Frequency Of Uterine Contractions Research Articles

THE EFFECTIVENESS OF ADDITIONAL INTRAMUSCULAR LUTEAL PROGESTERONE SUPPORT IN WOMEN WITH ENDOMETRIAL CONTRACTILITY ON ULTRASOUND THE DAY PRIOR TO PROGRAMMED FROZEN EMBRYO TRANSFER

Increased contractility at the time of embryo transfer (ET) adversely affects embryo implantation and pregnancy rates in IVF (1). It has been postulated that the high uterine contraction frequency seen on the day of ET resulted from an insufficient response to the uterorelaxing properties of progesterone (2). Therefore, we decided to investigate the effectiveness of increasing luteal progesterone support based on endometrial contractility (EC) prior to programmed frozen embryo transfer (FET).

Uterine contractile activity in healthy women throughout the menstrual cycle measured using a novel quantitative two-dimensional transvaginal ultrasound speckle tracking method

Research questionTo explore normal uterine contractile function across the menstrual cycle using a novel quantitative ultrasound method. DesignThis multicentre prospective observational study took place in three European centres from 2014 to 2022. Uterine contraction frequency (contractions/minute), amplitude, direction (cervix-to-fundus, C2F; fundus-to-cervix; F2C), velocity and coordination were investigated. Features were extracted from transvaginal ultrasound recordings (TVUS) using speckle tracking. Premenopausal women ≥18 years of age, with normal, natural menstrual cycles were included. A normal cycle was defined as: regular (duration 28 ± 2 days), no dysmenorrhoea, no menometrorrhagia. Four-minute TVUS were performed during the menstrual phase, mid-follicular, late follicular phase, early luteal phase and/or late luteal phase. Of the 96 recordings available from 64 women, 70 were suitable for inclusion in the analysis. ResultsContraction frequency (for the posterior wall) and velocity (for the anterior uterine wall in the F2C direction) were highest in the late follicular phase and lowest in the menstrual and late luteal phases (1.61 versus 1.31 and 1.35 contractions/min, P < 0.001 and 0.81 versus 0.67 and 0.62 mm/s, P < 0.001, respectively). No significant difference was found for contraction amplitude. Contraction coordination (simultaneous contraction of the anterior and posterior walls in the same direction) was least coordinated in the mid-follicular phase (P = 0.002). ConclusionsThis is the first study to objectively measure uterine contraction features in healthy women during the natural menstrual cycle on TVUS. Likewise, it introduces contraction coordination as a specific feature of uterine peristalsis. Differences in uterine contractility across the menstrual cycle are confirmed, with highest activity seen in the late follicular phase, and lowest in the late luteal phase.

Multi-Chain Semi-Markov Analysis of Intrapartum Cardiotocography.

Visual assessment of the evolution of fetal heart rate (FHR) and uterine pressure (UP) patterns is the standard of care in the intrapartum period. Unfortunately, this assessment has high levels of intra- and inter-observer variability. This study processed and analyzed FHR and UP patterns using computerized pattern recognition tools. The goal was to evaluate differences in FHR and UP patterns between fetuses with normal outcomes and those who developed hypoxic-ischemic encephalopathy (HIE). For this purpose, we modeled the sequence of FHR patterns and uterine contractions using Multi-Chain Semi-Markov models (MCSMMs). These models estimate the probability of transitioning between FHR or UP patterns and the dwell time of each pattern. Our results showed that in comparison to the control group, the HIE group had: (1) more frequent uterine contractions during the last 12 hours before birth; (2) more frequent FHR decelerations during the last 12 hours before birth; (3) longer decelerations during the last eight hours before birth; and (4) shorter baseline durations during the last five hours before birth. These results demonstrate that the fetuses in the HIE group were subject to a more stressful environment than those in the normal group. Clinical Relevance- Our results revealed statistically significant differences in FHR/UP patterns between the normal and HIE groups in the hours before birth. This indicates that features derived using MCSMMs may be useful in a machine learning framework to detect infants at increased risk of developing HIE allowing preventive interventions.

