Expulsion Interval Research Articles

Physiological and metabolic responses in newborn piglets associated with the birth order

The objective of this study was to evaluate the effect of birth order on the physiological and metabolic responses of the newborn piglet the first hours after birth. A total of 281 randomly selected newborn piglets were included, classified according to birth order in 12 groups (L1-L12). The expulsion interval, neonatal vitality, latency in connecting to the maternal teat and physiological profile were recorded for each piglet. The number of piglets born alive and dead was also recorded. The blood gases, electrolytes and glucose levels of the neonates were obtained by means of an automatic blood gas and electrolyte analyzer. Groups L1, L2, L11, and L12 had the least score on the vitality scale, the longest expulsion intervals, and longest latency to connect with the maternal teat, as well as greater physiological alterations (hyperglycemia, hyperlactatemia and hypercapnia) compared to groups L4 to L9. Likewise, type-II stillbirths only occurred in the first and last quarter of the birth order of the litter. In conclusion, piglets born in the first and last quarter of the birth order of the litter had a greater risk of having physiological and behavioral alterations during farrowing.

Comparison of Mifepristone Followed by Misoprostol with Misoprostol Alone for Treatment of Early Pregnancy Failure: A Randomized Double-Blind Placebo-Controlled Trial.

To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF). A randomized double-blind placebo-controlled clinical trial. Ninety-two women with EPF ≤12weeks were recruited and randomly allocated to receive either mifepristone 200mg (n=46) or placebo (n=46). Forty-eight hours later, patients in both the groups were given 800µg misoprostol per-vaginum. If no expulsion occurred within 4h, repeat doses of 400µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9weeks by scan and 4 doses in women >9weeks by scan. Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p=0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p=0.002), induction to expulsion interval (4.74±2.24 vs. 8.03±2.77h, p=0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p=0.000), and side effects. Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone.

Intrauterine Extra-amniotic Misoprostol Solution is Effective for Termination of Second Trimester Missed Abortion: A clinical pilot descriptive study

Objectives: The purpose of this study was to determine the efficacy and safety of intrauterine extra-amniotic misoprostol solution for termination of the second trimester missed abortion. Methods: A clinical pilot descriptive study that was done in Women Health Hospital, Assiut University, Egypt between March 2015 and June 2015. Fifty patients having missed abortion of gestational age between 13 to 24 weeks were included in the study. Insertion of an intrauterine Foley’s catheter followed by infusion of sterile misoprostol solution through a sterile infusion set at a constant drip rate. The primary outcome was successful expulsion of the fetus in 12 hours after starting misoprostol infusion. Results: The mean age of the study group was 27.25±4.08, the mean BMI was 26.35±3.6, the mean gestational age was 22.85±3.4 and the mean parity was 2.5±1.5. The mean induction expulsion interval was 5.27±2.66 hours. Six cases (12%) needed analgesic. Surgical evacuation of retained contents was needed in 3 cases (6%). Side effects in the form of rigors, fever and diarrhea were recorded in 4 cases (8%). No serious maternal events were recorded. Conclusion: Our results showed that intrauterine extra-amniotic misoprostol solution instillation appear to be effective and safe for termination of a second trimester missed abortions.

Comparison of Misoprostol and PGF2a for second trimester termination of Pregnancy

