical factors are predisposing for sexual difficulties. To optimize psychosexual comfort, the clinical management of women with vaginal hypoplasia needs to be multidisciplinary and individually tailored. With high success rates reported, vaginal dilation should remain the cornerstone of treatment. © 2012 International Society for Sexual

  13. The effect of mode of delivery on placental chorionic plate vascular reactivity.

    Science.gov (United States)

    Mills, Tracey A; Baker, Philip N; Wareing, Mark

    2007-01-01

    To determine whether delivery mode influences placental chorionic plate arterial and venous vascular reactivity. Normal term placentas were obtained after vaginal delivery or cesarean section. Chorionic plate arterial and venous function was assessed by wire myography. Sodium nitroprusside-induced arterial relaxation increased post cesarean section at 20% oxygen. Decreased U46619-induced venous contraction was observed in vaginal deliveries at 7% oxygen. Sodium nitroprusside-induced relaxation increased in vaginal delivery at 20% oxygen. Delivery mode does not alter chorionic plate arterial vascular reactivity under physiological conditions, however venous reactivity was modified, a factor for consideration when interpreting functional experimental data.

  14. Maternal and perinatal outcomes in pregnant women with first trimester vaginal bleeding.

    Directory of Open Access Journals (Sweden)

    Zhila Amirkhani

    2013-06-01

    Full Text Available To study the pregnancy outcomes in first trimester vaginal bleeding.This cross sectional study was done on 60 pregnant women with first trimester vaginal bleeding referring to university hospitals affiliated to Islamic Azad University, Tehran, Iran. All women were evaluated for the outcomes including abortion, preterm rapture of membranes, preterm labor, second and third trimester vaginal bleeding, low birth weight and intra uterine growth retardation and the mode of delivery. Data were analyzed using SPSS- 11.Placenta accreta, second trimester bleeding and preterm labor were significantly more prevalent in pregnant women with first trimester bleeding (P ≤ 0.05.According to results of present study vaginal bleeding in first trimester of pregnancy may predict further maternal and fetal complications. We recommend training pregnant women regarding those complications and their prevention.

  15. Second dose of PGE2 vaginal insert versus Foley transcervical balloon for induction of labor after failure of cervical ripening with PGE2 vaginal insert.

    Science.gov (United States)

    Mohr-Sasson, Aya; Schiff, Eyal; Sindel, Ofra; Suday, Ramy Rahamim; Kalter-Farber, Anat; Mashiach, Roy; Yinon, Yoav; Dulitzki, Moti; Sivan, Eyal; Mazaki-Tovi, Shali

    2017-09-01

    To determine the success rate of induction of labor (IOL) using Foley transcervical balloon (FTB) versus prostaglandin E2 (PGE2) vaginal insert, following failure of cervical ripening with PGE2 vaginal insert. A retrospective cohort study of all pregnant women admitted for IOL with either FTB or PGE2 vaginal insert. Either second dose of PGE2 vaginal insert or FTB was used as a second line treatment after failure (not giving birth in 24 h from insertion) of first PGE2 vaginal insert. During the study period, 1162 women were admitted for IOL. Failure was reported in 322/852 (37.8%) in the FTB versus 162/310 (52.2%) in the PGE2 group (p < 0.001). Among 162 patients treated with PGE2 as first line who did not deliver after 24 h, 14 had spontaneous rupture of membranes, 15 underwent stripping and 42 were in still in active labor. The remainder were allocated to either second trial of PGE2 treatment (n = 58) or FTB (n = 33) with failure rate higher in the PGE2 group, not statistically significant (p = 0.23). IOL with FTB was not superior to PGE2 vaginal insert for IOL following failure of cervical ripening with PGE2 vaginal insert.

  16. Successful Repeated Hepatic Gene Delivery in Mice and Non-human Primates Achieved by Sequential Administration of AAV5ch and AAV1.

    Science.gov (United States)

    Majowicz, Anna; Salas, David; Zabaleta, Nerea; Rodríguez-Garcia, Estefania; González-Aseguinolaza, Gloria; Petry, Harald; Ferreira, Valerie

    2017-08-02

    In the gene therapy field, re-administration of adeno-associated virus (AAV) is an important topic because a decrease in therapeutic protein expression might occur over time. However, an efficient re-administration with the same AAV serotype is impossible due to serotype-specific, anti-AAV neutralizing antibodies (NABs) that are produced after initial AAV treatment. To address this issue, we explored the feasibility of using chimeric AAV serotype 5 (AAV5ch) and AAV1 for repeated liver-targeted gene delivery. To develop a relevant model, we immunized animals with a high dose of AAV5ch-human secreted embryonic alkaline phosphatase (hSEAP) that generates high levels of anti-AAV5ch NAB. Secondary liver transduction with the same dose of AAV1-human factor IX (hFIX) in the presence of high levels of anti-AAV5ch NAB proved to be successful because expression/activity of both reporter transgenes was observed. This is the first time that two different transgenes are shown to be produced by non-human primate (NHP) liver after sequential administration of clinically relevant doses of both AAV5ch and AAV1. The levels of transgene proteins achieved after delivery with AAV5ch and AAV1 illustrate the possibility of both serotypes for liver targeting. Furthermore, transgene DNA and RNA biodistribution patterns provided insight into the potential cause of decrease or loss of transgene protein expression over time in NHPs. Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.

  17. The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma

    DEFF Research Database (Denmark)

    Willer, Hanne; Aabakke, Anna J M; Krebs, Lone

    2014-01-01

    BACKGROUND: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial is to compare the incidence and degree of perineal trauma after primary delivery of the anterior compared with the posterior shoulder during vaginal birth. The hypothesis is that pr...

  18. 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.

  19. Suburethral Slingplasty Using a Self-fashioned Gynemesh for Treating Urinary Incontinence and Anterior Vaginal Wall Prolapse

    Directory of Open Access Journals (Sweden)

    Chi-Feng Su

    2009-03-01

    Conclusion: We found that using self-fashioned Gynemesh for tension-free suburethral and anterior vaginal slingplasty provided a high success rate (97% in the 3 years of follow-up. Mechanical rejection may be one of the causes of vaginal mesh erosion.

  20. Tension-free vaginal tape and percutaneous vaginal tape sling procedures.

    Science.gov (United States)

    Rackley, R R; Abdelmalak, J B; Tchetgen, M B; Madjar, S; Jones, S; Noble, M

    2001-06-01

    Midurethral synthetic sling procedures for treatment of stress urinary incontinence (SUI) are gaining increased attention from surgeons specializing in female pelvic reconstructive techniques seeking successful patient outcomes through reproducible simplicity. This report describes the procedural steps and methods used to maximize the potential for successful outcomes using techniques of midurethral synthetic sling placement. Reported complications and surgical outcomes are reviewed with respect to patient selection and minimizing the potential for morbidity and mortality as long-term clinical experience is accumulated. Tension-free vaginal or transvaginal tape (TVT) and the recently introduced percutaneous vaginal tape (PVT) are two new procedural choices for placement of synthetic sling material at the midurethra. Both procedures use sling material composed of polypropylene mesh, a nonabsorbable synthetic material, placed at the level of the midurethra via an antegrade (PVT, using a percutaneous ligature carrier) suprapubic approach or retrograde (TVT, using vaginal trocars) vaginal approach. Patient selection, procedural techniques, and methods described are based on observations obtained or reported from clinical experience. Outcomes and complications for TVT are derived from a literature review of all published articles in Index Medicus from 1996 to 2000. The experience with TVT for the last 5 years is encouraging. At 3-year follow-up for TVT, reported cure rates for SUI range from 80% to 95%. A multitude of worldwide reports on PVT with shorter follow-up support the findings of the TVT experience. Reproducible findings with midurethral synthetic slings are the short operative times recorded for the sling procedure, ease of technical performance, minimal patient discomfort, and a high rate of early return of normal voiding function. The rate of complications such as obstructive voiding or de novo instability (0-15%) and urinary retention necessitating a

  1. 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....