P-333 The influence of hormonal stimulation on uterine peristalsis measured by ultrasound speckle tracking in women with IVF/ICSI treatment compared to normal ovulating women

Abstract Study question To investigate possible effects of ovarian stimulation during IVF/ICSI on uterine peristalsis features using ultrasound speckle tracking compared to normal ovulating women. Summary answer Patients with a normal uterus treated with exogenous hormones during IVF/ICSI treatment show significantly increased contraction amplitude and power parameters compared to normal ovulating women. What is known already Uterine peristalsis plays a role in procreation. Subjective visual inspection of uterine peristalsis is extensively researched throughout the menstrual cycle. Studies on uterine peristalsis in IVF/ICSI patients show higher frequency of uterine contractions during the periovulatory phase. Recently, a new automated quantitative method was validated to objectively analyse uterine strain using speckle tracking. Besides objective insight in frequency, also information on amplitude, power and coordination of motion is available. The effect of exogenous hormones on uterine contraction features has not objectively been studied using this new method. Study design, size, duration This multicentre prospective observational cohort study was performed between 2020 and 2022 in the Catharina Hospital in Eindhoven, the Netherlands, Embryolab Fertility Centre in Thessaloniki, Greece and University of Naples, Federico II in Naples, Italy. 30 normal ovulating patients served as controls. The primary outcomes were the contraction features frequency, amplitude, direction, velocity, power and coordination in women undergoing IVF/ICSI on the day of follicle aspiration compared to controls on cycle day 9 – 14. Participants/materials, setting, methods 19 women undergoing IVF/ICSI were included regardless of the treatment cycle number and stimulation protocol. Indication for IVF/ICSI treatment was male subfertility (n = 8), idiopathic subfertility (n = 5), tubal factor (n = 2), primary ovarian insufficiency (n = 2) or combined (n = 2), all women had normal uteri on transvaginal ultrasound. The control group consisted of 30 healthy pre-menopausal women with normal uteri on ultrasound and spontaneous regular cycles. Main results and the role of chance Each patient underwent a 2.5 – 4 minute transvaginal ultrasound of the uterus in mid-sagittal plane. The various contraction features were extracted using a quantitative dedicated speckle tracking algorithm analysis studying motion of the subendometrial junctional zone. Mean age of IVF/ICSI patients was 32.7 years and mean BMI was 25.6. Mean age of healthy controls was 33.8 years, BMI was 23.4, and cycle length was 27.44 days. Characteristics of IVF/ICSI patients and healthy volunteers showed no statistically significant differences. Both groups predominantly consisted of nulliparous women. In IVF/ICSI patients the contraction amplitude was significantly higher compared to controls (0.062 vs 0.040; p &amp;lt; 0.001). The contraction power (combination of amplitude and frequency) appeared to be significantly higher in IVF/ICSI patients compared to controls (1528.18 vs 683.44; p &amp;lt; 0.001). No significant differences were found in contraction frequency and coordination. Even though the mean coordination did not show statistically significant differences, the values were less scattered in IVF/ICSI patients, with a much smaller range of coordination values (1.04 – 3.06) compared to healthy volunteers (1.02 – 50.33). Limitations, reasons for caution The reported difference between IVF/ICSI patients and controls in contraction amplitude and power may not solely be attributed to the administration of exogenous hormones. The difference may also be due to an underlying cause for infertility in these patients. Another limitation of this study is the small sample size. Wider implications of the findings Future research should explore which uterine contraction profile is associated with viable pregnancy: during the natural menstrual cycle, or when treated with hormones. The question arises whether it is preferred to transfer the embryo in the stimulated cycle or implement a freeze-all policy and transfer during the natural menstrual cycle. Trial registration number NCT02310802

Literatur Review: The Effect of Lemon Aromatherapy on Labor Pain

Background: Labor pain is one of the clinical manifestations of fetal delivery characterized by an increase in the intensity and frequency of uterine contractions that can cause continuous pain and can be on a severe scale. Management of labor pain can be done by aromatherapy. The aromatherapy that can be used is lemon, which has natural ingredients that can reduce pain in labor. This study aimed to obtain representation and analyze articles about lemon aromatherapy for labor pain. Methods: This research is a literature review by searching international journals/articles in the google scholar database. Three keywords used are “lemon aromatherapy”, “citrus limon aromatherapy”, and “labor pain”. The articles selected by the step of literature review and PRISMA Flow Diagram. Data analysis is performed by presenting research journals/papers in a review table. Results: The results of the 5 articles analyzed have relevance to the research problem and state that The use of lemon aromatherapy during labor can help to greatly lessen discomfort. Conclusion: Lemon aromatherapy can minimize labor pain, so further research is needed to develop methods /standards for health facilities and future studies.