Aims: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F2alpha (PGF2alpha) injection for termination of pregnancy. Study Design: Interventional study. Setting: This study was conducted in gynae unit III Nishter hospital Multan over period f 15 months. Material & Methods: Patients admitted to labour ward with pregnancy of less than 20 weeks of gestation requiring termination of pregnancy due to fetal and maternal causes were included in this study. A detailed history was taken followed by clinical examination especially the cervical scoring was done. Sixty patients were randomly assigned to receive either tablet misoprostol (cytotec) intravaginally or extra-amniotic injection of prostaglandin F2a Induction-expulsion interval, need for evacuation and the incidence of side effects were analyzed for both groups. Results: Successful termination was achieved in 98% patients with misoprostol and 94% with PGF2a Induction expulsion interval was < 12 hrs in 80% patients in misoprostol group and 60% in PGF2a group (P value < 0.000). Evacuation rate was 23.3% with PGF2a and 10% with misoprostol group. The incidence of prostaglandin-associated pyrexia, vomiting and diarrhea were significantly increased in the PGF2alpha group (p<0.05). Conclusion: In this study, vaginal misoprostol has been found to be more effective and associated with a shorter induction to expulsion interval, fewer ERPOC for incomplete evacuation and less side effects when compared with extra-amniotic PGF2alpha. In view of its effectiveness, as shown in this study, vaginally administered misoprostol has the potential to provide a better option for medical abortion in many parts of the world.

A Comparative Study to Evaluate the Efficacy of Vaginal vs Oral Prostaglandin E1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion.

Missed miscarriages, occurring in upto 15% of all clinically recognized pregnancies are a cause of concern for the patients. Though many researchers in the past have compared the surgical and medical approaches in management of such patients, only a few have executed an appraisal of two routes of misoprostol at equal dosages in treatment of first trimester missed miscarriages. To compare the efficacy of misoprostol by vaginal and oral route, for the management of first trimester missed abortion; and to recognize the utility of misoprostol for cervical dilation prior to any surgical termination of pregnancy. A randomized prospective trial, comparing the efficacy of misoprostol, by vaginal and oral routes, for termination of first trimester missed abortion was conducted in the Department of Obstetrics and Gynecology, Government Multi-Specialty Hospital, Chandigarh over one year. Hundred subjects satisfying the inclusion criteria from 213 consecutive women presenting to the institute with first trimester missed abortion were hospitalized. The study participants were randomly assigned to one of the two treatment groups, using sequentially numbered envelopes, to receive 400mcg misoprostol vaginally or orally to a maximum of three doses six hours apart, and outcome documented. Patients were followed up on Day 14 and 6 weeks after discharge. Primary outcome evaluated was drug-induced complete expulsion of Products of Conception (POCs). Secondary outcomes measured were induction expulsion interval, number of doses required, classification of failures, cervical canal permeability in women requiring surgical evacuation, side effects, hemoglobin drop, duration and amount of post-abortal bleeding, time of resumption of menses, experience with side effects, patient satisfaction and acceptability to treatment. Both routes were highly effective (vaginal=92%, oral= 74%, p=0.032), safe and acceptable with tolerable side effects. The mean time to expulsion was longer (13.24hrs) in the oral than vaginal group (10.87hrs). All 4 unsuccessful cases in vaginal group and 12 of 13 in oral group had permeable cervices prior to surgical evacuation. Most women labeled the side effects as tolerable in both the groups. Overall acceptance rate to treatment was high in both the groups A and B (76% and 70%). Vaginal misoprostol is more effective than oral misoprostol for first trimester missed abortion.

Effects of various procedures for synchronisation of parturition in sows. Assessment of sows with a complication-free birth.

The effects of various parturition controlling measures in sows on the relevant parameters for parturition were investigated. A total of 1975 study animals were divided into five groups: control group: A (n=710); trial groups: B (n=719), C (n=180), D (n=175), E (n=191). The control group (A) included sows that spontaneously farrowed until day114 of gestation. The remaining sows were administered a PGF2α-analogue (175µg cloprostenol) on day114. All sows that farrowed within 24hours after prostaglandin-medication were summarised in trial groupB. Dams that did not farrow until day115 were either administered oxytocin (20 IU i.m., groupC) or carbetocin in two different doses (70µg, groupD or 35µg, groupE). The sows were monitored during the peripartal period over 24hours. 83.8% of the farrowings were without any complications. The percentage of dystocia varied between the individual groups. Given a complication-free farrowing the expulsion stage began 13.0hours (groupB), 2.4hours (groupC), 1.6hours (groupD) and 1.4hours (groupE) after medication. The expulsion interval of the farrowing of two piglets decreased from 21.1minutes with spontaneous farrowings (groupA) to 18.6 minutes (groupE) as a result of the administration of 35µg carbetocin. The rate of stillborn piglets as well as the incidence of puerperal disorders and the losses of the suckling piglets also gradually, partly even significantly (p≤0.05) decreased from groupA to E. The results of this study show that the use of the long-acting oxytocin carbetocin has advantages compared to oxytocin (e. g. shortened duration of birth, reduction of stillbirths). The tested dosages of carbetocin (35µg or 70µg) proved to be equally effective. Administration of the lower dose is recommended, since this reduces use of the active ingredient.

