Induction Of Hemorrhage Research Articles

Inhibition of SUMOylation exacerbates neurological dysfunction and delays hematoma clearance after intracerebral hemorrhage in mice.

Intracerebral hemorrhage is a kind of hemorrhagic stroke resulting from bleeding in the brain parenchyma. SUMOylation is one of post-translational protein modifications based on covalent binding of small ubiquitin-like modifier (SUMO) peptide. Although SUMOylation has been reported to play neuroprotective roles in ischemic stroke, the role of SUMOylation in the pathology of intracerebral hemorrhage remains unclear. Here we addressed the relationship between SUMOylation and pathogenesis of intracerebral hemorrhage. For in vivo study, hemorrhage was induced in the striatum of male ICR mice by local injection of type VII collagenase. After induction of hemorrhage, there was a significant increase in the levels of SUMO2/3 protein conjugation in the brain, without accompanying significant changes in the levels of free SUMO2/3 protein and Sumo2/3 mRNA. When intracerebroventricular injection of TAK-981, an inhibitor of SUMOylation, was performed 3 d before hemorrhage induction, it delayed recovery of body weight, recovery of neurological functions and hematoma clearance. TAK-981 also suppressed CD36 expression in hematoma-associated microglia/macrophages. For in vitro study, phagocytic activity of microglial BV-2 cells was examined using erythrocytes obtained from mouse blood. We found that both TAK-981 and small interfering RNA-mediated knockdown of SUMO2/3 inhibited erythrophagocytosis by BV-2 cells. These results suggest that SUMOylation by SUMO2/3 promotes hematoma clearance via regulation of CD36 expression in microglia and contributes to the recovery from pathology of intracerebral hemorrhage.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

The impact of prepregnancy body mass index on pregnancy and neonatal outcomes.

The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate. This study aims to investigate the prepregnancy BMI class specific risks for pregnancy and neonatal complications based on a prepregnancy BMI class. We conducted a retrospective cohort study of40,256 pregnant women with 55,202 singleton births between October 16, 2007 and December 3, 2023. We assessed the risk of pregnancy and neonatal morbidity based on the maternal prepregnancy BMI category. The primary outcome was composite maternal morbidity, including hypertensive disorders of pregnancy (i.e.,gestational hypertension [GHTN] and preeclampsia), and gestational diabetes mellitus (GDM), adjusted for pregestational diabetes mellitus and chronic hypertension (cHTN). Secondary maternal outcomes included preterm premature rupture of membranes (PPROM), preterm delivery (PTD<37 and <32weeks), induction of labor (IOL), cesarean delivery (CD), and postpartum hemorrhage (PPH). Neonatal outcomes included a composite adverse outcome (including stillbirth, intraventricular hemorrhage (IVH), hypoglycemia, respiratory distress syndrome [RDS], APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min, and neonatal intensive care unit [NICU] admission), birthweight, fetal growth restriction (FGR), and macrosomia. Composite maternal morbidity (odds ratio [OR] 4.40,confidence interval [CI] 3.70-5.22 for class III obesity [BMI≥40.0 kg/m2] compared with normal BMI), hypertensive disorders of pregnancy (HDP), GDM, PTD, IOL, CD, PPH, neonatal composite morbidity, hypoglycemia, RDS, APGAR<7 at 5 min, NICU admission, and macrosomia showed a significant increasing test of trend among BMI classes. Increased BMI was protective for FGR. Our data provides BMI-class specific odds ratios (ORs) for adverse pregnancy outcomes. Increased BMI class significantly increases the risk of HDP, GDM, IOL, CD, composite adverse neonatal outcomes, and macrosomia, and decreases the risk of FGR. Attaining a healthier BMI category prior to conception may lower pregnancy morbidity.

Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study.

What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation? The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage. Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration. This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC. Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available. In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population. The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications. This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed. No funding was received for this study. There are no conflicts of interest to declare. N/A.

Maternity Service Delivery in Manitoba, Canada: A Retrospective Analysis of Three Maternity Care Provider Types

