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A 24-year-old primigravida married for 1 year was referred from a village in the second stage of labour with an intrauterine foetal demise to the emergency room. There was mild tachycardia. She was not anaemic. The blood pressure was normal. A midline vertical sub-umbilical scar on the abdomen was claimed to be for an ovariotomy done during adolescence. The patient was exhausted. There was secondary inertia of the uterus. Vaginal examination confirmed full dilatation with fully rotated vertex at +2 station. Forceps delivery was uneventfully performed to deliver a 2.8 kg dead baby. Massive postpartum haemorrhage followed the delivery. There was no trauma to the lower genital tract. Since the brisk bleeding very quickly started exsanguinating the patient, she was taken up for urgent laparotomy, only to realize there was transverse rupture of a previous hysterotomy scar (Fig. 2.1).

Female genital mutilation (FGM) is a traditional practice that has no medical benefit and severe health consequences for girls and women. This article discusses the risks to patients who are pregnant and have had FGM. It will describe urinary tract infections caused by FGM, and how this condition increases the risk of preterm labour and delivery. It will also address the difficulty in vaginal examinations that can be caused by FGM and instances when this can delay diagnosis and treatment. In addition, it will explore a number of intrapartum risks caused by FGM and the role of deinfibulation in pregnancy. Finally, it will look at the link between maternal and fetal morbidity and mortality, and FGM.

Objective: To evaluate the effectiveness of sweeping of the membranes in nulliparous women to reduce the need for a formal induction of labor. Design: A randomized controlled clinical trial. Place and duration of study: The study was conducted in the Gynae unit 1 of Jinnah Hospital Complex. Lahore, from April 2001to March 2003. Patients and methods: 100 nulliparous women attending the antenatal clinic at 39 weeks of gestation were randomly allocated for the study. 50 women were randomized to sweeping of membranes and 50 to control group. Their outcome measures in terms of proportion of women achieving spontaneous labor, duration of labor and bishop score at the time of admission to the hospital were assessed. Results: Spontaneous labor occurred more often in the sweeping of the membranes group than in the control group (38/50(76%) vs. 19/50(38%) P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labo r ward (25/50 (49%) vs. 8/50 (16%) P = 0.005. Women allocated to sweeping showed a trend towards having a shorter randomization-delivery interval: 9.4 days vs. 10.6 days in the controls P = 0.087. The need for induction of labor was significantly reduced in those women who underwent sweeping (11% vs26% P = 0.004). Conclusion: Sweeping of membranes in nulliparous women at 39weeks of gestation significantly decreases the number that will reach 41 weeks of gestation.

The three kinds of cord accidents have been detailed, and a simple stepwise protocol for the management of these has been framed. Two absolutely new approaches have been presented here, namely, adoption of clear division of responsibility and a ‘timeless’, ‘real-time’, no miss record keeping method by e-mode.

Objective To compare the cervical length measured by TVS with modified Bishop's score for cervical assessment before induction of labor. Methods One hundred and twenty women in their first pregnancy were admitted for induction of labor. Digital vaginal examination was done to record the modified Bishop's score, followed by TVS to detect the cervical length. The method of induction of labor was decided after the initial vaginal examination, when the modified Bishop's score was evaluated. Dinoprostone pessary was used for labor induction if the Bishop score was Results The cervical length measured by TVS was significantly shorter in the patients delivered vaginally, compared with the patients delivered by cesarean section (24.7±6.9) versus (26.5±8.2) mm; respectively. A total of 72 (78.3%) of the patients delivered vaginally, and 10 (35.7%) of the patients delivered by cesarean section had cervical length 5. Conclusions Both Methods of cervical assessment (cervical length measured by TVS, and modified Bishop's score) were significantly associated with successful induction.

Objective We report here the clinical outcome of a simplified method to suspend the vaginal cuff during laparoscopic assisted vaginal hysterectomy. Materials and Methods This is a retrospective study. Fifty patients underwent laparoscopic assisted vaginal hysterectomy and received transvaginal uterosacral ligament fixation for vaginal cuff support (LAVHUS). Follow-up examinations were conducted for at least 24 months and included vaginal examination with prolapse grading using the POP-Q system. Subjective outcomes were measured using a questionnaire that asked patients to describe postoperative lower urinary tract symptoms and satisfaction with the procedure. Results The mean follow-up duration was 106 weeks (range 102–120 weeks).The postoperative POP-Q point C and total vaginal length were effectively sustained during this period. There were no intraoperative or postoperative complications, and no adverse postoperative lower urinary tract symptoms were reported. Conclusion The present study demonstrated satisfactory subjective and objective clinical outcomes following LAVHUS.