English

&nbsp; The objective of the study was to evaluate the efficacy of misoprostol in patients with complication of first trimester pregnancy loss. After the departmental approval, a total of 102 women with first trimester pregnancy failure were recruited for treatment with misoprostol. The inclusion criteria were gestational age of less than 12 weeks and hemodynamically stable. The exclusion criteria were patients with history of hypersensitivity to prostaglandin, bronchial asthma and hemoglobin less than 9 g. Main outcome measures were the successful resolution of miscarriages without surgical intervention; secondary outcomes were incidence of pain, vaginal bleeding, infection, pyrexia and gastrointestinal side effects. A total of 102 women were included in the study. Age ranged from 16 to 40 years and parity ranged from 0 to grand multipara. Women were not selected according to parity but parity was a random occurrence. No relationship was found between parity and response to treatment with misoprostol. Incomplete abortion was found in 82 (80.39%), an embryonic pregnancy in 7 (6.86%) and early fetal demise in 13 (12.74%). 62.74% women completely expelled the conceptual products on treatment with misoprostol alone, while 38 (37.25%) patients required surgical evacuation due to incomplete expulsion of conceptual products. Mean induction to expulsion interval was 15.66 h. Main side effects noted were pain, pyrexia, nausea, vomiting and diarrhea. More than one side effect was noted in 7 (22.54%) patients. Treatment of early pregnancy loss with misoprostol is efficient, acceptable and cost effective for patients with complications of first trimester pregnancy loss. &nbsp; &nbsp; Key words: Misoprostol, medical treatment, miscarriage.

Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: A meta-analysis

The development of safe and effective techniques for second-trimester abortion (associated or not with fetal death) has become a major clinical challenge. To compare the efficacy and safety of sublingual versus vaginal misoprostol for mid-trimester pregnancy termination. We conducted a meta-analysis of published randomised controlled trials that compared sublingual and vaginal routes. Primary outcome measures were complete abortion rate at 24 and 48 h and induction-abortion interval, and the secondary outcome measures were side effects and patients' preference for the route. Pooled risk ratios were calculated for categorical variables, and continuous variables were compared by means of weighted mean differences. Both routes' efficacy was similar following 24 h of treatment (pooled RR 1.04, 95% CI 0.93-1.7). Successful induction percentage after 24 h was significantly higher in nulliparous women with vaginal misoprostol (pooled RR 0.78; 95% CI 0.71-0.87). The efficacy after 48 h was significantly greater with vaginal misoprostol in the general population (pooled RR 0.96; 95% CI 0.93-0.99) and in nulliparous women (pooled RR 0.89; 95% CI 0.86-0.95). The sublingual route shortened the induction-fetal expulsion interval (WMD -4.54, 95% CI -8.03 to -1.05) and was the route preferred among women. No statistically significant differences between treatment groups were observed for placental retention or for any side effect except for fever, which was more common in the vaginal group. Sublingual and vaginal misoprostol are safe and effective for mid-trimester pregnancy termination. The differences obtained between both routes probably do not have clinical consequences.

