Talk:Cervix/GA2

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Reviewer: 97198 (talk · contribs) 10:30, 25 May 2014 (UTC)[reply]

Hi there! I'll be reviewing this article. I've had a look at the previous review and it looks like most of those issues have been resolved, so hopefully it'll pass this time. I've just done a copyedit f the article to fix minor issues but here are some other issues I've found:

Comments from 97198

Issues resolved from 97198
  • "Because of this change, known as metaplasia, this part of the cervix is at increased risk of cancer." — need to clarify what "this part of the cervix" is referring to, as it is unclear (I assume it's the transformation zone).
  • Under "Structure", you describe the lymphatic drainage routes for the "lateral cervix", then the "posterior and lateral cervix", and then the "posterior section of the cervix" — which is correct? What about the anterior cervix?
    •  Not done A question I also had when reading the source. --LT910001 (talk) 23:51, 27 May 2014 (UTC)[reply]
  • "The size of the cervix decreases over time relative to the uterus" — I get what you mean, but it kind of sounds like the cervix is literally shrinking, so do you think you could word it more clearly?
  • "when the endocervix is exposed to the harsh acidic environment of the vagina it undergoes metaplasia to squamous epithelium" — should briefly explain why/when the endocervix would be exposed as such, since it's not intuitive.
    •  Done Clarified. Also lead me down a fascinating path regarding DES. --LT910001 (talk) 23:15, 30 May 2014 (UTC)[reply]
  • The "Mucus plug" image should have a more descriptive caption, since there's a lot more than the plug pictured.
    •  Done I've removed this image, as I don't think it was contributing much. --LT910001 (talk) 23:51, 27 May 2014 (UTC)[reply]
  • "During the proliferative phase, the mucus is thin and serous to allow sperm to enter the uterus while during the secretory phase, the mucus is thick to prevent sperm from interfering with the already fertilized egg" — the average reader probably won't know what the proliferative and secretory phases are, so these should be explained.
    •  Not done The menstrual cycle is mentioned in the previous sentence and wikilinked. Is this sufficient? --LT910001 (talk) 23:51, 27 May 2014 (UTC)[reply]
  • "This counters a weakly founded theory put forward that the convulsing cervix, during orgasm, draws semen into the uterus. This upsuck theory has been generally accepted for some years, although there does not appear to be any evidence." — this is a pretty big claim, and it would be great if you could source it to a medical textbook, which would be more reliable than a single journal article.
    •  Done A sentence inherited. I've toned this down so it's not so sensational, and replaced the source. --LT910001 (talk) 23:15, 30 May 2014 (UTC)[reply]
  • Under "Clinical significance" there are a number of diseases involving the cervix apart from cancer that could be discussed — these include cervical stenosis, cervicitis and cervical agenesis. It may also be worth commenting on pre-cancerous lesions like cervical polyps and cervical intraepithelial neoplasia.
  • "An alternate approach, a LEEP procedure using a heated loop of platinum to excise a patch of cervical tissue" — an alternate approach to what? Visualising the cervix? Examining? Biopsying?
  • A minor point, but some of the books used as references don't have capitalised titles, which they should.
    •  Question: This is a result of the automatic template-filler. I have always found this somewhat confusing, as books in real life are not always written in title case. Is there a relevant policy or guideline I will be able to use for future reference? --LT910001 (talk) 23:57, 27 May 2014 (UTC)[reply]
I'd be very grateful if you could consider the footnote here: WP:GACR 2a, which states "Using consistent formatting or including every element of the bibliographic material is not required", as capitalising these is troublesome and quite effort-intensive. --LT910001 (talk) 23:15, 30 May 2014 (UTC)[reply]
  • Is there a reason for including the "Menstrual cycle" template at the bottom of the page? It doesn't seem particularly relevant to me.
    •  Done Thanks for pointing this out. Removed. --LT910001 (talk) 23:51, 27 May 2014 (UTC)[reply]
  • "The number of past vaginal deliveries is a strong factor in influencing how rapidly the cervix is able to dilate in labour" — should mention that dilation/labour is typically faster in multips.
    •  Not done Not so. According to the sources it is the number of vaginal deliveries, rather than the number of viable pregnancies at term, that affect this. --LT910001 (talk) 23:51, 27 May 2014 (UTC)[reply]
I think that the question raised is that how multiple vaginal deliveries affects the rate of dilation. ie the more vag deliveries the faster the labour. Could mention precipitate delivery. Snowman (talk) 22:50, 29 May 2014 (UTC)[reply]

