vaginal

The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.

The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.

There were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).

This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

Context: 

Birth is a physiological and multidimensional process with physical, psychological, and social aspects. Therefore, it needs to be addressed in all aspects. Today, metaphors are used to render multidimensional concepts more understandable.

 To determine the women’s emotions about the experience of normal childbirth based on the metaphors.

Setting and Design:

 A phenomenological study on postpartum women who gave vaginal birth at a state hospital in Turkey in 2019–2020.

 The purposive sampling was employed until data saturation. Data were collected with a descriptive characteristic form and an individual semi‑structured interview with 31 women who gave a vaginal birth.

Statistical Analysis Used: 

The content analysis defined by Graneheim and Lundman was used in the analysis of the data.

 Three different themes emerged from the interviews: metaphors reflecting positive emotions, metaphors reflecting complex emotions, and metaphors reflecting negative emotions.

 Extracted metaphors in this study showed that positive and negative childbirth experiences may affect women’s emotions about childbirth process. It was determined that received antenatal education was effective on women’s positive or negative perception of the birth process. Hence, providing the information for pregnant women in the prenatal period may be a helpful factor in the development of positive metaphors.

 Prediction of preterm delivery can reduce a large number of its complications. The present study aimed to compare vaginal and plasma fibronectin concentrations in the diagnosis of preterm delivery.

 Serum samples were obtained from 105 women at 24-36 weeks of gestation. However, only 40 women gave permission to collect vaginal samples. Fibronectin concentration was measured using the ELISA technique. Then, plasma and vaginal fibronectin levels were compared in term and preterm deliveries.

 The mean plasma fibronectin level was 6226.43±7174.97 ng/ml among the mothers with term infants and 7724.01±1143.82 ng/ml among those with preterm infants (p=0.667). The mean fetal fibronectin level was 156.61±126.42 ng/ml among the mothers with term infants and 127.71±43.14 ng/ml among those with preterm infants (p=0.241). The cut-off point of plasma fibronectin level was 1750 ng/ml with a sensitivity of 80.25% and specificity of 85.17%. Additionally, the cut-off point of vaginal fibronectin level was 158.98 ng/ml with a sensitivity of 94.62% and specificity of 22.08%.

 Plasma fibronectin analysis had lower sensitivity and higher specificity compared to vaginal fibronectin analysis. This implies that plasma testing has lower false-positive cases and can identify a more significant number of true positive cases of preterm delivery.

Misoprostol can be used by different routes in the medical management of abortion. This study aimed to compare the efficacy and safety of buccal and vaginal administration of misoprostol for the completion of first-trimester abortions.

This study was a randomized clinical trial in which women with first-trimester abortion referred to Imam Hossein Medical Center in 2018 were studied. Women were randomly divided into two groups of buccal or vaginal misoprostol treatment. From the time of drug administration to complete abortion, side effects, duration of drug use until tissue excretion, need for blood transfusion and need for surgical evacuation were recorded and compared in two groups.

One-hundred women (each group, 50 patients) were evaluated in this study. There was a significant difference between the two groups regarding the duration of misoprostol use (p-value = 0.028), and it was longer in the buccal group. Besides, there was a significant difference between the two groups in terms of the dose required until the tissue discharge (p-value = 0.034). In the buccal group, patients received higher doses of misoprostol. The rate of fever had a significant difference between the two groups and was more frequent in the vaginal group (p-value=0.023).

Vaginal misoprostol can be more effective in treating first-trimester abortions compared to buccal misoprostol and may be associated with longer duration of use and lower required doses.

Childbirth causes intense emotional arousal that may cause traumatic psychological symptoms in some women. This study investigated the prevalence of post-traumatic stress disorder (PTSD) in women with normal vaginal delivery and those with caesarian section. This was a cross-sectional study conducted in selected health centers affiliated to Shiraz University of Medical Sciences in 2018. The samples included 714 patients (328 vaginal deliveries and 386 cesarean deliveries). Sampling was performed using the convenience sampling method in two cluster stages after selecting the clinic. Mothers were determined to be traumatic in their delivery according to criterion A in the Diagnostic and Statistical Manual of Mental Disorders Version DSM-IV (with four questions). Then, a demographics checklist and a stress disorder questionnaire were filled out for all the mothers after a traumatic delivery through interviews. The prevalence of postpartum stress disorder was higher in the cesarean section group (10.8%) than in the normal vaginal delivery group (10%), but this difference was not significant (P = 0.275). Although the prevalence of PTSD between the two groups was not significant, the prevalence of PTSD was significantly higher in this study than in reports from other countries. This highlights the need for targeted interventions to reduce this disorder.