An EHG-based Preterm Delivery Prediction Algorithm via Convolution Neural Network

Premature delivery is one of the direct factors that affect the early development and safety of infants. Its direct clinical manifestation is the change of uterine contraction intensity and frequency. Uterine Electrohysterography(EHG) signal collected from the abdomen of pregnant women can accurately and effectively reflect the uterine contraction, which has higher clinical application value than invasive monitoring technology such as intrauterine pressure catheter. Therefore, the research of fetal preterm birth recognition algorithm based on EHG is particularly important for perinatal fetal monitoring. We proposed a convolution neural network(CNN) based on EHG fetal preterm birth recognition algorithm, and a deep CNN model was constructed by combining the Gramian angular difference field(GADF) with the transfer learning technology. The structure of the model was optimized using the clinical measured term-preterm EHG database. The classification accuracy of 94.38% and F1 value of 97.11% were achieved. The experimental results showed that the model constructed in this paper has a certain auxiliary diagnostic value for clinical prediction of premature delivery.

Maternal and foetal physiological response of sacral surface electrical stimulation during pregnancy: A preliminary study.

What is the central question of this study? The physiological response to sacral neuromodulation by pregnant women and foetuses has not been previously explored. What is the main finding and its importance? Sacral surface electrical stimulation had no adverse effect on pregnant women and foetuses at least 36weeks of gestation. It may cause uterine relaxation resulting from decreased uterine artery pulsatility index and increased umbilical venous flow volume and thereby improve utero-placental perfusion and improve lower back pain. This study aimed to examine the impact of sacral surface electrical stimulation on maternal and foetal physiology during pregnancy. Ten pregnant women at 36weeks of gestation without multiple gestations, foetuses with malformations, foetal growth restriction, hypertensive disorders, polyhydramnios, or oligohydramnios were enrolled. This prospective study monitored maternal and foetal physiological responses before and after sacral surface electrical stimulation for single pregnancies. Sacral surface electrical stimulation was performed once per patient. Each parameter was measured directly before and then immediately after stimulation. Follow-up measurements were conducted at 12 h, 1 day, 2 days and 7 days after stimulation. Variables of interest were compared before and after the stimulation. Regarding the foetal Doppler measurements, significant differences were not found in the umbilical and middle cerebral artery pulsatility index. However, foetuses showed a significant increase in the umbilical venous flow volume. The uterine contraction frequency and the maternal uterine artery pulsatility index significantly decreased. Pregnancy outcomes, and rates of caesarean section, foetal distress, and neonatal asphyxia were not confirmed. In conclusion, sacral surface electrical stimulation had no adverse effects on pregnant women or foetuses at 36weeks of gestation and might improve utero-placental perfusion and lower back pain.

The association between uterine contraction frequency and fetal scalp pH in women with suspicious or pathological fetal heart rate tracings: A retrospective study

ObjectiveCurrent guidelines provide little supporting literature for the definition of uterine tachysystole during labour and no distinction is made for optimal contraction frequency depending on the clinical situation. We hypothesize that fetal hypoxia is frequently caused by uterine tachysystole and that high uterine contraction frequencies are especially harmful when fetal heart rate (FHR) abnormalities are present. We studied the association between contraction frequency and fetal scalp pH values in women with an indication for fetal blood sampling (FBS) based on FHR abnormalities. Study designA retrospective study including 762 women was performed in a tertiary teaching hospital in the Netherlands from January 2015 until January 2020. Women with a singleton pregnancy with a gestational age ≥ 34+0 weeks were included when FBS was performed because of suspicious or pathological FHR tracings. Exclusion criteria were maternal age < 18 years, failed fetal scalp pH values, lack of thirty minute registration by tocodynamometry prior to FBS, poor quality of uterine monitoring, intrauterine resuscitation in the thirty minutes prior to FBS, maternal body mass index ≥ 30 kg/m2 and neonatal birth weight < 10th percentile.Uterine contractions in the thirty minutes prior to FBS were manually annotated by a researcher who was blinded to FBS values, FHR and other obstetrical data. Linear and logistic analysis were used to explore the association between uterine contraction frequency and FBS results. ResultsLow fetal scalp pH values were significantly associated with contraction frequency prior to FBS. Fetuses of women with four to five contractions per ten minutes prior to FBS were 2.4 times more likely to have hypoxia as compared to fetuses of women with two to three contractions per ten minutes (aOR 2.4, 95% CI 1.1–5.4). With increasing contraction frequency, the risk of fetal hypoxia further increased. ConclusionsContraction frequency above four per ten minutes prior to FBS is significantly associated with fetal hypoxia in women with FHR abnormalities. We suggest to aim for a maximum contraction frequency of four per ten minutes in these women.

