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Cervical Examination in Labor

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121. The role of routine cervical length screening in selected high-and low-risk women for preterm birth prevention Full Text available with Trip Pro

patient-level data. Acta Obstet Gynecol Scand 2015;94:352-8. 50.SchuitE,StockS,RodeL,RouseDJ,LimAC,NormanJE,NassarAH, et al. Global Obstetrics Network (GONet) collaboration. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an indi- vidual participant data meta-analysis. BJOG 2015;122:27-37. 51.Gomez R, Galasso M, Romero R, Mazor M, Sorokin Y, Gonçalves L, Treadwell M. Ultrasonographic examination of the uterine cervix is better than cervical digital examinationas (...) al. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. J Matern Fetal Neonatal Med 2012;25:1682-9. 13.FriedmanAM,SchwartzN,LudmirJ,ParryS,BastekJA,SehdevHM. Can transabdominal ultrasound identify women at high risk for short cer- vical length? Acta Obstet Gynecol Scand 2013;92:637-41. 14.Sonek JD, Iams JD, Blumenfeld M, Johnson F, Landon M, Gabbe S

2016 Society for Maternal-Fetal Medicine

122. Cervical Radiculopathy and Myelopathy

Cervical Radiculopathy and Myelopathy Effective December 1, 2014 Formatting and hyperlinks updated September 2016 Diagnosis and Treatment of Cervical Radiculopathy and Myelopathy Table of Contents I. Cervical Surgery Review Criteria II. Introduction III. Background and Prevalence IV. Establishing Work-Relatedness A. Cervical Conditions as Industrial Injury B. Cervical Conditions as Occupational Disease V. Making the Diagnosis A. History and Clinical Exam B. Diagnostic Tests and Imaging C (...) life, on a more-probable-than- not basis (Dennis v. Dept. of Labor and Industries, 1987). In epidemiological studies, this will usually translate to an odds ratio (OR) = 2. 8 Effective December 1, 2014 Formatting and hyperlinks updated September 2016 More information on filing a claim for an occupational disease, including billing information, can be found in the Attending Provider’s Handbook: http://www.lni.wa.gov/FormPub/Detail.asp?DocID=1669 MAKING THE DIAGNOSIS V. A. History and clinical exam

2016 Washington State Department of Labor and Industries

123. Effect of LI4 and BL32 acupressure on labor pain and delivery outcome in the first stage of labor in primiparous women: A randomized controlled trial. (Abstract)

Effect of LI4 and BL32 acupressure on labor pain and delivery outcome in the first stage of labor in primiparous women: A randomized controlled trial. This study examines and compares the effect of LI4 and BL32 acupressure with each other and control group on labor pain and delivery outcomes.In this randomized controlled trial, 105 primiparous women in active phase of first-stage of labor were equally assigned to two experimental groups [acupressure on LI4 (n=35) or BL32 (n=35)] and a control (...) group (n=35).The experimental groups received routine labor care and acupressure in LI4 or BL32 points in three cervical dilatations (4-5, 6-7, and 8-10cm). The control group only received routine labor care.Pain was assessed by numerical rating scale in three cervical dilatations, before and after intervention. Type of delivery (cesarean, vaginal or operative delivery) and neonatal Apgar score were considered as delivery outcomes, these data collected by a check list. Data were analyzed using

2016 Complementary Therapies In Medicine Controlled trial quality: uncertain

124. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women Full Text available with Trip Pro

Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor.We examined data on 1,202 nulliparous women (...) with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5-1.5 cm, N = 178), intermediate (2.5-3.5 cm, N = 320), and late (4.5-5.5 cm, N = 175). The Kaplan-Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second

