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Objective: To estimate the effect of speculum examination only versus digital cervical examination on maternal infectious morbidity in women with preterm prelabor rupture of membranes by performing a systematic review and meta-analysis. Materials and methods: We explored MEDLINE, Scopus, Embase, CINAHL, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials for studies comparing the rate of a composite maternal infectious morbidity (either chorioamnionitis, endometritis or both) in women with preterm prelabor rupture of membranes that underwent a speculum only versus digital cervical examination at the time of diagnosis. Two reviewers separately ascertained studies, obtained data, and gauged study quality. The rate of a composite maternal infectious morbidity (either chorioamnionitis, endometritis or both) were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Results: Four cohort studies, reporting on 1213 women were identified. The median point prevalence of the composite maternal infectious morbidity was 26% (interquartile range 15–35%) in women who had a speculum examination only compared to 33% (interquartile range 22–42%) in women who underwent a digital examination. The overall maternal composite infectious morbidity rate in women that had a speculum examination only was less compared to women that had undergone a digital examination (pooled OR 0.75, 95% CI 0.58–0.98, I² 17%). The weighted mean length of latency in women with preterm prelabor rupture of membranes was longer in individuals evaluated by speculum only versus digital examination, 6.6 d versus 2.9 d (mean difference 4.5 d, 95% CI 1.4 to 7.8, I² 99%). Conclusion: Speculum examination only in women with preterm prelabor rupture of membranes is associated with less maternal infectious morbidity and longer latency periods. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has changed medical teaching worldwide. Digital teaching and examinations are successful for cognitive learning objectives, whereas practical skills had to be carried out predominantly in person under strict hygiene standards. Aim: This study presents the opportunities and challenges of using a presence objective structured clinical examination (OSCE) at a distance with digital support. Method: Following surgical practical teaching an OSCE was conducted in presence, where students demonstrated practical skills in one room while the examiners were connected via videoconference from another room. Students were surveyed about the OSCE and sustained learning via a standardized online questionnaire after completion of the surgical teaching. Additionally, examiners were surveyed on their experiences. Results: In the online survey 40 students participated (25% of n = 157 students contacted) and 36 completed questionnaires were analyzed. Overall, the implementation of an OSCE even under pandemic conditions was perceived as very positive by the students (92% of students n = 33). In particular, the acquisition of practical skills was rated as very high. For 78% (n = 28) of the students, the acquisition of competencies through the practical examination was particularly sustainable. The vast majority of students and examiners felt safe regarding infection control because of the hygiene concept (92%, n = 33). Overall, 80 students achieved grade 1 (51%), 71 students grade 2 (45.2%) and 6 students grade 3 (3.8%) (grade 1 = very good, grade 6 = very bad). Conclusion: Practical examinations are essential for checking practical learning objectives and can be implemented at a distance with a well-developed hygiene concept and digital support. [ABSTRACT FROM AUTHOR]

Due to businesses’ growing use of IoT services in their day-to-day operations and the increased use of smart devices, digital forensic investigations involving such systems will need increasingly sophisticated digital evidence collection and processing. The majority of IoT systems are composed of disparate software and hardware components, which may pose security and privacy concerns. Recently, blockchain technology was presented as one of the options for achieving IoT security via the use of an immutable ledger, a decentralized architecture, and strong cryptographic primitives. Integrating blockchain platforms with IoT-based applications, on the other hand, poses a number of difficulties owing to the trustworthiness, integrity, and real-time responsiveness of IoT data. However, certain IoT devices may be incompatible with existing blockchain-based IoT forensic methods for additional digital evidence processing owing to their usage of conventional hash. A critical feature of cryptographic hash functions is that even if just one bit of the input is altered, the output acts pseudo-randomly, making it impossible to identify identical files. However, in the field of computer forensics, it is essential to locate comparable files (e.g., various versions of a file); therefore, we need a hash function that preserves similarity. It is getting more difficult to establish how forensic investigators might utilize traces from such devices. To effectively deal with IoT digital forensics applications, this article presents an improved blockchain-based IoT digital forensics architecture that uses the fuzzy hash to construct the Blockchain’s Merkle tree in addition to the conventional hash for authentication. Fuzzy hashing enables the identification of potentially damning documents that might otherwise remain undiscovered using conventional hashing techniques. By comparing blocks/files to all nodes in the blockchain network using fuzzy hash similarity, the digital forensics investigator will be able to verify their authenticity. To support the proof of concept, we simulated the suggested model.