Preterm Labor and Treatment Efficacy-Safety

With medical sciences on the verge of advancement, preterm labor still remains a bothersome issue in modern obstetrics. A few therapeutic agents that suppress uterine contractile activity have gained success up to some extent. Tocolytics are medications used to suppress premature labor. These drugs can decrease the strength and frequency of uterine contractions and help in delay the onset of labor but are not able to prolong pregnancy to full-term. Presently, the choice of a best tocolytic drug remains debatable. This review discusses efficacy and safety of various useful agents which have been used so far. Further clinical trials are required to select an effective, and most importantly, safe therapy for the threatened preterm labor.

Uterine contraction frequency in the last hour of labor: how many contractions are too many?*

Objective Increased frequency of uterine contractions is a component in the cluster of causal conditions that can lead to fetal hypoxia and acidosis and increase the risk for neonatal neurologic injury. For most international obstetrical societies, 5 contractions per 10 min averaged over 30 min is considered as the upper limit of normal uterine activity. We hypothesize that it might be safer to adopt an upper limit of 4 contractions per 10 min. Methods We reviewed our 1970’s research database containing 475 patients with closely monitored and well-documented labor and neonatal assessments that included cord blood (CB) pH, base excess (BE), and continuous recording of neonatal heart rate (NHR). Using data segregated by the proportion of the last hour before delivery when uterine contraction frequency (UCF) exceeded 4 and 5 contractions per 10 min respectively, we evaluated outcomes (CB BE, pH, Apgar scores at 1 min, the status of NHR at 16 min after birth, and the proportion of births that did not the result from normal spontaneous vaginal deliveries (NSVDs). ANOVA established relationships between UCF cutoffs and these outcomes. Our sample size is sufficiently large to provide the ability of UCF, per se, to accurately detect an alpha region of .05 88% of the time with an effect size of .15. Results During the last hour prior to delivery, a UCF cutoff at 4 contractions per 10 min performed better than a UCF cutoff at 5 contractions per 10 min to enable the earlier identification of risks for abnormal outcomes. The longer UCF was increased, the worse were the outcomes that were measured, and the region >4 but ≤5 contractions identifies the beginnings of worsening conditions in a variety of measures of poor outcomes. Conclusion Lowering the recommended threshold for UCF from 5 to 4 contractions per 10-minute period as averaged over 30 min facilitates earlier detection of potentially compromised fetuses and is also an important contributor to a multicomponent contextualized approach to risk assessment.

Changing Perspectives of Electronic Fetal Monitoring.

The delivery of healthy babies is the primary goal of obstetric care. Many technologies have been developed to reduce both maternal and fetal risks for poor outcomes. For 50 years, electronic fetal monitoring (EFM) has been used extensively in labor attempting to prevent a large proportion of neonatal encephalopathy and cerebral palsy. However, even key opinion leaders admit that EFM has mostly failed to achieve this goal. We believe this situation emanates from a fundamental misunderstanding of differences between screening and diagnostic tests, considerable subjectivity and inter-observer variability in EFM interpretation, failure to address the pathophysiology of fetal compromise, and a tunnel vision focus. To address these suboptimal results, several iterations of increasingly sophisticated analyses have intended to improve the situation. We believe that part of the continuing problem is that the focus of EFM has been too narrow ignoring important contextual issues such as maternal, fetal, and obstetrical risk factors, and increased uterine contraction frequency. All of these can significantly impact the application of EFM to intrapartum care. We have recently developed a new clinical approach, the Fetal Reserve Index (FRI), contextualizing EFM interpretation. Our data suggest the FRI is capable of providing higher accuracy and earlier detection of emerging fetal compromise. Over time, artificial intelligence/machine learning approaches will likely improve measurements and interpretation of FHR characteristics and other relevant variables. Such future developments will allow us to develop more comprehensive models that increase the interpretability and utility of interfaces for clinical decision making during the intrapartum period.

