Slowing of fetal head descent is an integral component of manual perineal protection

2020 ◽  
Vol 99 (4) ◽  
pp. 558-559 ◽  
Author(s):  
Hana Kleprlikova ◽  
Vladimir Kalis ◽  
Miha Lucovnik ◽  
Zdenek Rusavy ◽  
Mija Blaganje ◽  
...  
Keyword(s):  
Fetal Head ◽  
Integral Component ◽  
Manual Perineal Protection

scholarly journals Metrics of perineal support (MOPS) study

2020 ◽  
Author(s):  
Vladimir Kalis ◽  
Rusavy Rušavŷ ◽  
Linda HAVELKOVA ◽  
Tomas ZITKA ◽  
David TOLAR ◽  
...  
Keyword(s):  
Time Measurement ◽  
Fetal Head ◽  
Mean Values ◽  
Prospective Pilot Study ◽  
Real Time Measurement ◽  
Short Period ◽  
Manual Perineal Protection ◽  
Applied Forces ◽  
The Mean ◽  
Perineal Support

Abstract Background: Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP.Methods: Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPP Results: Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6s. In 20% it lasted <5s. The overall mean values of the average and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later. Conclusions: MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.

scholarly journals Metrics of Perineal Support (MOPS) Study

2020 ◽  
Author(s):  
Vladimir Kalis ◽  
Rusavy Rušavŷ ◽  
Linda HAVELKOVA ◽  
Tomas ZITKA ◽  
David TOLAR ◽  
...  
Keyword(s):  
Pilot Study ◽  
Time Measurement ◽  
Fetal Head ◽  
Prospective Pilot Study ◽  
Real Time Measurement ◽  
Short Period ◽  
Manual Perineal Protection ◽  
Applied Forces ◽  
The Mean ◽  
Perineal Support

Abstract Background: Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP.Methods: Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPPResults: Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall means of the mean and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later.Conclusions: MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.

scholarly journals Fetal head size and effect of manual perineal protection

PLoS ONE ◽  
2017 ◽  
Vol 12 (12) ◽  
pp. e0189842 ◽  
Author(s):  
Magdalena Jansova ◽  
Vladimir Kalis ◽  
Zdenek Rusavy ◽  
Sari Räisänen ◽  
Libor Lobovsky ◽  
...  
Keyword(s):  
Head Size ◽  
Fetal Head ◽  
Manual Perineal Protection

Flagellar Attachment in Selected Trypanosomes

1973 ◽  
Vol 31 ◽  
pp. 496-497
Author(s):  
J. J. Paulin
Keyword(s):  
Cell Membrane ◽  
Lateral Surface ◽  
The Body ◽  
Flagellar Pocket ◽  
Integral Component ◽  
Free Flagellum ◽  
Flagellar Axoneme

Movement in epimastigote and trypomastigote stages of trypanosomes is accomplished by planar sinusoidal beating of the anteriorly directed flagellum and associated undulating membrane. The flagellum emerges from a bottle-shaped depression, the flagellar pocket, opening on the lateral surface of the cell. The limiting cell membrane envelopes not only the body of the trypanosome but is continuous with and insheathes the flagellar axoneme forming the undulating membrane. In some species a paraxial rod parallels the axoneme from its point of emergence at the flagellar pocket and is an integral component of the undulating membrane. A portion of the flagellum may extend beyond the anterior apex of the cell as a free flagellum; the length is variable in different species of trypanosomes.

Imperfect Duty: Lawyers’ Obligation to Foster Access to Justice

2008 ◽  
pp. 107 ◽  
Author(s):  
Alice Woolley
Keyword(s):  
Legal System ◽  
Policy Response ◽  
Access To Justice ◽  
Legal Services ◽  
Imperfect Duty ◽  
Special Obligation ◽  
Legal Market ◽  
Integral Component

Access to justice is an integral component of the legal system. However, the question of upon whose shoulders the obligation of ensuring this access should fall has been widely debated. In particular, do lawyers, as part ofthe legalprofession, have a special obligation to foster access to justice? In this article, the author explores the legitimacy of various arguments with respect to whether lawyers should carry this obligation to a greater extent than other members of society. The author begins by critiquing the traditional arguments related to imposing such an obligation on lawyers — for instance, the refined monopoly arguments. She then goes on to critically consider an alternative argument: that imperfections in the marketfor legal services justify the existence of a special obligation for lawyers. An examination of the limitations of this justification follows. Overall, the author concludes that while the arguments arising from imperfections in the legal market offer the best justification for seeing lawyers have a special obligation to ensure access tojustice, the claims from the argument are modest ones, and any policy response in furtherance of such an obligation should be similarly modest.

