A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.

Anemia hemolítica fetal rápidamente progresiva en el pretérmino tardío: reporte de caso / Rapidly progressive fetal hemolytic anemia in the late preterm: case report and literature review

Resumen ANTECEDENTES: La isoinmunización Rh es el principal factor de riesgo de anemia fetal. Cuando ésta es moderada o severa la transfusión intrauterina antes de las 34 semanas, y el nacimiento del feto luego de las 37, son las opciones de tratamiento más aceptadas. CASO CLÍNCO: Paciente de 29 años, con 34 semanas de embarazo, con antecedentes de tres gestaciones que terminaron en dos partos y una cesárea e isoinmunización Rh con secuela neurológica por anemia hemolítica. Hallazgo de Coombs indirecto positivo 1/512 y velocidad pico sistólica de la arteria cerebral media de 57 cm/s. Registro cardiotocográfico reactivo y seguimiento ambulatorio semanal. Retornó a Urgencias debido a la percepción de contracciones uterinas esporádicas. El feto se encontró con 140 lpm, peso de 2760 g y cuantificaciones correspondientes a anemia leve. La cordocentesis reportó Hb = 7.7 g/dL; "O" Rh (+). El embarazo terminó mediante cesárea con el nacimiento de una niña de 2702 g, Apgar 9/9, hemoglobina neonatal de 7.9 y 7 g/dL, bilirrubina total de 6.8 y 10.71 mg/dL (a las 4 y 7 horas después del nacimiento). Se efectuó exanguinotransfusión en dos oportunidades por anemia recidivante, fototerapia intensiva durante 5 días, fue dada de alta a los 25 días. CONCLUSIONES: Es importante analizar y cuantificar los riesgos de prolongar el embarazo más allá de las 34 semanas y aplicar transfusión intrauterina versus interrumpirlo y continuar el tratamiento de forma extrauterina; después de las 35 semanas los riesgos de los procedimientos superan los del parto pretérmino.

Abstract BACKGROUND: Rh isoimmunization is the main risk factor for fetal anemia. When this is moderate or severe intrauterine transfusion before 34 weeks, and the birth of the fetus after 37, are the most accepted treatment options. CLINICAL CASE: A 29-year-old patient, 34 weeks pregnant, with a history of three pregnancies that ended in two deliveries and a C-section and Rh isoimmunization with neurological sequelae due to hemolytic anemia. Finding of positive indirect Coombs 1/512 and VPS-ACM = 57 cm/s. Reagent cardiotocographic record and weekly ambulatory follow-up. He returned to the Emergency Department due to the perception of sporadic uterine contractions. The fetus was found with 140 bpm, weight of 2760 g and quantifications corresponding to mild anemia. The cordocentesis reported Hb = 7.7 g/dL; "O" Rh (+). The pregnancy was terminated by caesarean section with the birth of a girl of 2702 g, Apgar 9/9, neonatal hemoglobin of 7.9 and 7 g/dL, total bilirubin = 6.8 and 10.71 mg/dL (at 4 and 7 hours after birth). Exchange transfusion was performed twice due to recurrent anemia, intensive phototherapy for 5 days, and was discharged after 25 days. CONCLUSIONS: It is important to analyze and quantify the risks of prolonging a pregnancy beyond 34 weeks and apply intrauterine transfusion versus interrupting it and continuing the treatment extrauterine; After 35 weeks, the risks of the procedures surpass those of preterm delivery.

Use of Nifedipine and Isoxpurine Hydrochloride in Prevention of Preterm Labor - A Prospective and Comparative Study

Background: The study was done in Obstetric & Gynaecology   Department of Dr. VRK Women's Medical college to prevent the preterm labor which one is better either Nifedipine or Isoxpurine hydrochloride. Methods: In one month period total 1884 patients  attended OPD of Obstetric & Gynaecology. Out of 416 patients came with preterm labor.200 patients chosen for tocolysis.100 patients were given Nifedipine and 100 patients Isoxpurine hydrochloride. Results: Preterm labor incidence was 22% while preterm delivery incidence was 20.9%. Nifedipine was more effective than Isoxpurine hydrochloride for preterm labor whether it is diagnosed either in early stage or late stage. In early-diagnosed preterm labor, Nifedipine had higher efficacy than Isoxpurine (P value 6.45 × 10−6) and also higher efficacy than its own in late diagnosed preterm labor (P value 2.08 × 10−5). Conclusions: In  India preterm labor incidence is very high. So Nifedipine is better option than Isoxpurine hydrochloride especially when patient is having early signs of preterm labor.