I'll put the review on hold for now because I don't think it'll be too hard to fix up these issues. Feel free to contact me for any help or questions! 97198 (talk) 10:30, 25 May 2014 (UTC)[reply]

Thanks for your comments and taking up the review. I will address these in coming days, and look forward to working with you to get this promoted. --LT910001 (talk) 21:29, 25 May 2014 (UTC)[reply]
Thanks 97198, for your thoughtful review. I believe I've addressed all your concerns. --LT910001 (talk) 23:15, 30 May 2014 (UTC)[reply]
97198 to keep track of this review, I've boxed issues I see as resolved. If you feel I've placed the wrong issues there, please take them out and we can continue discussion. --LT910001 (talk) 01:40, 6 June 2014 (UTC)[reply]

Comments from Snowmanradio

  • Actually the GA1 was a clear fail. I have partly re-written the introduction because is was badly written, amateurish, and factually wrong in parts. The very basic anatomy has not even been extracted correctly from Gray's Anatomy for Students, which is the book given as the relevant in-line reference. Of course, my version is not perfect, but my edits have helped to iron out some serious problems. In my opinion this article has not been prepared adequately to be a GA candidate, and I would support a quick fail. Alternatively, I think that it needs a lot of work to get to GA standard. Snowman (talk) 21:08, 29 May 2014 (UTC)[reply]
Snowmanradio this is the third article I have written or reviewed that you have been involved in in recent days, prior or subsequent to GA (Anatomy, Esophagus). Please stop following me. Over the next few days you will make a huge amount of mostly stylistic edits, with little to no discussion, that do not respect the sources I have used. I will take this to AN/I if this situation persists. --LT910001 (talk) 21:21, 29 May 2014 (UTC)[reply]
The guidelines say that anyone can contribute to a GA nomination discussion. I am interested in anatomy, so it is only natural that I have had a look at some of the anatomy articles. You do not own this article. The cervix is part of the uterus and this is explained in the the book that is used as the in-line citation in the article. How did a basic error about the anatomy of the uterus get into this article and not be corrected until after GA nomination? Snowman (talk) 21:29, 29 May 2014 (UTC)[reply]
Issues resolved from Snowmanradio
  • I would think that explaining dysplasia seen on smear slides and explaining cervical intraepithelial neoplasia (CIN) of the stratified squamous epithelium would be helpful. Snowman (talk) 21:59, 29 May 2014 (UTC)[reply]
 Done per 97198. --LT910001 (talk) 22:13, 30 May 2014 (UTC)[reply]
  • There are two HPV vaccines in the UK (and I presume the rest of the world); Gardasil and Cervarix (names used in the UK). I think that it would be reasonable to mention both or neither in a section about HPV vaccines. I do not know why you have only included Gardasil. Snowman (talk) 22:32, 29 May 2014 (UTC)[reply]
 Done included both. --LT910001 (talk) 22:13, 30 May 2014 (UTC)[reply]
  • "Together with regular Pap smears, the incidence of cervical cancer is declining rapidly.[25]". But this is only in the Western world. Snowman (talk) 13:56, 31 May 2014 (UTC)[reply]
 Done --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • HPV changes (pyknotic nuclei) are the main risk factor for CIN, not metaplasia. Note that the Wiki pages Cervical cancer and Cervical intraepithelial neoplasia do not mention metaplasia. There is some poppycock in the Wiki on this topic, so I would recommend getting information from RS, preferably specialized cytology or pathology books. Snowman (talk) 14:07, 31 May 2014 (UTC)[reply]
 Done thank you. I have changed metaplasia --> dysplasia in the appropriate section. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • "Cervical intraepithelial neoplasia is a possible result, ...". The language is important here. CIN is not reported in a smear test result, however dysplaia and HPV changes are. Abnormalities from cervical cytology would be reported as mild, moderate, or severe dysplasia, without mentioning CIN. Note that mild and sometimes moderate dysplasia seen by cervical cytology can resolve spontaneously. CIN may be subsequently diagnosed with some sort of biopsy of the cervix. Snowman (talk) 14:16, 31 May 2014 (UTC)[reply]