RESUMEN Se inicio un proyecto de investigacion para comparar el metodo de atencion del alumbramiento activo modificado con el metodo activo durante el tercer periodo del parto. En el metodo de atencion del alumbramiento activo modificado se utilizo un signo directo para verificar el descenso placentario, el examen vaginal, en contraste con el metodo de los indicadores indirectos prescritos por el Ministerio de Salud Publica del Ecuador. Una muestra aleatorizada de 300 mujeres en labor de parto fueron atendidas en cada grupo. La investigacion fue realizada en el Hospital Vicente Corral Moscoso de Cuenca, Ecuador, y fueron monitorizadas las siguientes variables durante el tercer periodo de atencion del parto para evaluar el comportamiento de ambos metodos de atencion: duracion del tercer periodo del parto, perdida de sangre, frecuencia de la retencion parcial y total placentaria, volumen de la perdida de sangre durante la primera hora posterior al tercer periodo del parto. Los resultados revelaron que el promedio de duracion del tercer periodo del parto en el alumbramiento activo modificado fue 4,35 ± 1,36 versus 4,22 ± 1,60 minutos en el alumbramiento activo con un valor de p igual a 0,297, que indica que la duracion del tercer periodo del parto en los dos tipos de atencion fue similar. La media de la perdida de sangre en el metodo activo modificado fue 193 ± 66,97 versus 182,97 ± 54,62 cc para la atencion del alumbramiento activo con un valor de p igual a 0,045. La investigacion comparativa revelo que las dos formas de atencion durante el tercer periodo del parto presentaron resultados iguales, con beneficio para la forma de atencion activa. Palabras clave: Tercer periodo del parto, alumbramiento activo modificado, alumbramiento activo. ABSTRACT A research project was initiated to compare the modified-active versus active attention method during the third labor phase in childbirth. In the modified-active attention method indirect indicators are used to verify the placental descent, in contrast to the vaginal examination in the active attention approach, a requirement prescribed by the Ecuadorian Ministry of Health. A random sample of 300 women in labor was subjected to each attention approach. The research was conducted at the Vicente Corral Moscoso Hospital of Cuenca, Ecuador, and the following variables were monitored during the third labor phase to assess the performance of both attention methods: duration of the third stage of labor, blood loss, the frequency of total and partial placental retention, and the volume of blood loss during the first hour posterior the third stage of labor. Results revealed that the average length of the modified-active third stage of labor was 4,35 ± 1,36 and the active third stage of labor 4,22 ± 1,60 minutes with a p value of 0,297, indicating that the duration of the third stage of the two types of attention methods are similar. The average blood loss of the modified-active third stage of labor was 193,01 ± 66,97 versus 182,97 ± 54,62 cc for the active attention approach with a p value of 0,045. The comparative research revealed that the two forms of attention during the third stage of labor perform equally well, with a slight preference for the active form of attention. Keywords: Third stage of labor, modified-active procedure, active procedure.

Vaginal examinations are routine procedures on dairy farms to diagnose pregnancy or puerperal diseases. Cows express their discomfort in certain situations with discrete behavioural reactions. These reactions can be described in their occurrence and extent. Although there is evidence that human contact is potentially stressful for cows, the impact of vaginal examinations on animal welfare has not been evaluated. Therefore, we hypothesized that (1) cows show discomfort before and during vaginal examination with different behavioural reactions, (2) these reactions can be semi-quantitatively scored and (3) the examination with a Metricheck device is less invasive than an examination with the gloved hand. In experiment 1, the behaviour of 10 cows during vaginal examination was videotaped and analysed. In total, 15 different behavioural reactions were identified. Based on these observations, a numerical rating system was created. The avoidance reactivity score (ARS) includes evasive reactions, which are scored on a 4-point scale, and signals of discomfort, scored with 1 point each. In Experiment 2, evasive reactions of cows were videotaped and scored by two observers and three times by the examiner. The inter- and intra-repeatability was 0.70 and 0.87, respectively. In experiment 3, vaginal examinations of 30 cows were videotaped and scored with the ARS by four observers and three times by one observer. The inter- and intra-observer repeatability during examination was 0.44 and 0.81, respectively. In experiment 4, 435 vaginal examinations were conducted either with the gloved hand (group GH) or the Metricheck device (group MD). Behaviour before and during examination was scored. The median ARS increased from 1 before (IQR: 1–2) to 3 during examination (IQR: 2–4) and cows in the group MD showed less avoidance reactions compared to cows in the group GH ( P

Introduction: Clinical practice audits present an opportunity for providers to examine and reflect on their practice. Vaginal examinations are an integral part of intrapartum care but can be uncomfortable for women and can increase the risk of chorioamnionitis. Thus, vaginal examinations should be performed thoughtfully and for necessary reasons. Methods: A busy midwifery service at a large academic center underwent an audit of the number of vaginal examinations performed in labor for 205 women admitted in spontaneous labor or with spontaneous rupture of membranes. The retrospective chart audit was performed by research midwives who queried 2 electronic medical record databases, 1 for provider progress notes and 1 for nursing notes. Results: On average, a woman underwent 4 vaginal examinations during labor, a rate greater than the World Health Organization recommendation of 1 examination every 4 hours during the first stage. The rate of presumed chorioamnionitis in this group of healthy, low-risk women was 6%, and women with this diagnosis averaged 7 vaginal examinations. Discussion: After presentation and discussion of the audit findings, the midwives expressed appreciation for the opportunity to explore such a fundamental element of clinical practice and a heightened awareness of the importance of performing and documenting vaginal examinations. Audits of a similar nature in other midwifery practices are needed, as are studies exploring rates and possible modifiable causes of chorioamnionitis in low-risk women.