Ultrasonography has been extensively used in obstetrics and gynecology since 1980’s. It found application in pediatric gynecology, procreation period, post-menopause, pregnancy monitoring and after delivery. Although the fi rst reports on the use of ultrasonography in assessing delivery mechanism were published in 1990’s, yet to date labor progress is evaluated by means of physical examination in most delivery units. Intrapartum sonography is not routinely performed despite the fact that numerous studies documented high error rates of conventional obstetrical examination. Even an experienced physician makes a mistake in every third case of the fetal head descent and fontanelle position assessment. Nowadays, obstetrician’s role is not to strain for vaginal delivery at all costs, but to provide the patient in labor and her newborn with maximal safety. To achieve this objective, an obstetrician should distinguish between women who will deliver spontaneously and whose who require Cesarean section. Proper decision should be made on the basis of objective and valid evaluation of obstetric setting, which cannot be achieved solely with physical examination. Intrapartum sonography was shown to be far more accurate than digital examination. Moreover, it is not technically demanding, provides high reproducibility and neither increases the rate of ascending infection or causes discomfort to the patient. Current research suggests that if used routinely, intrapartum sonography can increase the safety of labor and reduce cesarean section rate.

Objective:To compare elastosonography and digital examination of cervix for consistency in the prediction of successful vaginal delivery. Methods:A total of 64 pregnant women with the indication of induction of labor (IOL) were enrolled to the study. The uterine cervix is evaluated before and after the IOL with elastosonography and digital examination for consistency and sonography for length. Methods were compared in regard to the prediction of successful vaginal delivery. Results:The median of gestational age was 41.00 (IQR = 2.32). Out of 64 participants, 40 (62.5%) had vaginal delivery and 24 (37.5%) had cesarean delivery. The preinduction and postinduction elastosonographic indices were insignificant in delivery groups. The preinduction and postinduction evaluations of cervical consistency with digital examination were significant within vaginal delivery group (p = 0.046), whereas it was insignificant within cesarean delivery group and between the delivery groups. The preinduction and postinduction Bishop scores were significant within vaginal delivery group (p = 0.005), whereas it was insignificant within cesarean delivery group and between the delivery groups. Postinduction Bishop score was significant between the delivery groups. Conclusion:Evaluation of cervix for consistency with either elastosonography or digital examination was found to be insignificant in prediction of successful vaginal delivery after IOL with oxytocin. [ABSTRACT FROM AUTHOR]

Dry-mount fecal cytology (FC) is a component of the diagnostic evaluation of gastrointestinal diseases. There is limited information on the possible effect of the sampling method on the cytologic findings of healthy dogs or dogs admitted with diarrhea. We aimed to: (1) establish sampling method–specific expected values of selected cytologic parameters (isolated or clustered epithelial cells, neutrophils, lymphocytes, macrophages, spore-forming rods) in clinically healthy dogs; (2) investigate if the detection of cytologic abnormalities differs among methods in dogs admitted with diarrhea; and (3) investigate if there is any association between FC abnormalities and the anatomic origin (small- or large-bowel diarrhea) or the chronicity of diarrhea. Sampling with digital examination (DE), rectal scraping (RS), and rectal lavage (RL) was prospectively assessed in 37 healthy and 34 diarrheic dogs. The median numbers of isolated (p = 0.000) or clustered (p = 0.002) epithelial cells, and of lymphocytes (p = 0.000), differed among the 3 methods in healthy dogs. In the diarrheic dogs, the RL method was the least sensitive in detecting neutrophils, and isolated or clustered epithelial cells. Cytologic abnormalities were not associated with the origin or the chronicity of diarrhea. Sampling methods differed in their sensitivity to detect abnormalities in FC; DE or RS may be of higher sensitivity compared to RL. Anatomic origin or chronicity of diarrhea do not seem to affect the detection of cytologic abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to evaluate the utility of digital examination in addition to ultrasonic measurement of cervical length for predicting spontaneous preterm delivery in women with threatened preterm labor.Material and Methods: This was a prospective cohort study in Strasbourg University Hospital, France, between January 2013 and January 2015. All women with a singleton