  2. Nanoparticle-based drug delivery to the vagina: a review

    Science.gov (United States)

    Ensign, Laura M.; Cone, Richard; Hanes, Justin

    2014-01-01

    Vaginal drug administration can improve prophylaxis and treatment of many conditions affecting the female reproductive tract, including sexually transmitted diseases, fungal and bacterial infections, and cancer. However, achieving sustained local drug concentrations in the vagina can be challenging, due to the high permeability of the vaginal epithelium and expulsion of conventional soluble drug dosage forms. Nanoparticle-based drug delivery platforms have received considerable attention for vaginal drug delivery, as nanoparticles can provide sustained release, cellular targeting, and even intrinsic antimicrobial or adjuvant properties that can improve the potency and/or efficacy of prophylactic and therapeutic modalities. Here, we review the use of polymeric nanoparticles, liposomes, dendrimers, and inorganic nanoparticles for vaginal drug delivery. Although most of the work toward nanoparticle-based drug delivery in the vagina has been focused on HIV prevention, strategies for treatment and prevention of other sexually transmitted infections, treatment for reproductive tract cancer, and treatment of fungal and bacterial infections are also highlighted. PMID:24830303

  3. 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.

  4. Successful pregnancy and delivery after ICSI with artificial oocyte activation by calcium ionophore in in-vitro matured oocytes: a case report.

    Science.gov (United States)

    Kim, Jun-Woo; Yang, Seong-Ho; Yoon, San-Hyun; Kim, Sang-Don; Jung, Jae-Hoon; Lim, Jin-Ho

    2015-04-01

    The achievement of a successful pregnancy and delivery after oocyte activation with calcium ionophore is reported in a couple having low fertilization rates after intracytoplasmic sperm injection (ICSI) of in-vitro matured oocytes. A couple, in which the wife had polycystic ovary syndrome and the husband had moderate oligoteratozoospermia, showed a low fertilization rate in a previous in-vitro maturation cycle (2/11 [18.2%]). The most likely cause of complete fertilization failure or low fertilization rates is failure of oocyte activation. Therefore, artificial oocyte activation by calcium ionophore was combined with ICSI to achieve viable fertilized oocytes. Oocytes were stimulated with calcium ionophore for 30 min after ICSI. The fertilization rate of oocytes activated with calcium ionophore (13/15 [86.7%] and 7/9 [77.8%]) was higher than that of the non-activated oocytes. In the latest cycle, three embryos derived from the activated oocytes were transferred into the uterus on day 3. Subsequently, two gestational sacs were identified on ultrasound. The patient delivered dizygotic twins (girl 2260 g and boy 2760 g) at 35 weeks and 6 days gestation by caesarean section. This result suggests that calcium ionophore could be useful for oocyte fertilization in couples with low fertilization rates after ICSI of in-vitro matured oocytes. Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Simplified and standardized intrapartum management can yield high rates of successful VBAC in spontaneous labor.

    Science.gov (United States)

    Hehir, Mark P; Mackie, Adam; Robson, Michael S

    2017-06-01

    To examine the outcomes of vaginal birth after cesarean (VBAC) in women, in spontaneous labor, delivering after 37 weeks' gestation at an institution where trial of labor after a previous cesarean delivery (TOLAC) is encouraged and management of labor is standardized. This retrospective cohort study included 3071 women with one previous cesarean only and no vaginal delivery who underwent a trial of labor from 2001 to 2011. Women were managed using the standardized "active management of labor" intrapartum protocol. Outcomes and characteristics of women who delivered vaginally were compared with those who required cesarean delivery. In spontaneous labor in their second pregnancy, those who attempted TOLAC had a 72.5% (1611/2222) rate of successful VBAC. Women who had a successful VBAC had smaller babies (3584 ± 452 g versus 3799 ± 489 g; p < 0.0001) at earlier gestations than those who had a repeat intrapartum cesarean delivery. They also required less intrapartum intervention, such as oxytocin augmentation (14.5% [234/1611] versus 41% [251/611]; p < 0.0001) and epidural anesthesia (64.8% [1044/1611] versus 82.8% [506/611]; p < 0.0001). The rate of uterine rupture was 0.54% (12/2222), while the rate of peri-partum hysterectomy was 0.18% (4/2222). This study shows that serious complications associated with TOLAC are rare providing intrapartum care and decision-making is made simple for the benefit of staff and patients alike. This is achieved through a standardized labor management protocol.

  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. 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.

  8. Observational study of Streptococcus pyogenes isolated from vaginal swabs of adult women in a hospital and community laboratory.

    Science.gov (United States)

    Upton, Arlo; Taylor, Susan

    2013-12-01

    Streptococcus pyogenes or group A streptococcus (GAS) is a common cause of vulvo-vaginitis in pre-pubertal females but is uncommonly isolated from the vaginal swabs of adult females. We aimed to describe the clinical and laboratory findings of adult females with GAS isolated from vaginal swabs in a community and hospital laboratory. Over a 19 week period the two laboratories identified females ≥ 15 years of age with GAS isolated from vaginal swabs. At least 2 weeks after reporting, the referring doctor or midwife was telephoned by the authors for clinical information or the clinical notes were reviewed. Laboratory data were also collected. One hundred adult females with GAS isolated from vaginal swabs were identified from approximately 4500-5000 community laboratory, and 20 from approximately 2000 hospital laboratory swabs. Community patients were more likely to have presented with vaginal symptoms such as discharge, while hospital patients were more likely to have ascending infection related to pregnancy/recent delivery. Of the community patients, 15% were asymptomatic compared with 5% of the hospital patients. Review of Gram stain and culture quantification was not found to be particularly useful for discriminating between clinical infection and asymptomatic colonisation. Isolation of GAS from the vaginal swabs of adult females is uncommon. In the community setting it may represent infection with vulvo-vaginitis or asymptomatic colonisation. In the hospital setting, its isolation is frequently associated with pregnancy-related infectious complications.

  9. 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...... that vaginal delivery is associated with increased mortality and morbidity. However, validation of data and additional information from the medical records are needed before a recommendation of whether selection of parturients, structure of perinatal care or professional skills need to be improved, or all...

  10. Use of vaginal estrogen in Danish women

    DEFF Research Database (Denmark)

    Meaidi, Amani; Goukasian, Irina; Lidegaard, Oejvind

    2016-01-01

    INTRODUCTION: We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark. MATERIAL AND METHODS: The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years......, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products...... was estimated from sale statistics from the same register. RESULTS: In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60...

  11. Preferred Physical Characteristics of Vaginal Film Microbicides for HIV Prevention in Pittsburgh Women.

    Science.gov (United States)

    Fan, Maria D; Kramzer, Lindsay F; Hillier, Sharon L; Chang, Judy C; Meyn, Leslie A; Rohan, Lisa C

    2017-05-01

    Unprotected heterosexual intercourse is the leading cause of HIV acquisition in women. Due to the complex nature of correct and consistent condom use by both men and women, developing alternative female-controlled HIV prevention options is a global health priority. Vaginal films containing antiretroviral drugs are a potential delivery system for the prevention of HIV acquisition through sexual contact. In this study, we explored women's preferences regarding physical characteristics of microbicide vaginal films through questionnaires and focus groups. Eighty-four sexually active, ethnically diverse women 18-30 years of age from Pittsburgh, Pennsylvania, participated in the study. Women visually and manually examined a variety of vaginal films, as well as three other vaginal products undergoing evaluation for HIV prevention: tablet, ring, and gel. Means and standard deviations or frequencies and 95 % confidence intervals were calculated for questionnaire data. Focus groups were audio-recorded, transcribed verbatim, and coded for content analysis. Women most frequently preferred vaginal films to be smooth and thin (63 %), translucent (48 %), and 2″ × 2″ square size (36 %). Driving these preferences were five major themes: ease and accuracy of use, desire for efficacy, discretion, intravaginal comfort and minimal impact, and minimizing disruption of sexual mood/activities. Women's preferences for various microbicide vaginal film physical attributes represented a balance of multiple values. In general, women desired a comfortable, efficacious, easy to use, and minimally intrusive product.