Background Inclusion of sexual activity in the macaque model for topical microbicide safety evaluation would more closely mimic human use of topical microbicides and provide a more rigorous safety assessment. Methods Initially, male–female partners were monitored in cohousing arrangements to determine whether macaques would copulate ad libitum. The logistics of performing vaginal examinations before and after coital visits were analyzed and optimized. Findings from cervicovaginal examinations conducted before and after sexual activity were compared. Results Coital activity was reliably observed in the majority of cohousing sessions, representing all phases of the menstrual cycle. Female macaques were trained to be restrained while fully alert for pre-coital vaginal sampling. Post-coital examinations occur under general sedation. Post-coital examinations reveal alterations to tissues, microbiology, and pH compared with pre-coital visits. Conclusions This work clearly demonstrates that it is feasible to incorporate sexual activity in the macaque model for topical microbicide safety assessment.

Intimate gynaecological examinations are part of the necessary retinue in gynaecological consultation and management. To evaluate women’s perception of digital and speculum vaginal examinations in rural Southeast Nigeria. This was a prospective descriptive study. Gynaecologic clinic attendees in a Mission hospital in rural Nigeria were interviewed using a pre-tested questionnaire over a 3-year period. Four hundred and eighty-six women with a mean age of 35.2 ± 8.1 years were interviewed. They presented mainly for infertility (36.8%), menstrual abnormalities (31.1%) and early pregnancy complications (10.7%). Over a quarter of the women felt embarrassed at vaginal examination and 37.2% found it a bit painful or felt discomfort. In spite of the discomfort, 73.7% believed vaginal examination was necessary and over 95% indicated readiness to undergo such examination in future if necessary. Performing intimate gynaecological examination should be a carefully planned procedure with patient’s consent, and performed conscientiously taking patient’s feelings and emotions into consideration, to engender confidence.

The objective of this study was to evaluate the prevalence of clinical endometritis and its impact on reproductive performance in grazing dairy cattle in Argentina to compare data with previous reports from herds kept in confinement housing systems. A total of 243 Holstein dairy cows from three commercial dairy farms in Buenos Aires Province (Argentina) were examined for the signs of clinical endometritis 18-38 days postpartum (dpp) by external inspection and manual vaginal examination. Vaginal discharge was scored into the categories VDS 0 (transparent, clear mucus), VDS 1 (mucupurulent discharge), VDS 2 (purulent discharge) and VDS 3 (purulent discharge with fetid odour). Cows diagnosed with VDS 1 to VDS 3 were regarded as affected with clinical endometritis and cows with VDS 0 as free of clinical endometritis. All cows were re-examined 14 days later following the same examination protocol. Prevalence of clinical endometritis 18-38 dpp was 35% and decreased to 18% at re-examination. Cows with no palpable ovarian structures or periparturient disorders were at higher risk for clinical endometritis. Hazard for pregnancy was significantly lower in cows with purulent or fetid odour discharge compared with reference cows with no discharge (HR=0.49; p=0.01), resulting in a lower proportion of cows pregnant by 360 dpp (66% vs 78%). Furthermore, the number of services per pregnancy was higher for cows with clinical endometritis than for cows without clinical endometritis (4.4 vs 3.1; p=0.04). Cows with clinical endometritis were 1.6 times as likely to be culled as cows with no signs of clinical endometritis. In conclusion, the prevalence and the impact of clinical endometritis in a pasture-based, extensive dairy production system in Argentina were similar to previously published data from dairy farms with confinement production systems.

Objective: To investigate the characteristics of physical therapists (PTs) reporting high and low confidence in the examination of pelvic floor muscles (PFMs) and to evaluate the common characteristics of PTs who use little to no PFM examination when treating patients with PFM dysfunction. Study Design: Retrospective cross-sectional survey. Background: Educational opportunities for PTs to learn PFM examination techniques are varied and there are many methods to evaluate the PFMs. Factors related to increased confidence in performing PFM examination have not been studied. Methods and Measures: Women’s health PTs (N 1175) received an email invitation to participate in the study. Two hundred three (n 203) PTs completed the 38 question web-based survey (17.3% response rate). Results: Characteristics of PTs with low confidence include (a) having 1 to 6 months of pelvic physical therapy experience, (b) participated in self-study 1 to 3 times per year, (c) performed first vaginal examination less than 1 year ago, and (d) attended less than 1 day of continuing education. Higher confidence is associated with several factors including increased duration and frequency of experience in performing PFM examination as well as participation in postprofessional continuing education in PFM examination. Respondents using little to no PFM examination had less confidence than PTs who use PFM examination. Conclusions: To improve confidence in PFM examination, PTs should participate in postprofessional education in PFM examination and should perform this examination with increasing frequency for more than 6 months. Sporadic use of PFM examination may result in low confidence.

