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The objective of this study was to investigate the effects of obstetric gel application on the length of the first stage of labour and perineal trauma in primiparous women. This randomised controlled trial included 110 primiparous women. Women were randomly assigned to the two groups: lubricant gel group and control group. In the intervention group, during cervical dilatation of 4 cm until complete cervical dilatation, 5 ml of water-soluble lubricant gel was used at each vaginal examination. In the control group, routine care was performed. Mean duration of the total length (p = .025), the first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than control group. Perineal health was significantly better in the gel-applied pregnant women (p

BACKGROUND This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

Background: Precise evaluation of labour progresses can help mothers to be consulted on time and decrease maternal and neonatal morbidities. The purple line is non invasive methods to assess labour progress. The current study aimed to assign appearance percentage of the purple line during the first stage of labour, as well as the accuracy of the purple line to predict labour progress. Design: Longitudinal design was adopted. A purposive sampling method has been employed to recruit 120 labouring women at the obstetric department in El-Nabawy El Mohandes Hospital, Fayoum. Three tools of data collection were used: structure interviewing questionnaire, purple line observation record and partograph. Results: revealed that, the purple line appears among about four fifth of the total sample. A medium positive association was found among the purple line length, dilatations of the cervix and fetal stations. The purple line appearance in the expectation of labour progress had 87.91% sensitivity, 39.53% specificity and 85.25% accuracy. In addition, the purple line was more significantly in a spontaneous labouring woman and no significant association between parity, women age, BMI, fetal birth weight and the existence of the purple lines. Conclusion: The purple line is useful in assisting the health care providers in assessing and determining labour progress and lessen the number of vaginal examinations, particularly at consideration of females who refuse or feel that the examining intrusive. Recommendation: Integration between vaginal examination and purple line to evaluate the labour progress to reduce the vaginal examination rate and its risk. Further research still needed to identify the accuracy of other noninvasive methods to assess the labour progress.

This study aimed to explore the feasibility of transperineal virtual touch tissue quantification (VTQ) for predicting the outcome of labor induction. A total of 80 nulliparous pregnant women were included. Before labor induction, cervical length was measured by B-mode sonography, cervical stiffness was measured by VTQ, and Bishop score was assessed by vaginal examination. Subsequently, labor was induced using standard oxytocin infusion in all patients. Delivery within 24 hours after labor induction was classified as spontaneous delivery; otherwise, cesarean delivery was performed. Out of 80 participants, 48 (60%) delivered vaginally and 32 (40%) underwent cesarean delivery. The cervical length was significantly longer and the shear wave velocity (SWV) was greater in the cesarean delivery group than in the vaginal delivery group (p = 0.004 and p0.000, respectively). Logistic regression analysis indicated that only the mean SWV had independent predictive value for the outcome of labor induction (p = 0.011). The best diagnostic cut-off point of the mean SWV was 1.23 m/s, with a sensitivity of 93.8% and a specificity of 89.6%. Transperineal VTQ technique could predict the outcome of labor induction using oxytocin.

Introduction Our study assesses the patients’ opinion about gynecological examination performed by undergraduate students (UgSts). This assessment will be used in improving our undergraduate training program. A positive opinion would mean a lower chance of a patient refusing to be examined by a tutor or student, taking into account vaginal examination (VE). Materials and methods We performed a prospective cross-sectional survey on 1194 patients, consisting of outpatient and inpatient at the departments of obstetrics and gynecology from November 2015 to May 2016. The questionnaire consisted of 46 questions. Besides demographic data, we assessed the mindset of patients regarding the involvement of undergraduate student (UgSt) in gynecological and obstetrical examinations. We used SPSS version 23 for the statistical analysis. For reporting the data, we followed the STROBE statement of reporting observational studies. Results The median age was 38 years having a median of one child. 34% presented due to obstetrical problems, 38% due to gynecological complaints, and 19% due to known gynecological malignancies. Generally, we retrieved a positive opinion of patients towards the involvement of students in gynecological and obstetrical examination under supervision in 2/3 of the cases. Conclusions There is no reason to exclude medical UgSts from gynecological and obstetrical examinations after obtaining a written or oral consent.

Background The association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort. Methods This is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5–6 VEs (n = 4624), 7–8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared. Results Overall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5–6 VEs: aOR = 1.83, 95% CI (1.29–2.61), 7–8 VEs: aOR = 2.65 95% CI (1.87–3.76), 9 or more VEs aOR = 3.47 95% CI (2.44–4.92)), postpartum febrile morbidity (5–6 VEs: aOR = 1.29, 95% CI (1.09–1.86), 7–8 VEs: aOR = 1.94 95% CI (1.33–2.83), 9 or more VEs aOR = 1.91 95% CI (1.28–2.82)), and peripartum morbidity (5–6 VEs: aOR = 1.48, 95% CI (1.15–1.91), 7–8 VEs: aOR = 2.15 95% CI (1.66–2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97–3.34)). Conclusion The number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.

