Hysteroscopic Myomectomy
Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay in Fibroids and Reproduction, 2020
Close attention should be paid to avoiding uterine perforation, which can happen at any time during the procedure from uterine sounding, cervical dilation, hysteroscope insertion, and/or during fibroid resection. Perforation occurring at the time of cervical dilation is most commonly due to cervical stenosis, a severely retro- or anteverted uterus, or in nulliparous/menopausal women. If uterine perforation is recognized, it is important to identify which steps of the hysteroscopy have been completed thus far; regardless, the procedure should be terminated. If only a mechanical perforation without suspicion of bowel damage, patients can be placed in extended observation for a few additional hours and discharged home. If perforation is secondary to an activated electrode or sharp instrument, one should assume the possibility of bowel injury, and diagnostic laparoscopy should be performed immediately. If perforation is noted, the perforation should be sutured in patients of reproductive age even if hemostatic due to the risk of uterine rupture during pregnancy [25].
Biomechanical Factors In Fetal And Maternal Changes In Pregnancy And Labor
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Cervical dilation is routinely monitored during the first stage of labor. The assessment helps to determine the progress of labor. Clinically cervical dilation is determined by per vaginal examination using one or two fingers to find how many fingers could possibly be inserted into the cervix. One finger slipping into the cervix is deemed to represent a dilation of 1.5 cm, two fingers is 3 cm, two fingers loose being 4 cm, dilation with cervical lip is considered to be 7 cm and without a lip is full dilation. Clearly such a method of measurement is quite subjective and different observers will give varying estimates of a particular dilation. Even a particular doctor may give different assessments on repeat observations although the actual cervical opening size may not have changed.
Pain in pregnancy, childbirth, and the puerperium
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
To a great extent, the pain of parturition parallels the process of labor (Table 26.1). The stimulus for pain occurs primarily during the first and second stage of labor. During the first stage, uterine contractions lead to cervical effacement and dilation, producing pain that is visceral in nature. This stage can be subdivided into phases. The latent phase consists of cervical effacement and slow cervical dilation until approximately 3–4 cm of cervical dilation. The active phase consists of a rapid increase in cervical dilation rate until full (10 cm) cervical dilation is reached. During the active phase, the rate of cervical dilation accelerates to a maximum (1 cm/hour in the nulliparas and 1.5 cm/hour in the multiparas parturient), and then decelerates as the cervix reaches full (10 cm) dilation. The end of the first stage is termed the transition stage, during which the fetus begins to descend into the pelvic inlet in preparation for the second stage of labor. This can often be identified by the beginning of somatic pain.29 The second stage of labor begins with full cervical dilation. Uterine contractions now force the fetus through the bony pelvis, causing significant pressure and stretching and tearing of the cervix, vagina, and perineum. The second stage of labor ends with the birth of the fetus, and with this event, the vast majority of painful stimuli have been removed.
Management of twin–twin transfusion syndrome with an extremely short cervix
Published in Journal of Obstetrics and Gynaecology, 2018
Myrna S. Aboudiab, Andrew H. Chon, Lisa M. Korst, Arlyn Llanes, Joseph G. Ouzounian, Ramen H. Chmait
For this group of 17 patients, the median preoperative CL was 0.7 cm (0–1.0) and the median CL on postoperative day 1 was 1.7 cm (0.9–2.7). The median interval between laser surgery and delivery was 9.6 weeks (2.1–13.9) and only one patient (#14, Table 1) had PPROM within 3 weeks of surgery. The median GA at delivery was 30.9 weeks (23.1–37.6), 30-day survival of at-least-one twin was 88.2% (15 of the 17 patients) and dual survivorship at 30 days was 82.4% (14 of the 17 patients). At the time of cerclage placement, the cervix was dilated ≥1.0 cm in nine of the 17 patients (52.9%) with a median cervical dilation of 1.0 cm (1.0–5.0). In this subset of nine patients, the median interval between laser surgery and delivery was 9.4 weeks (2.1–13.6) and the median GA at delivery was 29.7 weeks (23.1–36.6). Both at-least-one and dual survivorship at 30 days were 88.9%. There were no outcome differences detected between those who did and did not have cervical dilation at the time of cerclage placement.
Reassessing the length of labour in healthy Turkish women: a retrospective and descriptive study
Published in Journal of Obstetrics and Gynaecology, 2019
İlkay Boz, Selahattin Kumru, Aysu Buldum, Mehmet Ziya Firat
The population of this study included women who had a vaginal birth in 2014 or 2015. All of the labours with a spontaneous onset were diagnosed in the hospital. The women who met the inclusion criteria in accordance with literature (Zhang et al. 2001, 2002, 2010b) were included in this study were: (a) of a maternal age between 18 and 45, (b) pregnancy in singleton, (c) gestational age from 37 weeks and 0 days to 41 weeks and 6 days, (d) birth weight from 2500 to 4000 grams, (e) had a vertex presentation of the baby, (f) duration of labour from admission to delivery greater than or equal to 3 hours, and a (g) 4 cm cervical dilation at the beginning of the partograph. Exclusion criteria included the following factors: (a) switch from vaginal birth to caesarean section, (b) non-Turkish and mixed-race women, (c) maternal obesity (BMI greater than or equal to 30), (d) multiple pregnancy, (e) gestational age below 37 weeks, (f) a non-vertex presentation of the foetus, (g) were less than 3 cm and greater than 5 cm in cervical dilation, (h) had the use of instruments (e.g. forceps and vacuum extraction), (i) administration of oxytocin, spinal and/or epidural analgesia, (j) and experienced complications (e.g. preeclampsia, early membrane rupture, gestational diabetes mellitus, and polyhydramnios).
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
The following classes of primiparas were excluded from the study:Women with psychological and mental disorders.Women with cervical dilation > 6 cm at admission, epidural analgesia, CS in latent phase and second stage of labour, CS because of foetal distress and elective CS during the active phase, operative vaginal delivery (vacuum or forceps), shoulder dystocia and induction of labour because of severe malformations such as full-term stillbirth, hydrocephalus and anencephaly.Those with incomplete demographic data.
Related Knowledge Centers
- Childbirth
- Mucus
- Miscarriage
- Cervix
- Uterine Contraction
- Pregnancy
- Abortion
- Cervical Effacement
- Bloody Show
- Placental Abruption