2016 Frontiers in medicine

125. Remifentanil vs. Combined Spinal-epidural Analgesia for Labor Analgesia and Progress of Labor in Multiparous

technique for the next delivery and/or recommend the same technique to somebody else. Duration of first and second stage of labor [ Time Frame: one year ] The time from onset of analgesia until 10-cm cervical dilation will be defined as the first stage of labor, while the second stage will be defined as the interval between full cervical dilation and delivery of the neonate. The mean cervical dilation rate will be defined as 10 minus last cervical examination before analgesia divided by time between (...) at the beginning of labour with a gradual elevation of pain scores as labour progresses. However, fast onset and limited time efficacy may render it useful in multiparous with a faster labor progression, thus even making it an alternative to single-shot spinal analgesia. Condition or disease Intervention/treatment Labor Pain Labor; Prolonged, Second Stage Labor; Prolonged, First Stage Drug: remifentanil Drug: combined spinal-epidural analgesia Study Design Go to Layout table for study information Study Type

2016 Clinical Trials

126. Stepwise Labor Induction Following Failure of Prostaglandin Vaginal Insert for Labor Induction

of Propess for additional 24 hours. Drug: Administration of Propess History taking and physical examination including cervical length Eligibility assessment Explanation regarding the study protocol Signed informed consent (at VAS<3) Women agreeing to continued induction of labor 24 hours after insertion of Propess, will be randomized using sealed envelopes to the subsequent method of induction of labor (additional vaginal insert vs. oxytocin infusion with intracervical balloon insertion with 60ml saline (...) induction of labor using vaginal insert slow release of dinoprostone 10 mg (Propess), defined as bishop score ≤ 7 24 hours after propess insertion will be randomized to one of the following treatment arms: 2. Intravenous oxytocin infusion combined with intracervical balloon administration, inflated with 60cc of saline. Device: balloon History taking and physical examination including cervical length Eligibility assessment Explanation regarding the study protocol Signed informed consent (at VAS<3) Women

2016 Clinical Trials

127. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)

that passive dilation of the cervix with prosta- glandins or similar agents might avert uterine perforation and cervicallacerationthroughareductionintheforcerequiredfor dilation [27,28]. In addition, older medical literature reflects a concern that forceful cervical dilation may cause permanent damage to the cervical tissue, leading to poor reproductive outcomes [24,29–34]. Cervical priming was therefore recom- mendedtopreventsuchlong-termcomplicationsasspontane- ous abortion, cervical insufficiency (...) more force [33,41]. It is easier to sense the loss of resistance of the internal os with Hegar dilators than with Pratt dilators [40]. No trials have compared the safety and efficacy of Pratt and Hegar dilators. A minority of providers report using the Hegar dilator [42]. 1.2. Cervical priming agents Cervicalprimingcanbeaccomplishedmechanicallywith osmotic dilators that absorb moisture from the cervix and slowlyexpandtodilatethecervicalosorbiochemicallywith prostaglandin analogues or progesterone

2015 Society of Family Planning

128. Recommendations on screening for cervical cancer

steadily with age, al - though the incidence of cancer is higher, the pro- portion of abnormal results that represent serious abnormalities is greater among older women. 8 Women whose initial Pap test result is abnor- mal may be asked to undergo a repeat test or have a colposcopy. The colposcopist may then biopsy the cervix. If the biopsy shows cervical intra - epithelial neoplasia, the colposcopist may then treat the cervix by excising the transformation zone using various methods. These procedures (...) cause short-term pain, bleeding and discharge, 9 and may cause early loss of future pregnancies or premature labour. 10 It is likely that many of these procedures can be considered overtreatment, 11 because fewer than one-third of even high-grade abnormalities progress to cancer. 12–14 This guideline provides updated recommen- dations for screening for cervical cancer in Canada based on new information about the epi- demiology and diagnosis of cervical cancer and a new systematic search

2013 CPG Infobase

129. Associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women. (Abstract)

of this study was to examine the associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women with spontaneous onset of labor.This was a cross-sectional, observational study of 21 858 nulliparous, singleton, term vertex births that occurred from 2002 to 2007 across nine hospitals in the Consortium on Safe Labor. Outcome measures included the individual and combined use of intrapartum interventions (amniotomy, epidural anesthesia, oxytocin augmentation (...) Associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women. Admission in early labor is associated with increased likelihood of cesarean birth, but the context in which this occurs is unclear. Previous research has explored the relationship between dilatation at admission and the use of single intrapartum interventions; however, the majority of women in the United States receive multiple intrapartum interventions. The objective