  12. Complete Utero Vaginal Prolapse in a Woman with Prolapsed ...

    African Journals Online (AJOL)

    vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later resulted in a satisfactory outcome. Keywords: Fibroid, Interval vaginal hysterectomy, Utero‑vaginal prolapse, Vaginal myomectomy. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI: *****.

  13. The effect of maneuvers for shoulder delivery on perineal trauma

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Willert, Hanne; Krebs, Lone

    2016-01-01

    INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS: This was a rando......INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS......: This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as......-treated analysis. RESULTS: Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups...

  14. Induction of labour: clinical predictive factors for success and failure.

    Science.gov (United States)

    Batinelli, Laura; Serafini, Andrea; Nante, Nicola; Petraglia, Felice; Severi, Filiberto Maria; Messina, Gabriele

    2017-10-23

    Induction of labour (IOL) is a widely-used practice in obstetrics. Our aim was to evaluate predictors of vaginal delivery in postdate pregnancies induced with prostaglandins. We conducted a retrospective cross-sectional study with analytic component. A total of 145 women, admitted for IOL after the 41st week of gestation, were induced with a vaginal pessary releasing prostaglandins. Type of delivery, whether vaginal or caesarean, was the outcome. Several maternal and foetal variables were investigated. The Kaplan-Maier curves, monovariate and a multivariate logistic regression were carried out. In our population, 80.7% of women had vaginal delivery after the induction. Multiparity and a high Bishop score at the beginning of the IOL were protective factors for a vaginal delivery (respectively OR 0.16, p = .028 and OR 0.62, p = .034) while age >35 years, and the foetal birth weight >3500 g at the birth, resulted in being risk factors for caesarean section (respectively OR 4.20, p = .006 and OR 3.63, p = .013). IMPACT STATEMENT What is already known on this subject: Induction of labour (IOL) is a widely used practice in obstetrics. Scientific literature shows several predictors of successful induction, although there is no unanimity except for 'multiparity' and 'favourable Bishop score' which are associated with positive outcome of the induction. The main difficulty in finding other predictive factors is the heterogeneity of this field (different local protocols in each hospital, type of induction, populations and outcomes chosen in each study). In addition to that, populations are not always comparable due to the different gestation. For this reason, we decided to select a specific population of women, such as low risk postterm pregnancies induced with prostaglandins, in order to detect possible predictive factors for the success of the IOL for women with uncomplicated pregnancies. What the results of this study add: Our study agrees with existing

  15. 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

  16. Comparison of Midterm Efficiency and Complications of Tension-Free Vaginal Tape Alone and Tension-Free Vaginal Tape Performed with Vaginal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Emre Sinan Güngör

    2017-09-01

    Full Text Available Aim: To evaluate and compare the results and complications of tension-free vaginal tape (TVT when performed alone or with vaginal hysterectomy (VH and to evaluate the mid-term success rates of TVT for both groups. Methods: A retrospective study was performed on 179 patients who had TVT alone for stress urinary incontinance (SUI or TVT with VH for SUI and vaginal prolapse. Demographic, outcome and complication data were obtained from medical records. The main outcome measures were postoperative SUI and voiding dysfunction. Results: The mean age of the patients who underwent TVT and TVT+VH were 50.2±6.8 and 52.2±8.1, respectively (p>0.05 and the mean parity was 4±2.07 and 4.15±2.02, respectively (p>0.05. The success rate was significantly higher in TVT alone group than in TVT+VH group (93.6% vs. 84.5%, p0.05. Overall complication rate was higher in TVT+VH group (4.2% vs. 9.5%, p<0.05. Postoperative residuel urine volumes were significantly higher than preoperative residuel urine volumes in both groups (p=0.001. Due to mesh rejection, second surgery was performed in one patient from both groups to reomove the mesh. Conclusion: Midterm success rates were significantly higher in TVT group than in TVT+VH group, but success rates in TVT+VH were acceptable. Overall complication rates were higher in TVT+VH group; requirement for a second surgery was similar for both groups.

  17. 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 pelvic floor muscles; however, the differences did not reach statistical significance. Pelvic floor muscle collagen content was not altered by parity but increased dramatically with aging (P pelvic floor muscles likely represents an adaptive response to the chronically increased load

  18. Successful pregnancy in a patient with autosomal dominant polycystic kidney disease on long-term hemodialysis.

    Science.gov (United States)

    Jung, Ji Hye; Kim, Min Jeong; Lim, Hye Jin; Sung, Su-Ah; Lee, So-Young; Kim, Dae Woon; Lee, Kyu Beck; Hwang, Young-Hwan

    2014-02-01

    Recent advances in dialysis and a multidisciplinary approach to pregnant patients with advanced chronic kidney disease provide a better outcome. A 38-yr-old female with autosomal dominant polycystic kidney disease (ADPKD) became pregnant. She was undergoing hemodialysis (HD) and her kidneys were massively enlarged, posing a risk of intrauterine fetal growth restriction. By means of intensive HD and optimal management of anemia, pregnancy was successfully maintained until vaginal delivery at 34.5 weeks of gestation. We discuss the special considerations involved in managing our patient with regard to the underlying ADPKD and its influence on pregnancy.

  19. CT vaginography: a new CT technique for imaging of upper and middle vaginal fistulas.

    Science.gov (United States)

    Botsikas, Diomidis; Pluchino, Nicola; Kalovidouri, Anastasia; Platon, Alexandra; Montet, Xavier; Dallenbach, Patrick; Poletti, Pierre-Alexandre

    2017-05-01

    Different types of vaginal fistulas is a relatively uncommon condition in the Western world but very frequent in developing countries. In the past, conventional vaginography was the radiological examination of choice for exploring this condition. CT and MRI are now both used for this purpose. Our objective was to test the feasibility and to explore the potential role of a new CT imaging technique implementing vaginal introitus obstruction and opacification of the vagina with iodine contrast agent, to show patency of a fistula. We describe the technical protocol of CT-vaginography as performed in Geneva University Hospitals, including vaginal catheterization with a Foley catheter and obstruction of the introitus by inflating the balloon of the catheter. We also report three cases of patients with suspected vaginal fistula who underwent CT-vaginography. The examinations were technically successful. In one patient, it revealed the presence of fistulous pathways from the vaginal fornix along the bilateral infected surgical prostheses. In a second patient, it showed a fistula between the vagina and the necrotic cavity of a recurrent cervical cancer. In a third patient, it proved the absence of a suspected vaginal fistula. CT-vaginography is a technically feasible CT protocol that provides anatomical and functional information on clinically suspected vaginal fistulas. Advances in knowledge: After the abandon of conventional vaginography in the era of transaxial imaging, the current modalities of imaging vaginal fistulas provide excellent anatomical detail but less functional information concerning the permeability of a vaginal fistulous pathway. We propose the use of CT-vaginography, a technical protocol that we describe in detail.