Long-acting reversible contraception methods, such as intrauterine devices (IUDs), are associated with high effectiveness in preventing unintended pregnancies, and thereby their significant health and economic consequences. IUCD insertion is generally associated with fear, which may decrease its acceptability, and anticipated pain or discomfort at the time of insertion could be a major barrier to the acceptance of IUCDs among both clients and healthcare providers. IUCD. Insertion pain may be felt during various stages of the procedure, including the vaginal examination, placement of the speculum, tenaculum use, and traction of the uterus, hysterometry and insertion of the IUCD. On assess the viability of lidocain former will iud insertion clinched alongside lessening torment contrasted with placebo. This will be An randomized control study; toward gynecology outpatient facility in Benha college healing facility Also Berket elsabee doctor's facility from january should june 2018. Partitioned under two aggregations; bunch A: ponder gathering of 75 cases, utilization lidocaine spread. Aggregation B: control assembly for 75 cases, utilization saline spread. Examination of Information uncovered that lidocaine spread requisition of the cervix Throughout IUCD insertion adequately diminished ache felt Throughout the the sum phases of the procedure Furthermore agony felt 5 minutes then afterward the entire methodology. There might have been secondary huge distinction the middle of lidocaine aggregation What's more control assembly viewing agony score Throughout tenaculum placement 1. 82±0. 84Vs4. 10±1. 00, heartless insertion, 1. 32±0. 87 vs 2. 49±1. 13, iud insertion, 0. 85±0. 80 vs1. 36±1. 05 Furthermore five minutes’ post insertion 0. 53±0. 77vs0. 78±0. 77. They were the greater part more level On lignocaine assembly over control bunch (P worth 0. 001). Our examine showed that nearby lidocaine spread is compelling for control for ache connected with IUCD insertion when compared placebo aggregation.

BACKGROUND: Surgical site infection is the main cause of morbidity and mortality in post-cesarean section patients. The objective of this study was to determine the preoperative factors associated with the surgical site infection in patients undergoing cesarean emergency section in the Goyeneche Hospital of Arequipa.METHODS: We conducted a cases-control study on women who presented with surgical site infection after cesarean section in a hospital in Arequipa, Peru. We evaluated associated factors to surgical site infection after cesarean section (sociodemographics and clinical variables). For the inferential analysis, we estimated logistic regression using odds ratio.RESULTS: Out of a total of 4346 cesarean sections, only 2.4% developed surgical site infection. The associated factors to surgicalsite infection were mild anemia (OR: 2.80), moderate anemia (OR:2.71), number of vaginal examinations higher than five (OR:2.71) and onset of labor (OR: 1.95).CONCLUSION: Patients with risk factors such as anemia, onset of labor and five or more vaginal examinations should be evaluated after surgery to prevent surgical site infection.

Objective To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery. Design Video of a single surgical procedure. Setting A university hospital. Patient(s) A 42-year-old woman, gravida 2 para 2, presented with chronic pelvic pain. Vaginal examination revealed a 4-cm spherical mass bulging through her posterior vaginal wall. Magnetic resonance imaging identified this mass as either a subserosal pedunculated uterine fibroid (type 7 according to the FIGO classification) or an ectopic fibroid of the posterior vaginal wall (type 8). Intervention(s) The whole procedure was performed using pneumovaginoscopy. The GelPOINT V-Path (Applied Medical, Rancho Santa Margarita, California) which is the device most often used to perform transvaginal natural orifice transluminal endoscopic surgical procedures, was introduced into the vagina to create a pneumovagina. Monopolar scissors were used to create an incision through the posterior vaginal wall to reach the fibroid. Myomectomy was performed using traction movements of the fibroid associated with the dissection of the capsule. The absence of a uterine pedicle at the end of the myomectomy was in favor of an ectopic fibroid of the vagina (type 8 of the FIGO classification). The vaginal defect was closed with interrupted sutures using the access points on the GelPOINT. Main outcome measure(s) The procedure was easily and efficiently performed using the pneumovaginoscopy technique and lasted less than an hour. The patient was discharged on postoperative day 1 without any postoperative complications. She was symptom-free at her 2-month postoperative visit. Result(s) Compared to the classical vaginal approach, pneumovaginoscopy improves visualization through targeted lighting and close-up vision. This technique is particularly interesting in cases where the vaginal opening is narrow and for lesions located in the upper half of the vagina. Because of the unusual expansion of the vagina, increased caution is required to avoid bladder or rectal injuries. Conclusion(s) Pneumovaginoscopy is a novel technique that can be performed for vaginal pathologies with the same device used for transvaginal natural orifice transluminal endoscopic surgery. We described this technique and assessed its feasibility.

