![]() ![]() Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. Patients with elevated BMI pose a number of challenges for the gynecologist. From 2007 to 2016, the obesity rate in women increased from 35.4 to 41.1%, while the rate of severe obesity (BMI ≥ 40) increased to 9.7%. Obesity has become epidemic in the United States. ![]() Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position. In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. ResultsĮleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. From until, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. ![]() The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.Patients with elevated BMI pose a number of challenges for the gynecologist. The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% ( P = .001). The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. One hundred and twenty women in labor with fetuses in POP position were included. This is an open, randomized controlled, clinical trial. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. ![]()
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