2019 Birth

130. Foley catheter placement for induction of labor with or without stylette: a randomized clinical trial Full Text available with Trip Pro

Foley catheter placement for induction of labor with or without stylette: a randomized clinical trial Foley catheters are used for cervical ripening during induction of labor. Previous studies suggest that use of a stylette (a thin, rigid wire) to guide catheter insertion decreases insertion failure. However, stylette effects on insertion outcomes have been sparsely studied.The purpose of this study was to compare catheter insertion times, patient-assessed pain levels, and insertion failure (...) rates between women who received a digitally placed Foley catheter for cervical ripening with the aid of a stylette and women who received the catheter without a stylette.We conducted a randomized clinical trial of women aged ≥ 18 years who presented for induction of labor. Inclusion criteria were singletons with intact membranes and cephalic presentation. Women received a computer-generated random assignment of a Foley catheter insertion with a stylette (treatment group, n = 62) or without

2016 EvidenceUpdates Controlled trial quality: predicted high

131. A prospective study into the benefits of simulation training in teaching obstetric vaginal examination. (Abstract)

that had not performed any simulator training procedures was also enrolled. Medical students performed six vaginal examinations on patients who were in labor. The students reported the findings of the examinations in terms of five items (cervical length, position, consistency, dilation, and fetal presentation). The students' findings were then compared with those of experienced midwives (whose answers were considered to be the gold standard) who examined the same patients.A total of 66 students were (...) A prospective study into the benefits of simulation training in teaching obstetric vaginal examination. To assess the benefits of incorporating simulations in obstetric vaginal-examination training.A single-center, randomized, prospective study was conducted in a French University Hospital. Medical students without obstetric experience were assigned, by simple random sampling, to perform either 10 or 30 vaginal-examination training procedures using a simulator. A control group of students

2016 International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Controlled trial quality: uncertain

132. Prevention of preterm birth with vaginal progesterone or 17-alpha-hydroxyprogesterone caproate: a critical examination of efficacy and safety. (Abstract)

Prevention of preterm birth with vaginal progesterone or 17-alpha-hydroxyprogesterone caproate: a critical examination of efficacy and safety. Progestogens are the first drugs to demonstrate reproducibly a reduction in the rate of early preterm birth. The efficacy and safety of progestogens are related to individual pharmacologic properties of each drug within this class of medication and characteristics of the population that is treated. The synthetic 17-hydroxyprogesterone caproate (...) . A therapeutic approach based on the identification of a sonographic short cervix has been studied in several phase III trials. Independent phase III trials and an individual patient metaanalysis suggest that vaginal progesterone is efficacious and safe in women with a singleton and a short cervix. Two trials that tested 17-hydroxyprogesterone caproate in women with a short cervix showed no benefit. No consistent benefit for the prophylactic or therapeutic use of progestogens has been demonstrated in larger

2016 American Journal of Obstetrics and Gynecology

133. Physical Examination-Indicated Pessary

cervix Cervical dilation more than 5 cm Labor (progressing cervical dilation) or painful regular uterine contractions Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02967445 Locations Layout table for location information Italy Gabriele Saccone (...) Summary: Cervical insufficiency, previously referred to as cervical incompetence, has classically been defined as painless dilation of the cervix in the absence of contractions or bleeding in the second trimester resulting in recurrent pregnancy losses. Painless mid-trimester cervical dilation is an uncommon finding in the general population occurring in less than 1% of pregnancies. Cerclage for the prevention pregnancy loss in cases with both prior preterm births and/or second trimester losses