Incomplete non-puerperal uterine inversion is a rare complication that can arise secondary to the presence of submucous fibroid.1 In the majority of cases reported in the literature, the definitive diagnosis is usually made at the time of hysterectomy.2 In reported cases where hysterectomy was not done, Haultain procedure was done to correct the inversion.3 In the following case, the diagnosis was made preoperatively and the fibroid was resected vaginally by LigaSure. A 31-year-old nulliparous woman presented to the emergency room with history of excessive bleeding for a few months. She also had urine retention for 1 day. On examination, she was pale. Vaginal examination showed …

Purpose – The aim of this paper is to examine an audit to assess compliance with the national standards for intimate examination and to identify areas where changes are required to improve the quality of patient's care.Design/methodology/approach – A patient‐based questionnaire was designed. The total numbers of clinics analyzed were 16. All the new patients, who had vaginal examinations, were asked to complete the semi‐anonymous questionnaire after their consultation. These questionnaires were designed on the basis of RCOG and GMC standards for the intimate examination.Findings – The overall response rate was 50 per cent. Only 27 patients (36 per cent) received the offer for a chaperone. Of the total 75 patients, 40 (53 per cent) patients have received the chaperone without an offer. The remaining eight patients (11 per cent), neither had the chaperone offered nor had one present at the time of examination. The presence of a chaperone was recorded for only 47 (62 per cent) patients.Practical implications...

BACKGROUND: Continuity of midwifery care during labour is beneficial. We investigated the relationship between midwife presence, interventions and outcome. PATIENTS AND METHODS: From the overall sample of singleton pregnancies in cephalic presentation (n = 4 438) we selected 541 prospectively documented hospital-based birth processes occurring at term without antenatal risks and spontaneous mode of birth. Univariate and multivariate analyses were performed. RESULTS: Midwives were present for up to six hours in 66 % of 247 births to primiparae, and for up to three hours in 61 % of 294 births to multiparae. Midwives were present for more than 75 % of the overall labour duration in 62 % of all births in nulliparae and 63 % in multiparae. Midwife presence for more than 75 % of the total birth duration correlated positively to immersion in water (p < 0.02), up to two CTG tracings (p < 0.001), and up to three vaginal examinations (p < 0.04). Midwives working in hospitals which contributed more than 50 % of their eligible births were present for longer during labour than midwives in units with a lower participation rate (p < 0.002). Multivariate regression revealed that up to two CTG tracings (p < 0.001) and a participation rate of more than 50 % (p < 0.002) were significantly related to midwife presence. DISCUSSION: Intensive intrapartum midwife presence during spontaneous birth was associated neither with fetal outcome nor with interventions, except for up to two CTG tracings. This might be due to shorter labour or the later commencement of care. CONCLUSIONS: Intrapartum midwife presence covers a large portion of the birth process, but continues to be poorly understood.

This article discusses the actual practice of the vaginal examination and compare the different methods that commonly are used in Europe, particularly the UK and the north European way. The advantages and disadvantages for the patient and the gynaecologist are described in a comprehensive way explaining why different gynaecological positions may be more efficient for both the patient and the gynaecologist. Emphasis is given on the training validation for the junior doctors and the future general practitioners.

This paper describes a study to explore the prevalence of postpartum tightening operations of the vulva and reinfibulation (RI) in Sudan. Participatory observations with digital vaginal examinations before and after delivery were carried out on a sample of 100 women in two hospital settings. In 61% of the women tightening vulval operations had been carried out after delivery. Of the women who had not been submitted to female genital mutilation (FGM) with suturing before delivery, 35% had such an operation after delivery. Two out of 20 women without any primary FGM had undergone a tightening operation following delivery. In the two study settings observed, the prevalence of postpartum tightening operations was 61% and included women without previous FGM. The tradition of tightening operations of the vulva after delivery is an important issue for further research concerning the implicit socio-cultural determinants and their possible relation to the tradition of primary forms of FGM.

Ultrasound is used on a daily basis and has become one of the most essential investigations in gynaecology, but what evidence is there to support its use? This article explores the role of ultrasound in the diagnosis and management of common gynaecological pathologies. It will also consider the use of ultrasound-based procedures to evaluate the uterine cavity and test tubal patency. Gynaecologists have traditionally used the vaginal examination to exclude common, benign gynaecological pathologies. However, this article will attempt to demonstrate that ultrasound provides a non-invasive, simple, well-tolerated and more accurate way of diagnosing such pathologies and should be offered to all women presenting to a gynaecological outpatient clinic.

