Will women’s choice of position in first stage of labor affect labor process?

Background: Controlling the process of childbirth has disabled the parturient to embrace the most spontaneous position of delivery but constricting her to assume a recumbent position. Objective of this study was to study if alternating comfortable maternal positioning i.e., recumbent and alternative position have any influence in the process of labor, type of delivery, neonatal well-being.Methods: Study conducted an observation study on term pregnant women. Study inclusion criteria included all term pregnant women. Exclusion criteria included multiple pregnancies, preterm patient, severe pre-eclampsia, and eclampsia, preterm premature rupture of membranes, sever intrauterine growth restricted fetus. The measured date were maternal general characteristics, duration of labor process, type of delivery and neonatal outcome. Patients were divided into two groups. Group A - if they spent more than 50% in a recumbent position and Group B - any other alternating position.Results: A total 250 women were equally included in this study. The demographic characteristics were matched in both groups and found no significant difference. In the process of labor, Group B had a difference of 1 hours as compared to Group A and the rate of cervical dilation was also faster in Group B. Both of these variables were found to be statistically significant. However, there were no significant difference in the terms of type of delivery and neonatal outcome.Conclusions: The ancient practice of recumbent position during labor is to be discarded as alternating maternal position during the process of labor may a positive influence on the total duration labor. However even though it may or may not have an influence on the other outcome such as route of delivery and neonatal outcome, it is best to encourage women to move and deliver in the most comfortable position.

The comparison of USG measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion

Background: The majority of women who undergo induced abortion are young and of low parity. Hence, it is desirable to look for any association effects of induced abortion with future reproductive outcomes. In this study, we aim to compare ultrasound measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion.Methods: This was a prospective observational study performed at tertiary care hospital. Total of 400 patients were recruited, divided into two groups. Patients with an induced abortion in previous pregnancy were included as cases and those with no history were taken as controls. Cervical length was measured by transvaginal ultrasound in all participants at 11-14, 18-22 and 28-32 weeks. Pregnancies were followed up to note incidence of spontaneous preterm delivery, preterm pre labour rupture of membranes (PPROM), threatened preterm, and second trimester miscarriage.Results: Authors have found that there was no significant difference in the cervical length of pregnant patients with or without a history of prior induced abortions.  In our study authors found that mean cervical length at 11-14weeks, 18-22 weeks, and 28-32 weeks was 3.47±0.126cm and 3.48±0.195cm; 3.44±0.296cm and 3.49±0.182cm; 3.36±0.477cm and 3.42±0.310cm respectively among cases and controls. However, there was a demonstrably increased risk of spontaneous preterm delivery, PPROM and threatened preterm in patients with a history of prior induced abortion.Conclusions: Authors conclude that previous induced abortion increases the risk of threatened preterm, PPROM, spontaneous preterm delivery in the subsequent pregnancy. But, this risk is not predictable by measuring cervical length as the mean cervical length remained the same in both the groups.

Evaluation of hysterosalpingoscintigraphy (HSSG) as a tool for tubal patency test.

Aim: To evaluate the role of hysterosalpingoscintigraphy (HSSG) as a tubal patency test and compare it with hysterosalpingography (HSG) in infertile patients. Objectives: To determine tubal patency with hysterosalpingoscintigraphy and test its accuracy as compared to hysterosalpingography; compare pain scale between hysterosalpingoscintigraphy and hysterosalpingography; determine time taken for the radiopharmaceutical to ascend up the genital tract during hysterosalpingoscintigraphy. Design: Prospective study Place: The study was conducted in the University Hospital setting. Patients and methods: HSSG was performed on 30 patients with 1 mCi technetium 99m labelled sulphur colloid. Sequential static images were obtained at 0, 15 minutes and 30 minutes. The results were compared to findings of hysterosalpingography. Results: Out of the 30 cases evaluated, 50% had bilateral patent tubes, 33.33% had unilateral patent tube, and 16.67% had bilateral blocked tubes. Time taken for sulphur colloid to reach uterus was 3 minutes 45 seconds; tubes 10 minutes 32 seconds; ovaries 25 minutes 48 seconds. All patients marked 0 on pain scale after HSSG while after HSG, 16 patients marked 3 and 14 patients marked 4 on pain scale. The sensitivity of HSSG was calculated to be 69.64%, specificity 75%, positive predictive value 97.5% and negative predictive value 15%. Conclusion: HSSG is easy to perform, with no premedication requirement and no pain in procedure with high positive predictive value (97.5%), but a poor negative predictive value (15%). This test can be used as compliment to other tubal patency test in the work up of infertility.