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

OBJECTIVETo observe the effect of moxibustion at Sanyinjiao (SP 6) on delivery stage of primipara.

METHODSSixty cases of primipara were divided into a moxibustion at Sanyinjiao group, a non-acupoint group and a blank group. When the diameter of wormb mouth opened to 2-3 cm, showing that it entered into active stage of uterine contraction, moxibustion at Sanyinjiao (SP 6) for primipara was applied in moxibustion at Sanyinjiao group; moxibustion was applied at 1 cun towards radialis from the region where 2 cun above Kongzui (LU 6) in non-acupoint group, 30 minutes treatment was for both groups. There was no intervention in blank group. After delivery, the time of first,second and third delivery stages and postpartum bleeding 2 hours after delivery were compared among three groups.

RESULTSThe active duration of first delivery stage in moxibustion at Sanyinjiao group was significantly shorter than that in the other two groups (P < 0.05, P < 0.01); the duration of the second delivery stage in moxibustion at Sanyinjiao group was significantly shorter than that in the other two groups (both P < 0.05) as well; the postpartum bleeding 2 hours after delivery in moxibustion at Sanyinjiao group was less than other two groups and the difference was statistic significant between moxibustion at Sanyinjiao group and blank group (P < 0.05).

CONCLUSIONBy moxibustion at Sanyinjiao (SP 6), the active duration of first delivery stage and the duration of second delivery stage are markedly shortened, postpartum bleeding 2 hours after delivery is obviously reduced, and the safety of vaginal delivery is increased.

Acupuncture Points ; Adult ; Delivery, Obstetric ; Female ; Humans ; Labor Onset ; Moxibustion ; Postpartum Hemorrhage ; therapy ; Pregnancy ; Young Adult

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

OBJECTIVE: The aim of this study is to predict spontaneous labor onset delivery within 7 days in low risk pregnant women at 38 weeks' of gestation by ultrasonographic examination of cervical changes. MATERIAL AND METHODS: This prospective study included 110 singleton low risk pregnancies between 37(+0) and 37(+6) weeks of gestation. Fifteen cases were lost during follow-up and finally 95 pregnant women (58 nulliparous, 37 multiparous) were analysed. The study period was from Oct/2005 to May/2007. Four cervical changes (length, gland thickness, funneling and canal formation) were evaluated. Main outcome was remaining day to delivery after the examination. Remaining days to actual delivery with spontaneous labor onset were recorded and the pregnancies were divided into two groups according to remaining days (within 7 days, over 7 days) to compare predicting power of delivery within 7 days. ROC curves were drawn to find out cut-off values of cervical length and gland thickness. Sensitivity, specificity, positive predictive value and negative predictive value were extracted from four cervical changes. RESULTS: Mean cervical length of pregnant women at 38 weeks' of gestation was 25.8 (+/-10.0) mm and mean cervical gland thickness was 4.3 (+/-1.2) mm. Funnelings of uterine cervix were detected in 13 cases (13.7%), canal formations in 6 cases (6.3%). All four cervical changes were statistically valuable to predict delivery within 7 days and the cervical length showed highest sensitivity. When the cervical length was measured under 20 mm, the possibility of delivery within 7 days was 78.6% (p<0.001). The cervical gland thickness less than 4 mm could predict the delivery within 7 days with sensitivity of 57.1% (p<0.01). Sensitivities of funneling and canal formation for delivery within 7 days were 54.5%, 36.4% each. CONCLUSION: Ultrasonographic examination of the cervical changes in low risk singleton pregnancy at 38 weeks' of gestation are valuable for predicting spontaneous labor onset delivery within 7 days. Among four cervical changes, cervical length is most sensitive ultrasonographic marker.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Labor Onset ; Parturition* ; Pregnancy* ; Pregnant Women ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