To retrospectively analyze the outcome of surgery in women followed up for 1 year after vaginal repair with the Apogee (support of posterior vaginal wall) or Perigee (support of anterior vaginal wall) system. A total of 120 patients with recurrent cystocele and/or rectocele or with combined vaginal vault prolapse were treated by either posterior or anterior mesh interposition depending on the defect. Follow-up after 1 year (+/-31 days) comprised a vaginal examination with prolapse grading using the POP-Q system, measurement of vaginal length, evaluation of the vaginal mucosa, and exploration for mesh erosions. Postoperatively, 112 (93%) women were free of vaginal prolapse, whereas 8 (7%) had level 2 defects. Erosions occurred significantly more often (p = 0.042) in patients treated with the Perigee system. Our results suggest that the Apogee and Perigee repair systems (monofilament polypropylene mesh) yield excellent short-term results after 1 year.

The World Health Organisation estimates that 2 million women undergo some form of female genital mutilation (FGM) annually. Because of increasing migration, clinicians in the UK are increasingly exposed to women who have suffered FGM. Recognising this trend, the RCOG has set standards for guidance of health professionals caring for women with FGM. As yet, no study has assessed levels of knowledge of FGM among relevant health professionals. An anonymous structured questionnaire based on the Royal College of Obstetricians and Gynaecologists' standards was circulated among staff at a University Teaching Hospital. A total of 45 participants completed the questionnaire. Only 40% were familiar with the regulations in the FGM Act of 2003; 58% were unable to list the different categories of FGM; 47% incorrectly thought that caesarean section is the best way of managing FGM if vaginal examination is not possible in the first stage of labour and 54% chose anterior episiotomy as the treatment of choice during the second stage. Our study found that there were significant gaps both in theoretical knowledge and practice.

To find out whether intrapartum translabial ultrasound examination is painless by comparing pain score of ultrasound-based versus digital vaginal examination of foetal head station.In 94 women carrying uncomplicated-term singleton pregnancies, labour progress was assessed by translabial ultrasound, followed immediately by conventional digital vaginal examination. Pain scores (0-10) using visual analogue pain scale were obtained for both examinations. Forty-eight and forty-six sets of data were obtained in first and second stage of labour, respectively. The difference in pain scores between digital vaginal examination and translabial ultrasound was analysed.The median pain score for translabial ultrasound was 0 (range 0-8), while that for vaginal examination was 4.5 (range 0-10), p 0.05. There was no significant difference in pain scores between first and second stages of labour for translabial ultrasound (p = 0.123) and for vaginal examination (p = 0.680). The pain score for vaginal examination was higher than that of translabial ultrasound in 81.9%, similar in 13.8% and lower in 4.3% of cases. There was no statistically significant difference in pain scores obtained for digital vaginal examination by clinicians with different experience (p = 0.941).Intrapartum translabial ultrasound is generally better tolerated than digital vaginal examination for assessment of labour progress, making it an acceptable adjunctive assessment tool during labour.

This technical report describes the creation and use of a cervical dilation and effacement model in a pre-licensure nursing course in reproductive health. Vaginal examination is typically taught in reproductive health courses; however, nursing students do not always have sufficient opportunity to practice on actual patients. This low-cost task-training model provides undergraduate nursing students the opportunity to experience performing a vaginal examination to assess for cervical dilation and effacement during the labor process.

To assess the benefits of incorporating simulations in obstetric vaginal-examination training.A single-center, randomized, prospective study was conducted in a French University Hospital. Medical students without obstetric experience were assigned, by simple random sampling, to perform either 10 or 30 vaginal-examination training procedures using a simulator. A control group of students that had not performed any simulator training procedures was also enrolled. Medical students performed six vaginal examinations on patients who were in labor. The students reported the findings of the examinations in terms of five items (cervical length, position, consistency, dilation, and fetal presentation). The students' findings were then compared with those of experienced midwives (whose answers were considered to be the gold standard) who examined the same patients.A total of 66 students were included in the analyses. Students who had performed 10 simulated procedures demonstrated significantly greater accuracy in vaginal examination assessments in comparison with the control group (P0.001). No significant difference was observed between the results for students that had performed 10 or 30 simulated procedures (P=0.44).Simulation training assisted novice students in improving their vaginal-examination skills before performing such procedures on real patients. Vaginal-examination simulations should be included in the training curriculum for students who will examine pregnant patients.

The second stage of labor is generally defined as the time elapsing from the full cervical dilation to the delivery of the fetus [1]. There is, therefore, a wide variability in its accuracy as it depends on the operator’s decision to perform a vaginal examination to determine whether the “diagnosis” of complete dilatation is made.

Pre-term birth (PTB) is a major health challenge to-day. Perinatal mortality is increased more than three times and PTB is the leading cause of short and long-term neonatal/infant morbidity. Many are the risk factors, previous PTB, cervical effacement or dilatation on clinical vaginal examination or shortening of the length of the cervical canal on ultrasound are major predisposing factors.