Internal podalic version, which was apparently first described by Hippocrates, is a procedure where a series of manoeuvres are performed with one hand inside the uterus, with the aim of bringing one or both feet through a fully dilated cervix. Internal podalic version and breech extraction has also been described as an alternative to emergency caesarean delivery in a multigravid woman with a singleton fetus lying transversely, under exceptional circumstances such as profound bradycardia and there is delay in performing surgery or when the fetus is already dead. The woman should be placed in lithotomy position, cleaned and draped and her bladder should be emptied. Vaginal examination should be performed to be able to ensure full dilatation of cervix. Traction should be applied downwards and backwards in line with the longitudinal axis of the maternal pelvis in order to bring both feet or one foot into the vagina.

Aim To measure the utility of the Simulation training model for training purposes over and above conventional methods of training for vaginal assessment during labour. Methods The study group included undergraduate trainees, and the control group included postgraduate trainees and qualified personnel, i.e. senior registrars and consultants. Participants from the study group were trained for vaginal assessment on the simulation training model. Then both the groups were tested on the model for accuracy in estimating each value of cervical dilatation and fetal station. Mean cervical dilatation and station accuracy scores were noted, and comparative analysis was done between the study and control groups. Results A total of 150 participants were included. The overall mean dilatation and station accuracy scores of a model trained study group participants were better than subjectively trained control group participants. Study group participants showed greater accuracy for smaller dilatations, i.e. 1, 2, 3, 4cm and middle dilatation, i.e. 5cm and 6cm (p value=

It's important that vaginal examinations are undertaken only when there is a clear clinical indication rather than applying a one-size-fits-all approach

To explore women's compliance with ultrasound evaluation (UE) during labor compared with standard vaginal examination (VE).This is a prospective observational cohort study including uncomplicated singleton pregnancies with the fetus in vertex presentation from 37 weeks of gestation. Labor progress was assessed by both VE and UE. Women acceptability was assessed using a modified Wijma Delivery experience questionnaire (W-DEQ) based on six different items and resulting in a score ranging from 6 (not tolerated) to 36 (well tolerated). The primary outcome of the study was to compute the differences in the overall modified W-DEQ questionnaire between UE and VE. Secondary outcomes were to assess the differences between UE and VE in each individual item of modified W-DEQ questionnaire and to elucidate whether such differences persist in pregnancies experiencing compared to those not experiencing prolonged labor or unplanned emergency operative delivery.One hundred and twenty-four women were included in the study and 109 completed the full questionnaire. The overall global acceptability score was significantly higher for UE compared to VE (27 IQR 25-29 versus 18 IQR 16-22;UE is better tolerated VE for assessment of labor progress; women's compliance with UE prior to delivery increased in the presence of prolonged labor or unplanned operative delivery.

BACKGROUND: Ultrasound is increasingly used in labour; however, little data exist on attitudes to its use. We sought to analyse and compare the views of pregnant women, midwives, and a women's panel on the value and use of ultrasound in labour. METHODS: Focus groups involving a short presentation on ultrasound, questionnaire, and a question and answer session were held with groups of pregnant women, midwives at 2 inner‐city maternity units, and a RCOG online Women's Panel. Data were collected on attitudes to vaginal examination, ultrasound, predicting Caesarean section, and the utility of a digital representation of labour. RESULTS: Twenty one midwives and 29 service users (19 pregnant women and 10 women's panel members) participated. Significantly more service users saw positive value in intrapartum ultrasound (P = 0.0005) and predicting Caesarean section (P = 0.03) than midwives. The majority of both groups – 72% (20/29) and 62% (13/21), respectively – thought women would want a digital representation of their labour, with the most popular format being on a mobile phone (56%, 20/36). CONCLUSIONS: Service users were most and midwives least positive about ultrasound versus vaginal examination, indicating divergence between midwives' perspective of women's need to understand risk and desire to know about their labour. Women found the non‐intrusive nature and accuracy of ultrasound valuable while midwives were concerned about de‐skilling and medicalisation of birth. All groups felt a graphical representation of labour on a device would be helpful.

The authors' aim in this study was to examine the experiences of women regarding vaginal examination (VE) performed during labor. This qualitative study is based on a hermeneutic-phenomenological approach. Fourteen women within the first 24 hours of the postpartum period following vaginal birth were enrolled in the study. We created six themes under the categories of "past experiences" and "future expectations". It was revealed that women had many negative feelings during the VE such as pain, ache, embarrassment, and fear. We recommend that the health care providers should inform women about relaxation methods that will reduce pain and discomfort.

