BACKGROUND: There is a growing body of evidence that the presence and length of the purple line could represent a non-invasive method of estimating and determining labour progress.
OBJECTIVE: The primary outcome was to provide a systematic review and meta-analysis on the association between the purple line length and cervical dilatation in active labour. The secondary outcome was to determine the association between the purple line length and the fetal head descent, and to calculate the pooled mean length of the purple line at a cervical dilatation of 3-4 cm and at a cervical dilatation of 9-10 cm.
METHODS: We searched the Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov and Cochrane Pregnancy and Childbirth\'s Trials Register databases from inception till March 25, 2023.
METHODS: We included observational studies of pregnant women in active first stage of labour who had their labour progress assessed with the use of regular vaginal examinations and who had the occurrence recorded and length of the purple line measured at the same time.
METHODS: Two reviewers independently evaluated study eligibility. We used the random effects and fixed effects model for meta-analysis.
RESULTS: There were six eligible studies included in the systematic review that reported on 982 women in total with the purple line appearing in 760 (77.3%) of cases. We found a moderate positive pooled correlation between the purple line length with cervical dilatation (r = +0.64; 95%CI: 0.41-0.87) and fetal head descent (r = +0.50; 95%CI: 0.32-0.68). For women either in spontaneous or induced labour, the pooled mean length of the purple line was more than 9.4 cm when the cervical dilatation was 9-10 cm, whereas it was more than 7.3 cm when the cervical dilatation was 3-4 cm.
CONCLUSIONS: The purple line is a non-invasive method that may potentially be used as an adjunct in labour progress assessment.

The past 20 years witnessed an invigoration of research on labor progression and a change of thinking regarding normal labor. New evidence is emerging, and more advanced statistical methods are applied to labor progression analyses. Given the wide variations in the onset of active labor and the pattern of labor progression, there is an emerging consensus that the definition of abnormal labor may not be related to an idealized or average labor curve. Alternative approaches to guide labor management have been proposed; for example, using an upper limit of a distribution of labor duration to define abnormally slow labor. Nonetheless, the methods of labor assessment are still primitive and subject to error; more objective measures and more advanced instruments are needed to identify the onset of active labor, monitor labor progression, and define when labor duration is associated with maternal/child risk. Cervical dilation alone may be insufficient to define active labor, and incorporating more physical and biochemical measures may improve accuracy of diagnosing active labor onset and progression. Because the association between duration of labor and perinatal outcomes is rather complex and influenced by various underlying and iatrogenic conditions, future research must carefully explore how to integrate statistical cut-points with clinical outcomes to reach a practical definition of labor abnormalities. Finally, research regarding the complex labor process may benefit from new approaches, such as machine learning technologies and artificial intelligence to improve the predictability of successful vaginal delivery with normal perinatal outcomes.

BACKGROUND: The call for women-centred approaches to reduce labour interventions, particularly primary caesarean section, has renewed an interest in gaining a better understanding of natural labour progression.
OBJECTIVE: To synthesise available data on the cervical dilatation patterns during spontaneous labour of \'low-risk\' women with normal perinatal outcomes.
METHODS: PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies.
METHODS: Observational studies and other study designs.
METHODS: Two authors extracted data on: maternal characteristics; labour interventions; the duration of labour centimetre by centimetre; and the duration of labour from dilatation at admission through to 10 cm. We pooled data across studies using weighted medians and employed the Bootstrap-t method to generate the corresponding confidence bounds.
RESULTS: Seven observational studies describing labour patterns for 99 971 women met our inclusion criteria. The median time to advance by 1 cm in nulliparous women was longer than 1 hour until a dilatation of 5 cm was reached, with markedly rapid progress after 6 cm. Similar labour progression patterns were observed in parous women. The 95th percentiles for both parity groups suggest that it was not uncommon for some women to reach 10 cm, despite dilatation rates that were much slower than the 1-cm/hour threshold for most part of their first stage of labours.
CONCLUSIONS: An expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women.
BACKGROUND: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, and the United States Agency for International Development (USAID).
CONCLUSIONS: Cervical dilatation threshold of 1 cm/hour throughout labour is unrealistic for most women, regardless of parity.

