Absence Of Uterine Contractions Research Articles

Comparison of Postpartum Exercises and Consumption of Purple Sweet Potato Leaves on Reduction of Uterine Fundamental Height in Postpartum Women

The bleeding after childbirth is caused 50 - 60%by weakness or absence of uterine contractions. It is important to provide postpartum services for mothers as one of the main pillars in the strategy to reduce the Maternal Mortality Rate (MMR). Postpartum exercise and administering decoction of purple sweet potato leaves are non-pharmacological techniques that can accelerate uterine involution. This study aims to determine the comparison of postpartum exercise and giving purple sweet potato leaves to reduce uterine fundal height in postpartum women at the Taman Sari Clinic, Pekanbaru City in 2023. This research is quantitative with a quasi-experimental design using one control group and one experimental group with the two method. The number of samples for this study was 20 people per group. Data collection method using observation method. The test used is the Independent T test with a significance level of 95%. The research results showed that the difference in TFU reduction after giving purple sweet potato leaves to postpartum mothers was 8.85 cm. The difference in TFU reduction after postpartum exercise was 10.4 cm. This shows that there is a difference between postpartum exercise and purple sweet potato in reducing TFU in postpartum women with a value of p=0.006. It is hoped that decoction of purple sweet potato leaves can reduce TFU in postpartum mothers

Etiology behind canine uterine inertia: Role of uterine expression of MLCK4, MYH2, and PKC genes

Dystocia is an obstetrical emergency, and primary uterine inertia (PUI) is the major etiological reason among the more prevalent maternal causes in dogs. The present study involved the relative expression analysis of genes associated with myometrial contraction in medium-sized dog breeds with uterine inertia. Dogs without any progress in the parturition process even after four hours of the onset of labor and the absence of uterine contractions were considered to have complete primary uterine inertia (CPUI, n = 9). Dogs that had expelled at least one fetus and made no further progress in parturition in the absence of active uterine contraction were considered to be experiencing partial primary uterine inertia (PPUI, n = 6). Dogs with the fetal cause of dystocia (FCD), i.e., obstructive dystocia, were taken as the third (n = 7) group. Uterine tissue samples were collected during cesarean section in each group, RNA was isolated, and the relative expression of myometrial ACTA2, ACTG2, MLCK4, MYH2, and PKC genes was analyzed. The MLCK4 gene expression was downregulated in CPUI (P ≤ 0.05) and PPUI (P ≤ 0.01) when compared to FCD. The MYH2 gene expression was downregulated in PPUI in comparison to CPUI (P ≤ 0.01) and FCD (P ≤ 0.05). The PKC gene expression was upregulated in PPUI in comparison to FCD and CPUI (P ≤ 0.05). The downregulation of MLCK4 and MYH2 gene expressions recorded in PPUI indicated the possibility of myometrial defects. The possibility of myometrial defects was also observed in CPUI, but to a lesser degree, suggesting other etiologies.

Incompetencia cervical: presentación de un caso

Cervical incompetence (CI) is characterized by progressive dilation of the cervix in the absence of uterine contractions. This pathology is one of the main reasons for early gestational losses and preterm births. It is the dilation of the cervix, which is the portion of the uterus that is responsible for maintaining the pregnancy until term, with a normal average measurement of 35 to 40 millimeters, although this dilation is not associated with painful contractions and perceived by the pregnant. Clinically it can be manifested by different signs such as dilation of the cervix, cervical shortening and preterm onset of labor. In addition, it is related to premature rupture of membranes and chorioamnionitis. To treat this pathology, avoid second-trimester losses and trigger premature labor, different techniques can be used, such as the placement of a pessary, the administration of progesterone and the performance of a cervical cerclage. The latter is the technique of choice for the treatment of incompetent cervix, being indicated due to poor obstetric history, as a therapeutic method in case cervical changes suggestive of the onset of labor are detected by ultrasound, or emergency when the pregnant woman shows cervical dilatation and/or exposure of the membranes.