Uterine Relaxation Potential of Ethanol Leaf Extract of Moringa oleifera Lam. VIA the Muscarinic Receptor Pathway.

Aim: The effect of Ethanol Leaf Extract of Moringa oleifera (ELMO) on uterine smooth muscles of non- pregnant female rats was studied in vitro with a view to finding out the mechanism(s) for observed effects. Experiential Design: In vitro studies using isolated rat’s uteri. Methods: Female albino rats (140-180g) pretreated 24 hours before experiments with diethylstilbestrol were sacrificed and the uterine horns carefully harvested into a beaker of De Jalon solution bubbled with 95% oxygen and 5% carbon dioxide. Each horn was mounted in an organ bath and allowed to equilibrate for 30 minutes, then the effects of graded doses of Acetylcholine, oxytocin and ELMO were established, using a physiograph and its accessories. The drugs were re-administered in the presence of their respective antagonists (Atropine for Acetylcholine and Atosiban for Oxytocin) and also in the presence of ELMO. Results: Results obtained showed that while Acetylcholine and oxytocin induced uterine contractions, ELMO caused relaxation. ELMO significantly (P<0.05) blocked the uterine contractile effect of Acetylcholine but had no effect on Oxytocin induced uterine contractions. The experiments therefore indicate that ELMO contain active ingredients capable of inducing uterine relaxation via the muscarinic receptor pathway. Conclusion: The extract therefore, may not be a valuable tocolytic agent in cases of Oxytocin induced uterine contractions, particularly in pregnancy but its observed strong anticholinergic activity may be exploited in the treatment of diseases associated with hyper activity of the parasympathetic arm of the autonomic nervous system.

SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL CON PROCESAMIENTO EN UNA FPGA PARA EL MONITOREO MATERNO-FETAL / DIGITAL CARDIOTOCHOGRAPHY SYSTEM WITH PARALLEL FPGA PROCESSING FOR MATERNAL FETAL MONITORING / SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL COM PROCESSAMENTO EM UM FPGA PARA MONITORAMENTO MATERNO-FETAL

El estudio clínico fetal relaciona aspectos críticos como la intensidad de las contracciones uterinas, movimientos del feto y frecuencia cardiaca de manera simultánea para evaluar el bienestar fetal. Los cambios periódicos o transitorios de la frecuencia cardiaca son objeto de estudio y aparecen en relación a diversos estímulos fetales como movimientos espontáneos o provocados, contracciones uterinas, hipo fetal, etc. Con este propósito, en una valoración de los mismos es necesario disponer de una constante monitorización, en la que se exprese la frecuencia y la variabilidad cardiaca fetal de manera eficiente. En este artículo se presenta el desarrollo de un sistema de tococardiografía para el registro de la frecuencia cardiaca fetal y la intensidad de las contracciones uterinas compuesto por tres tarjetas electrónicas, una unidad de procesamiento digital paralela, una campana acústica y una pantalla para adquirir y procesar de manera no invasiva las señales tococardiográficas.

Clinical evaluation on fetuses is related to simultaneous critical aspects such as intensity of uterine contractions, fetal movements, and heart rate. Periodic or transient changes in heart rate are studied and appear in relation to various fetal stimuli as spontaneous or induced movements, uterine contractions, fetal hiccups, and so on. Thus, their evaluation is necessary to obtain constant monitoring in which the frequency and variability are expressed efficiently. This paper presents the development of a cardiotochography system for recording fetal heart rate and intensity of uterine contractions, which is composed by three electronic boards, a digital parallel processing unit, a sounds bell and a screen to acquire non-invasively and process tococardiography’s signals.

