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The American Congress of Obstetricians and Gynecologists has recommended against elective induction before 39 weeks if there is no medical indication and the cervix is unfavorable. [14] One recent study indicates that labor induction at term (41 weeks) or post-term reduces the rate of caesarean section by 12%, and also reduces fetal death. [ 15 ]
Histologically, the cervix undergoes significant changes towards the end of gestation, allowing the ripening of cervix for the passage of birth delivery. First, there is an increase in the cervical synthesis of glycosaminoglycan hyaluronan (HA), which increases tissue hydration, thereby catalyzing the degradation of collagen and elastin-fibers.
Effacement translates to how 'thin' the cervix is. The cervix is normally approximately three centimetres long, as it prepares for labour and labour continues the cervix will efface until it is 'fully effaced' (paper-thin). Cervical dilation: Closed 1–2 cm 3–4 cm 5+cm Dilation is a measure of how open the cervical os is.
The cervix is dilated prior to the injection, and the chemical solution induces uterine contractions which expel the fetus. [1] Sometimes a dilation and curettage procedure is necessary to remove any remaining fetal or placenta tissue. [2] Instillation methods can require hospitalization for 12 to 48 hours. [2]
Cervical dilation may be induced mechanically by placing devices inside the cervix that will expand while in place. A balloon catheter may be used. Other products include osmotic dilators , such as laminaria stick (made of dried seaweed) or synthetic hygroscopic materials, which expand when placed in a moist environment.
Prostaglandin E 2 (PGE 2) achieves cervical ripening and softening by stimulating uterine contractions as well as directly acting on the collagenase present in the cervix to soften it. [7] There are currently two formulations of PGE 2 analog available for use in cervical ripening: Prepidil, a vaginal gel, and Cervidil, a vaginal insert. [24]
Rankins says cervical insufficiency happens when there's painless dilation, or opening, of the cervix, typically in the second trimester of pregnancy, or during weeks 13 through 28.
Definitions of cervical weakness vary, but one that is frequently used is the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester. [1] Cervical weakness may cause miscarriage or preterm birth during the