Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Antiretroviral agents and acid-base balance at delivery of the neonate

Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with a = 0.05 and ß = 20 percent, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20 percent. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.

Desempenho motor e emocional de parturientes durante o 2§ periodo do trabalho de parto: comportamento motor

Avaliar o desempenho motor e emocional de parturientes durante o 2§ periodo do trabalho de parto, no Centro Obstetrico do Hospital Universitario de Santa Maria, e verificar as relacoes com variaveis obstetricas foram os objetivos deste estudo. Considerou-se, como comportamento motor, a prensa abdominal, as condicoes do perineo e a respiracao da parturiente. Categorizou-se o comportamento emocional observado durante o parto como calmo, agitado, muito agitado ou outro comportamento. A amostra foi composta por 105 parturientes, por meio da Tecnica de Amostragem por Projecao. Coletaram-se os dados de prontuario, a paruriente foi entrevistada e teve seu parto observado pela pesquisadora. Utilizou-se o qui-quadrado na analise estatistica dos dados para verificar as relacoes entre as variaveis estudadas e o comportamento motor. As relacoes com o comportamento emocional foram analisadas quali-quantitativamente. dentre os resultados obtidos, a prensa abdominal associou-se significantemente (p< 0,01) ao tempo de duracao do 2§ periodo do trabalho de parto, quando o perineo estava relaxado e o parto ocorreu em menos de 30 minutos, em 86,8 por cento dos casos. Tambem houve associacao significante da prensa abdominal (p< 0,01) e do tempo do periodo expulsivo (p< 0,01) com o tipo de parto vaginal, sendo que 72,6 por cento das parturientes com prensa e 64,4 por cento dos partos ocorridos em menos de 30 minutos foram realizados sem manobras e/ou instrumentos. Houve relacao entre o comportamento motor e o comportamento emocional, com melhor desempenho das das parturientes calmas. Acredita-se que o parto, enquanto destreza motora, pode ser aprendido e ter seu desempenho melhorado por meio da pratica, o que devera ser observado em trabalhos futuros