This study was undertaken for the clinical analysis and evaluation on 121 patients with incompetent internal os of the cervix, who were admitted and treated with McDonald operation or Shirodkar operation at the Soonchounhyang Medical Center from January 1991 to December 1995. The results of this study were as follows : 1. The incidence of this IIOC was 1.1% of 11,116 cases of total delivery. 2. The mean age of IIOC was 31.7 years old. 3. The average number of gravida was 3.2. 4. The most common contributary factor was previous history of artificial abortion (51.2 %), and midtrimester abortion (17.4 %), cervical laceration due to previous vaginal delivery (8.3 %) etc. was followed. 5. The success rate of operation was 76 %, and the highest success rate (85.7 %) was reveald with period from 15th weeks to 16th weeks of gestation. 6. When cervical dilatation was abscent or small, the success rate of operation was high. 7. The factors of failed operation were preterm labor (58.7 %), PROM (34.5 %), and PIH, bleeding. 8. The delivery method after operation was vaginal delivery in 83 cases (68.6%) and cesarean section in 38 cases (31.4 %).
Cervix Uteri* ; Cesarean Section ; Female ; Hemorrhage ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second

INTRODUCTION: This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes. METHODS: A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes. RESULTS: Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar. CONCLUSION More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Adult ; Cesarean Section ; methods ; statistics & numerical data ; Databases, Factual ; Delivery, Obstetric ; Emergency Medical Services ; Extraction, Obstetrical ; methods ; statistics & numerical data ; Female ; Humans ; Labor Stage, First ; Labor Stage, Second ; Obstetrical Forceps ; Pregnancy ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult

OBJECTIVE: This study was performed to evaluate the effect of cervical cerclage and the clinical characteristics in incompetent internal os of the cervix (IIOC). METHODS: A study was conducted on 170 patients with IIOC, 199 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation at department of Obstetrics and Gynecology Il Sin Christian Hospital from January 1. 1994 to December 31. 1998, of this 14 cases were follow up lost, so 185 cases were analyzed. RESULTS: 1) The incidence of IIOC was 0.43%, 1 in 233 deliveries. 2) The mean age of IIOC patients was 30.54yrs old and the most frequent age group was in 30-34yrs old group (43.78%). 3) The average number of gravida and parity before operation were 4.71 and 1.62. & the success rate of operation was low at high gravida & parity. 4) The predisposing factor was previous history of dilation & curettage (43.75%), Cx. laceration after delivery (6.49%), midtrimester termination (4.32%) etc. 5) The operation methods were McDonald operation (91.35%) and modified Shirodkar operation (8.65%) & the success rate of McDonald operation and modified Shirodkar operation were 85.80% and 87.50%. 6) The successful fetal salvage rate was 85.95% and the highest success rate was 87.50% in 14-16 weeks of gestation group. 7) The more cervix dilate, the more failure occurred. 8) The causes of operation failure were premature rupture of membrane (50.00%), preterm labor (34.62%), FDIU, anomaly, APH etc. 9) The delivery methods after operation were vaginal delivery (65.54%), cesarean delivery (34.46%). CONCLUSION: The 14-16th weeks of gestation group & no cervical dilatation have higher success rate indicating that early diagnosis and appropriate timing of operation is associated with a greater operation success rate.
Causality ; Cerclage, Cervical ; Cervix Uteri* ; Curettage ; Early Diagnosis ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Parity ; Pregnancy ; Pregnancy Trimester, Second ; Rupture

BACKGROUND: The purpose of our study is to evaluate the usefulness of cervicovaginal fetal fibronectin assay for the prediction of rupture of membrane and preterm labor. METHODS: A group of 39 pregnant women was involved in this prospective study. Out of 139 pregnant women, 96 were clinically diagnosed as ruptured membranes (group A). The remaining 43 of 139 pregnant women were clinically diagnosed as preterm labor(group B). The assay was performed by using the ROMCheckTM kit (Adeza Biomedical Corp., Sunnyvale, CA). RESULTS: In group 4, fetal fibronectin (fFN) positive rate is 55% (53 patients) and negative rate is 45% (43 patients). In group B, fFN positive rate is 56% (24 patients) and negative rate is 44% (19 patients). Both group of fFN positive patients show a significantly shorter interval from sampling to delivery than fFN negative patients. Also in group A, the percentage of fFN positive patients who delivered at less than 48 hours after sampling is greater than those with fFN negative patients and in group B, the preterm delivery rate is 79% with positive fFN and 37% with negative fFN. As a predictor for preterm delivery, the presence of fFN has the sensitivity 79%, the specificity 84%, the positive Predictive value 76% and the negative predictive value 86%. CONCLUSIONS: The result suggests that a positive fFN in pregnant women who have uterine contractions and ruptured membrane indicates a significant risk for preterm delivery and labor onset, and a negative fFN is a reassuring sign.
Female ; Fibronectins* ; Humans ; Labor Onset ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnant Women* ; Prospective Studies ; Rupture ; Sensitivity and Specificity ; Uterine Contraction

