From Dec. 2003 to Feb 2004, 90 women of 6-12 week pregnancy received 100 μg intra vaginal misoprostol 3 hours before intervention at central Hospital of Ggn. and Obst. 96,67% had got success, with the mean cervical dilatation of 8,1± 0,92mm. Side effect manifested in 2,2% of patients
Misoprostol ; pregnancy ; Labor Stage, First

Emergency cerclage commonly known as that performed in the setting of advanced cervical dilatation with bulging membranes and associated with significantly increased failure rates. We experienced a successful emergency cerclage for advanced incompetent internal os of cervix ( IIOC ). Pregnancy was prolonged and we delivered viable fetus. Hereby we report this case with the brief review of literature.
Cervix Uteri ; Emergencies* ; Female ; Fetus ; Labor Stage, First ; Membranes ; Pregnancy

No abstract available.
Amniocentesis* ; Cerclage, Cervical* ; Female ; Labor Stage, First* ; Pregnancy

Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.
Cervix Uteri ; Extraembryonic Membranes* ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Uterine Cervical Incompetence*

OBJECTIVE: To assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women. METHODS: In this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery. RESULTS: Demographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed. CONCLUSION: In postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.
Cervical Ripening* ; Constriction, Pathologic ; Dilatation ; Estradiol* ; Female ; Humans ; Hysteroscopy* ; Labor Stage, First ; Misoprostol* ; Postmenopause ; Pregnancy

OBJECTIVE: To compare cervical dilatation efficacy and safety of intravaginal misoprostol with that of cervical laminaria tent insertion in endometrial curettage due to abnormal uterine bleeding METHOD: Patients requesting endometrial curettage due to abnormal uterine bleeding were randomized into two group. In group I (n=53), 100 g tablet of misoprostol was placed in the posterior vaginal fornix at midnight. In Group II (n=54), laminaria tent number 5 was inserted in cervical canal at midnight. Endometrial curettage was performed on the next morning. The degrees of cervical dilatation were measured by Hegar dilator just before endometrial curettage. Both groups were compared about cervical dilatation efficacy and side effect. RESULT: The degrees of cervical dilatation were 8.8+/-1.1 mm in group I and 9.3+/-1.9 mm in group II. There was no significant statistical difference. (P=0.134) The mean intervals from the use of misoprostol or laminaria to endometrial curettage were 704+/-140 minutes in group I and 829+/-156 in group II. In group I, mild fever (less than 38 degrees) was observed in four women and one complained mild abdominal pain. In group II, five women revealed mild fever and fifty women complained abdominal discomfort. All didn't need any medication or special therapy. CONCLUSION: Intravaginal misoprostol was appeared as efficacious as laminaria tent in cervical dilatatory effect before endometrial curettage in abnormal uterine bleeding patients. It was considered more convenient, safer and more cost effective method compared than cervical laminaria tent in cervical preparation before endometrial curettage.
Abdominal Pain ; Curettage* ; Female ; Fever ; Humans ; Labor Stage, First ; Laminaria* ; Misoprostol* ; Pregnancy ; Uterine Hemorrhage*

OBJECTIVE: We evaluated the effects of epidural analgesia on labor progress and perinatal outcomes in nulliparous women. METHODS: Between June 2004 and December 2004, we included total one hundred and thirty-two normal near term nulliparous women in early spontaneous labor or rupture of membranes for a prospective analysis. Patients were divided into those who received epidural analgesia (study group n=66) and those who did not (control group n=66). In order to evaluate the effects of epidural analgesia on labor progress, we compared the duration of active phase of labor and second stage of labor, cervical dilatation on admission, Bishop score and labor interval between the groups. We also compared perinatal outcomes between the two groups. RESULTS: The duration of active phase of labor was 4.7+/-2.0 hours in the study group and 3.6+/-1.9 hours in the control group showing a statistically significant prolongation in the duration of active phase of labor and significant slowing in the rate of cervical dilatation (p<0.05). The second stage of labor was also prolonged slightly in the study group (65.1+/-39.0 minutes) compared to the control group (54.1+/-33.5 minutes) but no statistical significance was noted. There was no significant difference in perinatal outcomes. CONCLUSION: Epidural analgesia may prolong active phase of labor. Therefore, we should always consider the effect of epidural analgesia before we decide to perform cesarean section.
Analgesia, Epidural* ; Cesarean Section ; Female ; Humans ; Labor Stage, First ; Membranes ; Pregnancy ; Prospective Studies ; Rupture

Emergency cerclage is the only way to prolong pregnancy for women with advanced cervical dilatation with or without prolapsed membrane. Without cerclage, miscarriage is almost always inevitable. Emergency cerclage should be performed after considering indications, contraindications, benefits and risks. Further researches on advanced operative skill, prognostic factors and postoperative medical treatment will improve the outcome of emergency cerclage.
Abortion, Spontaneous ; Emergencies* ; Female ; Humans ; Labor Stage, First ; Membranes ; Pregnancy ; Risk Assessment ; Uterine Cervical Incompetence

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Cervix Uteri ; Emergencies* ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Third

OBJECTIVE: This study examined the effect of a maximal cervical dilatation prior to their primary cesarean birth on the time length of labor in women attempting vaginal birth after cesarean section (VBAC). METHODS: From January 2000 to Jun 2005, a total of 526 patients with VBAC were entered into the study. Patients were classified into 4 groups according to the maximal cervical dilatation on the prior cesarean birth: Group 1 (0~3 cm), Group 2 (4~7 cm), Group 3 (8~9 cm), and Group 4 (10 cm). RESULTS: An analysis of the duration of labor showed that the time length of active phase was significantly shorter in each of Group 3 (147.3+/-103.9 minutes) and 4 (155.2+/-104.2 minutes) than in Group 1 (192.9+/-126.0 minutes) or 2 (195.1+/-148.2 minutes) (p<0.05), although there was no difference with regard to the second stage between each group. These results were also sustained even among the selected 248 patients without prior use of oxytocin, vacuum delivery, or epidural anesthesia that could affect the duration of labor. CONCLUSION: The time length of active phase on VBAC is significantly shorter in women with a prior maximal cervical dilatation of > or =8 cm than those without. Study results indicate that prior cervical dilatation may affect the labor time of subsequent VBAC. The proper understanding of the association between prior cervical dilatation and labor time on a subsequent VBAC may be useful for better management or further intervention in the setting of VABC.
Anesthesia, Epidural ; Female ; Humans ; Labor Stage, First* ; Oxytocin ; Parturition ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*