<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an e...<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an essential step to reduce the increasing rates of cesarean section reported worldwide.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Objective</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> To study the rate of cervical dilation in the</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour in spontaneous and induced labour and in primigravida and multigravida with singleton pregnancy.</span></span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Methods</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A prospective observational study conducted at a multispeciality hospital was carried out for a period of 3 years from Jan 2017 to Dec 2019. </span><span style="font-family:Verdana;">A </span><span style="font-family:Verdana;">total </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">640 patients who were admitted with spontaneous and induced labour having singleton pregnancy with cephalic presentation and intact membranes after 34 weeks who delivered vaginally were included for analysis. Progression of labor in </span><span style="font-family:Verdana;">the </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour was measured by </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">rate of cervical dilation as noted by serial per vaginal examination and findings were plotted in partograph.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Result</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> The difference between mean rate of cervical dilation in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">study group is statistically significant between 4</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">6 cm and 6 - 10 cm (P < 0.0001</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;">. When primigravida & multigravida patients were compared for the cervical dilation rate, statistically significant difference was seen between 4 - 6 cm but not in 6 - 10 cm</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">Average rate of cervical dilatation was 3.44 (Standard Deviation (SD</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> = 1.84</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in spontaneous labor while average rate of cervical dilatation was 2.69 (SD = 1.18</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in induced labor between 6</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cm of cervical dilatation. </span><u><span style="font-family:Verdana;">Conclusion</span></u></span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The active </span><span style="font-family:Verdana;">phase of labour starts at 6 cm of cervical dilation in the majority of the patients. </span><span style="font-family:Verdana;">In multigravida, cervix dilates at faster rate before 6 cm. In induced labour cervix dilates at a slower rate than spontaneous labour after 6 cm dilation.</span></span>展开更多
Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span st...Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">If the direction of the cervical canal is known</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Results</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">No operative complications were found.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Conclusion</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.</span></span></span>展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is ...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indi</span><span style="font-family:Verdana;">cates it is safe. Despite of this many reports of adhesions and bowel obstruction </span><span style="font-family:Verdana;">are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The objective was to quantify the exposure of barbed suture at vaginal </span><span style="font-family:Verdana;">vault by adopting a uniform technique of vault suturing and assessing p</span><span style="font-family:Verdana;">ost</span><span><span style="font-family:Verdana;">operative risk related to adhesions at vaginal vault. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">In 30 pati</span></span><span style="font-family:Verdana;">ents who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. </span><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"> Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. </span><b><span style="font-family:Verdana;">Conclusion and Recommendations:</span></b><span style="font-family:Verdana;"> The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.</span></span></span></span>展开更多
文摘<u>Introduction</u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Knowledge of change in the duration of stages of labour would be an essential step to reduce the increasing rates of cesarean section reported worldwide.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Objective</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> To study the rate of cervical dilation in the</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour in spontaneous and induced labour and in primigravida and multigravida with singleton pregnancy.</span></span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Methods</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A prospective observational study conducted at a multispeciality hospital was carried out for a period of 3 years from Jan 2017 to Dec 2019. </span><span style="font-family:Verdana;">A </span><span style="font-family:Verdana;">total </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">640 patients who were admitted with spontaneous and induced labour having singleton pregnancy with cephalic presentation and intact membranes after 34 weeks who delivered vaginally were included for analysis. Progression of labor in </span><span style="font-family:Verdana;">the </span><span style="font-family:;" "=""><span style="font-family:Verdana;">1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> stage of labour was measured by </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">rate of cervical dilation as noted by serial per vaginal examination and findings were plotted in partograph.</span><span style="font-family:;" "=""> </span><u><span style="font-family:Verdana;">Result</span></u><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> The difference between mean rate of cervical dilation in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">study group is statistically significant between 4</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">6 cm and 6 - 10 cm (P < 0.0001</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;">. When primigravida & multigravida patients were compared for the cervical dilation rate, statistically significant difference was seen between 4 - 6 cm but not in 6 - 10 cm</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;">Average rate of cervical dilatation was 3.44 (Standard Deviation (SD</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> = 1.84</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in spontaneous labor while average rate of cervical dilatation was 2.69 (SD = 1.18</span><span style="font-family:Verdana;">)</span><span style="font-family:Verdana;"> in induced labor between 6</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">10</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cm of cervical dilatation. </span><u><span style="font-family:Verdana;">Conclusion</span></u></span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The active </span><span style="font-family:Verdana;">phase of labour starts at 6 cm of cervical dilation in the majority of the patients. </span><span style="font-family:Verdana;">In multigravida, cervix dilates at faster rate before 6 cm. In induced labour cervix dilates at a slower rate than spontaneous labour after 6 cm dilation.</span></span>
文摘Introduction<span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">If the direction of the cervical canal is known</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Results</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">No operative complications were found.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Conclusion</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.</span></span></span>
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indi</span><span style="font-family:Verdana;">cates it is safe. Despite of this many reports of adhesions and bowel obstruction </span><span style="font-family:Verdana;">are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The objective was to quantify the exposure of barbed suture at vaginal </span><span style="font-family:Verdana;">vault by adopting a uniform technique of vault suturing and assessing p</span><span style="font-family:Verdana;">ost</span><span><span style="font-family:Verdana;">operative risk related to adhesions at vaginal vault. </span><b><span style="font-family:Verdana;">Method: </span></b><span style="font-family:Verdana;">In 30 pati</span></span><span style="font-family:Verdana;">ents who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. </span><b><span style="font-family:Verdana;">Result:</span></b><span style="font-family:Verdana;"> Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. </span><b><span style="font-family:Verdana;">Conclusion and Recommendations:</span></b><span style="font-family:Verdana;"> The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.</span></span></span></span>