This study was designed to assess the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. One hundred twenty-three nulliparas with a singleton cephalic pregnancy at term were randomized. Standard care was performed in the control group, and uterine fundal pressure by the Labor Assister(TM) (Baidy M-420/Curexo, Inc., Seoul, Korea) was utilized in addition to standard care in the active group. The Labor Assister(TM) is an inflatable obstetric belts that synchronized to apply uniform fundal pressure during a uterine contraction. The 62 women in the active group spent less time in the second stage of labor when compared to the 61 women in the control group (41.55+/-30.39 min vs. 62.11+/-35.99 min). There was no significant difference in perinatal outcomes between the two groups. In conclusion, the uterine fundal pressure exerted by the Labor Assistertrade mark reduces the duration of the second stage of labor without attendant complications.
Adult ; Delivery, Obstetric/*methods ; Female ; Humans ; *Labor Stage, Second ; Pregnancy ; Pressure ; Prospective Studies ; Time Factors ; Uterine Contraction

A 21-year old woman, G1P0, was referred for further prenatal check-up with sonographic examination revealing conjoined twins at 29 weeks age of gestation. The fetuses were in breech presentation positioned face-to-face with fusion at the level of the thoraces and gastric bubble suggestive of thoracoomphalopagus twins. There was a definite communication between the two fetal circulations at the ventricular level as seen on fetal echocardiogram with a single cardiac rhythm shared between the two hearts. Close antenatal and fetal surveillance was done during the entire pregnancy duration. The patient was counseled about therapeutic options and explained of the complexity of their cardiac anatomy. The twins were delivered by cesarean section at 35 weeks due to preterm labor and a neonatal 2D-echocardiogram was done shortly after to re-assess their cardiac anatomy. Since the results revealed a shared ventricle, the twins were considered inseparable. The family was apprised of their poor prognosis and opted for natural death to occur.

Human ; Female ; Adult ; Pregnancy ; Breech Presentation ; Twins, Conjoined ; Gastric Balloon ; Cesarean Section ; Obstetric Labor, Premature ; Echocardiography ; Ultrasonography ; Fetus ; Prognosis

BACKGROUND: Pudendal nerve block is one of the many methods of providing analgesia during the second stage of labor. This study was conducted in a university based tertiary hospital. The efficacy of pudendal nerve block was compared to low spinal anesthesia in patients who delivered vaginally METHODS: Thirty four parturients randomly received either pudendal nerve block (n=17) or low spinal anesthesia (n=17) during the second stage of labor. Those requiring analgesia during the first stage of labor were given a single shot epidural dose using bupivacaine 0.125 percent. No intravenous sedatives or analgesics were given throughout labor and delivery. Pain scores using a visual analog scale of 0.10 were recorded as well as the mean onset, mean duration and mean Apgar scores of the two groups. Complications of either technique were also noted down RESULTS: In pudendal nerve block, the mean pain score was 4.88 compared to 0 (zero) in spinal anesthesia. The pudendal group showed a longer onset, shorter duration of analgesia than the spinal group. The only complications noted were mild hypotension (11.7 percent) and minimal motor block (29.4 percent) seen in the spinal group. The mean Apgar scores of the two groups were greater than 7 and was not significantly different CONCLUSION: Pudendal nerve block is a simple and safe method of providing analgesia. The significant reduction of the pain score to more than half may imply a reduction in the amount of intravenous analgesics and potent sedatives often employed during labor and delivery. (Author)
Human ; Female ; ANESTHESIA, SPINAL ; VAGINAL DELIVERY ; ANALGESIA ; LABOR STAGE, SECOND ; OBSTETRIC DELIVERY