The Bachelor's thesis deals with a pelvic floor dysfunction with focus on the stress incontinence. It describes the influence of pelvic floor dysfunction on the deep stabilization system of the spine, the urinary tract function, the sexual function and partner and social life of the patients. In the Bachelor's thesis are summarized available information on the pelvic floor dysfunction and the stress incontinence. In the practical part are processed three casuistries of patients with the stress incontinence occurrence after two or more deliveries. The casuistries focus on complex kinesiological examination, including palpation vaginal examination pursuant to the PERFECT scale, diagnosis and course of the therapy and individual approach to the patients. The thesis adverts also to the quality of life change and the fact that the pelvic floor dysfunction can manifest itself at any age.

Araştırmanın amacı kadınlarda vajinal muayene sırasında rahatsızlık hissi, istismar öyküsü, cinsel istismar ve posttravmatik stres bozukluğu ve bu durumlar arasındaki ilişkileri incelemektir. Araştırma, Temmuz 2014 ve Ağustos 2015 tarihleri arasında, Aydın Kadın Doğum ve Çocuk Hastalıkları Hastanesinde yatan 320 kadın ile analitik-kesitsel olarak gerçekleştirilmiştir. Araştırma verileri kadınlara ilişkin tanıtıcı, vajinal muayene ve şiddete ilişkin verileri sorgulayan soru formu ve Post-Travmatik Stres Bozukluğu Soru Listesi-Sivil Versiyonu ile toplanmıştır. Veriler tanımlayıcı istatistikler, t-testi, varyans, Mann Whitney U, Kruskal Wallis ve ki-kare testleri ile analiz edilmiştir. Araştırmaya katılan kadınların yaş ortalaması 26,32±5,98'dir. Çalışmadaki kadınların %76,3'ünün ilkokul mezunu ve %88,1'nin ev hanımı olduğu, %87,5'inin sağlık güvencesinin bulunduğu saptanmıştır. Kadınların vajinal muayene sırasındaki rahatsızlık hissi puan ortalamasının 3,92±3,34 olduğu ve %26,3'ünün vajinal muayene sırasında rahatsızlık hissi yaşadığı belirlenmiştir. Kadınların Posttravmatik Stres Bozukluğu puan ortalamasının 27,82±9,66 olduğu, %64,7'sinin Posttravmatik Stres Bozukluğu yaşadığı, fiziksel, duygusal ve cinsel şiddete maruz kalmanın Posttravmatik Stres Bozukluğu yaşamayı artırdığı belirlenmiştir. Kadınların %11,9'unun duygusal ve %7,8'inin fiziksel şiddete maruz kaldığı, %7,8'inin istemediği zamanda eşi tarafından cinsel ilişkiye zorlandığı ve bu kadınların %40,0'ının bu durumu cinsel istismar olarak tanımladıkları bulunmuştur. Çalışmada vajinal muayene sırasında rahatsızlık yaşayan kadınların (% 75,0) yaşamayanlara (%61,0) göre daha fazla oranda Posttravmatik Stres Bozukluğu yaşadıkları, fakat istismar öyküsünün vajinal muayene sırasında rahatsızlık hissi puanını etkilemediği saptanmıştır. Bu çalışmada vajinal muayene sırasında rahatsızlık hissi yaşayan kadınların daha fazla oranda Posttravmatik Stres Bozukluğu yaşadıkları, istismar ve cinsel istismar öyküsünün vajinal muayene sırasında rahatsızlık hissi yaşamayı etkilemediği, istismar ve cinsel istismar öyküsünün Posttravmatik Stres Bozukluğu yaşamayı artırdığı sonuçları elde edilmiştir. Bu sonuçların vajinal muayene sırasında verilen bakıma entegre edilmesi ile kadınların bu deneyimleri daha olumlu duruma dönüştürülebilir ve yaşadıkları travma azaltılabilir. Anahtar Kelimeler: Cinsel istismar, ebelik bakımı, istismar, posttravmatik stres bozukluğu, rahatsızlık, vajinal muayene The aim of this study was to assess abuse, sexual abuse and posttraumatic stress disorders associated with experiencing discomfort during the vaginal examination. This descriptive study was carried with 320 women who are hospitalized in Aydın Women Birth and Child Desorders Hospital between July 2014 and August 2015. The data was obtained through Information Form about Women and Posttraumatic Stress Disorder checklist- Civilian Version. Descriptive statistics, t-test, variance, Mann Whitney U, Kruskal Wallis, and Chi-square analysis were employed while assessing the data. The average age of the women in the study was 26.32±5.98. It was found out that 76.3% of the women are primary school graduates, that 88.1% were housewives and that 87.5% had medical insurance. The average experiencing discomfort score during the vaginal examination of the women is 3.92±3.34. Also twenty six percent of the women reported strong discomfort during the vaginal examination. It was established that the average Posttraumatic Stress Disorder score of women is 27.82±9.66 and sixty four percent of the women reported Posttraumatic Stress Disorder. It was established that experienced of physical, emotional and sexual abuse in women increases to occurrence of Posttraumatic Stress Disorder. It was found out that 11.9% of women experienced emotional abuse, that 7.8% experienced physical abuse. Also 7.8% of women reported that were forced sexual intercourse by their partners. Fourty percent of that women described forcing sexual intercourse by partners as a abuse. A greater proportion of women who reported strong discomfort during the vaginal examination (75.0%) reported Posttraumatic Stress Disorder as compared with non-roperted strong discomfort group (61.0%). Abuse history was not associated with a discomfort during the vajinal examination.The study revealed that experiencing discomfort during the vaginal examination of the women more likely roperted Posttraumatic Stress Disorder, there was not an association between strong discomfort during the vajinal examination and a lifetime history of abuse and having a sexual and lifetime abuse history increased the Posttraumatic Stress Disorder rate. Integrating of this results into care during vaginal examination migth make a positive differance for vaginal examination experiance in women and reduce trauma of women.Keywords: Abuse, discomfort, midwifery care, post-traumatic stress disorder, sexual abuse, vaginal examination. 104