Association between uterine contractions before elective caesarean section and transient tachypnoea of the newborn: a retrospective cohort study

ObjectiveWe evaluated the association between the presence of predelivery uterine contractions and transient tachypnoea of the newborn (TTN) in women undergoing an elective caesarean section.DesignA retrospective cohort study.SettingNational Hospital Organization...

Postoperative imaging following fetal open myelomeningocele repair: The clinical utility of magnetic resonance imaging and sonographic amniotic fluid volumes in detecting suspected hysterotomy scar dehiscence.

Hysterotomy scar disruption, ranging from myometrial thinning to complete dehiscence, is a well-established complication of open-hysterotomy fetal myelomeningocele (MMC) repair. This study sought to (a) determine the feasibility of postoperative magnetic resonance imaging (MRI) in detecting signs of hysterotomy scar disruption and (b) identify the sonographic and clinical signs suggestive of subacute scar dehiscence, including decreasing amniotic fluid index (AFI) and uterine contractions, respectively. A unique index case of suspected hysterotomy dehiscence following MMC repair prompted a retrospective review of 31 total open-hysterotomy fetal MMC repairs performed at our center, including 21 cases found to have intact hysterotomy scarring and 10 cases of non intact scarring detected at subsequent cesarean delivery. In each case, routine post operative MRI, performed 6 weeks after the MMC repair, was reviewed to evaluate the thickness of the hysterotomy site. Cases were also reviewed for sonographic and clinical patterns preceding delivery, including changes in AFI and the presence or absence of uterine contractions. Of the 31 total reviewed cases, 21 cases were found to have intact hysterotomy scar sites at the time of cesarean delivery. Among the intact cases, the net change in AFI from the time of MRI to delivery ranged from -45% to 47%, with a mean increase in fluid levels of 8% over an average of 5.6 weeks. The other 11 cases, including the index case, were found to have signs of scar disruption at delivery, including seven with thinned scar sites and four with grossly dehiscent sites. Amongst non-intact cases, AFI predominately decreased, with a net change ranging from -56% to 9% for a mean change of -24% over an average of 5.4 weeks. Regular uterine contractions close to the time of delivery occurred in 82% of the non intact cases. Hysterotomy scar disruption can rarely be detected by MRI following MMC repair. Decreasing AFI and contractions may serve as early warning signs of scar dehiscence and should be taken into consideration for obstetric management.

Reliability of transperineal ultrasound for the assessment of the angle of progression in labor using parasagittal approach versus midsagittal approach

Objective To assess the inter-method agreement between midsagittal (msAoP) and parasagittal (psAoP) measurements of the angle of progression (AoP) during labor. In addition, we aimed to evaluate the correlation between AoP measurements by both midsagittal and parasagittal approaches with the mode of delivery. Methods We recruited a nonconsecutive series of women in active labor with a singleton uncomplicated term pregnancy with fetuses in vertex presentation. Women underwent transperineal ultrasound in the absence of uterine contractions or maternal pushing to measure both msAoP and psAoP. The inter-method agreement between the two acquisitions was then assessed. Lastly, both measurements were compared between women who had a vaginal delivery versus those who underwent cesarean section (CS). Results Overall, 151 women were included in the study. We found an excellent agreement between msAoP and psAoP (ICC 0.935; 95% CI 0.912–0.953, p < .001). On the other hand, psAoP overestimated the measurements in comparison with msAoP (101.2 ± 15.6 versus 98.2 ± 16.0, p < .001). There was a significant correlation between both methods of AoP assessment and duration of the active second stage of labor and AoP measured by either method was significantly wider in patients who delivered vaginally compared to those who had a CS. Conclusions Our data showed a significant difference in the measured angle between the psAoP and the originally described msAoP. The automated measurements of AoP that have been introduced are designed using the parasagittal visualization of the more echogenic pubic arch, rather than the hypoechogenic pubic symphysis. We think that in the light of our data, care should be taken before applying data from midsagittal measurement in centers using the parasagittal automated approach.