Introduction Intrapartum ultrasound is gaining high acceptance by many women as another method for assessing labour progression. Despite growing evidence of the effectiveness of ultrasound in labour, the acceptance of intrapartum ultrasound has not been previously investigated in black Africans. Aim This study aimed to determine women’s acceptance of intrapartum ultrasound and their preference for transperineal ultrasound or digital vaginal examination (digital VE) in Ghana. Methods An analytical cross-sectional study was conducted among mothers who had had both digital VE and transperineal ultrasound during labour in a tertiary hospital. Information about their sociodemographic characteristics, experience with, and preference for ultrasound or digital VE in labour using a pretested structured questionnaire was obtained. Their experiences were categorised as ‘tolerable, ‘quite uncomfortable’ or ‘very uncomfortable’. Categorical variables were compared using Fisher’s exact test. A p value

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

INTRODUCTION: The frequency of post-hysterectomy prolapse of the vaginal dome reaches 43% in patients after surgical treatment for complete uterine prolapse. Goal ― improving the effectiveness of surgical treatment with titanium mesh implants in pre- and postmenopausal patients with complete uterine prolapse. MATERIALS AND METHODS: The study involved 21 patients with complete uterine prolapse who underwent the proposed new method of transvaginal surgical prevention of post-hysterectomy prolapse of the vaginal dome. The result of surgical treatment was evaluated by analyzing the data of vaginal examination and ultrasound. RESULTS: Patients were observed for 2 years ― after 1, 6, 12 and 24 months. Analysis of vaginal examination and ultrasound data showed no displacement of the vaginal dome, pelvic organs and deformation of titanium implants. There were no mesh-associated complications during follow-up. CONCLUSIONS: The use of the developed surgical method for the correction of post-hysterectomy prolapse of the vaginal dome with the use of implants made of titanium silk is a reliable tool that provides anatomical efficiency in pre- and postmenopausal patients.

Aim: This study aims to determine qualitatively experiences and affecting factors of the women related to vaginal examination during labor. Methods: The study was conducted with 20 normal birth giving women at two state hospitals in a province in Turkey. The data were collected by personal information form, semi-structured interview form and interviewer observation form. The data were analyzed by the content analysis. Results: The average age of women was 34.60 ± 6.40, and 75% (n: 15) of them were multiparous. Two themes were identified as “vaginal examination concept” and “experience and emotional reactions related to the vaginal examination.” The themes affecting the vaginal examination experience were also determined as “affecting life” and “expectations on vaginal examination.” The participants often declared that the examination was performed to assess the progression of childbirth. They also stated that they did not get enough information from the healthcare professionals during the examination process. They declared that the professionals did not pay enough attention to their privacy, and they were exposed to unnecessary and frequent vaginal examinations. According to the results, most of their experiences were negative (especially feelings of shame, pain and loneliness). The healthcare professionals were expected to be friendly and informative. The examination environment was expected to be appropriate in terms of ergonomics. Conclusion: Women expect special attention for their physical and psycho-social care needs during vaginal examination.

Assessment of cervical dilatation by digital vaginal examination is commonly used during labor as one of the main indicators of labor progress. Despite consistent inaccuracies, this practice remains widely chosen among midwives and obstetricians. Several methods, including electromechanical and electromagnetic devices, have been trialed throughout the decades without being able to provide objective means of obtaining accurate measurements of cervical dilatation during labor. Intrapartum ultrasound in the form of transperineal or translabial applications has shown promising results in the assessment and monitoring of labor progress. Here, we described the validity of intrapartum ultrasound and its usefulness in the assessment of cervical dilatation during labor. Moreover, we highlighted the feasibility of ultrasound in obtaining these assessments.

Nowadays digital vaginal examination (DVE) is still the most used and traditional technique to assess fetal head station (FHS), fetal head position (FHP), and cervical dilatation during labor.

Evidence shows that the subjective digital vaginal examination for the purpose of determining the position, rotation, and descent of the fetal head during delivery may turn out inaccurate, in addition to causing discomfort to the patients involved [1, 2] (Fig. 52.1). Hence, as recent studies have indicated, the assessment of fetal head descent through intrapartum ultrasound can go a long way toward offsetting such limitations [3].

Introduction Post cesarean section surgical site infection increases both the duration of a patient’s hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities. Method Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers’ who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value Result Age 20–34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level 12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection. Conclusion Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Objective: Vaginal examinations (VE’s) are techniques that are widely used by midwives, nurses or doctors to assess the progress of labor. The present study aimed to determine the women’s experiences and frequency of VE during labor. Methods: A total of 328 women who gave vaginal birth were included in this descriptive study conducted in Turkey between January and October 2019. Data were collected in the first 24 h after birth using the “The Women's Experiences of Vaginal Examinations in Labour (WEVEL)” Scale. Results: VE was performed 4.05±1.721 (range,1–12) times and by 2.41±1.241 (range,1–7) different medical personnel during labor. During VE, women mostly experience fear, pain, and shame. The average score of women on the WEVEL scale was 74.18±10.078 (good level). VE experiences of women to whom information was provided before the procedure, for whom the sex of medical personnel did not matter, whose privacy was protected, and on whom VE was performed by the same medical personnel were more positive; the difference was statistically significant (p