The Influence of Uterine Abnormalities on Uterine Peristalsis in the Non-Pregnant Uterus: A Systematic Review

Study Objective The aim of this systematic review is to explain the effect of uterine abnormalities, categorized in leiomyomas, adenomyosis and congenital uterine anomalies, on uterine peristalsis in the non-pregnant uterus. Design Systematic review. Setting N/A. Patients or Participants Non-pregnant women with uterine abnormalities such as adenomyosis, leiomyomas or congenital uterine anomalies. Interventions Measurement of uterine peristalsis. Measurements and Main Results Fourteen eligible studies were included; eight case-control studies and six controlled prospective studies. The sample sizes ranged from twelve to 205 participants. Various methods of analyzing uterine contractions were used, including transvaginal ultrasound, hysterosalpingo-radionuclide scintigraphy, cine MR and intrauterine pressure measurement. The researched types of uterine abnormalities seem to have an influence on uterine peristalsis, majorly reflected in the presence and frequency of uterine contractions. The included studies suggest that the presence of uterine abnormalities leads to a decreased presence of uterine peristalsis. An increment of frequency of uterine contractions was noted in presence of uterine abnormalities as well. Furthermore, dysperistalsis was observed in patients with leiomyomas, endometriosis and adenomyosis. The included studies were difficult to compare due to heterogeneity, a result of differences in e.g., used methods, analysis and definition of uterine peristalsis and the report of the phases of the menstrual cycle. Conclusion It can be concluded that uterine abnormalities have a clear adverse effect on uterine peristalsis. Further research is needed on objective measurement tools, treatment and clinical consequences of abnormal uterine peristalsis in patients with uterine abnormalities. The aim of this systematic review is to explain the effect of uterine abnormalities, categorized in leiomyomas, adenomyosis and congenital uterine anomalies, on uterine peristalsis in the non-pregnant uterus. Systematic review. N/A. Non-pregnant women with uterine abnormalities such as adenomyosis, leiomyomas or congenital uterine anomalies. Measurement of uterine peristalsis. Fourteen eligible studies were included; eight case-control studies and six controlled prospective studies. The sample sizes ranged from twelve to 205 participants. Various methods of analyzing uterine contractions were used, including transvaginal ultrasound, hysterosalpingo-radionuclide scintigraphy, cine MR and intrauterine pressure measurement. The researched types of uterine abnormalities seem to have an influence on uterine peristalsis, majorly reflected in the presence and frequency of uterine contractions. The included studies suggest that the presence of uterine abnormalities leads to a decreased presence of uterine peristalsis. An increment of frequency of uterine contractions was noted in presence of uterine abnormalities as well. Furthermore, dysperistalsis was observed in patients with leiomyomas, endometriosis and adenomyosis. The included studies were difficult to compare due to heterogeneity, a result of differences in e.g., used methods, analysis and definition of uterine peristalsis and the report of the phases of the menstrual cycle. It can be concluded that uterine abnormalities have a clear adverse effect on uterine peristalsis. Further research is needed on objective measurement tools, treatment and clinical consequences of abnormal uterine peristalsis in patients with uterine abnormalities.

