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Cervical Examination in Labor

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21. Genital examination in women

, and therefore this document is intended as both a refresher and guide for enhancing practice. Why are genital examinations performed? A genital examination is performed in the three main areas of health care below. Assessment or diagnosis – for example, of adnexae, vagina, external genitalia, genital infections, colposcopy, cervical biopsy, pregnancy and labour, uterine and vaginal prolapse, incontinence, vaginal swabs, Bartholin’s cyst and abscess, transvaginal ultrasound, vaginal bleeding, amenorrhoea (...) of an almond. In post-menopausal women they are smaller gentle moving of the cervix slightly from side to side will demonstrate ‘cervical excitation’. Should there be any adnexal masses or tenderness, advice should be sought if there is a potential diagnosis of ectopic pregnancy, this procedure should be performed by a skilled clinician, following pregnancy testing and ultrasound scanning. Following the examination Switch off the examination light and provide privacy for the woman to get dressed

2016 Royal College of Nursing

22. Harm of HPV vaccine: Latest information and examination of epidemiological studies

in Japan. The epidemiological surveys from Europe and North America that Japan’s Ministry of Health, Labour and Welfare (MHLW) used as evidence for safety of the vaccine have flawed methodologies. One study confused prevalence with incidence, and the other two have serious risk of bias attributable to the "healthy vaccinee effect". While there is no evidence yet confirming that HPV vaccination decreases the incidence of and mortality from cervical cancer, assuming that the vaccine could halve cervical (...) Harm of HPV vaccine: Latest information and examination of epidemiological studies MED CHECK - TIP APRIL 2015 / Vol.1 No.1 · Page -The Informed Prescriber C N o 1 M ED HECK Volume 1 April 2 0 1 5 H.pylori eradication may shorten life span CONTENTS (April 2015,Vol. 1, No. 1) Editorial: An independent drug bulletin for medical practice New Products SGLT-2 inhibitors: Unacceptable products -- can we call these “medicines”? Methadone (Limited use): Useful only in opioid rotation with special

2015 Med Check - The Informed Prescriber

23. SMFM Statement: Elective induction of labor in low-risk nulliparous women at term: The ARRIVE trial

nulliparous women, reduces the risk of a composite outcome ofperinataldeathor severeneonatalmorbidity. Nulliparouswomenwithreliabledatingandnoobstetricor medical complications were eligible, regardless of favor- ability of cervical examination. Of the 22,533 women who were eligible for participation, 27% (n¼6106) enrolled. Recruitment occurred at 41 academic and community- based hospitals, with 3062 women randomly assigned to the IOL group and 3044 women randomly assigned to the expectant treatment group (...) . Randomization occurred be- tween 38 weeks 0 days and 38 weeks 6 days of gestation; womenintheIOLgroupplannedtoundergoinductionfrom 39 weeks 0 days through 39 weeks 4 days of gestation. Womenintheexpectantmanagementgroupwereaskedto undergoinductiononlyifmedicallyindicatedat<40weeks 5daysofgestation,andallwomenweretobedeliveredby 42weeks2 daysofgestation. Most of the enrolled women (63%) had an unfavorable cervix,whichwasde?nedasamodi?edBishopscore<5,at the time of randomization. A cervical ripening agent

2019 Society for Maternal-Fetal Medicine

24. Approaches to Limit Intervention During Labor and Birth

difference that exceeded the effect of amniotomy with oxytocin (mean difference, 21.11 hours). Women in upright positions also were less likely to have a cesarean delivery (RR, 0.71; 95% CI, 0.54–0.94) (43). A second Cochrane meta-analysis of RCTs that examined the effect of position during the second stage of labor found that upright or lateral positions compared with supine positions are associated with fewer “abnormal” fetal heartratepatterns(RR,0.46;95%CI,0.22–0.93),areduc- tion in episiotomies (RR (...) , Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phase of spon- taneous labor. Obstet Gynecol 2005;105:77–9. 3. Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Womens Health 2014;59:28–34. 4. Wood AM, Frey HA, Tuuli MG, Caughey AB, Odibo AO, Macones GA, et al. Optimal admission cervical dilation in spontaneously laboring women. Am J

