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Training in safe operative birth is a key priority in obstetrics. Around one in five women are dissatisfied with their labour and birth, especially operative birth, often because of poor communication or inadequate technical skills. This can lead to sexual dysfunction and aversion to further pregnancy, as well as increases in complaints and litigation. This book accompanies the Royal College of Obstetricians and Gynaecologists' Operative Birth Simulation Training (ROBuST) course, and will be an essential resource for all obstetricians and maternity care providers. Internationally recognised contributors discuss all aspects of operative birth including: vacuum and forceps-assisted birth; Caesarean section at full dilatation; safe and effective practice of Kielland's forceps; essential non-technical skills; teamwork; and medico-legal aspects. A simple-to-use flowchart is included to guide the reader through the essential steps for a successful operative vaginal birth. Each chapter identifies the key learning points and provides step-by-step instructions for performing each technique.
A transvaginal scan (TVS) is performed with an empty bladder using a curvilinear, multifrequency, endocavity transducer with a typical central frequency of 6.5MHz. A fibroid outline is usually well visualized by TVS, even in the very small lesion, because of the pseudocapsule. The mixed tissue make-up of the fibroid produces a heterogeneous echo pattern on an ultrasound scan and can be highly attenuating of the ultrasound beam in some lesions. The most common gynecological symptoms of fibroids are menorrhagia and dysmenorrhea and, when significantly enlarged, they can also cause compression of adjacent pelvic structures. Most studies that have examined the relationship between fibroids and miscarriage rates have looked predominantly at intramural fibroids, with few data available on impact of submucosal fibroids. Myolysis is ablation of a fibroid mass by use of radiofrequency (RF) electricity, cryoprobes or focused ultrasound.