PROPHYLACTIC USE OF PROGESTERONE VAGINAL SUPPOSITORY IN PREVENTION OF RECURRENT PRETERM LABOR

Background: Prematurity is the leading cause of neonatal morbidity and mortality. Although perinatal care advanced in the last few decades, preterm labor did not decrease but even is increasing and creating a great social and economic problem. Objective: To test the effectiveness of progesterone vaginal suppository in prevention of preterm labor in patients with previous history of preterm labor. Patients and Methods: This was a randomized , prospective, single blind study after approval of the medical ethical committee at Al-Azhar university Hospitals, Department of Obstetrics and Gynecology, and after patients giving written consents, during the period from February 2020 to October 2020 . We enrolled 168 women for the study at high risk for preterm labor who were randomly divided into two groups (progesterone group and placebo group). Two hundred mg of vaginal progesterone pessary or placebo were used by the patient from 24 to 36 weeks of gestation. Uterine contractions were recorded by external tocodynamometer every other week from 28 to 36 weeks of gestations. Results: There was a statistically significant reduction in the incidence of preterm delivery between the two groups from 38.5% in placebo group, compared with 21% in progesterone group. There was also a statistically significant reduction in the incidence of early preterm delivery (<34 week) between the two groups from 21.2% in placebo group, compared with 5.7% in progesterone group. There was a significant prolongation of the mean gestational age at delivery from 36.36 ± 2.83 weeks in placebo group compared to 37.57 ± 1.72 weeks in progesterone group. There was no statistically significant difference in the average gestational age for those who had preterm birth between both groups. There were fewer women in progesterone group who reported symptoms of preterm labor of 52.4%, compared with 75% in placebo group. There was a significant more frequent uterine contraction in placebo group of 48.1% compared to progesterone group of 24.8%. Conclusion: Prophylactic vaginal progesterone reduces the rate of preterm labor, prolongs gestational age at delivery, reduces the frequency of uterine contractions, and improves the symptoms of preterm labor in women at high risk of preterm labor.

P–362 The effect of nolasiban on uterine contractility at the time of embryo transfer in in vitro fertilisation patients

Abstract Study question What is the effect of nolasiban on the uterine contractility of in-vitro fertilisation (IVF) patients prior to embryo transfer (ET) ? Summary answer A single oral dose of nolasiban 900 mg administered 4 h before ET significantly decreased contraction frequency and increased coordination compared to placebo. What is known already Nolasiban is an investigational oral oxytocin receptor antagonist (OTRa) being developed to improve the chance of pregnancy following ET. Increased uterine contraction frequency can influence embryo implantation, and the coordination of these uterine contractions is equally important. OTRa have been shown to decrease uterine contractions and increase endometrial perfusion. Recently, an automated and quantitative measurement tool using transvaginal ultrasound (TVUS) to better characterise uterine contractility has been developed which can be used to quantify the effect of nolasiban on uterine contractility. Study design, size, duration This study is part of a completed multi-centre randomised placebo-controlled trial (IMPLANT 1 – NCT02310802) in IVF patients (n = 247) carried out in 2015. Our study retrospectively assessed a sub-set of patients with good quality TVUS recordings to evaluate their mechanical uterine motion that were randomised to receive either nolasiban 900mg (n = 39) or placebo (n = 42). Participants/materials, setting, methods Subjects were &amp;lt; 37 years, undergoing ET on Day 3 following IVF/ICSI and with evidence of uterine contractions 4 h before ET. Nolasiban was administered 4 h before ET. Patients underwent TVUS immediately before drug administration and again immediately before ET. Uterine contraction frequency, amplitude, power and coordination were measured by applying dedicated speckle tracking and strain analysis. The Shapiro–Wilk test, followed by the Wilcoxon rank-sum test were applied to compare features between treatment groups. Main results and the role of chance The mean (SD) frequency of uterine contractions was 1.54 (0.25) in the nolasiban group versus 1.57 (0.12) in the placebo group (p = 0.016). The mean (SD) coordination was 0.10 (0.17) in the nolasiban group versus 0.02 (0.16) in the placebo group (p = 0.034). The coordination feature was measured by assessing the presence of simultaneous movements of the anterior and posterior uterine walls, a higher value reflects increased coordination. There was no difference in contraction amplitude or power. Limitations, reasons for caution This was a retrospective analysis of TVUS videos. The small sample size limits the generalisability of the findings. Furthermore, our initial results do not show how the changes in uterine motion may affect pregnancy rate after ET, meaning that the clinical relevance of our results remains to be proven. Wider implications of the findings: Our results show that in patients taking one 900mg dose of nolasiban prior to ET, beneficial uterine contractions are seen, which could be promising for embryo implantation and pregnancy in IVF patients. Our quantitative TVUS measurement tool can be applied to different patient populations to accurately quantify uterine motion. Trial registration number NCT02310802

Identification of a novel distension-evoked motility pattern in the mouse uterus.