To study the association between the number of vaginal examinations (VEs) performed during labor and subsequent severe perineal trauma. This is a retrospective cohort study. We included all women admitted to the delivery ward between 2008 and 2017, in active labor. Exclusion criteria included preterm deliveries (

Pelvic organ prolapse (POP) may affect the woman’s quality of life. It is currently accepted that POP has a prevalence of 3–6% when defined by symptoms and up to 50% when based on vaginal examination [1–3]. However, only 10–20% of women need precise evaluation of their condition [4]. The main treatment is surgical. There are a significant number of corrective surgical techniques for POP described in the literature, which shows that there is still a lack of consensus on this issue. The traditional vaginal techniques with native tissue are still performed in many centres. Recent advances in laparoscopy and in robot-assisted laparoscopy explain that many centres are orienting themselves and practising these new techniques for prolapse.

Objective: To identify the prevalence and the main types of Obstetric Violence suffered by a group of women; in addition to investigating the level of knowledge of these women on the subject and instructing them. Methods: In this study, qualitative, observational and cross-sectional analytical research was used, through interviews and surveys conducted with women linked to the Centro de Educacao Alegria e Cia. Results: Through the analysis and reading of the questionnaires answered by women, 65 , 9% confirmed having suffered obstetric violence, even though 87.2% of them stated that they had knowledge about the topic. Most of these women (70%) report having higher education and age between 20- and 29-years during pregnancies. The most frequent obstetric violence was routine serum, direction of pulls, vaginal examination, and routine cesarean delivery. Conclusion: According to the research, despite the high level of education and knowledge on the subject, many women still suffer obstetric violence, even though it is currently being commented on more. Most women were unaware of Obstetric Violence.

Background Intrapartum ultrasound has been proposed as a method of assessing labour progress but its acceptability has not been comprehensively assessed. Aims We evaluated the acceptability of intrapartum ultrasound in women having vaginal examination (VE) and ultrasound (US) assessment (transabdominal (TA) and transperineal (TP)) prior to delivery, with and without regional analgesia (RA). Materials and Methods Women at 24–42 weeks gestation were included in a prospective observational cohort study. The acceptability of digital VE and TP US were assessed pre‐ and post‐examination using the modified validated Wijma Delivery Experience Questionnaire. Acceptability scores ranged 6–36 (6 being most and 36 being least positive) in six domains: positive‐trust and relax, negative‐harmful to baby, worrying, painful, intrusive. Results Of 119 women recruited, 104 completed both pre‐ and post‐assessment questionnaires. Eighty‐nine per cent of women were nulliparous with median gestation 40 + 2 weeks (25–42+1). Thirty‐two per cent had RA before assessment, 91% in total. The combined acceptability scores of both negative and positive experiences (6 = most acceptable, 36 = least acceptable) for VE and US pre‐assessment were 15 and 7 respectively (P < 0.0001: Mann‐Whitney U‐test). VE was associated with less positive / more negative domain scoring post‐assessment 12 and 6, respectively (P < 0.0001). Although RA made no difference to the perceived experience pre‐VE (P = 0.9), post‐VE, women with RAs considered VEs more acceptable than those without RA (P = 0.0022). Conclusion(s) This is the first study to comprehensively assess the acceptability of VE and intrapartum US. US assessment prior to delivery is more acceptable than VE. RA ameliorated the negative experience of the VE post‐assessment.

Aim: The study aimed to assess women's feelings regarding vaginal examination during childbirth. Design: Descriptive study design Setting: This study was conducted at labor unit of Obstetric and Gynecological Department at Benha university Hospital for all pregnant women in active phase of labor. Sampling: convenient sample included 200 pregnant women in active phase of labor were recruited in the current study. Tools: An interviewing questionnaire was used to collect data related to women's feelings regarding vaginal examination Results: The present study revealed that vaginal examination was conducted too frequently with range (5–12 times) by different providers and this increase women's feeling of pain. The proportion of women who received high frequency of vaginal examination during childbirth was significantly larger in primipara as compared to multipara. Conclusion: The study concluded that most of women had feeling of pain regarding vaginal examination during childbirth. Recommendation: Health care provider who conducted vaginal examination should be perform the ideal exam and only when necessary, carefully without causing pain, with minimal discomfort to women and with dignity.