Luteal-phase support is a complex and controversial issue in the field of reproductive management.

To compare the safety and efficacy of low-dose subcutaneous progesterone with the vaginal progesterone for luteal-phase support in patients undergoing rozen-thawed embryo transfer.

In this cross-sectional study, information related to 77 women that had frozen-thawed embryo transfer was reviewed. The patients were divided into two groups based on the route of progesterone administration used as a luteal-phase support. When the endometrial thickness reached ≥ 8 mm, in one group progesterone (Prolutex) 25 mg/ daily subcutaneous and in another group, vaginal progesterone (Cyclogest®) 400 mg twice or (Endometrin®) 100 mg thrice daily, were administrated and continued until menstruation or in case of clinical pregnancy for 8 wk after the embryo transfer when the fetal heart activity was detected by ultrasonography.

The patientchr('39')s characteristics were matched and there was no significant difference. The chemical and clinical pregnancy rate was higher in the vaginal progesterone group compared to the prolutex group, but statistically unnoticeable, (40% vs. 29.6%, p = 0.367) and (28% vs. 22.2%, p = 0.581), respectively.

The findings of this study demonstrate that the new subcutaneous progesterone can be a good alternative for intramuscular progesterone in women that dislike and do not accept vaginal formulations as luteal-phase support in assisted reproductive technology.

Desirable bishop score is necessary for having a successful delivery. Prostaglandins are effective on cervical ripening, and primrose contains precursors of these materials. Therefore, the present study was conducted to evaluate the effect of vaginal Evening primrose on the bishop score among term nulliparous women.

The present double-blind, randomized clinical trial was conducted on 86 nulliparous women who referred to the comprehensive health service centers of Rafsanjan from November 2017 to May 2018. The samples were selected through convenient sampling method and allocated into two intervention and placebo groups with simple random assignment. The intervention group used a daily dose of 1000 mg vaginal capsules of Evening primrose from the 38th week of pregnancy until delivery, and the placebo group received a similar placebo with a similar administration method. The Information about the women’s bishop score was gathered from the participants’ medical files in the hospital and then was analyzed using SPSS software version 16 and Kolmogorov-Smirnov test, Chi-square test, and independent t-test.

The total mean and standard deviation of the bishop score in the intervention and placebo groups were respectively 7.83 ± 2.09 and 4.46 ± 2.39, and the simplified bishop score in the intervention and the control groups was respectively 5.93 ± 2.42 and 2.81 ± 2.02. The difference between the two groups considering both of the bishop scores was statistically significant (p = 0.001).

Vaginal Evening primrose is useful to ripen the cervix of term nulliparous women, and so, it could be administered for this purpose.

Obstructed defecation syndrome (ODS) occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD) is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed.

In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR) in females with one of the two modes of delivery (VD or caesarean section (C/S).

We used Longo’s ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi) and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant.

In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3%) had Vaginal Delivery VD and 11 (36.7%) had Cesarean Section (C/S). The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery.

Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing

Cervical ripening for labor induction is one of the most important issues in midwifery. Isosorbide dinitrate (ISDN) is one of the most important choices that have been proposed for cervical ripening, but still there are controversies regarding its prescription. The present study aimed to evaluate the effects of vaginal and oral ISDN compared to the control group for pre-induction cervical ripening.

In this non-blinded clinical trial, 149 nulliparous women with term or prolonged pregnancy were randomly selected and divided into three groups by block randomization. The intervention group included vaginal (50 subjects, 40 mg) and oral (49 subjects, 20 mg) ISDN groups. The third group was the control group (50 subjects) which did not receive any medication. The amount of ripening was given by Bishop score evaluated before taking medication and 24 h after taking it.

After 24 h, Bishop score in vaginal ISDN group significantly increased compared to the oral ISDN and control groups (P < 0.001 for both). Although the increase in Bishop score was lower in the oral ISDN group than in the vaginal group, it had a statistically significant increase in comparison to the control group (P = 0.001). All the three groups were matched regarding pregnancy termination and cesarean causes, and there was no statistically significant difference among the three groups (P > 0.05).

Prescribing vaginal ISDN for cervical ripening was effective, and it can be used with confidence.