Hubungan Motivasi dengan Perilaku Ibu Post Partum dalam Melakukan Mobilisasi Dini

Perdarahan Pasca persalinan merupakan salah satu penyebab kematian pada ibu. Yang mana penyebab terbanyak dari perdarahan pasca persalinan tersebut 50-60% karena kelemahan otot atau tidak adanya kontraksi uterus. Hal ini bias disebabkan karena ibu post partum tidak melakukan mobilisasi dini pasca bersalin normal 24 jam pertama setelah proses persalinan dan hari-hari berikutnya. Rancang bangun analitik - cross sectional. Jumlah sampel sebanyak 28 orang dan teknik pengambilan sampel consecutive sampling. Variabel independen adalah motivasi ibu post partum melakukan mobilisasi dini, sedangkan variabel dependentnya adalah perilaku ibu post partum dalam melakukan mobilisasi dini, pengumpulan data dengan menggunakan kuesioner. Berdasarkan hasil penelitian bahwa lebih dari 50% responden (60%) tidak termotivasi dalam melakukan mobilisasi dini, paling banyak perilaku ibu post partum melakukan mobilisasi dini adalah kurang sebanyak t orang (48%). Hasil uji wilcoxon didapatkan bahwa α hitung lebih kecil dari α tabel yaitu 0,000 &lt; 0,05, artinya ada hubungan antara motivasi dengan perilaku ibu dalam melakukan mobilisasi dini. Diharapkan bidan dapat memberikan informasi tentang mobilisasi dini dengan menerapkan langsung dan juga membantu ibu post partum dalam melakukan mobilisasi dini sehingga ibu post partum tidak takut untuk melakukan mobilisasi dini.

Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency

Cervical insufficiency is a risk factor for spontaneous midtrimester abortion or early preterm birth. Intra-amniotic infection has been reported in 8-52% of such patients and intra-amniotic inflammation in 81%. Some professional organizations have recommended perioperative antibiotic treatment when emergency cervical cerclage is performed. The use of prophylactic antibiotics is predicated largely on the basis that they reduce the rate of complications during the course of vaginal surgery. However, it is possible that antibiotic administration can also eradicate intra-amniotic infection/inflammation and improve pregnancy outcome. To describe the outcome of antibiotic treatment in patients with cervical insufficiency and intra-amniotic infection/inflammation. The study population consisted of 22 women who met the following criteria: (1) singleton pregnancy; (2) painless cervical dilatation of >1 cm between 16.0 and 27.9 weeks of gestation; (3) intact membranes and absence of uterine contractions; (4) transabdominal amniocentesis performed for the evaluation of the microbiologic and inflammatory status of the amniotic cavity; (5) presence of intra-amniotic infection/inflammation; and (6) antibiotic treatment (regimen consisted of ceftriaxone, clarithromycin, and metronidazole). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction for Ureaplasma spp. was performed. Intra-amniotic infection was defined as a positive amniotic fluid culture for microorganisms or a positive polymerase chain reaction for Ureaplasma spp., and intra-amniotic inflammation was suspected when there was an elevated amniotic fluid white blood cell count (≥19 cells/mm3) or a positive rapid test for metalloproteinase-8 (sensitivity 10 ng/mL). For the purpose of this study, the "gold standard" for diagnosis of intra-amniotic inflammation was an elevated interleukin-6 concentration (>2.6 ng/mL) using an enzyme-linked immunosorbent assay. The results of amniotic fluid interleukin-6 were not available to managing clinicians. Follow-up amniocentesis was routinely offered to monitor the microbiologic and inflammatory status of the amniotic cavity and fetal lung maturity. Treatment success was defined as resolution of intra-amniotic infection/inflammation or delivery ≥34 weeks of gestation. Of 22 patients with cervical insufficiency and intra-amniotic infection/inflammation, 3 (14%) had microorganisms in the amniotic fluid. Of the 22 patients, 6 (27%) delivered within 1 week of amniocentesis and the remaining 16 (73%) delivered more than 1 week after the diagnostic procedure. Among these, 12 had a repeat amniocentesis to assess the microbial and inflammatory status of the amniotic cavity; in 75% (9/12), there was objective evidence of resolution of intra-amniotic inflammation or intra-amniotic infection demonstrated by analysis of amniotic fluid at the time of the repeat amniocentesis. Of the 4 patients who did not have a follow-up amniocentesis, all delivered ≥34 weeks, 2 of them at term; thus, treatment success occurred in 59% (13/22) of cases. In patients with cervical insufficiency and intra-amniotic infection/inflammation, administration of antibiotics (ceftriaxone, clarithromycin, and metronidazole) was followed by resolution of the intra-amniotic inflammatory process or intra-amniotic infection in 75% of patients and was associated with treatment success in about 60% of cases.