2016 Clinical Trials

134. 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

2015 FP Notebook

135. Cervical Cancer Prevention (PDQ®): Health Professional Version

to environmental smoking.[ ] Case-control studies of women infected with HPV have examined the effect of various types and levels of tobacco exposure and found similar results.[ - ] DES exposure Diethylstilbestrol (DES) is a synthetic form of estrogen that was prescribed to pregnant women in the United States between 1940 and 1971 to prevent miscarriage and premature labor. DES is associated with a substantially increased risk of developing clear cell adenocarcinoma of the vagina and cervix among the daughters (...) of HPV infection and subsequent development of cervical cancer. Magnitude of Effect : Women who experience first sexual intercourse at age 17 years or younger or women who have had six or more lifetime sexual partners have approximately two to three times the risk of squamous cell carcinoma or adenocarcinoma of the cervix, compared with women aged 21 years or older or who have a single sexual partner.[ ] Study Design : Evidence obtained from cohort and case-control studies. Internal Validity : Good

2017 PDQ - NCI's Comprehensive Cancer Database

136. Preterm Labor Management

of oligohydramnios, premature closure ductus arteriosus) Load: 30 mg orally Maintenance: 10-20 mg every 4-6 hours (max: 180 mg/day) Higher risk of maternal adverse effects when combined with Other s Load: 0.25 mg SQ every 20-30 min for up to 4 doses Maintenance: 0.25 mg every 3-4 hours until quiet for 24 hours References V. Management: Ambulatory Protocol Weekly cervical exam between 20 and 37 weeks Home self monitoring for contractions Evaluation for over 4 to 6 contractions per hour Pelvic rest Bedrest (...) Preterm Labor Management Preterm Labor Management 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 Preterm Labor Management Preterm

2018 FP Notebook

137. Preterm Labor

or bicornuate s (DES) exposure in utero Genitourinary Infection (40% of preterm births) Vaginal infections ( ) vaginalis Infections with possible risk urealyticum hominis References VI. Symptoms Keep a high index of suspicion Contraction frequency does not predict risk Symptoms do not predict risk Pelvic pressure Vaginal pain Menstrual-like cramps Backache or fluid leakage (see ) VII. Signs Examine as soon as possible Assess and dilation Avoid cervical exam until labor if confirmed Examine Assess for e (...) Check for firm, tender with minimal relaxation VIII. Evaluation: Five key concerns Precautions Preterm Labor patients who deliver within 6 days of presentation: <10% Assessment goal is to differentiate the patients at high risk of delivery Avoid digital vaginal exam UNLESS delivery is imminent (risk of infection) Perform sterile speculum exam and cervical instead Is patient preterm (<37 weeks)? Review and prior s (especially earliest s) Late preterm: 34 to 37 weeks Early preterm: 32 to 34 weeks Very

2018 FP Notebook

138. Emergency Department Active Labor Presentation

) Contraction history Onset Frequency Duration Intensity Associated obstetric symptoms (and is there meconium staining) Fetal movement Other symptoms or concurrent illness Oral intake III. Indications: Evaluation at Labor and Delivery (via phone triage) ral Unable to speak during 2 contractions during triage Suspected Nulliparous patient Contractions every 5 minutes Multiparous patient Contractions every 8-10 minutes IV. Exam (if available) Contraction frequency exam See Cervical dilation (closed (...) to completely dilated at 10 cm) Cervical effacement ( ) (vertex or ) ( or ) V. Management See VI. Complications Second Stage of Labor (and ) VII. References Doty in Herbert (2016) EM:Rap 16(5):3-4 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Emergency Department Active Labor Presentation." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in LAD

2018 FP Notebook

139. Cervical length screening for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a Cochrane systematic review and meta-analysis of randomized controlled trials using individual patient-level data

Cervical length screening for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a Cochrane systematic review and meta-analysis of randomized controlled trials using individual patient-level data 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 (...) . 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 of index ischemia (linear); stem cell dose (linear); blinding of outcome assessment reported (stratified

2016 PROSPERO

140. Cervical dilatation patterns of 'low-risk' women with spontaneous labour and normal perinatal outcomes: a systematic review

Cervical dilatation patterns of 'low-risk' women with spontaneous labour and normal perinatal outcomes: a systematic review 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

2016 PROSPERO

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