2019 American College of Obstetricians and Gynecologists

25. Pharmacological and mechanical interventions for labour induction in outpatient settings. (Full text)

Pharmacological and mechanical interventions for labour induction in outpatient settings. Induction of labour is carried out for a variety of indications and using a range of methods. For women at low risk of pregnancy complications, some methods of induction of labour or cervical ripening may be suitable for use in outpatient settings.To examine pharmacological and mechanical interventions to induce labour or ripen the cervix in outpatient settings in terms of effectiveness, maternal (...) satisfaction, healthcare costs and, where information is available, safety.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2016) and reference lists of retrieved studies.We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Cluster trials were eligible for inclusion.Two review authors independently assessed trials for inclusion and risk of bias, extracted data

2017 Cochrane PubMed abstract

26. Combined value of placental alpha microglobulin‐1 detection and cervical length via transvaginal ultrasound in the diagnosis of preterm labor in symptomatic patients (Full text)

Combined value of placental alpha microglobulin‐1 detection and cervical length via transvaginal ultrasound in the diagnosis of preterm labor in symptomatic patients We aimed to evaluate the combined value of placental alpha microglobulin-1 (PAMG-1) and cervical length (CL) via transvaginal ultrasound for assessing risk of imminent spontaneous preterm delivery in patients presenting with threatened preterm labor (PTL).Clinical exam, PAMG-1 test, cardiotocography, and CL measurement via

2017 The journal of obstetrics and gynaecology research PubMed abstract

27. The induction of labor by mechanical cervical dilation plus misoprostol compared to misoprostol alone: a systematic review and meta-analysis

The induction of labor by mechanical cervical dilation plus misoprostol compared to misoprostol alone: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration (...) into the relationship between study characteristics (e.g. species, sex or drug class or dose) and effect size. They should be considered hypothesis-generating. Ideally, a threshold describing the number of studies per subgroup required for analysis should be specified. For further guidance please refer to the and to pre-clinical meta-analysis. Example: The following study characteristics will be examined as potential source of heterogeneity: species (stratified per species); sex (stratified per sex); duration

2019 PROSPERO

28. Ultrasound Exam of Cervical Length

of Cervical Length Ultrasound Exam of Cervical Length Aka: Ultrasound Exam of Cervical Length , Uterine Cervix Assessment by Ultrasound , Preterm Labor Assessment with Ultrasound , Cervical Length II. Indications III. Protocol No pressure on , observe 5 minutes Take 3 measurements and length is the shortest of 3 IV. Exam: Normal course of Cervical Length Wide variation in Cervical Lengths at 22-30 weeks Length of 2.0 cm: 5th percentile Length of 2.5 cm: 10th percentile Length of 3.5 cm: 50th percentile (...) Ultrasound Exam of Cervical Length Ultrasound Exam of Cervical Length Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ultrasound Exam

2018 FP Notebook

29. The expected labor progression after labor augmentation with oxytocin: A retrospective cohort study. (Full text)

, vaginal delivery, and neonatal Apgar score at 5 minutes at 7 or higher, and complete information on oxytocin augmentation in 2005-2007.Linear interpolation was used from the vaginal exam records for each woman to estimate the cervical dilation when oxytocin was started and the highest dose was first reached by parity. We used survival methods to estimate quartiles of the traverse time distributions of cervical dilation.Duration of labor under oxytocin augmentation.When oxytocin was just started (...) in multiparas. Low- and high-dose oxytocin regimens had similar effects on labor.When oxytocin is just started for labor augmentation in early first stage, it may take up to 10 hours for the cervix to dilate by 1 cm. Once effective uterine contractions are achieved and the cervix is dilated more than 5 cm, cervical dilation to the next centimeter occurs within 2 hrs in both nulliparas and multiparas in 95% of the cases. High- and low-dose oxytocin had a similar impact on labor progression in augmented labor.

2018 PLoS ONE PubMed abstract

30. Point of care tests to exclude pre-term labour: Quantitative Fetal Fibronectin (fFN) testing for predicting pre-term labour

binding protein (phIGFBP-1) testing for predicting pre-term labour. Therefore, both applications were considered simultaneously. The proposed item descriptor requested MBS funding for pregnant women where gestation is greater than 24 weeks and less than 36 weeks who present with symptoms of threatened pre- term labour and are found to have intact amniotic membranes on sterile speculum examination of the cervix. MSAC noted that the main comparator for this intervention was routine clinical care (...) others are advised bed rest at home for significant proportions of their pregnancy. PASC recommended access to the intervention for pregnant women, between 24 and 33 weeks and 6 days gestation who present with the symptoms of threatened preterm labour and are found to have intact amniotic membranes on sterile speculum examination of the cervix. The SBA proposed MBS descriptor is for pregnant women between 24 to 36 weeks gestation. 5 Proposed MBS item descriptor for fFN tests in women with threatened