 Done Clarified. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • "Conversely, methods of thinning the mucus may help to achieve pregnancy; one suggested method is to take guaifenesin in the few days before ovulation.[5]". This looks out of context to me, because this drug in not licensed for this purpose, at least not in the UK. I would advise extreme caution in writing about drugs that may be used in women, who wish to get pregnant. Snowman (talk) 15:37, 1 June 2014 (UTC)[reply]
 Done It has been a balance to maintain the edits of other users prior to expansion,which is why there are some very odd sentences like this. I've removed it. --LT910001 (talk) 21:30, 2 June 2014 (UTC)[reply]
  • The stages of labour need some work. The first stage of labour includes the early uterine contractions, the effacement of the cx and dilation of the cx to about 3-5 cm dilation (classification slightly different in different countries - 4 cm in the UK). Then the second stage of labour begins and the cx dilates to its maximum as the baby moves along the birth canal. The second phase ends when the baby is born. The third stage is the delivery of the placenta and remaining membranes. Snowman (talk) 21:59, 29 May 2014 (UTC)[reply]
Yes. Please clarify what your concern is. --LT910001 (talk) 22:13, 30 May 2014 (UTC)[reply]
Please give a clearer description of the stages of labour. Snowman (talk) 14:24, 31 May 2014 (UTC)[reply]
I have given the stages of labour relevant to the cervix. Any more is out of this article's scope, contained within Childbirth and can be viewed there. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • In the UK a cervical smear is simply called a cervical smear or smear test. As far as I am aware, Pap test is mainly a USA or North American term. Snowman (talk) 21:59, 29 May 2014 (UTC)[reply]
 Not done See here: [1]. --LT910001 (talk) 22:13, 30 May 2014 (UTC)[reply]
The ngram is somewhat tangential to the issue. In the UK conventional pap tests, are just called smear tests (or cervical smear tests) in the UK and the ngram would not show this. In the UK they have been replaced with Liquid-based cytology (LBC); see About cervical screening on one of the NHS webpages. LBC produces better slides. I do not know what sort of preparations are made in North America, but I would be surprised if they are all using the old style Pap tests over there. For LBC the cervical cells are brushed off the cervix rather than being scraped off with a spatula. Snowman (talk) 13:53, 31 May 2014 (UTC)[reply]
This is cutting-edge and I can only write about what is in the sources I have available. It may be sensible to wait 4-5 years and then, as this is used more widely and reported about in tertiary sources, to include it then. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
Actually, all routine NHS smears in the UK were changed from the old cervical smear method to LBC using the brush method about 5 years ago. Snowman (talk) 15:42, 1 June 2014 (UTC)[reply]
@LT910001: as Snowmanradio notes, "pap smear" is not a term I've ever heard used in when addressing laypeople in the UK, and if you had chosen the British English corpus in the Google ngram, since this is the issue here, you would see that the most common term is "cervical smear". This alternative terminology should be included in the article. Peter coxhead (talk) 07:28, 6 June 2014 (UTC)[reply]
 Done Thanks, I wasn't aware of that, and have included it. I had not changed this earlier because I didn't have any hard evidence to the contrary. --LT910001 (talk) 08:52, 6 June 2014 (UTC)[reply]
  • The existence of reserve cells could be included. What is interesting and speculative is the role of the reserve cells in the cervical transition zone in the pathogenesis of neoplastia, but this might not be within the scope of this GA. Snowman (talk) 15:15, 31 May 2014 (UTC)[reply]
Yep. There is no requirement for complete comprehensiveness, only that the 'main' issues have been covered. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • "In 2008, cervical cancer was the third most common cancer in women worldwide, ...". This is interesting, but this is six years ago, so presumably this is out-of-date. Is there anything more recent? Snowman (talk) 16:51, 31 May 2014 (UTC)[reply]