The System of Contractile Vacuoles in the Green Alga Mesostigma viride (Streptophyta)

The contractile vacuole (CV) is an osmoregulatory organelle which is found in many protists. We have investigated the structure and function of the CV in the green alga Mesostigma viride by light (video) and serial section electron microscopy. Mesostigma is the only known flagellate streptophyte (charophycean green algae and land plants) and therefore of great importance for our understanding of the evolution of streptophytes. The entire CV system of Mesostigma has been reconstructed 3-dimensionally for three cells. Based on light microscopy cells contain an average of 8 CVs. The maximal diameter of a CV in Mesostigma was 1.5 microm and the expulsion interval 24.1s in 10 mosM medium. Video microscopy revealed the system of CVs to be very dynamic with individual CVs connecting temporarily or fusing completely with each other. Electron microscopy confirmed these observations and showed coated vesicles to be predominantly associated with large CVs. No expulsion pore was observed by electron microscopy. Instead we encountered close contact zones of approximately 150 nm diameter, which we propose to be the site of water expulsion. A model for the function of CVs in Mesostigma is presented.

The Effect of Dose and Route of Administration of R‐cloprostenol on the Parturient Response of Sows

The aims of the present study were to further examine the efficacy of different doses and routes of R-cloprostenol administration on the parturition response in sows. Fifty crossbred multiparous sows (Landrace x Yorkshire) with an average parity number of 4.7 +/- 2.4 were allocated to induce farrowing by one of the following treatments: Group I (control, n = 10) injection with normal saline 2 ml administered intramuscularly (i.m.); Group II (n = 10) injection with 75 microg of R-cloprostenol administered i.m. (at 7 AM); Group III (n = 10) injection with 75 microg of R-cloprostenol (at 7 AM) together with 10 IU of oxytocin (24 h after injection of R-cloprostenol) administered i.m.; Group IV (n = 10) injection with 37.5 microg of R-cloprostenol (at 7 AM) administered into perivulva region; Group V (n = 10) injection with 37.5 microg of R-cloprostenol (at 7 AM) administered into perivulva region together with 10 IU of oxytocin (24 h after injection of R-cloprostenol) administered i.m. The following parameters: pre-farrowing maternal behaviour, restless behaviour, R-cloprostenol or oxytocin injection to farrowing interval, expulsion intervals, duration of farrowing, total number of piglets born, litter birthweight, umbilical cord morphology and the degree of meconium staining were record. There were no significant differences among groups for the pre-farrowing maternal behaviours. In all the sows, the restless behaviour was not observed. There were no significant effect of oxytocin administration (10 IU, i.m.) on the percentage of umbilical cord morphology and the degree of meconium staining in different groups. There were no significant effect of route and dose of administration on the number of total piglet born, piglet born alive, stillbirth, mummy and litter birthweight. No significant effects of the different groups were found on the R-cloprostenol and oxytocin injection to farrowing interval, expulsion interval and farrowing duration. In conclusion, the present results demonstrated that a half dose (37.5 microg) of R-cloprostenol administered into the perivulva region was effective for inducing farrowing as the full recommended dose (75 microg) administered into the neck region (i.m.) and with no restless behaviour.

Use of oxytocin in penned sows and its effect on fetal intra-partum asphyxia

The objective of the present study was to evaluate in penned sows the effect of two commercial oxytocin products on umbilical cord pathology, degree of asphyxia and intra-partum mortality. This study included 120 sows divided in three groups of 40 animals with eight animals for parities one to five per subgroup, respectively. Group 1 (G 1) or control received saline solution while oxytocin groups (G 2) and (G 3) were injected at the onset of fetal expulsion with two oxytocin products. The doses of oxytocin were as follow: Primiparous sows weighing less than 130 kg received 20 IU; multiparous sows weighing 130–180 kg received 30 IU, and those above 250 kg, 40 IU. Piglets born alive and/or dead were classified at birth using a subjective scale based on the degree of meconium staining on skin. Umbilical cords of intra-partum stillbirths (IPS) were classified as adhered or ruptured and subdivided into four categories: without pathological changes, edematous, congested and hemorrhagic. Result analyses revealed significant differences ( P<0.01) between groups 1 and 2, and 1 and 3 regarding the following traits: expulsion interval (min) (X: G 1 27.7; G 2 22.6; G 3 22.2), IPS with a severe stain degree (X: G 1 0.10; G 2 0.45; G 3 0.50), IPS with ruptured umbilical cords (X: G 1 0.07; G 2 0.42; G 3 0.47), and detectable heartbeats in IPS (X: G 1 0.27; G 2 0.25; G 3 0.22). Treatment with oxytocin reduced the duration of the expulsion of the fetus, increased the number of IPS with ruptured umbilical cords and with severe meconium-stain degree and reduced the number of fetuses with inspiration attempts. Furthermore, the use of this hormone increased the need for obstetric assistance due to increased frequency of dystocia.