2014 Medical Services Advisory Committee

31. Fever during labor

) • Threatening preterm labor/PPROM B-C Temperature measurement during labor is recommended every 2-4 hours in case of afebrilia, subfebrilia (37.5-38,0°C) and after placement of epidural analgesia D If the woman in labour has a fever or developes fever, the temperature measurement should be repeated as a minimum every hour D In case of intrapartum fever the following actions are recommended: • Assessment by physician, possibly including physical examination in order to find explanation of fever and plan (...) ) OR febrile) OR pyrexia) OR temperature) OR hyperthermia)) AND ((((((((criteria) OR diagnosed) OR diagnose) OR diagnosis) OR diagnostic) OR define) OR defined) OR definition) 2) 22-10-2017: ((((((("Delivery, Obstetric"[Mesh]) OR "Parturition"[Mesh]) OR "Labor, Obstetric"[Mesh]) OR labor) OR intrapartum)) AND ((maternal) OR mother)) AND temperature 3) 25-10-2017: ((((rectal) AND tympanic) AND "Body Temperature"[Mesh])) AND "Review" [Publication Type] 4) 25-10-2017: ((((rectal) AND oral) AND "Body

2018 Nordic Federation of Societies of Obstetrics and Gynecology

32. CRACKCast E180 – Labor & Delivery

● Progression ● Bloody show / mucus ● Plug expelled ● Cervical dilation and/or effacement (first stage of labour) When in doubt, ask for obstetric assessment; wait and see; and get fetal/electrical monitoring! 2) Describe the 4 phases of labor Phase 1 Phase 2 Phase 3 Phase 4 Latent phase Active phase (cervix >3cm) ● Where we determine what the presenting part is Fully dilated cervix Urge to push Usually lasts < 1 hr Get ready for delivery! Signs of placental separation include the following: the uterus (...) 17) What is the management of Uterine inversion and Uterine rupture? Uterine inversion: Usually occurs during stage 4 of labour And usually culminates in a passive early postpartum hemorrhage The patient will complain of sudden, severe abdominal pain. The abdominal examination reveals tenderness and an absence of the uterine corpus, which is potentially visualized at the cervical os or bulging from the introitus. Profuse bleeding with hemodynamic instability can also occur. Ultrasound may assist

2018 CandiEM

33. Induction of labour

: Per vaginam; SROM: spontaneous rupture of membranes; TPR: Temperature, pulse and respirations; =: greater than or equal to; =: less than or equal to Queensland Clinical Guideline: Induction of labour Refer to online version, destroy printed copies after use Page 6 of 30 Flow Chart: Artificial rupture of membranes Flowchart: F17.22-4-V5-R22 Indications · After cervical ripening method · Favourable cervix (MBS = 7) · Before oxytocin infusion commenced Relative contraindications · Poor application (...) is planned 71,77,78 Clinical practice point · Discuss the benefits of membrane sweeping in the antenatal period · Offer prior to formal IOL 71 · If the cervix is closed and membrane sweeping is not possible, cervical massage in vaginal fornices may achieve similar effect 1 Queensland Clinical Guideline: Induction of labour Refer to online version, destroy printed copies after use Page 17 of 30 4 Methods of IOL Table 14. Methods of IOL Aspect Recommendation Cervical ripening for unfavourable cervix

2018 Queensland Health

34. A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labour: a cohort study. (Full text)

A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labour: a cohort study. The aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor.This was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015. All women (...) infection (OR 4.28, 95% CI 1.52-12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery.Our study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor.© 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

2016 Acta Obstetricia et Gynecologica Scandinavica PubMed abstract

35. Nitric oxide donors for cervical ripening and induction of labour. (Abstract)

Nitric oxide donors for cervical ripening and induction of labour. Sometimes it is necessary to bring on labour artificially because of safety concerns for the mother or baby. This review is one of a series of reviews of methods of labour induction using a standardised protocol.Induction of labour occurs in approximately 20% of pregnancies in the UK. The ideal agent for induction of labour would induce cervical ripening without causing uterine contractions. Currently most commonly used cervical (...) ripening or induction agents result in uterine activity or contractions, or both. Cervical ripening without uterine contractility could occur safely in an outpatient setting and it may be expected that this would result in greater maternal satisfaction and lower costs.To determine the effects of nitric oxide (NO) donors for third trimester cervical ripening or induction of labour, in comparison with placebo or no treatment or other treatments from a predefined hierarchy.We searched the Cochrane