  20. Should progressive perineal dilation be considered first line therapy for vaginal agenesis?

    Science.gov (United States)

    Gargollo, Patricio C; Cannon, Glenn M; Diamond, David A; Thomas, Phaedra; Burke, Vicki; Laufer, Marc R

    2009-10-01

    In women with vaginal agenesis progressive perineal dilation provides a minimally invasive method to create a functional vagina without the attendant risks or complications of traditional surgical options. We report our 12-year experience with this technique. Patients with vaginal agenesis treated at our institution were analyzed retrospectively and followed prospectively using case report forms and semistructured interviews. Patients diagnosed with vaginal agenesis were counseled on vaginal reconstruction options. Those electing progressive perineal dilation were instructed on the proper use of vaginal dilators by one of us (MRL) and advised to dilate 2 or 3 times daily for 20 minutes. All patients received physician, nursing and social work education and counseling. Parameters reviewed included primary diagnosis, start and end of vaginal dilation, dilation frequency, dilator size, sexual activity and whether the patient experienced pain or bleeding with dilation or sexual activity. Functional success was defined as the ability to achieve sexual intercourse, vaginal acceptance of the largest dilator without discomfort or a vaginal length of 7 cm. Univariate and multivariate analysis was performed to identify factors associated with successful neovaginal creation. From 1996 to 2008 we enrolled 69 females with vaginal agenesis in a progressive perineal dilation program. The primary diagnosis was Mayer-Rokitansky-Küster-Hauser syndrome in 64 patients. Mean age at the start of vaginal dilation was 17.5 years (range 14 to 35) Mean followup was 19 months (range 0 to 100). Four patients (5.7%) were lost to followup. In 7 of the remaining 65 patients (12%) treatment failed due to noncompliance and 50 (88%) achieved functional success at a median of 18.7 months. Patients who dilated frequently (once daily or greater) achieved a functional neovagina at a mean +/- SD of 4.3 +/- 2.4 months. Functional success correlated positively with frequent (once daily or greater

  1. [Vaginal hemorrhage after hysterectomy as a complication of alcohol-induced liver cirrhosis].

    Science.gov (United States)

    Marzotko, E; Pfeiffer, R; Nenning, H; Köhler, U

    1996-01-01

    We report on a 50-year-old woman with a decompensated alcoholic liver cirrhosis and Korsakow syndrome since 1991. In July 1992, an abdominal hysterectomy with bilateral salpingoophorectomy was made because of an endometrial carcinoma pT1NOMO. A postoperative abscess of the vaginal stump was evacuated. The patient was admitted three years later with a massive vaginal bleeding. Her general appearance and nutritional status were bad. The vaginal bleeding was caused from ruptured varicose pelvic veins secondary to portal hypertension. Neither conservative (vaginal tamponade, infusions) nor operative (laparotomy with an intraabdominal and transvaginal tamponade) therapy was successful. The patient died as a result of severe bleedings. We discuss differential diagnostics and planning therapy.

  2. Forensic discrimination of vaginal epithelia by DNA methylation analysis through pyrosequencing.

    Science.gov (United States)

    Antunes, Joana; Silva, Deborah S B S; Balamurugan, Kuppareddi; Duncan, George; Alho, Clarice S; McCord, Bruce

    2016-10-01

    The accurate identification of body fluids from crime scenes can aid in the discrimination between criminal and innocent intent. This research aimed to determine if the levels of DNA methylation in the locus PFN3A could be used to discriminate vaginal epithelia from other body fluids. In this work we bisulfite-modified and amplified DNA samples from blood, saliva, semen, and vaginal epithelia using primers for PFN3A. Through pyrosequencing we were able to show that vaginal epithelia present distinct methylation levels when compared to other body fluids. Mixtures of different body fluids present methylation values that correlate with single-source body fluid samples and the primers for PFN3A are specific for primates. This report successfully demonstrated that the analysis of methylation in the PFN3A locus can be used for vaginal epithelia discrimination in forensic samples. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. More frequent vaginal orgasm is associated with experiencing greater excitement from deep vaginal stimulation.

    Science.gov (United States)

    Brody, Stuart; Klapilova, Katerina; Krejčová, Lucie

    2013-07-01

    Research indicated that: (i) vaginal orgasm (induced by penile-vaginal intercourse [PVI] without concurrent clitoral masturbation) consistency (vaginal orgasm consistency [VOC]; percentage of PVI occasions resulting in vaginal orgasm) is associated with mental attention to vaginal sensations during PVI, preference for a longer penis, and indices of psychological and physiological functioning, and (ii) clitoral, distal vaginal, and deep vaginal/cervical stimulation project via different peripheral nerves to different brain regions. The aim of this study is to examine the association of VOC with: (i) sexual arousability perceived from deep vaginal stimulation (compared with middle and shallow vaginal stimulation and clitoral stimulation), and (ii) whether vaginal stimulation was present during the woman's first masturbation. A sample of 75 Czech women (aged 18-36), provided details of recent VOC, site of genital stimulation during first masturbation, and their recent sexual arousability from the four genital sites. The association of VOC with: (i) sexual arousability perceived from the four genital sites and (ii) involvement of vaginal stimulation in first-ever masturbation. VOC was associated with greater sexual arousability from deep vaginal stimulation but not with sexual arousability from other genital sites. VOC was also associated with women's first masturbation incorporating (or being exclusively) vaginal stimulation. The findings suggest (i) stimulating the vagina during early life masturbation might indicate individual readiness for developing greater vaginal responsiveness, leading to adult greater VOC, and (ii) current sensitivity of deep vaginal and cervical regions is associated with VOC, which might be due to some combination of different neurophysiological projections of the deep regions and their greater responsiveness to penile stimulation. © 2013 International Society for Sexual Medicine.

  4. Membrane Sweeping for Vaginal Birth after Caesarean Section and its Outcome -A Comparative Study.

    Science.gov (United States)

    Ramya, V; Ghose, Seetesh; Pallavee, P

    2015-08-01

    Sweeping of membrane is a method of induction of labour. This is used to avoid prolonged labour. However, there is paucity of data about the use of this method for induction of labour and reducing prolonged labour in pregnancy with previous caesarean section. This study is an effort to find the effect of membrane sweeping in previous caesarean section. To initiate labour in previous LSCS patients by membrane sweeping and maternal outcome. This prospective randomised control study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry between January 2011 to June 2012. Seventy five women were randomly assigned to membrane sweeping and seventy five to control. In study group serial membrane sweeping was done once weekly from 39 weeks of gestation until the onset of labour up to 41weeks of gestation. In control group, no intervention up to 41 weeks of gestation. All the cases were monitored by biophysical profile. The primary outcomes measured were number of patients who had onset of labour. The secondary outcome included the successful vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval and amount of oxytocin required. The onset of labour in study group was 61.3% similar in control group 64% with p 0.736. The mean interval from sweeping to labour onset was 50.15±8 hours. The rate of VBAC was 17.3% in study group in compared to 18.7% in control group and LSCS was 82.7% in study group in compared to 81.3% in control group respectively. The mean gestation age at delivery 40±0.56 weeks for study group compared with 39.92±0.55 weeks for control group. Although membrane sweeping is an easy way of inducing labour, present study failed to demonstrate its beneficial effect on obstetrical outcome.

  5. [Interventions during labor for reducing instrumental deliveries].

    Science.gov (United States)

    Schmitz, T; Meunier, E

    2008-12-01

    Several interventions have been demonstrated, with high evidence levels (EL), to be associated with reduced instrumental deliveries and should therefore be undertaken during labor for increasing spontaneous vaginal deliveries. Using a partogram (EL1) and continuous support during labor and childbirth (EL1) lead to fewer operative vaginal deliveries. Systematic early amniotomy increases the frequency of fetal heart rate abnormalities (EL2) without decreasing the incidence of instrumental deliveries (EL1) and should thus be avoided. Early oxytocin in dysfunctional labor (EL2) and manual rotation of posterior and transverse presentations (EL3) may reduce operative vaginal deliveries. Even without epidural analgesia, any upright or lateral positions compared to supine or lithotomy positions do not reduce instrumental deliveries (EL2). Epidural analgesia alters significantly instrumental delivery rates and therefore patient management in the labor ward. Indeed, when used with high concentration of local anesthetic, epidural analgesia is associated with increased operative vaginal deliveries (EL1), at least in part because of increased posterior presentations (EL2). However, the effect of epidural analgesia on instrumental delivery rates closely depends from the type of anesthetic and concentrations used. This effect is reduced when low concentrations of local anesthetic are used in combination with fat-soluble morphinated agent (EL1). Finally, for nulliparous women with continuous epidural analgesia, unless irresistible urge to push or medical indication to shorten second stage of labor, delayed pushing is associated with reduced difficult instrumental deliveries (EL1). Fundal pressure maneuvers should be prohibited because of their inefficiency (EL2) and dangerousness (EL4).