The dynamic changes in uterine contractility in response to distension are incompletely understood. Rhythmic, propagating contractions of nonpregnant uterine smooth muscle occur in the absence of nerve activity (i.e., myogenic), events that decline during pregnancy and reemerge at parturition. We therefore sought to determine how myogenic contractions of the nonpregnant uterus are affected by distension, which might provide mechanistic clues underlying distension-associated uterine conditions such as preterm birth. Uteri isolated from nulliparous adult female mice in proestrus were video imaged to generate spatiotemporal maps, and myoelectrical activity simultaneously recorded using extracellular suction electrodes. Motility patterns were examined under basal conditions and following ramped intraluminal distension with fluid to 5 and 10 cmH2O. Intraluminal distension caused pressure-dependent changes in the frequency, amplitude, propagation speed, and directionality of uterine contractions, which reversed upon pressure release. Altered burst durations of underlying smooth muscle myoelectric events were concurrently observed, although action potential spike intervals were unchanged. Voltage-gated sodium channel blockade [tetrodotoxin (TTX); 0.6 µM] attenuated both the amplitude of contractions and burst duration of action potentials, whereas all activity was abolished by L-type calcium channel blockade (nifedipine; 1 µM). These data suggest that myogenic motility patterns of the nonpregnant mouse uterus are sensitive to changes in intraluminal pressure and, at high pressures, may be modulated by voltage-gated sodium channel activity. Future studies may investigate whether similar distension-evoked changes occur in the pregnant uterus and the possible pathophysiological role of such activity in the development of preterm birth.

Vaginal versus Intramuscular Progesterone in the Prevention of Recurrent Preterm Labour

Background: Preterm labHarbor is characterized as the occurrence of uterine contractions of sufficient frequency and intensity to affect the cervix's progressive effacement and dilation before to term gestation. Objective: Comparison of vaginal and intramuscular progesterone to prevent premature labor in women with a history of spontaneous preterm labor recurrence. Patients and Methods: From April to November 2020, Al-Hussein Hospital, Al-Azhar University, conducted a comparative clinical trial study. In this research, one hundred (100) of pregnant women have been selected and divided into 3 groups (vaginal progesterone group (A), intramuscular progesterone group (B) and control group (C)) with a history of prior spontaneous premature labor. Results: Statistically significant differences were found among the progesterone groups and the control group with respect to NICU admissions, with a higher percentage of NICU admission among the control group (63.3%) compared to the progesterone groups (25.2%). There were also statistically significant differences among the vaginal progesterone group & the intramuscular progesterone group as regards NICU admission with higher percentage of NICU admission among the intramuscular progesterone group (40%) compared to the vaginal progesterone group (11.4%). Conclusion: In ladies who have had repeated spontaneous preterm labors, progesterone used prophylactically decreases the rate of premature labor, lowers the frequency of uterine contractions, and enhances the symptoms of preterm labor. In women at risk for PTL, vaginally administered progesterone was almost as effective as intramuscular progesterone in preventing PTL, with the vaginal route having a superior impact.

E D U K A S I T E N T A N G TEKNIK MASSAGE COUNTER PRESSURE TERHADAP PENGURANGAN RASA NYERI PERSALINAN KALA I

Labor pain is a physiological condition that is generally experienced by almost all women who give birth. Pain comes from uterine contractions and cervical dilation. With the increasing frequency of uterine contractions, the pain felt by the mother in childbirth will be even stronger. This education aims to increase the knowledge and insight of mothers about how to use counter pre ssure massage techniques to reduce the pain of childbirth during the first stage of labor. This education uses an approach approach to mothers in labor so that they can perform counter pressure massage techniques during the first stage of labor. This massage technique is carried out for 20 minutes during contractions. The targets in this education are 1st stage mothers. This counseling technique starts from identifying the first stage mothers, preparing places and targets, preparing materials, extension tools and implementing teams. This education was carried out at the Kurnia Independent Practice Midwives, Deli Tua District. The results of this counseling indicate that by applying a counter pressure massage technique on the mother's waist can reduce labor pain from mothers who experience moderate pain to mild pain and mothers who experience severe pain to moderate pain p value = 0.007 (p. &lt;0.05). It can be concluded that there is a significant effect of the application of counter pressure massage techniques on reducing pain in stage I labor. It is recommended that mothers who give birth during stage I are able to do this technique of counter pressure massage correctly.