Effect of oxytocin treatment in sows on umbilical cord morphology, meconium staining, and neonatal mortality of piglets.

To evaluate the effect of 2 oxytocin products administered to sows at the onset of fetal expulsion on the integrity of umbilical cords, meconium staining, and piglet mortality. 2099 neonatal pigs. 180 parturient sows were randomly assigned to 3 stratified groups of 60 sows each. Two groups of sows were injected IM at the onset of fetal expulsion with 1 of 2 oxytocin commercial products (20, 40, or 50 U for sows weighing 120 to 150 kg, 151 to 250 kg, or > or = 251 kg, respectively). Control sows were treated IM with saline (0.9% NaCI) solution. Farrowing time, expulsion intervals, and numbers of stillborn and liveborn piglets were recorded for each sow. Piglets were evaluated for inspiratory effort, heart rates, and degree of meconium staining of skin (nonstained, and moderately or severely stained). Umbilical cords were classified as normal in appearance, edematous, congested, hemorrhagic, or ruptured. Oxytocin-treated sows had a significant decrease in farrowing time and expulsion intervals and also had a significantly higher number of stillborn piglets per litter, compared with control sows. The number of piglets per litter with ruptured and hemorrhagic umbilical cords was significantly greater in oxytocin-treated sows, compared with control sows. In near-death stillborn piglets, oxytocin treatment significantly decreased inspiratory efforts at birth and increased the rate and severity of meconium staining, compared with saline treatment. Oxytocin given to sows at the onset of fetal expulsion significantly increases the rate of fetal distress, anoxia, and intrapartum death in piglets.

SULPROSTONE FOR PREGNANCY TERMINATION IN WOMEN WITH SEVERE (PRE-) ECLAMPSIA

Condensation: Sulprostone, used in a continuous low-dose intravenously, is effective for pregnancy termination. Caution is necessary when using this drug in severely preeclamptic patients. Objective: To evaluate the safety and efficacy of induction of labor with a prostaglandin analogue in women with severe (pre-) eclampsia. Study Design: A retrospective analysis of a 12-year cohort in which labor was induced in women with severe (pre-) eclampsia with sulprostone (a prostaglandin E2 analogue) in a continuous intravenous low-dose intravenous dose of 1 μg/min. Results: In 30 severely preeclamptic and one eclamptic women, labor was induced on maternal indication with sulprostone. The median gestational age at induction was 28 weeks (range 16–37 weeks). The fetuses were either dead (n=19) or considered not viable (n=12). All women delivered vaginally after a median induction–expulsion interval of 14 hr (range 6–57 hr). In all but one woman, a delivery was achieved within 37 hr. Two of the nine women who suffered dyspnea at the time induction was started, experienced deterioration during infusion of sulprostone. In one of these women, infusion had to be discontinued after 2 hr and the pregnancy was terminated by dilatation and evacuation. One woman gave birth after 57 hr of sulprostone infusion. We did not observe any cardiovascular complications. All but one woman recovered after pregnancy termination: a severely eclamptic woman died 10 days after delivery, after developing adult respiratory distress syndrome, sepsis and multiple organ failure. Conclusion: Sulprostone, in a continuous low-dose intravenously, is effective for termination of pregnancy in the critically ill preeclamptic woman. Our study, including two patients with serious deterioration of pulmonary function during and one maternal death after induction, does not permit definitive conclusions regarding the safety in these patients.