  6. Vaginitis

    Science.gov (United States)

    ... vagina as a cream or gel. What is trichomoniasis? Trichomoniasis is a condition caused by the microscopic ... transmitted infections (STIs) . What are the symptoms of trichomoniasis? Signs of trichomoniasis may include a yellow-gray ...

  7. 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 ...

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

    African Journals Online (AJOL)

    2012-12-13

    40.2%), birth asphyxia 15 (18.3%), low birth weight 12 ... peripartum complications and the babies show increased need for ..... application can be downloaded from https://market.android.com/details?id=comm.app.medknow.

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

    African Journals Online (AJOL)

    2008-05-05

    May 5, 2008 ... spontaneous perineal tearing, subsequent pelvic floor dysfunction, urinary and faecal incontinence, and sexual dysfunction (1,7). on the .... surgical repair cannot restore normal anatomy and function, it is critically important to ...

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

    African Journals Online (AJOL)

    The average gestational age of admission was 32 } 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 } 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic ...

  11. [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.

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

    African Journals Online (AJOL)

    2012-12-13

    Dec 13, 2012 ... abnormal lies and presentations and hypertension in pregnancy.Two‑hundred and seventeen ... Access this article online. Quick Response Code: ... Systematic review and meta‑analysis by Hogle et al. found no significant ...

  13. Heterotopic pregnancy with spontaneous vaginal delivery at 36 ...

    African Journals Online (AJOL)

    infection génitale et l'emploi croissant de nouvelles technologies par les malades qui souffient de la stérilité. Le cas d'une prophétesse de 30 ans qui était para 2+1 est présenté. Elle a eu un accouchement par voie vaginale spontané à terme.

  14. 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.

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

    African Journals Online (AJOL)

    conduct this research. The focus was to obtain information that would facilitate understanding of the women's experiences of labor while under the care of a private midwife in a midwife obstetric unit. A qualitative design was used where the phenomenological method was employed. Purposeful, convenient sampling was ...

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

    African Journals Online (AJOL)

    2008-05-05

    May 5, 2008 ... factors influencing the performance of episiotomy and document complications associated with the procedure. Design: A hospital ... Historically, the procedure has been indicated in circumstances such as abnormal ... informed of the specific risks and benefits associated with performing episiotomy, and ...

  17. 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

  18. Value of bacterial culture of vaginal swabs in diagnosis of vaginal infections

    Directory of Open Access Journals (Sweden)

    Nenadić Dane

    2015-01-01

    Full Text Available Bacground/Aim. Vaginal and cervical swab culture is still very common procedure in our country’s everyday practice whereas simple and rapid diagnostic methods have been very rarely used. The aim of this study was to show that the employment of simple and rapid diagnostic tools [vaginal fluid wet mount microscopy (VFWMM, vaginal pH and potassium hydroxide (KOH test] offers better assessment of vaginal environment than standard microbiologic culture commonly used in Serbia. Methods. This prospective study included 505 asymptomatic pregnant women undergoing VFWMM, test with 10% KOH, determination of vaginal pH and standard culture of cervicovaginal swabs. Combining findings from the procedures was used to make diagnoses of bacterial vaginosis (BV and vaginitis. In addition, the number of polymorphonuclear leukocytes (PMN was determined in each sample and analyzed along with other findings. Infections with Candida albicans and Trichomonas vaginalis were confirmed or excluded by microscopic examination. Results. In 36 (6% patients cervicovaginal swab cultures retrieved several aerobes and facultative anaerobes, whereas in 52 (11% women Candida albicans was isolated. Based on VFWMM findings and clinical criteria 96 (19% women had BV, 19 (4% vaginitis, and 72 (14% candidiasis. Of 115 women with BV and vaginitis, pH 4.5 was found in 5, and of 390 with normal findings 83 (21% had vaginal pH 4.5. Elevated numbers of PMN were found in 154 (30% women - in 83 (54% of them VFWMM was normal. Specificity and sensitivity of KOH test and vaginal pH determination in defining pathological vaginal flora were 95% and 81%, and 79% and 91%, respectively. Conclusion. Cervicovaginal swab culture is expensive but almost non-informative test in clinical practice. The use of simpler and rapid methods as vaginal fluid wet mount microscopy, KOH test and vaginal pH offers better results in diagnosis, and probably in the treatment and prevention of sequels of vaginal

  19. Influencing factors in choosing delivery method: Iranian primiparous women's perspective.

    Science.gov (United States)

    Moosavi, Ahmad; Sheikhlou, Sepideh Gareh; Sheikhlou, Sara Gareh; Abdolahi, Kolsum; Yaminifar, Leila; Maktabi, Maryam

    2017-04-01

    Studies on the primiparous mothers' decision on delivery method are limited. The aim of his study was to determine the factors that influence the choice of delivery method by Iranian primiparous women. This cross-sectional study was conducted in April through September 2014. Participants were 460 primiparous women in 8 hospitals of 4 cities in Iran. Finally, 230 cesarean section and 230 vaginal delivery women were selected. Inclusion criteria were being primiparous, and having no contraindication for vaginal delivery. Study tool was a researcher-developed questionnaire that its validity and reliability were proved. Data were gathered by direct interview and analyzed by SPSS version 16. Average age of the participants was 23 years. Factors that correlated with the choice of Cesarean section were upper education, high socioeconomic level, tendency of husband, living with the husband's family, insistence of the physician, receiving maternal care in personal offices, fear of delivery pain, low knowledge of the mother, high age of marriage and pregnancy, history of abortion, and lack of family support. More than 60% of the participants had little knowledge about the delivery methods. Satisfaction with cesarean section was 70% and with the vaginal delivery was 77%. Half of the cesareans were performed on the insistence of the physician. Considering the factors identified in this study, can enforce the intention of mothers to have vaginal delivery by improving their knowledge and perception about this delivery method.

  20. Examining the efficacy, safety, and patient acceptability of the combined contraceptive vaginal ring (NuvaRing®

    Directory of Open Access Journals (Sweden)

    Devorah R Wieder

    2010-11-01

    Full Text Available Devorah R Wieder, Lynn PattimakielCenter for Specialized Women’s Health, Ob/Gyn and Women’s Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USAAbstract: The contraceptive vaginal ring is a novel contraceptive method that offers unique advantages. Intravaginal delivery of both estrogen and progesterone allows continuous release of medication, resulting in lower systemic levels. The use of long-term combined hormonal contraception enables improved cycle control compared with progesterone-only methods. The indications and usage of the NuvaRing® are described along with the efficacy, tolerability, and safety. Overall, the contraceptive vaginal ring appears to be very effective, with a favorable side-effect profile, and is highly acceptable to most patients.Keywords: vaginal contraception, vaginal ring, hormonal contraception, contraceptive agents, contraceptive device, etonogestrel, ethinyl estradiol, NuvaRing

  1. Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India.

    Science.gov (United States)

    Iyengar, Sharad D; Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril

    2009-04-01

    A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.