pregnancy hospitalized with threatened preterm labor between 23 and 34 weeks of gestation were included. Cases of iatrogenic preterm delivery were excluded. A multivariable logistic regression model to estimate the significant predictive parameters of spontaneous preterm delivery was performed. The primary endpoint of our study was a preterm birth before 34 weeks of gestation.Results: A total of 395 women were included in our study. The rate of preterm delivery before 34 weeks was 13%. In univariate analysis every single cervical parameter assessed by the digital examination and all the ultrasound parameters were significantly associated with preterm delivery. The final model included five variables predicting preterm birth: visualization of the membranes at the speculum examination (OR 15.8, 95% CI 2.43-146), ultrasound cervical length (OR 0.82, 95% CI 0.75-0.89), signs of inflammation (OR 6.23, 95% CI 2.07-22.9), gestational age on admission (OR 0.84, 95% CI 0.71-1.0), and presence of vaginal infection (OR 4.28, 95% CI 1.52-12.7). None of the cervical parameters assessed by the digital examination provided additional predictive value of preterm delivery.Conclusion: Our study suggests that digital examination does not add to the information given by vaginal ultrasound evaluation in predicting preterm labor. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether routine vaginal examination during labor is associated with increased levels of anxiety and pain compared with transperineal ultrasound assessment.Methods: This was a single-blinded, parallel, randomized controlled trial conducted in a tertiary care facility. Parous pregnant women without a known psychiatric condition who were seen at the care facility between November 2015 and March 2016 were included in the trial. Participants had an uneventful pregnancy and were assigned randomly to routine digital vaginal examination or transperineal ultrasound assessment during labor. Psychological distress levels, measured by the Symptom Checklist-90-Revised, and anxiety levels, measured by State-Trait Anxiety Inventory (STAI), were recorded before admission, and pain, measured using a visual analog scale, and anxiety were recorded during the latent phase of labor, the beginning of active labor and the postpartum period. A sample size of 45 women per group (n = 90) was planned to compare methods of assessment.Results: Ninety women were randomized (1:1 allocation) to one or other of the interventions. Preadmission psychological distress and anxiety levels were similar between the two groups (P = 0.93 and 0.65, respectively). Most of the studied characteristics were similar in each group including duration of labor, number of examinations, analgesic administration during labor, episiotomy rate and interval between deliveries. Visual analog scale scores revealed that pain perception was reduced during latent (mean difference, -1.5 (95% CI, -2.51 to -0.57); P < 0.01) and active (mean difference, -1.2 (95% CI, -2.45 to -0.09); P = 0.03) stages of labor and during the postpartum period (mean difference, -0.5 (95% CI, -1.02 to -0.06); P = 0.02) in participants who had a transperineal ultrasound assessment compared with participants who had a digital vaginal examination. STAI scores revealed that anxiety levels were similar between the two groups during the latent and active phases of labor and during the postpartum period (P = 0.07, P = 0.38 and P = 0.13, respectively).Conclusions: The perception of pain was significantly reduced with the use of a transperineal ultrasound assessment compared with routine digital vaginal examination. However, only during the latent stage of labor was the magnitude of the observed effect sufficiently great to be considered clinically significant. Our results indicate that transperineal ultrasound assessment could be preferred to digital examination for the evaluation of progression of labor during this phase. Digital examination has no clinically relevant effects on state anxiety levels, as measured by the STAI. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Les moyens diagnostiques actuels ne permettent pas de prévoir si une patiente consultant en urgence pour une menace d’accouchement prématuré (MAP) accouchera ou non prématurément. Un nouveau marqueur biochimique de détection d’accouchement prématuré a été développé et permettrait de prédire un accouchement dans les 7 à 14 jours. Les performances diagnostiques du test de détection de la PAMG-1 ont été validées avant la réalisation d’un toucher vaginal (TV). Cependant le TV est souvent réalisé en première intention. L’objectif de notre étude était de vérifier la reproductibilité de ces performances diagnostiques après TV et échographie endovaginale (EEV). Patientes Une étude prospective, observationnelle a été réalisée dans une maternité de type 3 (CHU de Saint-Etienne), entre juin 2013 et janvier 2014. Les patientes ayant consulté aux