2011 Cochrane

36. Labor progress determined by ultrasound is different in women requiring Cesarean delivery from those who experience a vaginal delivery following induction of labor. (Abstract)

way.The objective of the study was to determine the differences in labor progress by the use of serial transperineal ultrasound assessment of fetal head descent between women having vaginal and Cesarean delivery.This was a prospective longitudinal study performed in 315 women with singleton pregnancy undergoing labor induction at term between December 2016 and December 2017. Paired assessment of cervical dilatation and fetal head station by vaginal examination and transperineal ultrasonographic (...) vaginal examination and ultrasound assessments was 1,198 with a median of three per woman. The median assessment-to-assessment interval was 4.6 hours (interquartile range 4.3-5.1). Women achieving vaginal delivery (n=261) had steeper slopes of para-sagittal angle of progression and head-perineum distance against fetal head station and cervical dilatation than those achieving Cesarean delivery (n=54). Objectively, an additional decrease of 5.11° and 1.37° in para-sagittal angle of progression

2019 American Journal of Obstetrics and Gynecology

37. Labor Curve Analysis of Medically Indicated Early Preterm Induction of Labor. (Abstract)

examinations available during labor. Prior cesarean delivery, 5-minute Apgar score less than 5, and arterial cord pH less than 7.0 were exclusions. The course of cervical dilation was modeled using repeated measures analysis, and smoothed curves for nulliparous and parous women were generated separately. Estimates of the median (5th-95th percentile) traverse times between two dilations were computed using interval censored regression. Traverse times (ie, the elapsed time between two given dilation measures (...) Labor Curve Analysis of Medically Indicated Early Preterm Induction of Labor. To analyze the labor curves of nulliparous and multiparous women between 23.0 and 34.0 weeks of gestation who underwent induction of labor and achieved vaginal delivery.This is a retrospective cohort study of all live singletons delivered vaginally after medically indicated induction of labor between 23.0 and 34.0 weeks of gestation from 2011 through 2014 at our institution. We excluded those with one or no cervical

2019 Obstetrics and Gynecology

38. Factors that affect ultrasound-determined labor progress in women undergoing induction of labor. (Abstract)

by the transperineal ultrasonographic parameters, in women achieving vaginal delivery.This was a prospective longitudinal study performed in 315 Chinese women with singleton pregnancy undergoing labor induction at term between December 2016 and December 2017. Paired assessment of cervical dilatation and fetal head station by vaginal examination and transperineal ultrasonographic assessment of fetal head descent (para-sagittal angle of progression and head-perineum distance) were made serially following (...) the commencement of labor induction until full cervical dilatation. The researchers were blinded to the findings of the clinical team's vaginal examination and vice versa. The repeated measure data were analyzed by mixed effect models to identify the significant factors (age ≥35 years, obesity, parity, methods of labor induction, and epidural anesthesia) affecting the relationship between para-sagittal angle of progression and head-perineum distance against fetal head station and cervical dilatation.The total

2019 American Journal of Obstetrics and Gynecology

39. Preterm labour and birth

(including a speculum or digital vaginal examination) that confirms the possibility of preterm labour but rules out established labour. Cervical tr Cervical trauma auma Physical injury to the cervix including surgery; for example previous cone biopsy (cold knife or laser), large loop excision of the transformation zone (LLETZ – any number) or radical diathermy. Diagnosed preterm labour Diagnosed preterm labour A woman is in diagnosed preterm labour if she is in suspected preterm labour and has had (...) of false positive and false negative test results taking into account gestational age. 1.7.2 Offer a clinical assessment to women reporting symptoms of preterm labour who have intact membranes. This should include: clinical history taking the observations described for the initial assessment of a woman in labour in the NICE guideline on intrapartum care a speculum examination (followed by a digital vaginal examination [2] if the extent of cervical dilatation cannot be assessed). 1.7.3 If the clinical

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

40. Transvaginal sonographic assessment of cervical length for predicting the outcome of labor induction in nulliparous women

Transvaginal sonographic assessment of cervical length for predicting the outcome of labor induction in nulliparous women Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence (...) the number of studies per subgroup required for analysis should be specified. For further guidance please refer to the and to pre-clinical meta-analysis. Example: The following study characteristics will be examined as potential source of heterogeneity: species (stratified per species); sex (stratified per sex); duration of index ischemia (linear); stem cell dose (linear); blinding of outcome assessment reported (stratified yes vs no). For stratified analyses, a minimum number of 8 studies per subgroup

2018 PROSPERO

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