OBJECTIVE: Vaginal examination is widely used to assess the progress of labor; however, it is subjective and poorly reproducible. We aim to assess the feasibility and accuracy of transabdominal and transperineal ultrasound compared to vaginal examination in the assessment of labor and its progress. METHODS: Women were recruited as they presented for assessment of labor to a tertiary inner city maternity service. Paired vaginal and ultrasound assessments were performed in 192 women at 24-42 weeks. Fetal head position was assessed by transabdominal ultrasound defined in relation to the occiput position transformed to a 12-hour clock face; fetal head station defined as head-perineum distance by transperineal ultrasound; cervical dilatation by anterior to posterior cervical rim measurement and caput succedaneum by skin-skull distance on transperineal ultrasound. RESULTS: Fetal head position was recorded in 99.7% (298/299) of US and 51.5% (154/299) on vaginal examination (p

Objective: To report the neglected pessary in a patient with pelvic organ prolapse. Pelvic organ prolapse (POP) is one of the most important medical challenges in women especially elderly. One of the conservative treatments of symptomatic POP is pessary placement. Case report: A 84-year-old woman, para 10 was referred to female pelvic floor clinic of an academic hospital for vaginal bleeding and neglected vaginal pessary. Vaginal examination in the pelvic floor clinic revealed an entrapped ring pessary in severely atrophic vaginal mucosa with purulent discharge. Conclusion: Although pessary is the first choice and one of the best conservative treatment for pelvic organ prolapse, it shouldn’t be used for poor cooperative patient who cannot comply with regular follow-up visits which may cause harmful complications.

BackgroundPrevious research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts.MethodsA secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains).ResultsOf the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care; 233/1430 (16.4%) women had their private information shared; 397/1430 (27.8%) women had their genitalia exposed; and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9; Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9; Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9; Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7; Guinea: AOR 0.21, 95% CI 0.12 to 0.38).ConclusionOur results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.

Introduction Intrapartum hemorrhage constitutes a life-threatening obstetric complication and can have multiple etiologies. Some rare causes of intrapartum bleeding warrant consideration when assessing these patients. This case study represents one such instance where cervical deciduosis presented with bleeding relatively early in labor and explores the management that followed. Case A review was requested for a woman undergoing induction of labor due to intrapartum hemorrhage. On vaginal examination, a mass was palpated attached to the cervix which extended from 3 o'clock to 9 o'clock. During emergency caesarean section, a circumferential, sessile, polypoidal mass was attached to the superior margin of the internal cervical os. Histopathology revealed cervical deciduosis. Conclusion With regard to this patient, it is unknown if this episode of cervical deciduosis (and the associated intrapartum hemorrhage) was the sole cause of fetal distress or if it was an incidental finding. It is worth remembering that although placental causes of intrapartum hemorrhage are foremost in our minds, there can be other structures and causes that lead to intrapartum bleeding. This shows the complexity that may be associated with intrapartum care., Highlights • Cervical deciduosis is a benign pregnancy-specific finding, which usually self resolves. • In this particular case study, it caused a significant intrapartum hemorrhage. • At caesarean section a circumferential, sessile, polypoidal mass was found attached to the internal cervical os. • Histopathology is required to confirm cervical deciduosis.

The purpose of the study was to evaluate the rate of postoperative voiding dysfunction after the insertion of an adjustable transobturator sling for the treatment of primary stress urinary incontinence (SUI). The secondary aim was to assess the objective and subjective cure rates and the impact of the surgery on quality of life. This prospective study included 171 patients with primary SUI who underwent insertion of an adjustable transobturator tape. A postoperative tension adjustment algorithm that included a cough stress test (CST), uroflowmetry and postvoid residual volume (PVR) measurement was applied in all patients the day after surgery. The baseline and control postoperative evaluations included vaginal examination, CST, Q-tip test, uroflowmetry and PVR measurement, 1-h pad test and administration questionnaires (UDI-6, IIQ-7, PISQ-12, ICIQ-SF). The day after surgery 65 patients (38.0%) required tape tension adjustment: an increase in tension in 53 patients (31.0%) and a decrease in 12 (7.0%). Continence was achieved in all patients. No patients showed voiding dysfunction after adjustment. Follow-up data for 12 months were available in 157 patients (91.8%). The objective and subjective cure rates were 96.2% and 97.5%, respectively. There was no statistically significant decrease in Qmax (p = 0.899) or increase in PVR (p = 0.187). According to the questionnaires scores, quality of life was improved in all patients. The adjustable transobturator sling minimizes the risk of postoperative voiding dysfunction and allows high objective and subjective cure rates to be achieved in patients with primary SUI. The technique also improves the patient’s quality of life.