urgences obstétricales pour suspicion de MAP entre 24 et 34 SA (semaines d’aménorrhées) ont été incluses. La reproductibilité du test a été évaluée après TV, EEV et à distance de toute investigation. Résultats Quarante et une patientes ont été incluses dans notre étude. L’âge gestationnel moyen était de 29 SA, le TV était modifié chez 36 patientes, alors que l’EEV était inférieure à 26 mm chez seulement 17 patientes. Dans notre étude, 100 % des résultats des tests ne se modifient pas après la réalisation d’un TV et 95,1 % après une échographie endovaginale. Nos résultats ont confirmé son excellente spécificité (97,5 %[IC 95 % ; 86,8–99,9]) et valeur prédictive négative (97,5 % [IC 95 % ; 86,8–99,9]). Ce travail a permis de démontrer la reproductibilité du test de détection de la PAMG-1. Conclusion Une prise en charge initiale ayant recours au test de détection de la PAMG-1 pourrait permettre de diminuer le taux d’hospitalisation inutile en ciblant plus précisément les patientes à fort risque d’accouchement prématuré. Objectives With current diagnostic resources, it is impossible to predict if a patient consulting in the obstetrics emergencies with symptoms of preterm labor, preterm delivery or not. A novel test for the detection of time to spontaneous preterm delivery was developed and would predict imminent delivery in 7 or 14 days from the time of testing. The diagnostic performances of detection test of PAMG-1 have been validated before digital examination. However digital examination is usually made in first line. The objective of this study was to assess the reproducibility of these diagnostic performances after digital examination and transvaginal ultrasound cervical length. Methods A prospective and observational study was conducted in a level 3 maternity (University Hospital of Saint-Etienne), from June 2013 to January 2014. Patients consulted in the obstetrics emergencies for threatened preterm birth between 24–34 weeks were enrolled with written and signed consent. Reproducibility of this test was assessed after digital examination, transvaginal ultrasound cervical length and a long time after all investigations. Results Forty-one patients were included in our study. Average gestational age was 29 weeks, digital examination was changed in 36 patients, whereas cervical length was less than 26 mm for only 17 patients. In our study, 100% of tests results remain negative or positive after digital examination and 95,1% after transvaginal ultrasound. Our results confirmed this excellent specificity (97.5% [IC 95%; 86.8–99.9]) and negative predictive value (97.5% [IC 95%; 86.8–99.9]). Conclusion This work allowed to demonstrate the reproducibility of detection test of PAMG-1 after a digital examination. An initial management with detection test of PAMG-1 could allow reducing the rate of unnecessary hospitalization. [ABSTRACT FROM AUTHOR]

Assessment through new technology has gained a firm foothold within the university system in the last decade. This paper summarizes the experiences during the introduction of digital examination over the past two years at the Royal Institute of Technology in Stockholm, Sweden. These experiences come from three different perspectives; teachers, students and administrators. From the teachers' perspective the experience has been very positive - less time was allocated to grading written examinations, the grades are perceived as fairer and the time saved can be spent on increasing the quality of other parts of the courses. From a student perspective the experience has also been very positive - most students are enjoying obtaining the results much more quickly, editing their answers on the examination more easily and the grades are perceived as fairer. The administrators' experience is far more complex. While some parts of the administrative system encouraged the introduction of digital examination, other parts tried to stop it. The paper concludes with some advice on implementing changes in written examinations, based on the experience of the Swedish case. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to prospectively investigate the degree of pain experienced by the patients receiving transrectal ultrasonography (TRUS) of the prostate by applying a visual analog scale. We also identified the clinical parameters influencing pain during the TRUS examination. Materials and methods: Records were obtained from a prospective database for male patients who received TRUS of prostate in the outpatient department of Chang Gung Memorial Hospital, Taiwan, from January 2014 to June 2014. The patients underwent a detailed physical examination and medical history review. Immediately after the TRUS examination, the patients completed questionnaires based on a ten-point visual analog pain scale. The variables of interest were age, body mass index, prostate volume, prostate sagittal length, prostate-specific antigen, previous TRUS experience, external