Low dose sulprostone for termination of second and third trimester pregnancies

Objective: The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador ®) for labour induction in the event of foetal death or foetal malformations. Study design: Retrospective analysis of 284 women with intrauterine foetal death ( n=137), or foetal abnormalities ( n=147), who underwent labour induction with sulprostone in a continuous dose of 1 μg/min intravenously. Results: All but three women had a successful vaginal delivery. The median induction–expulsion interval was significantly shorter (12 h) in the foetal death group compared to the foetal malformation group (25 h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant. Conclusions: The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.

Effect of causing fetal cardiac asystole on second-trimester abortion

Objective: To compare second-trimester abortions with prostaglandin (PG) E 2, with and without pretreatment-induced fetal death. Methods: A retrospective chart review of all vaginal PG E 2-induced abortions at Westchester Medical Center between January 1996 and April 1998 was done. Only women who sought terminations between 18 and 24 weeks’ gestation by prostaglandin induction were included. These abortions were predominantly secondary to fetal structural and chromosomal anomalies. The study population was subdivided into groups based on the use of pretreatment cardiac puncture with potassium chloride. The groups were compared for maternal, fetal, and procedural characteristics. The χ 2 test, Student t test, and Wilcoxon rank-sum test were used for analysis. Results: There were no differences between the cardiac puncture and control groups when compared for various maternal and procedural characteristics, fetal weight, and the need for curettage for retained products of conception. However, the required median doses of PG E 2 and the initiation to expulsion interval were significantly lower in the cardiac puncture group compared with the control group (2.0 doses compared with 3.0 doses, P < .001; 570 minutes compared with 890 minutes, P = .006). Conclusion: Pretreatment-induced fetal death significantly reduced the interval to expulsion and doses of PG E 2 required for late second-trimester abortion.

Influence of umbilical vein administration of oxytocin on the third stage of labor: A randomized, double-blind, placebo-controlled study

A randomized, double-blind, placebo-controlled study evaluated the influence of umbilical vein administration of oxytocin on the third stage of labor. Five minutes after delivery, 37 women received 10 units of oxytocin diluted in physiologic saline solution to a total volume of 20 ml; 41 women received 20 ml of saline solution alone. There was no significant difference between groups in mean (+/- SD) injection-placental expulsion interval (9 +/- 7 versus 10 +/- 8 minutes).

Combined pericervical and intramuscular administration of prostaglandin for the termination of pregnancy in the 2d and 3d trimester

In 64 patients with pathological pregnancies (missed abortion, molar pregnancy, intrauterine fetal death, fetal malformation, maternal disease) termination of pregnancy was induced by local application of PGE2 by means of a portio cap and subsequent intramuscular application of Sulproston. In 21 women 1,5 mg and in 43 2,25 mg PGE2 or more were used for cervical priming. In 21 cases expulsion of the fetus could be obtained during or shortly after the priming procedure. In the remaining 43 women Sulproston was administered on the following day with a starting dose of 200 mcg and 100 mcg subsequently at two hours intervals up to a total dose of 500 mcg. With the exception of 3 cases this led to the expulsion of the products of conception. In the remaining 3 patients abortion was obtained on the third day by additional Sulproston-application. The mean expulsion time was 6,3 +/- 2,1 hours, being significantly lower when the fetus was not alive compared to viable pregnancies. Side effects during the priming procedure were only observed in 3 cases; the total rate of side effects was 57,8% and the incidence of use of analgetics 51,5%. The softening effect of locally applied prostaglandins apparently adds in an advantageous manner to the strong contractile effects of Sulproston resulting in shorter expulsion intervals, lower total dosage of prostaglandins and a reduction of the incidence of side effects and the use of analgetics.