The objective of this review was to assess the effectiveness of intrapartum ultrasonography in measuring cervical dilatation, head station and position. Electronic literature searches were carried out of MEDLINE, CINAHL, and Web of Knowledge, plus manual reference list checks of all relevant articles. All published prospective studies comparing intrapartum ultrasonography with digital VE in the determination of cervical dilatation, head station and position were then evaluated for the success rate and level of agreement between ultrasonography and digital VE. Ultrasonography had higher success rate than digital VE in the determination of fetal head position, with a statistically significant difference in the first stage of labour. Second, although the successful determination of cervical dilatation was in favour of digital VE, the difference was not statistically significant. In addition, there was high agreement between ultrasound and digital VE findings on cervical dilatation. Lastly, a significant but moderate correlation between digital VE and ultrasound methods was found in the assessment of fetal head station. However, no meta-analysis could be done for the fetal head station due to the methodological differences between ultrasound anatomical landmarks and that of digital VE. The findings suggest that ultrasonography is superior to digital VE in the assessment of fetal head position, but has moderate correlation with digital VE in the assessment of head station. It also showed high agreement with digital VE in the assessment of cervical dilatation with no statistically significant difference in terms of success rate.

The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 μg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy.

Despite being available for over 50 years, cervical cerclage remains one of the controversial interventions in obstetrics. Rescue cerclage is the operative cervical closure of a widely dilated cervix with or without unruptured membrane prolapsus. In the literature, the effectiveness of rescue cerclage in the prolongation of pregnancy is debatable. Prolongation of pregnancy and improvement of neonatal survival is of utmost importance in pregnancies achieved by in vitro fertilization (IVF). We report here two IVF pregnancies with second trimester cervical dilatation treated with rescue cerclage and who delivered healthy babies near term without maternal and neonatal morbidities.
50 yıl önce tanımlanmış olmasına rağmen servikal serklaj halen obstetrideki tartışmalı girişimlerden biridir. Acil serklaj ise dilate olmuş bir servikste membranlar prolabe olmuş iken veya prolabe olmamış iken serviksin cerrahi olarak kapatılmasıdır. Literatürde acil serklajın gebeliği uzatmadaki rolü tartışmalıdır. Özellikle IVF sonrası elde edilmiş gebeliklerde, gebelik süresinin uzatılması ve yenidoğanın yaşama şansının arttırılması çok önemlidir. Bu çalışmada ikinci trimester servikal dilatasyonu nedeniyle acil serklaj uygulanan iki IVF gebeliğinin önemli bir maternal ve neonatal morbidite olmadan terme yakın doğum ile sonuçlanmasını sunuyoruz.

Various techniques are available for inducing abortion. Evacuation of the uterus through the vagina is generally the preferred method in first trimester pregnancies. Dilation of the cervical canal by inserting rod dilators or laminaria tents allows the withdrawal of the fetus. Suction procedures (vacuum aspiration, uterine aspiration, or suction curettage) are possible since the decidua are separable from the basal layer of endometrium. This removal by force does not damage other maternal tissue. A cannula is introduced into the uterine cavity through the dilated cervix and its operator is then connected to a pump by way of a flexible tube which delivers negative pressure of about 600 mm of mercury. When the fetus is withdrawn, the uterus is felt to contract onto the cannula. The average time for this procedure is 5 minutes. Surgical curettage or dilatation and evacuation first dilates the cervical canal and then removes fetal parts and tissue from ovum forceps; a sharp curette does the rest. Anesthesia for these procedures may be general, local, or spinal. The techniques of menstrual regulation is used before pregnancy can be confirmed. However with the advent of the RIA test for the beta subunit of HCG this procedure is rarely indicated. Induction of premature labor is used in the later 1/2 of the second trimester and utilizes prostaglandins. Intraamniobor usually begins within 24 hours. Hysterotomy and hysterectomy are surgical procedures used in abortions.