“ROLE OF PARTOGRAM IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA PATIENT AT TERTIARY CARE CENTRE”

Introduction: Although labor is a natural physiological process characterized by progressive increase in frequency, intensity and duration of uterine contractions, resulting in effacement and dilatation of cervix, with descent of the fetus through the birth canal, this physiologic process many a time may lead to prolonged labor. The partograph developed by World Health Organization is the best-known partograph in the lowresource setting. Partograph when used with dened management protocol is an inexpensive tool which can effectively monitor labor and be helpful in reducing incidences of both maternal and fetal morbidity and mortality by reducing the number of operative interventions, prolonged labor, obstructed labor and caesarean section. Then WHO in 1994 endorsed the partogram and later modied in 2000 and removed latent phase and dened active phase at 4 centimetres instead of previously used 3 centimetres. WHO advocated its use as a necessary tool in management of labor and recommended its universal use during labor. Objective: To analyse the patterns of labor amongst spontaneous parturient using a WHO modied partogram and to compare outcome of labor and neonatal outcomes in relation to partogram ndings. Methods: This prospective study was carried over a period of 18 months on 100 parturients. Modied WHO Partogram was used to assess the progress of the labor. Parturients were divided on basis of partogram ndings. Group-I (n=64), where parturients partogram remained to the left of alert line, Group-II (n=20), where parturients partogram remained between the alert and action lines and Group-III (n=16), where parturients partogram crossed the action line. In these three groups, the maternal and fetal outcomes were assessed. Results: Normal vaginal delivery was done in 95.3% of Group-I, 80% of Group-II and 43.75% of Group-III parturients. Instrumental delivery was done in 1.56% of Group-I, 10% of Group-II and 18.75% of Group-III parturients. LSCS was done in 3.1% of Group-I, 10% of Group-II and 37.5% of Group-III parturients. Instrumental / LSCS deliveries were higher in Group-II and Group-III parturients. Alarge proportion of newborns of Group-II and Group-III parturients had Apgar Score &lt;7. Conclusion: The Modied WHO partogram is very helpful in the prediction of maternal and fetal outcome. It is highly recommended for use in resource decient medical facilities, where early decision for delivery or referral can be taken on the basis of partogram ndings..

712 Uterine contraction frequency in the last hour of labor: how many are too many?

ACOG defines the upper limit of normal uterine contraction frequency (UCF) at 5 per 10 minutes, averaged over 30 minutes. Others suggest 4/10 min as max. The choice has significant implications for maintaining progress in cervical dilatation while avoiding fetal deterioration. We compared the two cutoff points to predict postnatal outcomes (cord blood BE, pH, 5 min Apgar’s, prediction of BE≤ -12mMol/l, & neonatal recovery of FHR tachycardia at 16 min) and examined the implications of UCF over the last hour of labor before birth on them. We evaluate 475 cases from a unique research data set developed in the 1970’s by ANOVA and ROC. 346 fetuses had at least one 10-min period (last hour) with >4 UCF while there were 159 with >5 For both UCF>4 and >5, there were between-time-group differences in for almost all measures. (most p < .001) However, the patterns of worsening outcomes differed appreciably & consistently. For >4, there was an approximately linear deterioration in the last hour before birth correlating with duration of >4. For >5, however, slightly poorer outcomes were noted beginning even at < 20 minutes. They remained relatively stable until 40+ minutes of >5, but then outcomes worsened dramatically. (BE Fig 1) ROC showed >4 had better AUC for adverse outcomes (BE ≤-12 & NHR failure to recover). (Fig 2 recovery) What constitutes abnormal UCF has significant implications for predicting postnatal outcomes. Using the > 5 definition of abnormal masks impending compromise. Many at-risk cases read normal even with 40 minutes of increased UCF. However, when as a result of too many contractions fetal reserve is then depleted, sudden clinical deterioration can occur carrying over into the neonatal period. Using >4, vs. >5, demonstrated a gradual, predictable, and basically linear depletion of reserve with improved discrimination of risk. Recognizing deterioration earlier in the pathophysiology allows more time to assess and safely intervene. Thus, we believe the definition of increased uterine activity should be changed to an average of >4 UCF per 10 min period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology.

The journey of human labor involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of the umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as labor progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labor. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially in the presence of a super-imposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labor may increase the risk of hypoxic-ischemic injury. Clinicians need to move away from pattern recognition guidelines (normal, suspicious, pathological), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.