I can't find a review of this size using more recent data. Please note WP:MEDRS asks for reviews published in the last 5 years and this was published in 2011.--LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • The association between diethylstilbestrol, and clear cell adenocarcinomas is interesting, but I think that this is outside the scope of the page on cervix. The "double cervix" (see Uterus didelphys) would be relevant in the abnormalities section. Snowman (talk) 16:56, 31 May 2014 (UTC)[reply]
Thank you! I have been looking everywhere for this and I will include it. I won't be removing DSB as I think it's quite relevant. --LT910001 (talk) 23:01, 31 May 2014 (UTC)[reply]
  • "Most methods of hormonal contraception, such as the oral contraceptive pill, work primarily by preventing ovulation, ...". Wrong. POP pills do not necessarily prevent ovulation and mainly work by enhancing the cervical mucus plug. COC pills prevent ovulation. Snowman (talk) 15:47, 1 June 2014 (UTC)[reply]
Please provide a reliable source to back up this claim. --LT910001 (talk) 21:30, 2 June 2014 (UTC)[reply]
I thought is was common knowledge rather than a claim. It is really basic stuff in the field of contraception. See Progestogen-only pill, for an account of very-low-dose progestogen-only contraceptives, which do not rely on preventing ovulation. Snowman (talk) 08:47, 3 June 2014 (UTC)[reply]
  • "It is visible as a blood-tinged mucous discharge.[26]". This implies that a "show", as it is called in the UK, is inevitable at the about the time of labour. Snowman (talk) 16:14, 1 June 2014 (UTC)[reply]
Thank you. Please clarify your concern. --LT910001 (talk) 21:30, 2 June 2014 (UTC)[reply]
Although this is not necessarily a RS for the Wiki this webpage is written by midwifes. It says; "Before labour starts, you might see a blob of mucus ...". Hence it says that a show does not always appear. Another webpage said that a show could occur 2 weeks before labour. Also, I think that it would be worth including the word "show" as an alternative common name for this phenomenon. Snowman (talk) 08:38, 3 June 2014 (UTC)[reply]
  • A number of the sources are older than five years. Do these need to be replaced to be consistent with WP:MEDMOS? Snowman (talk) 15:47, 2 June 2014 (UTC)[reply]
    This applies to medical claims, please clarify by stating the section or statement at hand. --LT910001 (talk) 21:30, 2 June 2014 (UTC)[reply]
    The "Contraception section" is supported with four different sources. Three of these are older than five years and hence incompatibly with WP:MEDMOS. Note that the "Weschler, Toni (2006)." reference is older than five years and is used five times in the article. Please check the rest of the sources for consistency with WP:MEDMOS. Snowman (talk) 13:01, 3 June 2014 (UTC)[reply]
    WP:MEDMOS is part of the Manual of Style. MEDMOS is not listed in the WP:GA criteria as a Manual of Style page that may be considered when reviewing GAs.
    On the assumption that this is actually about WP:MEDDATE, then notice how gently that section is positioned: "Here are some rules of thumb for keeping an article up-to-date, while maintaining the more-important goal of reliability. These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." There is no hard-and-fast rule against using sources that are more than 5 years old. In practice, sources up to 10 years old are routinely accepted unless there is a good reason to believe that information has changed since then. None of the things sourced to this book are likely to have changed in the last several decades. WhatamIdoing (talk) 15:11, 5 June 2014 (UTC)[reply]
  • Re; "This provides a protective seal for the uterus against the entry of pathogens and against leakage of uterine fluids.". I have never heard the expression "uterine fluids" before. What does it mean? Snowman (talk) 07:53, 3 June 2014 (UTC)[reply]
  • Omission: isthmus of the cervix, the upper third. It forms the lower segment of the uterus in pregnancy. Snowman (talk) 22:48, 3 June 2014 (UTC)[reply]