ВПЛИВ БЛИЗЬКОГО ОТОЧЕННЯ ЯК ЧИННИКА СОЦІАЛІЗАЦІЇ НА ФОРМУВАННЯ ОБДАРОВАНОЇ ОСОБИСТОСТІ

2020 ◽  
pp. 32-36
Author(s):  
Admink Admink ◽  
Тетяна Добіна
Keyword(s):  
Cultural Environment ◽  
Cultural Formation ◽  
Integral Component ◽  
Personality Changes ◽  
Anthropological Approach

Висвітлено педагогічну діяльність Б. Лятошинського як певну складову процесу українського культуротворення. Використано культурно-антропологічний підхід, який дає можливість дослідити особистість Б. Лятошинського як вихователя і як вихованця та визначити ряд чинників соціалізації, що впливають на зміни особистості в її культурному оточенні. Зазначено специфіку педагогічної діяльності Б. Лятошинського та його освітньо-виховних принципів як невід’ємної складової українського культуротворення, представленої у вимірах педагогічної діяльності. The pedagogical activity of B. Lyatoshynsky as a certain component of the process of Ukrainian cultural formation is highlighted. A cultural and anthropological approach was used to investigate B. Lyatoshynsky's personality as an educator and as a pupil and to identify a number of socialization factors that influence personality changes in his or her cultural environment. The specifics of the pedagogical activity of B. Lyatoshynsky and his educational principles as an integral component of Ukrainian cultural formation, presented in the dimensions of pedagogical activity, are indicated.

The Comparison of Intrapartum Sonographic Signs and Digital Examination in Fetus with Cephalic Presentation

2020 ◽  
Vol 103 (11) ◽  
pp. 1178-1184
Keyword(s):  
Pregnant Women ◽  
Cross Sectional Study ◽  
Head Position ◽  
Vaginal Examination ◽  
Fetal Head ◽  
Cross Sectional ◽  
Percent Agreement ◽  
Anterior Position ◽  
Fetal Head Position ◽  
Digital Vaginal Examination

Objective: The agreement of fetal head position examined by digital vaginal examination (DVE) and intrapartum sonographic signs (ISS) in pregnant women during labor. Materials and Methods: A cross-sectional study was conducted. Two hundred eight-term singleton pregnant women attending labor at Ramathibodi Hospital, Thailand with the fetal cephalic presentation, cervical dilatation of 4 to 8 cm, station –2 or below and no contraindication for DVE were enrolled. The DVE evaluating fetal head position was performed by the third-year obstetrical residents. After DVE, ISS via transabdominal ultrasound for determining fetal head position was obtained immediately by the first researcher. The DVE report and the ultrasonographic images of ISS were recorded separately. The fetal head position based on ISS was designated by the second researcher blinded to the DVE result. The agreement of DVE and ISS for determining fetal head position was analyzed. Results: Two hundred eight pregnant women were analyzed. The fetal head position detected by DVE was consistent with that of ISS at 41.3% (p<0.001). The most percent agreement was observed in the fetus with left occiput anterior position at 72.7% (p<0.001). The lowest percent agreement was found in the direct occiput posterior at 14.3% (p=0.243). Parity, gestational age, current body mass index, epidural analgesia, cervical effacement, caput succedaneum, molding, and station did not significantly affect the discrepancy between DVE and ISS. Conclusion: The agreement between DVE and ISS for evaluating the fetal head position was low. The ISS might be considered for evaluating the fetal head position. Keywords: Fetal head position, Intrapartum sonographic sign, Digital vaginal examination

The three lines: origin of sonographic landmarks of the fetal head

1989 ◽  
Vol 152 (2) ◽  
pp. 432-433
Author(s):  
LC de Crespigny ◽  
HP Robinson
Keyword(s):  
Fetal Head
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