The Use of Mersilene Tape in Transabdominal Cerclage

Aim: The purpose of this article is to show the use and utility of mersilene tape in medical procedures, such as transabdominal cerclage (TAC). Material and methods: Based on their biomechanical properties, we present our experience with mersilene tape used as treatment for cervical incompetence. Cervical insufficiency or cervical incompetence is defined as asymptomatic cervical shortening and dilatation with the absence of detectable uterine contractions. The mechanical properties of cervical tissue are derived from its extracellular matrix and its most important constituent the fibrillar collagen, alongside other constituents such as proteoglycans, hyaluronic acid, elastin, and water. In the absence of the uterine contractions, the cervix is loaded by intrauterine pressure (including the weight of the growing fetus and amniotic sac), the gravity as well as passive pressure from the uterine wall. These forces also depend on the support action of pelvic floor structures and abdominal wall. The static load resulting from the combination of uterine growth, hydrostatic pressure and gravity seems to be the dominant determinants that cause cervical shortening. The placement of the mersilene tape acts as a barrier between the intrauterine pressure and the cervix. The main advantage of the TAC procedure is the placement of the nonabsorbable suture (mersilene tape at the level of the internal os, avoiding the placement of a vaginal foreign body and subsequently increasing the risk of ascending lower genital tract infection, decreased incidence of slippage, and the ability to leave the stitch in place between pregnancies. Results: The follow-up was without complications regarding the pregnancies treated with transabdominal cerclage. None of the pregnancies terminated prematurely as related to the presence of the tape, but it necessitates to be performed a caesarean section for delivery. Conclusions: Mersilene tape is safe and useful in different medical procedures, including transabdominal cerclage during pregnancy.

83 The variability of the maternal heart rate during labor of pregnant women with pre-eclânpsia and normotensive pregnant women and their correlation with maternal and perinatal outcomes.