hemorrhoids, anal surgical history, prostate calcification, and image artifact caused by stool in the rectum. All variables were correlated to the visual analog scale by applying multivariate regression analysis. Results: By using linear regression analysis, we identified the independent factors that affected the pain score during the TRUS examination. The patients who received the examination for the first time or had longer prostate sagittal lengths, external hemorrhoids, anal surgical history, or stool stored in the rectum experienced more pain during the TRUS examination. Furthermore, the pain was reduced when we provided the patients with a detailed explanation before the procedure and allowed them to observe the real-time images during the examination. Conclusion: Although a TRUS examination is uncomfortable for patients, after having identified the factors affecting pain, physicians can assist patients in reducing pain during the procedure, thus providing higher quality examinations. [ABSTRACT FROM AUTHOR]

Objetivo: avaliar o colo uterino por meio do toque vaginal e da ultra-sonografia transvaginal em gestantes de risco elevado para o parto prematuro. Métodos: durante o período compreendido entre fevereiro de 1995 e setembro de 1997 foram acompanhadas 38 gestantes com elevado risco para o parto prematuro entre a 20ª e 36ª semana de gestação. Estas pacientes foram submetidas semanalmente ao toque vaginal e ao exame ultra-sonográfico transvaginal. O toque vaginal avaliou o colo uterino quanto a dois parâmetros: comprimento e dilatação. A ultra-sonografia transvaginal estudou o comprimento e o diâmetro anteroposterior do colo uterino. Foram analisados os comportamentos destas medidas cervicais ao longo da gestação. Os dois métodos foram comparados quanto à avaliação cervical e à acurácia no diagnóstico do parto prematuro. Resultados: a incidência de partos prematuros foi de 18,4% (7/38). As medidas do comprimento cervical obtidas pela ultra-sonografia foram sempre maiores em relação às medidas obtidas pelo toque vaginal. Mediante análise pelo teste de hipóteses foram observadas uma relação indireta entre o comprimento cervical e a idade gestacional por meio do toque e do estudo ultra-sonográfico (pObjective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods were compared regarding cervical evaluation and accuracy of premature birth diagnosis. Results: the rate of premature deliveries was 18.4% (7/38). Digital examination resulted in cervical evaluations with variation coefficients of 30.3% for length and 193% for dilation. Transvaginal ultrasound resulted in cervical evaluations with variation coefficients of 14.7% and 26.5% for the anteroposterior diameter and length, respectively. The cervical length measures obtained on ultrasound were always greater than those obtained on digital examination. Through analysis with the hypothesis test, an indirect relationship was observed between the cervical length and the gestational period for digital examination and ultrasound study (p

Objective To compare clinical data and transperineal ultrasound results for the diagnosis of fetal head engagement. Methods The present prospective longitudinal study enrolled 100 term women attending the Mongi Slim Hospital, La Marsa, Tunisia, between July and September 2012. The clinical assessment of fetal engagement was compared with ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was the distance between the perineum and external table of fetal skull. Results The ultrasound measures of the perineum to external table of fetal skull ranged from 13 to 75 mm. The measures of the perineum to succedaneum bump ranged from 22 to 68 mm. A threshold of 55 mm was determined as the perineum to fetal head distance above which a diagnosis of engagement would be reversed. This proposed threshold had a positive predictive value of 98.6%, a sensitivity of 86.7%, and a specificity of 94.1%. Conclusion Transperineal ultrasound is a simple, rapid, and reproducible method for the diagnosis of fetal head engagement. It can be used in the delivery room in addition to clinical examination and when the latter is hampered by a succedaneum bump. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Le toucher vaginal est la méthode de référence dans le diagnostic de l’engagement de la tête fœtale à dilatation complète. Cependant, cet examen clinique est subjectif et peu reproductible. L’échographie pourrait être un nouveau moyen de préciser l’engagement de la tête fœtale avec des mesures objectives et reproductibles. Objectif: Comparer les données de l’examen clinique et l’étude échographique par voie transpérinéale dans le cadre du diagnostic de l’engagement de la tête fœtale. Patientes et méthodes: Nous avons réalisé une étude prospective longitudinale sur une série de 70 patientes et comparé l’appréciation clinique de l’engagement fœtal aux mesures échographiques. L’examen échographique était