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: To investigate the expression of Calponin-1 and Transgenlin in the uterine smooth muscles during normal labor on-sets, and to evaluate their effect on initiating the normal labor. METHODS: A total of 14 uterine bodies and lower segments of human pregnancy were divided to a non-labor group (NIL) and a labor group(IL). Immunohistochemical technology and Western blot were used to determine the expression of Calponin-1 and Transgelin in the 2 groups. RESULTS: Immunohistochemical detection and Western blot showed that Calponin-1 protein in the uterine smooth muscle tissue of the body and the lower uterine segment of smooth muscle tissues had significant difference (P<0.05). The expression of Transgelin in the uterine body smooth muscle tissue in the IL was higher than that in the NIL(P<0.05). In the lower uterine segments of the smooth muscle, the expression of Transgelin was not significantly different in the 2 groups (P>0.05). CONCLUSION Calponin-1 of the uterine smooth muscle and Transgelin of the uterine body smooth muscle may involve in the regulation of uterine smooth muscle contractility, which is closely related to child birth launch.
Adult ; Calcium-Binding Proteins ; genetics ; metabolism ; Female ; Humans ; Labor Onset ; metabolism ; Microfilament Proteins ; genetics ; metabolism ; Muscle Proteins ; genetics ; metabolism ; Myometrium ; metabolism ; Pregnancy ; Uterine Contraction ; metabolism

OBJECTIVETo investigate the clinical efficacy of estrogen in preventing postpartum hemorrhage and shortening the birth process during induced abortion.

METHODSTotally 320 puerperants for termination of pregnancy for medical reasons were randomly assigned into 2 groups, the estrogen group (n=175) and the control group (n=145), and the former were given oral estrostilben 3 mg thrice a day from the day before acrinol injection to the end of delivery. The amount of blood loss 2 h after delivery, cases of postpartum hemorrhage, and the duration of total birth process were recorded.

RESULTSSignificant differences were noted in blood loss 2 h after delivery between estrodiol and control groups (123.3-/+81.8 vs 206.3-/+114.4 ml). Two cases of postpartum hemorrhage were found in estrogen group and 10 in control group. The duration from acrinol injection to delivery was similar between the two groups (31-/+11 vs 33-/+12 h), but the former had significant shorter duration from contraction onset to delivery than the latter (6.03-/+3.19 vs 9.7-/+5.9 h). No side-effects were found in either group.

CONCLUSIONEstrogen given before delivery can be effective in stimulating uterine contraction for preventing postpartum hemorrhage and shortening the birth process in women undergoing induced abortion.

Abortion, Induced ; adverse effects ; Adult ; Estrogens ; therapeutic use ; Female ; Humans ; Labor Onset ; drug effects ; Postpartum Hemorrhage ; etiology ; prevention & control ; Pregnancy ; Time Factors ; Treatment Outcome ; Uterine Contraction ; drug effects

A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+/-5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+/-5.6 (range 22 to 39+6) weeks for the entire group, 36.1+/-2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+/-5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+/-971.6 (range 498 to 3500)g for the entire group, and 2712.9+/- 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.
Cerclage, Cervical* ; Cervix Uteri* ; Dilatation* ; Emergencies* ; Female ; Gestational Age ; Humans ; Infant ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Retrospective Studies ; Survival Rate

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

OBJECTIVETo explore the effect of low-energy semiconductor laser intranasal irradiation of the blood on blood coagulation status in healthy pregnant women at term.

METHODSLow-energy semiconductor laser was introduced into the nasal cavity in 126 healthy pregnant women at term and 123 healthy young unmarried women as the control group. The plasma prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen levels were examined using transmissive turbidimetry after the therapy.

RESULTSPT, APTT and TT levels were significantly lowered, whereas fibrinogen level significantly increased in the healthy pregnant women before the laser therapy as compared with those in the control group (P<0.01). After intranasal laser therapy, these parameters were significantly improved in the healthy pregnant women (P<0.05) although there were differences from those of the control group.

CONCLUSIONLow-energy semiconductor laser intranasal irradiation of the blood can effectively improve high blood coagulation status in healthy pregnant women at term.

Adult ; Blood Coagulation ; radiation effects ; Blood Coagulation Tests ; Female ; Humans ; Labor Onset ; blood ; Low-Level Light Therapy ; Nasal Cavity ; radiation effects ; Partial Thromboplastin Time ; Pregnancy ; Prothrombin Time ; Semiconductors ; Thrombin Time ; Young Adult