  2. 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

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

    Science.gov (United States)

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

    2017-02-21

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

  4. Via de parto em gestações sucessivas em adolescentes: estudo de 714 casos Route of delivery in successive gestations in adolescents: study of 714 cases

    Directory of Open Access Journals (Sweden)

    Vamberto Oliveira de Azevedo Maia

    2004-10-01

    Full Text Available OBJETIVO: analisar a associação da via de partos consecutivos de 714 gestantes adolescentes, que pariram na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco, no período de janeiro a dezembro de 2001. PACIENTES E MÉTODOS: em estudo prospectivo, analítico, transversal, tipo incidência, foi analisada a sucessão das vias de parto da primeira até a quarta gestação de 714 parturientes adolescentes, com idade variando entre 13 e 19 anos (média 17,2±1,5 anos. Identificando-se, no livro da sala de parto, a cada dia, as adolescentes que pariram, após ter obtido o consentimento livre e esclarecido, cada uma respondeu a um questionário estruturado, com 65 perguntas diretas e respostas fechadas, pré-codificadas, entre as quais estavam vias de parto e o número de gestações. RESULTADOS: observou-se que 527 (73,8% adolescentes tiveram uma única parturição, 149 (20,9% duas parturições, 35 (4,9% três partos e 3 (0,4% quatro partos. Dentre os 273 partos cesáreos, 207 (75,8% ocorreram em primíparas, 65 (23,8% em paucíparas e 1 (0,4% em multípara. Houve associação estatisticamente significante entre via de parto da primeira e da segunda parturições; em 83 (55,7% gestantes adolescentes quanto à via transvaginal e em 41 (27,5%, para a via cesárea. Coincidiram também as vias de parto de segunda e terceira parturições, em 23 (65,7% gestantes adolescentes no parto transvaginal e em outras 10 (28,6% na cesárea. CONCLUSÃO: identificou-se tendência da coincidência das vias de parto em gestações sucessivas em parturientes adolescentes, até a terceira parturiçãoPURPOSE: to analyze the association between modes of consecutive deliveries of 714 adolescents attended at the Maternity sector of the Hospital das Clínicas da Universidade Federal de Pernambuco (Federal University of Pernambuco, from January to December 2001. PATIENTS AND METHODS: according to a prospective, analytic, transversal, and incidence

  5. Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

    Science.gov (United States)

    Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Erkilinc, Selcuk; Aksakal, Orhan Seyfi; Doganay, Melike

    2015-05-01

    To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

  6. Laparoscopic reconstructive surgery is superior to vaginal reconstruction in the pelvic organ prolapse.

    Science.gov (United States)

    Park, Young-Han; Yang, Seong Cheon; Park, Sung Taek; Park, Sung Ho; Kim, Hong Bae

    2014-01-01

    Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse. Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ(2)-test or the Fisher exact test as appropriate. There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, papproach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p laparoscopic approach group. Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.

  7. Exploring the umbilical and vaginal port during minimally invasive surgery.

    Science.gov (United States)

    Tinelli, Andrea; Tsin, Daniel A; Forgione, Antonello; Zorron, Ricardo; Dapri, Giovanni; Malvasi, Antonio; Benhidjeb, Tahar; Sparic, Radmila; Nezhat, Farr

    2017-09-01

    This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.

  8. High Diversity and Variability in the Vaginal Microbiome in Women following Preterm Premature Rupture of Membranes (PPROM): A Prospective Cohort Study.

    Science.gov (United States)

    Paramel Jayaprakash, Teenus; Wagner, Emily C; van Schalkwyk, Julie; Albert, Arianne Y K; Hill, Janet E; Money, Deborah M

    2016-01-01

    To characterize the vaginal microbiota of women following preterm premature rupture of membranes (PPROM), and determine if microbiome composition predicts latency duration and perinatal outcomes. A prospective cohort study. Canada. Women with PPROM between 24+0 and 33+6 weeks gestational age (GA). Microbiome profiles, based on pyrosequencing of the cpn60 universal target, were generated from vaginal samples at time of presentation with PPROM, weekly thereafter, and at delivery. Vaginal microbiome composition, latency duration, gestational age at delivery, perinatal outcomes. Microbiome profiles were generated from 70 samples from 36 women. Mean GA at PPROM was 28.8 wk (mean latency 2.7 wk). Microbiome profiles were highly diverse but sequences representing Megasphaera type 1 and Prevotella spp. were detected in all vaginal samples. Only 13/70 samples were dominated by Lactobacillus spp. Microbiome profiles at the time of membrane rupture did not cluster by gestational age at PPROM, latency duration, presence of chorioamnionitis or by infant outcomes. Mycoplasma and/or Ureaplasma were detected by PCR in 81% (29/36) of women, and these women had significantly lower GA at delivery and correspondingly lower birth weight infants than Mycoplasma and/or Ureaplasma negative women. Women with PPROM had mixed, abnormal vaginal microbiota but the microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period.

  9. [Prevalence of self-reported vaginal discharge and associated factors in pregnant women].

    Science.gov (United States)

    Cesar, Juraci A; Mendoza-Sassi, Raúl A; González-Chica, David A; Menezes, Eduardo H M; Brink, Günther; Pohlmann, Marcela; Fonseca, Tania M V

    2009-12-01

    This study aims to determine the prevalence self-reported abnormal vaginal discharge and to identify associated risk factors in pregnant women in the municipality of Rio Grande, Rio Grande do Sul State, Brazil. A standardized questionnaire was applied to all pregnant women admitted for delivery in local maternity hospitals. The chi-square test was used to compare proportions, and Poisson regression was applied using multivariate analysis. Prevalence of vaginal discharge was 40%. Adjusted analysis showed the following prevalence ratios for vaginal discharge: 1.6 (1.4-1.8) for adolescents; 1.3 (1.1-1.6) for 8 years of schooling or less; 1.3 (1.1-1.5) for alcohol consumption; 2.0 (1.8-2.2) for vaginal discharge in the previous pregnancy; 1.4 (1.3-1.6) for urinary tract infection in the current pregnancy; and 0.8 (0.7-0.9) for history of prematurity. Local health services should target adolescent women, those with low schooling or low family income, and those with a history of vaginal discharge in the previous pregnancy or urinary tract infection in the current pregnancy.

  10. Simplified Bishop score including parity predicts successful induction of labor.

    Science.gov (United States)

    Ivars, Joanna; Garabedian, Charles; Devos, Patrick; Therby, Denis; Carlier, Sabine; Deruelle, Philippe; Subtil, Damien

    2016-08-01

    Our objectives were to confirm the predictiveness of parity for successful labor induction and propose an improvement in the Bishop's score to take parity into account and simultaneously simplify the original Bishop score. Retrospective study of 326 deliveries induced by oxytocin and amniotomy before prostaglandins between January 1, 1987, and June 30, 1988. We conducted a univariate and then a multivariate analysis of the relation between successful labor induction - defined by vaginal delivery- and the components of Bishop's score and parity. Nulliparous accounted for 38% of the studied population. The mean Bishop at induction was 5.75±1.4. Fetal station, cervical effacement, and parity were the only factors associated with the success of induction in this study. Removing the cervical position and consistency from the score as well as adding parity significantly improved the prediction of success (ROC curves, AUC 0.88 vs 0.68, plabor in 90% of the women that were considered in the study (vs 26% or 60%, according to whether the cutoff point of the original Bishop's score is set, respectively, at 7 or 6, plabor induction by oxytocin and amniotomy. We confirmed the usefulness of a simplified Bishop score that considers parity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. [Pregnancy, delivery and pelvic floor disorders].

    Science.gov (United States)

    Aukee, Pauliina; Tihtonen, Kati

    2010-01-01

    Pregnancy and vaginal delivery affect pelvic floor by increased intra-abdominal pressure, direct muscle trauma, nerve injury and connective tissue damage. Even if pelvic floor dysfunction is more common after vaginal delivery compared to cesarean section, the differences are less clear after long-term follow up. This implies that other factors such as age, estrogen levels, genetic factors and overweight have also a role in the pathophysiology of pelvic floor dysfunctions. It is possible to prevent some of the birth injuries by careful obstetric management. Pelvic floor muscle training during pregnancy or after delivery may reduce the incidence of fecal and urinary incontinence after delivery, but data about long-term effects is scarce.

  12. [Outcomes of anterior vaginal wall repair using polypropylene mesh].