Objectives The association of autonomic modulation with maternal and perinatal outcomes was evaluated in preeclamptic women and in normotensive pregnancy women. Studied groups were matched for important determinants of HRV. Methods This is a prospective cross-sectional study evaluated the HRV in 36 pregnant women with gestational age over 28th weeks. All women had single fetus gestation and did not present any systemic disease prior pregnancy or were not using any type of medication during pregnancy. Seventeen women had preeclampsia (PE) and 19 normotensive pregnant (NP) women. Pregnant women with PE were kept in absolute rest in the left lateral decubitus and submitted to eclampsia prophylaxis with 6 g of magnesium sulfate at 50%, followed by 2 g/h continuous infusion. NP women did not receive any medication. During rest in the left lateral position, in the absence of uterine contractions or pain, patients were monitored Holter ECG recordings used for HRV analysis for 20 min. Natural logarithm (Ln) of mean NN (LnMean NN ), the the standard deviation of NN intervals (LnSDNN), the square root of the mean squared differences of successive NN intervals (LnRMSSD), low frequency (LnLF) and high frequency (LnHF) and LH/HF ration were used to evaluate HRV. Neonatal outcomes were evaluated immediately after birth being registered weight, Apgar index at 1 ° and 5 ° min and gestational age calculated by Capurro method. To compare the variables between groups we used ANOVA (ANOVA One Way) and for comparison post hoc Tukey test. Multivariable regression was performed using SPSS (Statistical Package for Social Sciences, Inc., Chicago, IL) version 16.0 for Windows. Descriptive data were presented as mean, SD and median. Student t test , Mann–Whitney and Chi-square test were using where apropriated. P 0.05 was considered significant. Results The comparative analysis of HRV demonstrated that PE women had significantly lower LnSDNN (25,93 ms vs. 41,72 ms, P .05) and LnRMSSD (13,25 ms vs. 24,76 ms, P 0.05). The LnSDNN was inversely correlated with the systolic blood pressure (SPB) (r-0.36, P .05) and diastolic blood pressure (DPB) (r-0,36, P .05) and directly correlated with gestational age (r 0.38, P .05). The LnRMSSD presented a positive correlation with gestational age (r 0.39, P .05). LF/HF was elevated in two groups (PE 7,5; NP 2,97). LnHF was directly correlated with gestational age (r 0.34, P .05). PE women had increased SBP (164,71 mmHg vs. 104,74 mmHg, P .001) and DBP(109,41 mmHg vs. 67,89 mmHg,P .001); newborns had lower weight (2694,67 g vs. 2937,89 g, P .05), lower Apgar Score in the 1 ° min (7,0 vs. 8,0, P .05) and in the 5 ° min (9,0 vs. 10, P .05). Three neonates from PE women were admitted to the neonatal ICU and one of them dies. Conclusion The study demonstrated that PE women have lower autonomic modulation by HRFcompared to NP women. This reduction is association to higher maternal blood pressure and lower gestacional age.

Misoprostol versus High Dose Oxytocin and Laminaria in Termination of Pregnancy in Second Trimester Pregnancies.

Background:In 2 recent decades, found drug regimen to induce abortion that are more effective than surgery. Prostaglandins especially misoprostol, oxytocin and osmotic dilators such as laminaria use for termination but the best method is unknown. Therefore we aimed to assess the comparison between the Misoprostol regimen and the highly concentrated oxytocin with laminaria regimen in second trimester of pregnancy termination.Methods:In this randomized clinical trial, 100 women with gestational age 14 to 24 week coming to hospital due to termination of pregnancy in the absence of uterine contractions and items of exclusion criteria enrolled to study and randomly assign to 2 groups and received misoprostol (group 1) or oxytocin (group 2). Data collected with use of observation, examination and demographic checklist. In group 1, in admission time and then every 6 hour patients received 200 µgr misoprostol until start the pain or vaginal bleeding or abortion in 48 hr. in group 2, patients first received laminaria in cervix with duration of 6 hr and then oxytocin 50 unit in 500 cc normal saline in 3 hr. after 1 hr rest, oxytocin dosage elevated as multiple into 2 and continue until termination or maximum dose of 300 u in 500 cc normal saline. Data entered to SPSS software version 16 and analyzed with use of descriptive methods and also Chi-square and T-test.Results:In each group enrolled 50 women that approximately no different in baseline characteristic. Number of abortion in misoprostol group was more than oxytocin group (P<0.001) and duration of abortion also was shorter than oxytocin in misoprostol group (P<0.001). Side effects in 23 (46%) women in misoprostol group were seen but no side effect seen in oxytocin group. Complementally interventions was seen in 31 women (60%) in misoprostol group versus 32 women (62%) in oxytocin group but this difference was not significant (P>0.05).Conclusion:This study demonstrated that misoprostol is effective than oxytocin in termination of pregnancy but with attention to limitation of this study include of limited abortion causes due to legal laws, additional studies on different doses of misoprostol and oxytocin due to achieve to suitable regimen with lower side effects recommended.