réalisé sur table d’accouchement, par voie transpérinéale. La sonde était posée sur l’espace ano-vulvaire. La mesure échographique utilisée était : la distance périnée–repère osseux de la tête fœtale. Résultats: Les mesures échographiques de la distance (périnée–repère osseux de la tête fœtale) allaient de 13 à 75mm ; et les mesures de la distance (périnée–bosse sérosanguine) allaient de 22 à 68mm. Nous avons essayé de retenir une valeur seuil de la distance (périnée–repère osseux de la tête fœtale) au-dessus de laquelle le diagnostic de l’engagement serait infirmé. Le seuil ainsi proposé est celui de 55mm avec une valeur prédictive positive à 98 %, une sensibilité à 87 % et une spécificité à 93 %. Discussion et conclusion: L’échographie permet le diagnostic d’engagement par la mesure de la distance périnée–repère osseux de la tête. Ce nouvel outil peut être très utile en salle de naissance dans le cas où l’examen clinique s’avère non concluant gêné, par exemple, par la présence d’une bosse sérosanguine. [Copyright &y& Elsevier]

The occiput posterior (OP) position is one of the most frequent malposition during labor. During the first stage of labor, the fetal head may stay in the OP position in 30% of the cases, but of these only 5-7% remains as such at time of delivery. The diagnosis of OP position in the second stage of labor is made difficult by the presence of the caput succedaneum or scalp hair, both of which may give some problem in the identification of fetal head sutures and fontanels and their location in relationship to maternal pelvic landmarks. The capability of diagnosing a fetus in OP position by digital examination has been extremely inaccurate, whereas an ultrasound approach, transabdominal, transperineal and transvaginal, has clearly shown its superior diagnostic accuracy. This is true not only for diagnosis of malpositions, detected in both first and second stage of labor, but also in cases of marked asynclitism. [ABSTRACT FROM AUTHOR]

Objectives To describe a two-dimensional (2D) ultrasound technique to measure cervical dilatation in labor, and to compare ultrasound with digital measurements. Methods 2D transperineal ultrasound was performed in 21 nulliparous women in labor with a singleton fetus in cephalic presentation and cervical dilatation measured before or after a digital vaginal examination. The absolute difference was calculated and Bland-Altman analysis was used to assess the mean difference between digital vaginal examination and ultrasound examination of cervical dilatation. Pearson analysis was used to determine the correlation between digital and ultrasound measurements. Intraclass correlation coefficients (ICCs) with 95% CI were used to evaluate the reliability of the two methods. Results Satisfactory quality images of the cervix were obtained in 19 of 21 cases. There was positive correlation between 2D ultrasound measurement of cervical dilatation and digital vaginal examination (Pearson coefficient r = 0.821, n = 19, P < 0.001). Bland-Altman analysis showed a mean difference between digital and ultrasound measurements of 0.08 cm (95% limits of agreement: -1.83 to 2.00) and the mean absolute difference was 1.24 cm. The ICC between the two methods was 0.81 (95% CI, 0.58-0.92). Conclusions Assessment and measurement of cervical dilatation by 2D transperineal ultrasound is feasible, with close agreement shown between the technique and digital vaginal examination. The technique that we describe could represent an important component of a 'sonopartogram' for ultrasound assessment of labor progress. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Aim of this study is to investigate pelvic floor muscle pain scores in a group of healthy, asymptomatic, nulliparous women using a simple visual analogue scale, and to examine the inter-rater and test-retest reliability of the digital palpation of the pelvic floor muscle. Methods: Seventeen female volunteers were recruited. Different sites of their pelvic floor muscle were examined digitally according to the suggestions of the International Continence Society from two investigators blinded to the clinical data in two consecutive visits and pain scores were obtained. Level of agreement between investigators, inter-rater and intra-rater reliability were assessed. Results: Overall pain scores were low. There were statistically significant differences between scores at different pelvic sites, with the levator ani showing the lowest scores. Reliability was heterogeneous among pelvic sites, varying from poor to excellent. Conclusions: Pain upon palpation of the pelvic floor muscle in asymptomatic, nulliparous women should be considered an uncommon finding. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasonography could be helpful to determine fetal head engagement during the second stage of labor. Patients and methods: Prospective unicentric study to compare the diagnostic of fetal head orientation and engagement between digital examination and ultrasonography. One hundred measurements were performed in 100 patients at complete cervical dilatation. Results: In 80 % of patients, abdominal ultrasound assessments were consistent with digital examinations in depicting fetal head position. We were not able to evaluate engagement by abdominal ultrasonography. Perineum to fetal head distance was measured between 12 and 83mm by translabial ultrasonography. When the head was not engaged (−1), the mean distance was 66.4±7.53mm. The measure was 56.15±10.86mm when the head was at the upper part of the birth canal (+1), 46.47±12.49mm at the middle part (+2) and 35.81±10.42mm at the lower part (+3; +4). A threshold of 55mm was associated with a sensibility and a negative predictive value of 100 % for vaginal birth. Discussion and conclusion: Abdominal intrapartum ultrasound increases the accuracy of fetal head position assessment. Translabial ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. Ultrasound during the second stage of labor may serve as an educational tool for physicians in training. [Copyright &y& Elsevier]

Purpose: The objective of this study was to determine if transvaginal ultrasound (TVUS) examination of cervical length correlates to digital pelvic examination and if it can predict time to and mode of delivery in term pregnancies. Methods: We conducted a prospective cohort study of 726 consecutive non-laboring, term pregnant women presenting to University-based antenatal testing unit between 1 July 2001 and 31 March 2002. Subjects underwent a TVUS for cervical length followed by a digital cervical examination by a physician blinded to the results of the ultrasound. Linear regression analysis was used to correlate the findings of cervical length by ultrasound with cervical dilatation and effacement by digital examination. Results: In 726 women, the relationship between TVUS cervical length and cervical dilatation and effacement measured digitally were found to be significantly related (p < 0.001), but weak, with a 15 and 23% goodness of fit, respectively, based on the linear model. Using multivariate logistic and linear regression, respectively, TVUS cervical length predicted mode of delivery but did not predict time to spontaneous labor. Digital measurement of cervical dilatation was predictive of time to spontaneous labor. Conclusions: There is a statistically significant correlation between TVUS measurement of cervical length and digital cervical exam though the correlation is weak. TVUS measurement of cervical length was predictive of mode of delivery while controlling for digital cervical examination, parity and time to spontaneous labor. Digital cervical dilatation was predictive of time to spontaneous delivery. [ABSTRACT FROM AUTHOR]

The article presents a prospective observational study regarding the evaluation on the degree of cervical length shortening among women with singleton gestations after an initial induction of labor. The study administered transvaginal ultrasound (TVS) to predict the success of labor induction and preterm delivery and used multiple logistic regression analysis. Results showed that shortening cervical length is of predictive value after its failure on the first day of serial induction.

Objective: The objective of this study was to explore factors influencing the accuracy of transvaginal digital examination for determining fetal head position during the first stage of labor. Materials and Methods: Fetal head position was assessed in 87 women in the first stage of labor at term with normal singleton cephalic presentation. Transvaginal digital examinations were performed by attending midwives and were followed immediately by transabdominal ultrasound assessments performed by a single sonographer. Accuracy was defined as agreement of the results of each examination. Multivariate logistic regression analysis was performed to determine the independent factors influencing accuracy. Results: In only 40.3% of patients (n = 35) were transvaginal digital examinations consistent with ultrasound assessments. Multivariate logistic regression analysis showed that the accuracy of digital examinations was significantly associated with cervical dilatation more than 7 cm (odds ratio, 3.01; 95% confidence interval [CI], 1.03-9.4), birth weight less than 2,500 g (odds ratio, 8.68; 95% CI, 1.08-86.28), and the anterior occiput position group (odds ratio, 4.73; 95% CI, 1.76-13.49). Conclusions: The present study demonstrates that transvaginal digital examination is less accurate than ultrasonography for determining fetal head position during the first stage of labor. The results suggest that ultrasound assessments should be routinely performed in patients with a cervical dilatation less than 7 cm, an estimated fetal body weight more than 2,500 g, the occiput posterior position, or the occiput transverse position. [ABSTRACT FROM AUTHOR]