    Science.gov (United States)

    Huser, M; Pastorčáková, M; Belkov, I; Sedláková, K

    2012-10-01

    Pelvic organ prolapse (POP) is a major health concern especially in the elderly women. Anterior vaginal wall prolapse (AWP) represents the most common form of POP with reoperation rate 30-40% when primary treated by anterior colporrhaphy. Modern surgical techniques of POP repair uses polypropylene (PP) mesh implants to better support pelvic structures and lower the risk of recurrence. Aim of our study was to assess the safety and efficacy of anterior vaginal wall prolapse repair using PP mesh system NAZCA TC (Promedon). The kit consists of preformed PP mesh anchored to pelvic structures by two needle inserters via pre-pubic and trans-obturator route. From January 2010 to February 2011, 21 patients with stage III/IV AWP underwent transvaginal repair with implantation of PP mesh. The stage of POP measured according to POP-Q system, surgery length, blood loss and complications has been evaluated six month after the surgery. Surgery has been assessed as successful when POP stage 0/I o has been reached. In 42.9% of patients AWP repair was combined with other procedures: vaginal hysterectomy or posterior vaginal repair. (Statistical evaluation was done by Wilcoxon test.). The average age of operated women was 62.4±9.4 years, average body mass index was 27.5±4.1 kg/m2, with overall parity of 2.2±1.4 children. The surgery time was 64.0±26.0 minutes with average blood loss of 185.0±17,0 ml. No serious per-operating complication has been recorded. The objective cure rate at 6 months was 90.5%. Statistically significant difference in the position of points Aa, Ba and C (ppolypropylene mesh is an effective and safe technique in the hands of surgeon experienced in classical POP reconstruction techniques. For the assessment of long term efficacy the further follow-up of patients is necessary.

  13. Educational outcomes following breech delivery: a record-linkage study of 456947 children.

    Science.gov (United States)

    Mackay, Daniel F; Wood, Rachael; King, Albert; Clark, David N; Cooper, Sally-Ann; Smith, Gordon C S; Pell, Jill P

    2015-02-01

    Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes. We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011. Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (≤3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (CI) 4.44-8.54, p<0.001] or cephalic vaginal delivery (adjusted OR 3.84, 95% CI 2.99-4.93, p<0.001). Children born by vaginal breech delivery had lower examination attainment than those born by either planned caesarean section for breech presentation (adjusted OR 1.16, 95% CI 1.02-1.32, p=0.020) or vaginal cephalic delivery (adjusted OR 1.14, 95% CI 1.01-1.28, p=0.029). Vaginal delivery of term breech infants was associated with lower examination attainment, as well as poorer Apgar scores, suggesting that the adverse effects are not just short-term. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  14. Prolapso vaginal e uterino em ovelhas

    OpenAIRE

    Maíra Bianchi R. Alves; Benesi,Fernando J.; Lilian Gregory; Della Libera, Alice M.M.P.; Sucupira,Maria Cláudia A.; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade sup...

  15. Pieter Cullis' quest for a lipid-based, fusogenic delivery system for nucleic acid therapeutics: success with siRNA so what about mRNA?

    Science.gov (United States)

    Tam, Ying K; Madden, Thomas D; Hope, Michael J

    2016-11-01

    For the best part of 40 years, lipids and membrane fusion have been at the center of Pieter's research. Projects range from the purely academic quest of understanding the roles of lipids in biological membranes, to the translation of this knowledge into the most advanced lipid nanoparticle (LNP) drug delivery systems in clinical trials to-date. Pieter's pioneering work in lipid polymorphism and characterizing the unique properties of unsaturated phospatidyethanolamines (PE), together with the introduction of ionizable, dialkylamino lipids to trigger membrane fusion at acidic pH, provided the foundation on which a new generation of highly potent, well-tolerated LNPs for intravenous delivery of nucleic acid therapeutics has been built. In this contribution to the special edition honoring Pieter's achievements we highlight key research conducted in Pieter's laboratory and at several biotechnology companies, some spun out of his research group, which resulted in the development of a fusogenic delivery system for siRNA therapeutics. Patisiran®, an LNP encapsulating siRNA for hepatic gene silencing, is currently in Phase III clinical trials for treatment of Transthyretin amyloidosis as are several other siRNA products employing this delivery technology. Finally, we describe more recent work in which the platform shows real promise in the rapidly growing new field of mRNA therapeutics.

  16. Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in ...

    African Journals Online (AJOL)

    Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair ...

  17. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  18. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  19. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure.

    Science.gov (United States)

    Zilberlicht, Ariel; Feiner, Benjamin; Haya, Nir; Auslender, Ron; Abramov, Yoram

    2016-11-01

    Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.

  20. Predicting mode of delivery using mid‑pregnancy ultrasonographic ...

    African Journals Online (AJOL)

    Objectives: The objective is to determine the relationship between cervical length at mid‑pregnancy and mode of delivery and preterm delivery. Materials and Methods: Trans‑vaginal ultrasonographic scan measurement of cervical length was done for 281 pregnant women at a mean gestational age of 22 weeks.

  1. [Neonatal and maternal morbidity related to the type of delivery].

    Science.gov (United States)

    Cardoso, Priscila Oliveira; Alberti, Luiz Ronaldo; Petroianu, Andy

    2010-03-01

    An evaluation of infant morbimortality and mother morbidity was undertaken according to the type of delivery. A prospective study was undertaken on 170 puerperal patients divided into two groups: Group 1 (n = 95), natural or vaginal delivery, Group 2 (n = 75), submitted to caesarean delivery. Complications in mothers were classified in small, moderate and severe. The infant parameters were: period of pregnancy, weight on birth, Apgar score, necessity of intensive care and neurological disorders. Mothers who had not completed elementary school (p=0.0045) had more vaginal delivery. Previous vaginal deliveries were more common in Group 1 than caesarean section in Group 2 (p = caesarean section (p = 0.0002) (OR = 4; 1.77 caesarean section (8 cases) than patients of Group 1 (2 cases) (p = 0.018) (OR = 0.18; 0.03 < OR < 0.96). Obstetric trauma was found in 14 deliveries of Group 1 and 7 of Group 2 (p = 0.28). Infant hospitalization was greater in Group 2 (3.43 +/- 0.70 days) in comparison with Group 1 (2.71 +/- 0.67 days) (p < 0.0001). The infant morbidity was greater after vaginal deliveries, but maternal morbidity was greater after caesarean deliveries.

  2. Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women.

    Science.gov (United States)

    Bodner-Adler, Barbara; Kimberger, Oliver; Käfer, Andreas; Husslein, Peter; Bodner, Klaus

    2017-08-17

    The main objective of this study was to evaluate the association of mediolateral episiotomy with severe perineal trauma during Kiwi omnicup vacuum delivery. This retrospective study analyzed all Kiwi omnicup vacuum deliveries between 2010 and 2015 in nulliparous women. Secondary outcomes of interest included frequency of genital tract trauma, outcome of Kiwi extraction and influence on neonatal parameters. A total of 572 nulliparous women who were delivered with the aid of vacuum were analyzed. Successful completion of birth was achieved in 549/572 (96%) resulting in a failure rate of 4%. Out of 572 women, 372 (65%) underwent the Kiwi vacuum delivery system in conjunction with episiotomy. Third- or fourth-degree perineal tears occurred in 38 out of the 572 (6.6%) women and the rate of severe perineal trauma was statistically and significantly lower in women who delivered with the aid of the Kiwi vacuum in conjunction with episiotomy (p = 0.0001). Besides, perineal tears of all degrees, vaginal tears and labial trauma were significantly less common in the Kiwi vacuum delivery system when combined with mediolateral episiotomy (p = 0.0001, p = 0.006, and p = 0.0001, respectively). Our data showed that the performance of a mediolateral episiotomy was associated with a decreased risk of severe perineal tears as well as vaginal and labial trauma in Kiwi omnicup vacuum deliveries. © 2017 S. Karger AG, Basel.

  3. 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.