Assessment of Maternal Heart-Rate Variability during Labor Using Wavelet-Based Power Spectral Analysis

Objective: Changes in the maternal cardiac autonomic nervous system were assessed in the presence and absence of uterine contractions by analyzing maternal heart-rate variability during labor using wavelet-based power spectral analysis. Methods: We assessed the heart-rate variability in 20 pregnant women during labor and in 15 pregnant women with threatened premature labor with the use of wavelet-based power spectral analysis. Results: There was no significant difference in high-frequency components between the uterine contraction and non-contraction periods. The intensities of the low-frequency and very-low-frequency components during uterine contractions were significantly stronger than the corresponding intensities between uterine contractions. Conclusion: Maternal sympathetic activity was upregulated during uterine contractions, and influenced the very-low-frequency components. This method of analysis may represent a novel means of identifying uterine contractions.

The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor

BackgroundObjective pain assessment that is not subject to influences from either cultural or comprehension issues is desirable. Analysis of heart rate variability has been proposed as a potential method. This pilot study aimed to assess the performance of the PhysioDoloris™ analgesia monitor which calculates an Analgesia Nociception Index derived from heart rate variability. It was compared with visual analogical pain scores. MethodsForty-five parturients who requested epidural analgesia were recruited. Simultaneous couplets of pain scores and Analgesia Nociception Index values were recorded every 5min regardless of the presence or absence of uterine contractions. The relationship between indices was characterized, and a cut-off value of Analgesia Nociception Index corresponding to a visual analogical score >30 (range 0–100) was used to determine the positive and negative predictive value of the Analgesia Nociception Index. ResultsThere was a negative linear relationship between visual analogical pain scores and Analgesia Nociception Index values regardless of the presence of uterine contractions (regression coefficient±SEM=−0.18±0.032 for entire dataset). Uterine contraction significantly reduced the Analgesia Nociception Index (P<0.0001). Using a visual analogical pain score >30 to define a painful sensation, the lower 95% confidence limit for the Analgesia Nociception Index score was 49. ConclusionThe Analgesia Nociception Index has an inverse linear relationship with visual analogical pain scores. Further studies are necessary to confirm the results of this pilot study and to look at the influence of epidural analgesia on the Analgesia Nociception Index.

Ultrasonographic evaluation of myometrial thickness in twin pregnancies

The objective of the study was to evaluate longitudinally the in vivo changes in myometrial thickness (MT) during gestation in patients carrying twin gestations in relation to pregnancy outcome. Serial abdominal ultrasounds were performed prospectively in 92 patients carrying twin gestations through each trimester. Ninety-seven patients pregnant with singletons served as controls. For twins, the primary endpoint was spontaneous delivery at less than 35 weeks' gestational age (GA). The myometrium was defined sonographically as the echohomogeneous layer between the serosa and the decidua and was measured at the anterior, fundal, and lower uterine segment (LUS) walls. The estimated fetal weight, maximum vertical pocket of amniotic fluid, and placental thickness were also assessed ultrasonographically at the same time as the MT and served as estimates for the contribution of each to the uterine volume. In twins, cervical length measurements were performed transvaginally, as clinically indicated. Data analysis included 2-way analysis of variance and linear, nonlinear, and multivariate regression. A total of 41.3% of twin pregnancies (38 of 92) delivered preterm (< 35 weeks). There were no significant changes in measurements at the anterior and fundal site over time throughout pregnancy and no differences in these sites between twin and singleton gestations. Conversely, in both twins and singletons, there was a significant and gradual thinning of the LUS myometrium during gestation. In the absence of uterine contractions or symptoms of preterm labor, twins that delivered preterm had a significantly thinner LUS at an earlier gestation, compared with twins that delivered at term (P < .001), suggesting that LUS thinning occurred earlier in these cases. There was a significant correlation between cervical length and LUS thinning during gestation in twins that delivered 35 weeks GA or later (r = 0.352; P < .001) but not in those that delivered preterm (< 35 weeks GA; r = 0.125; P = .326). Twin pregnancy is characterized by a significant, selective, and gradual thinning of the LUS during gestation, which does not occur in the anterior and fundal myometrium. Thinning of the LUS occurs earlier in twin pregnancies destined to deliver preterm. These observations suggest that similar to the cervix, the LUS changes dynamically during twin pregnancy and that this too may be assessed through ultrasound imaging.