Snowmanradio, to help organise this review and my responses I've boxed what I believe to be your comments which I have addressed. If I have done this incorrectly please take out the relevant issue and we can continue discussion.--LT910001 (talk) 01:40, 6 June 2014 (UTC)[reply]

Comments from GA1 reviewer

Thanks for your comments. I feel this article is more suitable for GA promotion so will respond to your comments in full this time. --LT910001 (talk) 06:04, 31 May 2014 (UTC)[reply]

Issues resolved from GA1 reviewer
The following are unresolved from GA1.--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 04:59, 31 May 2014 (UTC)[reply]
 Not done. Sorry, I don't know what you mean. Please let me know and I'll see what I can do. --LT910001 (talk) 21:56, 31 May 2014 (UTC)[reply]
The link in the toolbox in the upper right of this page shows that the page has links that lead to disambiguation pages. Find them and fix them.--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 15:50, 1 June 2014 (UTC)[reply]
I see that this has now been resolved.--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 15:52, 1 June 2014 (UTC)[reply]
 Done Removed the summary, and provided source for said information in text. I've reordered so that 'Fertility' comes before 'Childbirth'. --LT910001 (talk) 21:56, 31 May 2014 (UTC)[reply]
  • "The cervical canal varies greatly in length and width" over the course of one's life or from woman to woman? (still not clarified, IMO)--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 04:59, 31 May 2014 (UTC)[reply]
 Done both. --LT910001 (talk) 21:56, 31 May 2014 (UTC)[reply]
  • Cervix as reservoir: This topic also seems misleading. It suggests that the sperm end their travel at the cervix. However, Human fertilization suggests otherwise. See "The sperm plasma then fuses with the egg's plasma membrane, the sperm head disconnects from its flagellum and the egg travels down the Fallopian tube to reach the uterus." which suggest the sperm travel up the fallopian tubes.--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 04:59, 31 May 2014 (UTC)[reply]
 Done I'm sorry for the confusion. I hope my edits have cleared this up. --LT910001 (talk) 21:56, 31 May 2014 (UTC)[reply]

TonyTheTiger, I've boxed issues I believe are resolved. If this is not the case, please take them out and we can continue discussion. --LT910001 (talk) 01:40, 6 June 2014 (UTC)[reply]

It would be logical to expand this line with an account of cervical cerclage. Snowman (talk) 09:32, 2 June 2014 (UTC)[reply]
 Not done Making sure you notice this one.--TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 14:31, 3 June 2014 (UTC)[reply]

Further comments from 97198

This is my second sweep of the article, and I'll be re-identifying the issues from above that haven't been addressed, or new issues that have arisen:

Resolved issues from 97198's second round of comments
  • I'm still not happy with the description of the lymphatic drainage, as I mentioned above. It sounds as if there may have been an error in the source(s); are you able to find another source that describes the cervical lymphatics to clear it up?
 Done The original source said "The cervix drains in three directions: laterally, in the broad ligament, to the external iliac nodes; posterolaterally along the uterine vessels to the internal iliac nodes; and posteriorly along the recto-uterine fold to the sacral lymph nodes," but having consulted the source I've added, the meaning was the anterior and lateral cervix rather than just the lateral cervix; I've corrected this. --LT910001 (talk) 23:06, 8 June 2014 (UTC)[reply]
  • I agree with Snowman's suggestion to mention liquid-based cytology along with Pap tests — unfortunately its wiki article is pretty shoddy, but it from what I can gather it's fairly widely used and there's plenty of tertiary and secondary (try Google Books if you don't have access to other textbooks) sources that discuss it as an alternative to Paps.
As far as I'm aware it isn't commonly used. Maybe mentioning it would be okay, but I don't really see the need. CFCF (talk · contribs · email) 13:44, 2 June 2014 (UTC)[reply]
http://www.ncbi.nlm.nih.gov/pubmed/24021666 seems to mention the use in endometrial cancers, so maybe it should be mentioned in uterus?
As for cervical cancers I can only say that there are 23 review articles on LBC + cervix [2], none of which are really relevant except Technologic advances for evaluation of cervical cytology: is newer better?, which is from 2001. I suggest we skip it. CFCF (talk · contribs · email) 13:49, 2 June 2014 (UTC)[reply]
LBC is primarily for screening for ca of cervix. However, as with conventional smears, occasionally cells from the endometrial cancers are also seen and would be reported as such. LBC could be mentioned on the uterus article, but it is more relevant in the cervix article. LBC has been routine practice in the UK for several years, so just mentioning Pap smears here would be inappropriate. This NICE review should be adequate, published in 2003 and last updated in 2014. Snowman (talk) 14:27, 2 June 2014 (UTC)[reply]
Okay, that may very well be true. In that case it would be good to add a UK guideline/review and add a sentence, but I don't agree it is necessary for a GA-review. If you'd give me a source I will gladly add it.Sorry, somehow missed your link CFCF (talk · contribs · email) 14:58, 2 June 2014 (UTC)[reply]
LBC has superseded Pap smears (at least in the UK), so I think that the article would not be up-to-date if it excluded LBC. The article includes cytology and Pap smears, but do you think Pap smears should be excluded as well? Do you know type of test is done in Sweden? (I understand this is where you live).Snowman (talk) 15:10, 2 June 2014 (UTC)[reply]
Update; I have included LBC briefly using a 2010 book ref. I am from the UK, where LBC is now routine, so excluding LBC seemed odd to me. Snowman (talk) 15:44, 2 June 2014 (UTC)[reply]
In Sweden the common practice is a Pap, and in certain cases biopsy. [3] -- CFCF (talk · contribs · email) 07:14, 3 June 2014 (UTC)[reply]
  • The "Clinical significance" section is looking a whole lot better now; well done.
  • The "toolbox dablink" issue referred to by Tony is about the tool on the top right of the page that lists the disambiguation links in the article, but I've fixed these myself.
Thank you --LT910001 (talk) 21:34, 2 June 2014 (UTC)[reply]
  • "These abnormalities are found in both the mothers and daughters of the mothers exposed, and diethylstilbestrol is no longer used" — needs a citation.
 Done I've removed this uncited sentence and clarified the above statements as relating to the daughters. --LT910001 (talk) 23:19, 8 June 2014 (UTC)[reply]
  • Regarding Snowman's comments above about the stages of labour, I agree with LT91 that further detail is unlikely to be significantly relevant to the cervix.
Perhaps, I did not make myself clear. To me this is the problem area; "Along with other factors, cervical dilation is used to divide childbirth into stages. Generally, the active first stage of labour is defined by a cervical dilation of more than 3–5 centimetres (1.2–2.0 in),[17][18] with the second phase of labor defined when the cervix is dilated to more than 10 centimetres (3.9 in), which is regarded as its fullest dilation.[15]". I would tend to agree that there is no need for more detail here, but there is a need for the description about the stages of labour to be accurate. The beginning of the first stage of labour has two main definitions, depending on whether the early part is included or not. The dilation of the cervix is used in both definitions to mark the end of the first stage of labour and hence also the start of the second phase. The first stage ends when the cervix is dilated to about 3-4 cm dilated (international variation in this definition - ie 3 cm in some nations and 4 cm in others, and so on). The second phase begins immediately after the first stage and during the second phase the cervix dilates beyond 3-4 cm, the cervix reaches max dilation, and then the baby pushed along the birth canal, gradually at first and then the baby is born (all part of the second phase). The second stage ends when the baby is delivered and note that this is not defined by the dilation of the cervix. The cervix will have been fully dilated for the last minutes of the second stage, the exact period of time varying. Of course the full dilation of the cervix is significant, but it does not define the end of the second stage. The third stage begins when the baby is born (again not defined by the dilation of the cervix) and ends when the placenta and membranes have been delivered (of course the placenta has to pass through the cervix). The is basic stuff, and mistakes or ambiguities would be an embarrassment to the Wiki. See "Intrapartum care: Care of healthy women and their babies during childbirth". NICE. 2007. {{cite web}}: Unknown parameter |month= ignored (help), which is an authoritative statement on childbirth in the UK and it gives clear accounts of the stages of labour. Perhaps, the most relevant thing to say is that midwifes and doctors use the degree of dilation of the cervix together with other factors to assess the progress of labour. Snowman (talk) 14:37, 1 June 2014 (UTC)[reply]
Is this really necessary? I feel it is more relevant in an article like childbirth, and here we should probably stick to mentioning it and then linking to childbirth, somewhat like the bottom suggestion from SMR. CFCF (talk · contribs · email) 13:44, 2 June 2014 (UTC)[reply]
Of course, dramatically shortening the section on childbirth could provide an alternative solution and it think that this would work. Snowman (talk) 14:20, 2 June 2014 (UTC)[reply]
 Not done This does not relate to the GA criteria, and both the primary reviewer and I do not see this as necessary. I will not be shortening childbirth nor will I be including this information. We have wikilinks that do a stellar job at linking users to relevant articles. --LT910001 (talk) 21:34, 2 June 2014 (UTC)[reply]
Correcting the definitions of the stages of labour is well within GA criteria. Snowman (talk) 08:39, 3 June 2014 (UTC)[reply]
  • "The number of past vaginal deliveries is a strong factor in influencing how rapidly the cervix is able to dilate in labour" — I perhaps wasn't clear about this above, but you should clarify that more past vaginal deliveries lead to quicker dilation (basically, you've said that there's a correlation but not how they're correlated).
 Not done It is surprisingly difficult to find any reliable sources that state that this is proportional. All the books and sources I have consulted differentiate between the times taken in multiparous women and primiparous women, but do not say that there is a direct correlation between parity and speed of dilation. Thus the strange wording currently. --LT910001 (talk) 23:19, 8 June 2014 (UTC)[reply]