Using oral agents for induction of labor would reduce the need for repeated vaginal examinations; this is more acceptable to women and could reduce infection rates. A systematic review was conducted of 41 randomized trials comparing oral misoprostol to other induction agents. Oral misoprostol is effective at achieving vaginal delivery, and may have benefits over both vaginal and intracervical dinoprostone. Although it does not achieve vaginal delivery as quickly as vaginal misoprostol, the rates of hyperstimulation are lower when using comparable doses. As the primary consideration should be safety rather than speed, an oral regimen using a maximum of 50 mcg 4 hourly is recommended.

To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary.A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2 x 2 table. The primary outcome measure was the false negative rate of the scalp stimulation test.There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pHor=7.20). Three of these five fetuses had accelerations at VE, giving a false negative rate of 6.25%.These data do not support previous reports that accelerations in response to fetal scalp stimulation before FBS exclude fetal acidosis when the CTG is suspicious and FBS is otherwise indicated. A larger sample may help answer this question.

Objective Evaluation of the efficiency and safety of different surgical techniques with bands for urinary incontinence (UI) in the period February 2000-June 2004, and also the patient satisfaction post-operatively. Material and methods We made a retrospective transversal study, analyzing different variables in 77 patients with UI who had surgery in the Obstetric and Gynaecology Department of the G.U. Hospital in Alicante. Objective evaluation (efficacy and adverse effects) was obtained on checking the follow up at 2 months, 6 months and annually. This consisted of vaginal examination, Valsalva manoeuvre, Q-test, mictional diary, patient self evaluation of symptoms and urodynamics if necessary. Subjective evaluation was made by telephone with the questionnaire already in use. Results Objective results could be valued in only 60 of the 77 patients (77.92%). We considered 59.74% to be objectively continent (46/77) or 76.66% (46/60) if we don’t count those who were not controlled. Subjectively, only 65 patients (84.41%) replied, their “satisfaction was between 72.72% and 86.14% (excluding those who did not reply). Complications were similar to other groups. It was difficult to establish a comparative analysis since criteria of followup and evaluation are very different. Normally they do not include a subjective component of the patient without taking into consideration her quality of life. They are disparate and reproducing them is of little value. Conclusions The surgery with bands is effective and safe although its recommendation needs long term studies where the quality of life should be included. The introduction of new surgical techniques must be preceded by controlled and randomized studies including not only the objective but also the subjective results.

Introduction: There are few published reports on the incidence and management of urethral and vaginal erosions following the use of polypropylene synthetic slings. Moreover, there is very little Australasian data on their use for management of female urinary incontinence or on their associated complications. Methods: A 1-page survey was mailed to the Australian and New Zealand members of the Urological Society of Australasia ( N =326). The survey included questions on the use of polypropylene synthetic sling and the incidence and management of post-operative vaginal and urethral erosions and urinary retention. Results: 198 surveys were returned (response rate: 61%). Polypropylene synthetic sling procedure is practiced by 39% of the respondents with a total of 1459 cases (TVT: 993, SPARC: 466). The incidence of vaginal erosions, urethral erosions and urinary retention was 1.2%, 0.6% and 6.5%, respectively. Thirty five percent of vaginal erosions were asymptomatic and only identified on routine post-operative vaginal examination. One third of urethral erosions presented more than 1 year after surgery and 89% of these were symptomatic. Thirty four percent of patients with urinary retention required surgical intervention to correct the retention. Conclusions: The incidence of urethral and vaginal erosions following polypropylene synthetic sling procedures is lower than that with other synthetic slings. However, a high index of suspicion and long-term follow-up are required to identify and manage these complications of this relatively new procedure.

In a small, multi-centre study conducted in three maternity units in Cambridgeshire, England, a prospective, analytical survey design employing postal questionnaires was used to investigate women's experiences of vaginal examinations in labour. An unselected, consecutive, random sample of 104 primiparae participated in the research of whom 73 returned completed questionnaires, a response rate of 70%. Regarding information-giving during vaginal examination in labour, approximately two thirds of women rated the information provided by midwives as good or very good, the equivalent figure for doctors being one third. A Likert scale addressing ten broad elements of information-giving generated a total of 715 responses of which 63% were positive, 18% were negative and 19% were in between. These findings suggested, on average, that while three fifths of women reported positive experiences of information giving, almost a fifth had negative experiences overall and a further fifth also had, mediocre communication experiences related to their vaginal examinations in labour.