O estudo clinico fetal relaciona aspectos críticos, como a intensidade das contrações uterinas, movimentos fetais e batimentos cardíacos simultaneamente para avaliar o bem-estar fetal. As mudanças periódicas ou transitórias da frequência cardíaca são estudados e aparecem em relação a vários movimentos fetais espontâneas ou induzidas, as contrações uterinas, soluços fetais, etc. Para este efeito, em uma revisão do mesmo é necessário ter monitoramento constante, na que se exprese a freqüência e variabilidade do ritmo cardíaco fetal de forma eficiente. Este artigo é apresentado o desenvolvimento de um sistema de tococardiografía para registar o ritmo cardíaco fetal e intensidade das contrações uterinas composto por três placas eletrônicas, uma unidade de processamento digital paralelo, uma cabine acústica e uma tela para adquirir e processar de maneira não invasiva as sinais tococardiográficas.

Combined with Shakuyakukanzoto at the Time of Embryo Transfer in is vitro Fertilization : A Randomized, Retrospective Study / 日本東洋医学雑誌

In vitro fertilization-embryo transfer (IVF-ET) therapy for subfertile couples has become widespread. However, it has been reported that high frequency uterine contractions at the time of embryo transfer influence adversely IVF-ET outcome. This article focuses on the methods of administration of shakuyakukanzoto combined with ET for subfertile women. 186 patients who underwent IVF-ET were recruited. 94 women undergoing IVF were randomly assigned to ET with shakuyakukanzoto for 4 days or 92 with no treatment. Background characteristics (age, number of embryo transferred, quality, and luteal function) were similar in the two groups. Pregnancy rate was 33.0% in the shakuyakukanzoto group as compared with 20.7% in the nontreated group. The increased pregnancy rate with shakuyakukanzoto compared with no treated was significant. However, the precise mechanism to explain for the results of this investigation remains to be unclear. Therefore, further research might be necessary to evaluate the effect of shakuyakukanzoto, at the time of ET.

Influence of time at which oxytocin is administered during labor on uterine activity and perinatal death in pigs

Oxytocin is extensively used to induce or augment uterine contractions, especially to facilitate the third stage of labor in humans. Administration of oxytocin to parturient sows reduces duration of labor whereas mortality of the offspring may remain unchanged. This study aimed to evaluate whether time of administration of oxytocin during parturition may alter the uterine response and fetal outcomes. Two hundred parturient sows were randomly assigned to intramuscularly receive either saline solution (control group) or oxytocin 0.083 IU/kg immediately after the delivery of the 1st, 4th or 8th piglet (groups O-1, 0-4 and 0-8, respectively). Uterine effects and fetal outcomes were registered in all groups. The duration of labor was 20-40 min shorter (P < 0.0001) and time interval between babies was reduced by 3-5 min (P < 0.0001) in the three groups receiving oxytocin. The duration and intensity of contractions, meconium-stained piglets and intrapartum deaths decreased as time at which oxytocin administered during labor was increased. In group 0-8, we observed approximately 70 percent less meconium-stained piglets and intrapartum deaths than in the control group. In conclusion, oxytocin administered at early phases of parturition to sows may increase duration and intensity of uterine contractions as well as adverse fetal outcomes.

Ultrasound-induced uterine smooth muscle contraction / 中华物理医学与康复杂志

Objective To study the influence and dose effect of ultrasound on the contraction of uterine smooth muscle in rats.Methods Estradiol benzoate was injected into rats three days before conducting an in-vitro experiment.Their uteri were resected and irradiated with ultrasound(0.8 MHz,3 W/cm~2,0-40 rain).The contrac- tion frequency and amplitude were recorded using an MS-302 biological experiment system.Results It could be seen that the contraction frequency and amplitude,and general contractile activity were significantly increased during ultrasonic irradiation(P＜0.01).The increased contraction frequency and amplitude lasted for ten minutes,and then the normal contraction pattern resumed.The contraction frequency as well as the percentage change in eontraction fre- quency were highest during the first 15 minutes of ultrasonic irradiation;the contraction amplitude as well as the per- centage change in amplitude were highest during 40 minutes of ultrasonic irradiation.Contraction activity was at its highest for 30 minutes,but the percentage change in activity was highest for 20 minutes.Conclusions Ultrasound can induce uterine smooth muscle contraction in rats.This biological effect is related to the irradiation time.