As I see it, there are only a few minor issues remaining which can hopefully be resolved fairly easily. In the meantime, I'll keep the review on hold. 97198 (talk) 13:22, 1 June 2014 (UTC)[reply]

Personally speaking, I would like to know what some members of WP Medicine about think parts of the article to make sure that the article is not going-off the rails anywhere. May I ask user 97198, if there are any aspects of cytology, clinical medicine, pharmacology, or anything else that you would like assistance with in your review of this article. This GA covers a broad topic. It would be appropriate for GA reviewers to ask at Wiki Project talk pages for a relatively expert opinion about something, even for small sections of the article. By way of an example, see the GA nomination on the Salt article, where a section on the health aspects of salt were reviewed and amended following a request to WP Medicine and the final outcome was satisfactory to all interested participants. Snowman (talk) 16:12, 1 June 2014 (UTC)[reply]
I'd be willing to offer assistance concerning this if you need any help, just ping me and I'll come running! CFCF (talk · contribs · email) 13:38, 2 June 2014 (UTC)[reply]
That would be fine by me. I have also notified WP medicine to see if anyone else is interesting in contributing. Snowman (talk) 14:37, 2 June 2014 (UTC)[reply]
Thanks, CFCF. If you're happy to do it, it would be great if you could read over the article and highlight anything you find that you think is problematic. @Snowmanradio: I do feel pretty comfortable with medical topics, and especially gynaecology, otherwise I wouldn't have taken on the review, although if anyone from WP:MED has any additional comments to offer, that would be helpful. 97198 (talk) 04:00, 3 June 2014 (UTC)[reply]
I've looked over the article and found some small things which I corrected myself. On the whole I would say the article is of high quality and your comments have helped it further. I don't really have anything further to add. CFCF (talk · contribs · email) 07:14, 4 June 2014 (UTC)[reply]
Apart from this red link Vaginal adenosis CFCF (talk · contribs · email) 07:16, 4 June 2014 (UTC)[reply]
Thank you CFCF. --LT910001 (talk) 21:34, 2 June 2014 (UTC)[reply]
I would ask user User:CFCF to comment on my queries above including what is the meaning of "uterine fluids" and the relevance of the isthmus of the cervix. I would ask user User:LT910001 to bring the citations in the clinical sections up to WP:MEDMOS standards. I think that the readability is not yet good enough is parts. I have not finished checking factual content. I will correct the text on the stages of labour myself. Snowman (talk) 08:30, 4 June 2014 (UTC)[reply]

I overlooked that comment because to me uterine fluids simply refers to any fluid excreted by the uterine glands. I understand this might not be entirely clear for a lay reader though. Possibly needs clarification. CFCF (talk · contribs · email) 14:57, 4 June 2014 (UTC)[reply]

Again, I have marked addressed issues as 'resolved', if I have wrongly identified any please unbox it and we can continue discussion. --LT910001 (talk) 23:06, 8 June 2014 (UTC)[reply]

Stop

Snowmanradio, please stop

This process is insane. Snowmanradio, I am extremely unhappy with your conduct during this review. I have noted this on your talk page. With regards to your review:

  • Please do not simultaneously review and edit
  • You do not WP:OWN the article. Your edits are often completely unrelated to discussion and even at times at odds with it ([4]) and they are unrelenting in nature. You have made 27 edits since the review started.
  • Please do not make a huge amount of edits while this article is under review. This is completely insane, the article will not be able to be reviewed and I will not be able to respond if the article is constantly changing in front of our eyes.
  • Please stop following me from review to review (Met at Anatomy, 20 May Esophagus [5], 30 May Cervix [6], 5 June Parathyroid gland [7])
  • Please list your comments once, in a single location, and wait for a reply.
  • Please do not make ambiguous demands (" I think that the readability is not yet good enough..." "In my opinion this article has not been prepared adequately ..." [8])
  • Please do not insult me ("amateurish", again ([9]) and again ("It is really basic stuff in the field of contraception", [10] and again [11] )
  • Please do not modify my signatures or indentation is the midst of a discussion as you have just done. ([12])
  • Please show understanding of the GARC, which do not demand complete comprehensiveness, and MEDRS, which does not require sources be less than 5 years old. ([13])
  • If you want to review the article yourself, (cfr. Esophagus and comments about the primary reviewer here), please take up the responsibility and do it, rather than reviewing an article pre-GA or acting as a secondary reviewer.