A healthy 26 year old Para 1 presenting with a 2 months of amenorrhoea was diagnosed to have right tubal ectopic pregnancy after vaginal examination and ultrasonography. The case illustrates the need for careful history taking and considering ectopic pregnancy in women of reproductive age group even with negative pregnancy test. Emergency laparotomy confirmed swollen right tube containing a fetus with highly necrotic changes.

Vaginal stones are extremely rare and are classified as primary and secondary. A 45 year-old female presented with an unexplained dyspareunia and vaginal discomfort for 2 years unresponsive to traditional treatment. Vaginal examination revealed no prolapse or vaginal fistula. Digital examination revealed multiple small rounded firm to hard or tender masses varying in size from 0.5 to 1.5 cm anterior to the vagina. Patient was treated with midline anterior vaginal wall incision with the extraction of eight smooth surfaced stones with uneventful postoperative course. Stone analysis revealed that they were composed of pure ammonium acid urate (AU). We recommend that for any patient with unexplained dyspareunia or vaginal discomfort that has proved to be unresponsive to traditional treatment, the possibility of anterior vaginal wall stones should be kept in mind.

In Workshop 8 at the International Conference on Interstitial Cystitis (Kyoto March 2003, future research needs for the definition/diagnosis of interstitial cystitis (IC) were discussed by the participants. To structure discussions a study proposal was used. This workshop decided that research should focus on identifying and validating classification criteria for the diagnosis of IC. This might well be done in a (multi-centre) study with a control group of urge-frequency patients without pain (OAB?). However, before doing so standards should be defined as on how to perform and interpret vaginal examination, urodynamic investigation, cystoscopy under anesthesia, potassium sensitivity test, and histopathology in these patients.

This study aims to find the incidence and outcome of caesarean wound infection in Patan Hospital, duringMarch 2002 to January 2003. We retrospectively analyzed records of patient who developed wound infectionfollowing caesarean section. Incidence of wound infection in Patan Hospital is comparatively low 2.76%.The minor wound infections (56.66%) required conservative management as an OPD basis while majorwound infections required resuturing. The wound infection is more commonly associated with color ofliqour, PROM and frequent number of vaginal examinations and emergency surgery.Key Words: Wound Infection, Caeserean Section, Nepal.

Urinary bladder stone is a rare cause of mechanical dystocia. We report a case of mechanical dystocia due to two large vesical calculi. The diagnosis was made during labor when on vaginal examination two large stone of sizes 5x5 cm and 5x4 cm were palpated from the anterior vaginal wall pushing the cervix to one side and obstructing the descent of head. Emergency caesarean section was performed along with simultaneous removal of urinary bladder stones by cystolithotomy. The post operative period was uneventful.

Non-puerperal uterine inversion is an extremely rare event, and the diagnosis is made during vaginal examination or exploratory laparotomy. We report a case of complete uterine inversion which was diagnosed on abdominal ultrasound examination in a 50-year-old nulliparous virgin who was admitted to the hospital because of profuse vaginal bleeding, lower abdominal pain and anuria. The confirmatory diagnosis of complete uterine inversion secondary to a fundal fibroid was made at exploratory laparotomy. Total abdominal hysterectomy was performed, and the pathological examination confirmed its benign nature. Ultrasound evaluation is useful in the diagnosis of non-puerperal uterine inversion.

Objective: to explore women's experiences during vaginal examinations in labour. Design: qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period. Data analysis: phenomenological hermeneutic analysis based upon Riceour's interpretation theory. Participants: a purposive sample of eight women post-delivery who had given birth vaginally and were able to speak and read Chinese. Setting: a maternity unit of a University affiliated District General Hospital in Hong Kong. Key findings: women accepted the necessity for vaginal examinations, but expressed the need to be able to trust that the examiner would respect them as individuals and try to maintain their dignity, perform the examination skillfully and communicate the findings to them. Pain and embarrassment were frequently experienced during vaginal examination. Women wanted to be supported during the examination by someone they knew and trusted; they appreciated practitioners who tried to minimise their physical and psychological discomfort. Some women felt embarrassed when examined by a male doctor, but the attitude and approach of the examiner was generally found to be more important than gender. Implications for practice: practitioners should be continuously aware of the need to show respect and consideration for the dignity of a woman undergoing vaginal examination in labour. Although this seems an obvious statement to make it is reiterated because some practitioners display insensitivity in this regard. Each woman should be treated with courtesy and respect, and her modesty protected by minimal exposure and examiners/examinations. Findings from the examination should be discussed with her. Practitioners should be aware of the cultural influences that may lead a woman to hide her pain during examination and should be alert for signs of this.