141: Accuracy of digital measurement of the cervical portio length

RICHARD BURWICK, GENE LEE, JENNIFER BENEDICT, MARGARET POURTEMOUR, MICHAEL G. ROSS, Harbor-UCLA Med. Ctr. (LABioMed), Dept. of Ob/Gyn, Torrance, California OBJECTIVE: To evaluate the accuracy of clinician-performed cervical length measurements using digital exams, as compared to an objective measure using the Cervilenz device in women presenting with symptoms of preterm labor. STUDY DESIGN: Informed consent for cervical exams was obtained from women presenting in preterm labor between 24-34 weeks gestation, as part of a prospective trial of factors predictive for preterm delivery. Exclusion criteria included cervical dilation 3cm, ruptured membranes, multiple gestation, vaginal bleeding, or intercourse within the prior 24 hours. Cervical length was measured initially by digital exam, estimated to the nearest 0.1 cm. A second examiner, blinded to the results of the digital exam, measured the cervical portio length (at 3:00 or 9:00) utilizing the Cervilenz measuring device. RESULTS: Digital measures of cervical length varied widely, and did not correlate significantly with the objective Cervilenz measures (r 0.23, p 0.10). Digital measures tended to be less than Cervilenz measurements, with a mean absolute difference of 0.88 cm (range 0.20-2.10cm, p 0.0005). The mean absolute difference between digital exam and Cervilenz measurements trended to be even greater among women with cervices described as “soft” versus “medium” or “firm” (1.08 vs. 0.76cm, p 0.07), and in women with long ( 3.5cm) versus short ( 2.5cm) cervices (1.29 vs. 0.76cm, p 0.09), but these did not reach statistical significance. The mean absolute difference between the two measures did not change in the presence or absence of uterine contractions (0.84 vs. 0.92cm, p 0.36). CONCLUSION: Using the objective Cervilenz measure as the standard, these results illustrate the relative inaccuracy of digital exams for cervical length assessment in preterm labor patients. We propose that if cervical length assessments are used for clinical decisions regarding preterm hospitalization or tocolysis, they be performed by an objective measure.

Dopplervelocimetria do ducto venoso na predição da acidemia fetal

To investigate the possibility of predicting acidemia at birth in pregnancies with placental insufficiency by Doppler velocimetry of the ductus venosus and to establish the best parameter and cut-off points in this prediction. This was a prospective cross-sectional study, involving 47 single pregnancies with placental insufficiency after 26 weeks of gestation, carried out at the "Hospital São Paulo (UNIFESP) and Maternidade-Escola Assis Chateaubriand (UFC)". Placental insufficiency was defined as the umbilical artery pulsatility index above the 95th percentile for gestational age. Fetuses with chromosomal or structural anomalies were excluded. The time interval between the Doppler velocimetry and the birth was of less than 24 hours. The umbilical arterial blood samples were collected immediately after birth. Acidemia was defined as umbilical arterial pH < 7.2 in the absence of uterine contractions and < 7.15 in the presence of contractions. Metabolic or mixed acidemia at birth was considered pathological. Receiver operating characteristics (ROC) curves were calculated for S, D and A-velocities, pulsatility index for veins and the S/A ratio and (S-A)/S ratio of the ductus venosus. Parameters were compared using the MacNemar Test S, D and A-velocities of the ductus venosus were poor predictors of acidemia at birth. The pulsatility index for veins (area under the curve 0.79, p=0.003), S/A ratio and (S-A)/S ratio (area under the curve 0.818, p=0.001) of the DV were strongly related to fetal acidemia. The cut-off points calculated were: pulsatility index for veins = 0.76; S/A ratio = 2.67 and (S-A)/S ratio = 0.63. The angle-independent indices of the DV Doppler are adequate for the diagnosis of fetal acidemia in gestations with placental insufficiency. No statistically significant differences were observed between these parameters.

