Objectives: Well-established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head-perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women's pain during such examinations.
Methods: Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed-effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery.
Results: A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1-3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0-2), with no significant difference between vaginal- or Cesarean-delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0-1) and for VE it was 3 (IQR, 0-6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD.
Conclusions: Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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http://dx.doi.org/10.1002/uog.27634 | DOI Listing |
Mol Carcinog
January 2025
Department of Neurosurgery, Huanggang Central Hospital of Yangtze University, Huanggang, China.
Glioblastoma (GBM) is the most common malignant primary brain tumor, with a mean survival of less than 2 years. Unique brain structures and the microenvironment, including blood-brain barriers, put great challenges on clinical drug development. Sophoricoside (Sop), an isoflavone glycoside isolated from seeds of Sophora japonica L.
View Article and Find Full Text PDFInt J Psychoanal
December 2024
Training and Supervising Analyst, Faculty and former Chair, Student Progression Committee, Psychoanalytic Association of New York (PANY) affiliated with NYU Grossman School of Medicine, New York, NY, USA.
Countertransferential and other types of personal responses to candidates are inevitable among psychoanalytic educators, whether they be supervisors, progression advisors, the progression committee as a whole, or course instructors. Nonetheless many educators remain unaware of these phenomena - despite the robust literature on this subject in supervisors - perhaps because we do not like to think of ourselves as having potentially deleterious personal reactions to younger colleagues with whom we have significant and highly valued relationships. This paper emphasizes the role of such phenomena in progression advisors' deliberations about candidates' development, as well as in the committee as a whole - a subject not addressed in the literature.
View Article and Find Full Text PDFInt J Psychoanal
December 2024
SBPSP (Brazilian Society of Psychoanalysis, São Paulo), São Paulo, Brazil.
In order to honour the work of Dana Birksted-Breen I will attempt to show how the reading of her work has impacted on my own thinking and changed it or modified it. I would like to begin by highlighting one of Dana's claims in . I will focus on two areas: (1) the development of symbolic capacity and its connection with temporality, and (2) the concept of reverie as a .
View Article and Find Full Text PDFCureus
December 2024
Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, SGP.
This case report describes a 70-year-old male presenting with limb weakness, urinary retention and tandem cervical and lumbar spinal stenosis with complicating white cord syndrome, a rare reperfusion injury post decompression surgery. Initially admitted following an unwitnessed fall, the patient's neurological examination indicated that progressive weakness of the limbs and sensory loss etiology is cervical and lumbar spondylosis with severe spinal canal stenosis, confirmed by imaging. Due to rapid deterioration, he underwent C5 corpectomy, cervical decompression and fusion.
View Article and Find Full Text PDFCureus
December 2024
Department of Family and Community Medicine, Arabian Gulf University, Manama, BHR.
Introduction: Mumps is a vaccine-preventable disease caused by the paramyxovirus affecting the salivary gland and may be complicated by orchitis, oophoritis, and encephalitis. This study aims to describe the epidemiology, clinical presentation, and transmission of mumps cases in the Kingdom of Bahrain between 2012 and 2022.
Methodology: A retrospective cross-sectional study was conducted using national surveillance data of confirmed mumps cases, including all age groups and both Bahraini and non-Bahraini nationals, from January 2012 to December 2022.
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