  4. Vaginal Calculus in a Woman With Mixed Urinary Incontinence and Vaginal Mesh Exposure.

    Science.gov (United States)

    Winkelman, William D; Rabban, Joseph T; Korn, Abner P

    2016-01-01

    Vaginal calculi are extremely rare and are most commonly encountered in the setting of an urethrovaginal or vesicovaginal fistula. We present a case of a 72-year-old woman with mixed urinary incontinence and vaginal mesh exposure incidentally found to have a large vaginal calculus. We removed the calculus surgically and analyzed the components. Results demonstrated the presence of ammonium-magnesium phosphate hexahydrate and carbonate apatite.

  5. Condom-catheter tamponade for the treatment of postpartum haemorrhage and factors associated with success: a prospective observational study.

    Science.gov (United States)

    Aderoba, A K; Olagbuji, B N; Akintan, A L; Oyeneyin, O L; Owa, O O; Osaikhuwuomwan, J A

    2017-10-01

    To determine the outcomes and factors associated with postpartum haemorrhage (PPH) treatment with condom-catheter uterine balloon tamponade (C-UBT). Prospective observational study. A secondary healthcare facility in Nigeria. Women with PPH refractory to first-line treatment. Demographic and clinical characteristics were compared in women with successful and unsuccessful treatment. Univariate and multivariate logistic regression analyses were used to examine the association of these characteristics with successful treatment. The success rate of C-UBT, factors associated with success, and maternal morbidity rates in both successful and unsuccessful treatment groups. Overall, 203/229 (88.6%) women had successful treatment. Women with successful treatment had lower mean blood loss (1248.8 ± 701.3 ml versus 3434.6 ± 906.6 ml; P success rates compared with vaginal delivery. In the regression model with three factors, advanced maternal age (aOR 0.31; 95% CI 0.11-0.90) and caesarean section (aOR 0.17; 95% CI 0.07-0.41) were associated with lower success rates in comparison with younger maternal age and vaginal delivery, respectively. Second-line PPH treatment with C-UBT is effective, and is associated with low maternal morbidity rates. Advanced maternal age and caesarean section are associated with lower success rates. Condom-catheter tamponade is a useful second-line treatment modality for intractable postpartum haemorrhage. © 2016 Royal College of Obstetricians and Gynaecologists.

  6. Bioadhesive vaginal tablets containing spray dried microspheres loaded with clotrimazole for treatment of vaginal candidiasis.

    Science.gov (United States)

    Gupta, Naresh Vishal; Natasha, Shirodker; Getyala, Anil; Bhat, Ramnath Sudeendra

    2013-09-01

    The aim of the present investigation was to prepare and evaluate novel bioadhesive vaginal tablets containing clotrimazole loaded microspheres in order to provide long-term therapeutic activity at the site of infection. Tablets were prepared by incorporating drug loaded microspheres and using bioadhesive polymers hydroxypropylmethylcellulose, sodium carboxymethylcellulose and Carbopol. Microspheres were prepared by the spray drying technique using Eudragit RS-100 and Eudragit RL-100. Microspheres were characterized by SEM, DSC, FTIR, particle size analysis and evaluated for percentage yield, drug loading, encapsulation efficiency and in vitro drug release. To achieve bioadhesion to the mucosal tissue, optimized microspheres were incorporated into bioadhesive tablets and were evaluated for in vitro drug release, in vitro and in vivo mucoadhesion. FTIR and DSC studies showed that no chemical interaction occurred between the drug and polymers. The sphericity factor indicated that the prepared microspheres were spherical. Formulation Mt6 indicated a controlled in vitro drug release and good bioadhesive strength. The in vivo images confirmed the bioadhesion and retention property of tablets up to 24 h. The results indicated that this drug delivery system can be explored for controlled intravaginal drug release.

  7. The maternal childbirth experience more than a decade after delivery.

    Science.gov (United States)

    Bossano, Carla M; Townsend, Kelly M; Walton, Alexandra C; Blomquist, Joan L; Handa, Victoria L

    2017-09-01

    Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period. This study investigated whether differences in satisfaction based on mode of delivery are observed more than a decade after delivery. This was a planned, supplementary analysis of data collected for the Mothers' Outcomes after Delivery study, a longitudinal cohort study of pelvic floor disorders in parous women and their association with mode of delivery. Obstetric and demographic data were obtained through patient surveys and obstetrical chart review. Maternal satisfaction with childbirth experience was assessed via the Salmon questionnaire, administered to Mothers' Outcomes after Delivery study participants >10 years from their first delivery. This validated questionnaire yields 3 scores: fulfillment, distress, and difficulty. These 3 scores were compared by mode of delivery (cesarean prior to labor, cesarean during labor, spontaneous vaginal delivery, and operative vaginal delivery). In addition, the impact of race, age, education level, parity, episiotomy, labor induction, and duration of second stage of labor on maternal satisfaction were examined. Among 576 women, 10.1-17.5 years from delivery, significant differences in satisfaction scores were noted by delivery mode. Salmon scale scores differed between women delivering by cesarean and those delivering vaginally: women delivering vaginally reported greater fulfillment (0.40 [-0.37 to 0.92] vs 0.15 [-0.88 to 0.66], P childbirth is influenced by mode of delivery. The birth experience leaves an impression on women more than a decade after delivery. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Predictors of successful induction of labour at a tertiary obstetric ...

    African Journals Online (AJOL)

    misoprostol cervical ripening the night before induction and administering the medication orally rather than vaginally. Key words: Induction of labour; intervention; outcome; predictor of success. Introduction. Induction of labour (IOL) is the process of artificially creating uterine contractions with the aim of achieving a vaginal ...

  9. Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri.

    Science.gov (United States)

    Ibrahim, S M; Bukar, M; Mohammed, Y; Mohammed, B; Yahaya, M; Audu, B M; Ibrahim, H M; Ibrahim, H A

    2013-01-01

    Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software. The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

  10. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    National Research Council Canada - National Science Library

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    .... PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement...

  11. Do vaginal lactobacilli prevent preterm labour?

    African Journals Online (AJOL)

    % before 34 weeks (obstetric database - Tygerberg Hospital). Therefore, it is not surprising that preterm labour is the main cause of perinatal mortality.1According to recent information, infection and particularly vaginal bacteriosis play a major ...

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

    Science.gov (United States)

    ... School Has a Weapon. What Should I Do? School Counselors Kidney Stones Brain and Nervous System ... the vagina, and helping to prevent and fight infections. Although it's normal for the color, texture, and amount of vaginal fluids to vary ...

  13. VBAC (Vaginal Birth After C-Section)

    Science.gov (United States)

    ... www.uptodate.com/home. Accessed May 19, 2015. Lang CT, et al. Uterine dehiscence and rupture after ... Health Letter PRC-20395237 Patient Care & Health Information Tests & Procedures Vaginal birth after C-section (VBAC) Request ...

  14. ureteric perforation following laparoscopic assisted vaginal ...

    African Journals Online (AJOL)

    2011-03-03

    Mar 3, 2011 ... SUMMARY. Ureteric injury is one of the most common complications of hysterectomy, both in open ... the laparoscopic hysterectomy (abdominal or vaginal approaches) is ... primary end to end anastomosis due big gap, the.

  15. Vaginal itching and discharge - adult and adolescent

    Science.gov (United States)

    ... other symptoms ( atrophic vaginitis ). Forgotten tampon or foreign body, which may cause a foul odor. Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams, ...

  16. Microbes on the Human Vaginal Epithelium

    National Research Council Canada - National Science Library

    Richard W. Hyman; Marilyn Fukushima; Lisa Diamond; Jochen Kumm; Linda C. Giudice; Ronald W. Davis

    2005-01-01

    Using solely a gene-based procedure, PCR amplification of the 16S ribosomal RNA gene coupled with very deep sequencing of the amplified products, the microbes on 20 human vaginal epithelia of healthy...

  17. Minimizing genital tract trauma and related pain following spontaneous vaginal birth.

    Science.gov (United States)

    Albers, Leah L; Borders, Noelle

    2007-01-01

    Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in r