To clarify, I am more thank happy to work with other contributors on a review, and I believe I have a track record of doing this both are reviewer and nominee, and in article space. I am not happy when dealing with a reviewer who follows me from article to article, significantly rewrites content I've put a lot of effort into making while it is actively or about to be reviewed, who is unable to compromise during discussion, and who personally insults me. --LT910001 (talk) 04:42, 5 June 2014 (UTC)[reply]

Update: raised at AN/I: Wikipedia:Administrators'_noticeboard/Incidents#User_stalking_and_harassment_by_Snowmanradio --LT910001 (talk) 05:37, 5 June 2014 (UTC)[reply]
For what it's worth, I'm inclined to agree with LT910001. I am more than happy to collaborate with other users in writing, improving and reviewing articles but many of your contributions to this review have been less than productive and unnecessarily nitpicky for a GAN. You've shown a complete unwillingness to compromise on any of the points you've raised and it seems as if, regardless of what changes were made, you would never support this article's passing. GA is not about making articles perfect; see WP:GVF. 97198 (talk) 11:37, 5 June 2014 (UTC)[reply]

Reply

You will reply, please do so below:

Hiatus

I am determined to get this article passed. To keep track of the review I've boxed the issues I think are resolved; if they are not please let me know. 97198, I'm really quite exhausted and will take a couple of days to catch my breath and recover. I would like to ask everyone here to slow down and restrain editing of the actual article for a while. When the article's stable again, the review can continue. 91798, I'd ask you, when the article is a bit more stable, to give this article a thorough re-read as it has changed quite a bit. I would like this article to be able to be read by laypeople, and so I'd be grateful if you could point out anything that has been included that hinders this or could be included to facilitate this.

Lastly, I have pretty strong feelings about including "Contraception" in "Clinical significance" section but I am not feeling up to editing and will, with consensus, make this change after I have come back. I feel it is, essentially, a form of implicit sexism to consider issues such as contraception as under the purview of clinical medicine. Contraception is a choice and should be viewed from the perspective of the woman (ie from a social / culture or incorporated into the 'function' section) rather than from the perspective of a practitioner. --LT910001 (talk) 01:40, 6 June 2014 (UTC)[reply]

 Done moved to 'function' section. --LT910001 (talk) 23:22, 8 June 2014 (UTC)[reply]

97198 I believe I have addressed your concerns. --LT910001 (talk) 23:22, 8 June 2014 (UTC)[reply]

Okay, looking good. There are just a few small things that I'd like to see fixed:
  • The first paragraph of the lead is somewhat awkwardly worded, with a lot of very short sentences beginning the same way. Could this be reworded slightly to improve the flow?
 Done--CFCF (talk · contribs · email) 11:31, 9 June 2014 (UTC)[reply]
  • Ref #6 ("SINGER2005") is broken.
 Done--CFCF (talk · contribs · email) 11:29, 9 June 2014 (UTC)[reply]
  • Inconsistencies between British and American English have been introduced in edits throughout the review (such as oestrogen/estrogen and foetus/fetus). Either is fine, but the article should be consistent.
 Done oestrogen estrogen Feel free to change.--CFCF (talk · contribs · email) 11:29, 9 June 2014 (UTC)[reply]
Other than that, in my opinion the article meets all of the GA criteria, so if you ping me after making those changes I think it'll be ready to pass (finally!). 97198 (talk) 08:48, 9 June 2014 (UTC)[reply]
I'm guessing it is okay that I made those minor changes. 97198 -- CFCF (talk · contribs · email) 11:32, 9 June 2014 (UTC)[reply]
Thanks! It all looks good to me so I'll go ahead and promote the article. 97198 (talk) 11:38, 9 June 2014 (UTC)[reply]
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