OBJECTIVE: To investigate the clinical significance of emergency cerclage on prologation of pregnancy and perinatal outcome in mid-trimester cervical incompetence with advanced cervical dilatation. METHODS: We analyzed the pregnancy outcome retrospectively by the medical record review for 16 patients who had emergency cervical cerclage placed from March 1995 to June 2001. And these data were compared with those of 48 patients who had elective cervical cerclage placed during the same period. RESULTS: The mean gestational age of the patients at emergency cerclage was 22.0+/-2.3 weeks. The mean cervical dilatation was 2.9+/-1.2 cm and mean effacement was 55.3+/-4.7%. The mean prolongation of pregnancy after cerclage was 63.1+/-54.7 days (median 61, range 2-152) and the mean duration of antepartum hospitalization was 10.1+/-12.6 days (2-52). After cerclage, preterm premature rupture of the membranes occurred in 5 cases (31%), clinical chorioamnionitis in 3 cases (19%), and preterm labor in 5 cases (31%). The mean gestational age at delivery was 31.1+/-7.1 weeks. Perinatal survival rate was 85% (17/20), and neonatal survival rate was 94% (17/18). CONCLUSION: It seems that emergency cerclage contribute to maintenance of pregnancy and improve perinatal outcome of fetuses in cervical incompetence with advanced cervical dilatation.
Cerclage, Cervical ; Chorioamnionitis ; Emergencies* ; Female ; Fetus ; Gestational Age ; Hospitalization ; Humans ; Labor Stage, First* ; Medical Records ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Rupture ; Survival Rate

OBJECTIVE: The aim of this study was to evaluate whether the presence of phIGFBP-1 in cervical secretion of patients with symptoms suggestive of preterm labor predicts preterm delivery. METHODS: Patients who were examined at the Department of Obstetrics and Gynecology, Daegu Fatima hospital between 24 weeks' and 34 weeks' gestation with intact membrane, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilatation <3 cm were recruited. Cerviacal swab samples were assayed for the presence of phIGFBP-1 by immunoenzymometric assay, with a positive result defined as >or=10 microgram/L. Tocolysis and corticosteroids were used when clinically indicated after specimen collection. RESULTS: phIGFBP-1 was detected in 21 patients among 50 patients analysis. Compared with patients who had negative results, patients who had positive results for phIGFBP-1 were more likely to deliver before 37 weeks (p<0.001), before 34 weeks (p=0.008) and within 7 days (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 77.3%, 85.7%, 81.0%, and 8.28%. Patients with positive results were also treated more with tocolysis and corticosteroids use than patients with negative results. Gestational age at delivery (p<0.001) and birthweight (p<0.001) were lower for patients with positive results. CONCLUSION: In a population of patients with symptoms, the presence of phIGFBP-1 in cervical secretions defines a subgroup at increased risk for preterm delivery.
Adrenal Cortex Hormones ; Daegu ; Female ; Gestational Age ; Gynecology ; Humans ; Labor Stage, First ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Pregnancy ; Sensitivity and Specificity ; Specimen Handling ; Tocolysis

OBJECTIVE: To assess the clinical significance of emergency cerclage in the patients with advenced painless cervical dilatation. METHODS: We performed the analysis of the pregnancy outcomes of the 14 patients who underwent emergency cerclage between January 1990 and December 2001 at Seoul National University Hospital. Only singleton pregnancies were included. We compared these results with those of the 56 patients who underwent elective cerclage in the same period. RESULTS: In the patients with emergency cerclage, mean gestational age at cerclage was 20.71 +/- 3.24 weeks and mean gestational age at delivery was 29.84 +/- 7.40 weeks. The mean cerclage-to-delivery interval was 9.14 +/- 7.53 weeks and overall perinatal survival rate was 63.4%. After cerclage, rupture of membrane occurred in 2 cases (14.3%), preterm labor developed in 8 cases (57.1%) and slipping out of cerclage suture developed in 3 cases (21.4%). In comparison with elective cerclage, mean gestational age at delivery, interval between cerclage and delivery, Apgar scores at birth, perinatal death, preterm delivery rate before 28 and 32 weeks' gestation and neonatal birth weight showed worse outcome in emergency cerclage group than elective cerclage group. CONCLUSION: Although emergency cerclage shows worse outcomes than elective cerclage, it seems to be optional treatment modality for patients with painless cervical dilatation considering pregnancy prdongation and neonatal survival.
Birth Weight ; Emergencies* ; Female ; Gestational Age ; Humans ; Labor Stage, First* ; Membranes ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Pregnancy Outcome ; Rupture ; Seoul ; Survival Rate ; Sutures