Uterine contractions might increase heart preload in the recipient fetus in early‐onset twin–twin transfusion syndrome: an ultrasound assessment

Uterine contractions (UC) in twin pregnancy are often experienced, yet the effects of UC in twin-twin transfusion syndrome (TTTS) remain to be clarified. The recipient heart preload condition and the effects of UC were evaluated and the final objective was to clarify the effects of tocolysis. Firstly, the preload indexes (PLIs) and cardiothoracic area ratios (CTARs) were analyzed on both fetuses of 10 TTTS cases, aged from 14 to 28 gestational weeks in stage III/IV cases for evaluating the preload condition. Then, the PLIs in the presence and absence of UC in the recipient fetuses were determined to evaluate the difference. The PLIs of the recipient and the donor fetuses were 0.78 +/- 0.34 (n = 163) and 0.35 +/- 0.13 (n = 71) respectively. The CTARs were 30.2 +/- 6.1 (n = 62) and 23.4 +/- 5.4 (n = 62) respectively. The PLIs in the absence and presence of UC in the recipient fetuses were 0.69 +/- 0.29 and 0.99 +/- 0.38 (n = 35). All above comparisons showed highly significant differences (p < 0.0001). The recipient fetuses have signs of cardiac dilatation and a high-preload condition. UC transiently further raises high-preload conditions of the recipient fetus. Thus, tocolysis may be necessary for management in cases of early-onset severe TTTS.

Índices veno-arteriais para predição da acidemia fetal ao nascimento em gestações com insuficiência placentária

OBJETIVOS: investigar a possibilidade da predicao da acidemia no nascimento, em gestacoes com insuficiencia placentaria, com o emprego de indices veno-arteriais avaliados pela dopplervelocimetria, definindo seus pontos de corte para esta predicao. METODOS: trata-se de estudo transversal prospectivo no qual foram incluidas 47 gestacoes unicas com insuficiencia placentaria (presenca de indice de resistencia e indice de pulsatilidade (IP) na arteria umbilical (AU) superiores ao percentil 95), apos a 26a semana. Foram excluidos os casos com fetos apresentando anomalias estruturais ou cromossomicas. O Doppler foi realizado a menos de 24 horas do parto. Amostra de sangue arterial umbilical para analise da acidemia foi coletada imediatamente apos o nascimento. Diagnosticou-se acidemia quando o pH encontrava-se abaixo de 7,20 na ausencia de trabalho de parto e abaixo de 7,15 quando parto vaginal. Foram consideradas patologicas as acidemias metabolicas ou mistas. Construiu-se curva ROC para os indices veno-arteriais: IP para veias do ducto venoso (IPV DV)/IP/AU e IPV DV/IP arteria cerebral media (ACM). Determinaram-se os pontos de corte e posteriormente foram calculados a sensibilidade, especificidade, VPP, VPN e acuracia. RESULTADOS: o IPV DV/IP AU nao mostrou ser bom parâmetro para a predicao da acidemia. A analise do IPV DV/IP ACM mostrou uma area sob a curva ROC de 0,785 com p = 0,004, e, para o ponto de corte de 0,582, encontraram-se sensibilidade de 66,7%, especificidade de 77,1% e acuracia de 74,5%. CONCLUSOES: o IPV DV/IP ACM mostrou-se adequado na predicao da acidemia no nascimento em gestacoes com insuficiencia placentaria. O ponto de corte para esse indice que demonstrou melhores valores de predicao foi 0,582.

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour

Objective To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of intrauterine pressure during the second stage of labour. Setting North American university hospital. Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor–tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a ‘controlled environment’ for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour.

To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Prospective measurement of intrauterine pressure during the second stage of labour. North American university hospital. Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor-tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness. Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a 'controlled environment' for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.