Purple line is one of the non-invasive methods to assess the progress of labour. This longitudinal observational study was performed on 350 women during the active phase of labour. We assessed the relationship between length and width of the purple line and foetal head descent. Women were examined in the lateral position and researcher recorded the presence or absence of the line before each vaginal examination. Where present length and width of the line was measured using a disposable tape measure. The purple line appeared in 75.3% of 350 women during the active phase of labour. There was a positive correlation between length of the purple line and station of the foetal head (r = +0.29, p = .001). There was also a medium positive correlation between width of the purple line and the station of the foetal head (r = +0.71, p -.001). There is a positive correlation between purple line and station of the foetal head. Where the purple line is present, measurement of it may reduce the number of vaginal examinations, especially when the single aim is to measure station of the foetal head. Further research is needed to confirm the current finding in other races. IMPACT STATEMENT Current knowledge on the subject: In the literature, purple line is one of the non-invasive methods to assess the progress of cervical dilatation and foetal head descent in labour. Failure of the foetal head is the second most common indication for performing surgical deliveries. Progression of labour has been evaluated by vaginal examination for the assessment of cervical dilatation and foetal head station. Vaginal examinations can be unpleasant, intrusive, embarrassing and so painful for women. Researchers suggested to explore whether the line is also present in women across other ethnic and racial groups and they also suggested further researches to examine the width of purple line. The contribution made by the results of this study: The results of this study add to the growing body of research on progression of labour that the purple line appeared in most of Iranian women during the active phase of labour. There was a positive correlation between length and width of the purple line and station of the foetal head. The implications are of these findings for clinical practice and further research: The results of this study can be used reduce the number of vaginal examinations, especially when the single aim is to measure station of the foetal head. Further research is needed to confirm the current finding in other races.

Objective: The aim of the study is to evaluate the possible effects of the various conditions especially bimanual examination on the adequacy of pap smear test.Study Design: Presented here is a prospective controlled clinical trial carried out at Ankara Atatürk Training and Research Hospital between November 2013 and March 2014. Total of 1771 patients seen at the gynecology outpatient clinic were included in the study. The technique described by the American Society of Cytopathology Criteria 2000 for the preparation of the specimen was followed. Updated Bethesda system 2014 was used for reporting the results.Results: Number of subjects in smear before examination group was 1194 and in the smear after examination group was 577. Two percent (n=36 subjects) of the cervicovaginal report was inadequate. When other clinical conditions were not taken into consideration, the likelihood ratio for inadequate smear in the smear after examination group was 2.64 compared to smear before examination group (p=0,004). Conclusions: In some conditions cervicovaginal smear sampling may be carried out after bimanual vaginal examination instead of missing the chance to screen the women. However, the patients have to be informed that cervicovaginal smear result might be inadequate so that a repeat test has to be carried out.

Background: Ultrasound is found to have many uses in obstetrics. As the transvaginal ultrasound is used to examine the cervix in non-pregnant cases, it’s also can be used in pregnant cases to detect any cervical changes early in pregnancy, in cases of cervical incompetence, or late in pregnancy in labour to detect progression of cervical changes. Vaginal birth occasionally requires urgent medical intervention to avoid harm to the labouring woman and her baby. Intrapartum ultrasound is a simple technique that improves the understanding of abnormal labour and provides a more scientific basis for assessing labour. In this study, two hundred pregnant women, full term, non-complicated, single tone, cephalic presentation, active stage of labour, attending El-Shatby Maternity University Hospital labour ward were recruited for this study.Methods: Intrapartum transvaginal ultrasound is done by the obstetrician followed immediately by digital examination done by a second obstetrician in charge to avoid bias.Results: The results revealed that comparison between mean cervical length measurements assessed by TVUS and digitally revealed statistically significant difference with p

A 37-year-old pregnant woman at 39 weeks of gestation, gravida 3, para 2, with a history of uncomplicated spontaneous vaginal deliveries at term, presented to the emergency department with lower abdominal cramps and watery vaginal discharge that started 2 hours before. Vaginal examination

Retained intrauterine objects are rare causes of persistent vaginal discharge and pelvic inflammatory disease. Hysteroscopy is a minimally invasive technique used for removing these materials. A 47-year-old female who had recurrent vaginal discharge was admitted to our emergency department with pelvic pain. Retained nonabsorbable suture material was observed during her vaginal examination. After treating with intravenous antibiotics, operative hysteroscopy was performed, and the material was removed from the lower segment of the uterus.

Objective of the study was t o examine the outcome differences between women presenting in early and late phase of labor. We evaluated all low - risk women with t erm (37 – 42 weeks), singleton , vertex presentation who presented in early labor ( 4cm cervical dilatation at admission only 9.6% nulliparas and 5.9% multipara required Caesarean section. Women presenting at

CASE DESCRIPTION A 2-year-old primiparous miniature Scottish Highland cow with an unknown breeding date was evaluated for suspected hydrops. CLINICAL FINDINGS Transabdominal and transrectal ultrasonographic examination identified a large amount of hypoechoic fluid within an enlarged uterus; the fetus could not be identified. Presence of a severely distended uterus and concerns regarding associated health risks to the cow led to the decision to induce labor. Although fluids were expelled, parturition did not progress further over the following 48 hours. Vaginal examination revealed a partially dilated cervix and an abnormally shaped fetus that was too large to pass vaginally. TREATMENT AND OUTCOME Supportive care was provided to the cow, and a stillborn bull calf was delivered by cesarean section. Grossly evident chondrodystrophic dwarfism with hydrocephalus, compatible with so-called bulldog calf malformations, was confirmed by diagnostic imaging and histopathologic evaluation. The cow recovered from surgery uneventfully and was discharged from the hospital the following day. Genetic analysis of DNA from hair roots collected from the sire and dam confirmed both were carriers of an aggrecan-1 gene mutation (bulldog dwarfism1) previously associated with dwarfism and bulldog calf malformations in Dexter cattle. CLINICAL RELEVANCE To our knowledge, this is the first reported case of bulldog calf malformations associated with an aggrecan-1 gene mutation in miniature Scottish Highland cattle, confirming that at least 1 genetic mutation associated with this condition is found in cattle breeds other than Dexter. The findings highlighted the clinical importance of testing for known genetic diseases in breeding cattle, particularly among miniature breeds.

The author submitted a report on this to the Cincinnati Medical Society. He examines separately 3 different epochs of a woman's life: 1) the period of virginity, 2) the full development of sexual life, and 3) fading (climacterium). In the 1st, indications for examination are rare. However, the shortcomings of the development of the sexual organs in a girl preparing to marry her husband require the study of such a girl. Dizmenorrhea, which is not inferior to the general treatment or constant pain in the lower abdomen - also give the right to examine the girl. In America, checkup in the 1st is given under anesthesia to avoid pain and mental shock.

Objective: To assess perceptions about vaginal examinations (VEs) during labor among women referred to the Akbarabadi Hospital in Tehran, Iran. Methods: This was a cross-sectional study conducted from December 2015 to May 2016. It included 200 primiparous women. Convenience sampling was used to select participants. The data collection tool was a questionnaire that collected both demographic and obstetric data from participants, as well as data in relation to women’s experiences according to a designated and validated scale, 24 hours after childbirth. Higher scores were indicative of a more positive perception in relation to a participant’s experience of VE. Results: The mean ± SD score for the perception of the VE and number of examinations in the active phase of labor was 62.9 ± 26.2 and 7.4 ± 2.44, respectively. Multiple linear regression analysis showed a significant relationship between perceived duration of examination (short, average [B = −1.03], long [B = 3.84]), feeling of comfort with the examiner (B = 2.73), and number of examiners (B = −0.81) with the mean scores of their perceptions ( P < .05). These 3 variables accounted for 8% of the changes in the women’s perceptions score of VE. Conclusion: The majority of participants in this study underwent excessive VEs during labor. If obstetrically safe, a reduction in the number of examinations during labor along with decreased duration based on women’s perceptions could improve women’s perceptions of VE overall. Additionally, should each VE be performed by the same clinician, women’s perceptions in relation to VEs may also improve.

BackgroundA high number of vaginal examinations (VEs) may lead to a higher risk of infections, as well as discomfort/dissatisfaction with intrapartum care.ObjectiveTo determine the frequency of potential excess of vaginal examinations (PEVE) during the management of labor and identify its associated factors, in Peruvian hospitals.MethodsSecondary analysis of the data collected in theDisrespEct and abuse during ChIlDbirth in pEru (DECIDE)study, held between April and May 2016. In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations (VEs) performed during the management of labor. Poisson regression models with robust variance were performed to calculate crude and adjusted prevalence ratios (cPR and aPR) as well as their 95% confidence intervals (95% CI).ResultsOne thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between 100 and 129. The median age was 26 years (interquartile rank: 22–31). The median number of VEs was 3 (interquartile rank: 2–5). The proportion of women who underwent PEVE was 33.9%, this ranged from 0.9 to 69.9% at the studied hospitals. The frequency of PEVE was higher in women who attended > 2 obstetric psychoprophylaxis sessions, compared to those who attended ≤ 2 sessions (aPR: 1.78 95% CI: 1.01–3.12); and among women who gave birth between 18:00 h and 23:59 h, compared to those who did it between 7:00 and 17:59 h (aPR: 1.28 95% CI: 1.04–1.57).ConclusionAround one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals. Women with more psychoprophylaxis sessions, and who gave birth between 18:00 h and 23:59 h, had a higher PEVE frequency. Future studies should assess in depth the causes and consequences of this high frequency.

In the objective structured clinical examinations (OSCE), one can expect one station from gynecology and one from obstetrics. This is usually a history-taking station with counseling or discussing a management plan with the patient. You will not be asked to perform a pelvic, breast, rectal, or vaginal examination.

In the objective structured clinical examinations (OSCE), the number of stations is always limited between 10 and 14, with 1–2 pilot stations. One may or may not get a case from the genitourinary system. This is usually a history-taking station with counseling or discussing a management plan with the patient. You would not be asked to perform a pelvic, rectal, or vaginal examination. Please keep in mind that with the increasing use of manikins/plastic models in practice modules and training facilities, one can expect to take a history from a role player, and then the examiner can ask you to perform a rectal/vaginal examination on a manikin/model. So do not be surprised if you get one. Breast examination has already been introduced in some OSCE, in a similar way.