Background: Alleviating shortages in health workforce and delivery of efficient maternity care models are unresolved policy issues in Canada. In the province of Manitoba, obstetricians do the majority of maternity care, family practice physicians take care of low-risk women, and midwives continue to deliver care to about 5% of the low-risk pregnant women. The purpose of this study was to describe how maternity care is provided in Manitoba, based on a revised definition of Most Responsible Provider, and to compare maternal and perinatal outcomes by provider type. Methods: Administrative data were used from the Manitoba Centre for Health Policy (MCHP) to select women who had a low-risk pregnancy. Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates. Results: From 2004/05 to 2012/13, there were a total of 132,918 births in Manitoba. Of those births, 47,083 were identified as high risk (35%), and 85,835 (65%) were identified as low risk. Key findings demonstrate midwifery care compared to obstetrical care was associated with lower odds of interventions such as cesarean section (0.47 [0.40–0.54]), induction (0.42 [0.39–0.49]), and episiotomy (0.48 [0.41–0.55]), but higher odds of postpartum hemorrhage (1.35 [1.18–1.55]), and shorter lengths of stay in hospital (-0.58 [-0.61-0.56]). Family practice physicians also had decreased odds of assisted vaginal delivery (0.82 [0.76–0.89]), epidural use (0.59 [0.57–0.62]) and third- and fourth-degree tears (0.82 [0.73–0.92]), but higher odds of augmentation (1.06 [1.01–1.11]). Results reported for midwives and family practice are compared to obstetricians. Conclusions: A health workforce strategy that optimizes how to address the maternity care needs in the province of Manitoba is needed. There is suboptimal integration of midwifery services that could meet the low-risk population needs. Human health workforce development requires a good understanding of each provider’s role, opportunities for collaboration and integration to be strengthened, and the potential to optimize the outcomes for mothers and infants. This article has been peer reviewed.

Targeting Pro-Oxidant Iron with Exogenously Administered Apotransferrin Provides Benefits Associated with Changes in Crucial Cellular Iron Gate Protein TfR in a Model of Intracerebral Hemorrhagic Stroke in Mice.

We have previously demonstrated that the post-stroke administration of iron-free transferrin (apotransferrin, ATf) is beneficial in different models of ischemic stroke (IS) through the inhibition of the neuronal uptake of pro-oxidant iron. In the present study, we asked whether ATf is safe and also beneficial when given after the induction of intracerebral hemorrhage (ICH) in mice, and investigated the underlying mechanisms. We first compared the main iron actors in the brain of IS- or collagenase-induced ICH mice and then obtained insight into these iron-related proteins in ICH 72 h after the administration of ATf. The infarct size of the IS mice was double that of hemorrhage in ICH mice, but both groups showed similar body weight loss, edema, and increased ferritin and transferrin levels in the ipsilateral brain hemisphere. Although the administration of human ATf (hATf) to ICH mice did not alter the hemorrhage volume or levels of the classical ferroptosis GPX4/system xc- pathways, hATf induced better neurobehavioral performance, decreased 4-hydroxynonenal levels and those of the second-generation ferroptosis marker transferrin receptor (TfR), and restored the mRNA levels of the recently recognized cytosolic iron chaperone poly(RC) binding protein 2. In addition, hATf treatment lowered the ICH-induced increase in both endogenous mouse transferrin mRNA levels and the activation of caspase-2. In conclusion, hATf treatment provides neurobehavioral benefits post-ICH associated with the modulation of iron/oxidative players.

Induction of labor and risk of postpartum hemorrhage in women with vaginal delivery: A propensity score analysis.

To explore the association between induction of labor (IOL) and postpartum hemorrhage (PPH) after vaginal delivery. We included women from the merged database of three randomized prospective trials (TRACOR, CYTOCINON, and TRAAP) that measured postpartum blood loss precisely, with standardized methods. IOL was considered overall and according to its method. The association between IOL and PPH was tested by multivariate logistic regression modeling, adjusted for confounders, and by propensity score matching. The role of potential intermediate factors, i.e. estimated quantity of oxytocin administered during labor and operative vaginal delivery, was assessed with structural equation modeling. Labor was induced for 1809 of the 9209 (19.6%) women. IOL was associated with a significantly higher risk of PPH of 500 mL or more (adjusted odds ratio 1.56, 95% confidence interval 1.42-1.70) and PPH of 1000 mL or more (adjusted odds ratio 1.51, 95% confidence interval 1.16-1.96). The risk of PPH increased similarly regardless of the method of induction. The results were similar after propensity score matching (odds ratio for PPH ≥500 mL 1.57, 95% confidence interval 1.33-1.87, odds ratio for PPH ≥1000 mL 1.57, 95% confidence interval 1.06-2.07). Structural equation modeling showed that 34% of this association was mediated by the quantity of oxytocin administered during labor and 1.3% by women who underwent operative vaginal delivery. Among women with vaginal delivery, the risk of PPH is higher in those with IOL, regardless of its method, and after accounting for indication bias. The quantity of oxytocin administered during labor may explain one third of this association.

Lung Ultrasound Induction of Pulmonary Capillary Hemorrhage in Rats With Consideration of Exposimetric Relationships to Previous Similar Observations in Neonatal Swine.

Lung ultrasound (LUS) has become an essential clinical tool for pulmonary evaluation. LUS has been found to induce pulmonary capillary hemorrhage (PCH) in animal models, posing a safety issue. The induction of PCH was investigated in rats, and exposimetry parameters were compared with those of a previous neonatal swine study. Female rats were anesthetized and scanned in a warmed water bath with the 3Sc, C1-5 and L4-12t probes from a GE Venue R1 point-of-care ultrasound machine. Acoustic outputs (AOs) of sham, 10%, 25%, 50% or 100% were applied for 5-min exposures with the scan plane aligned with an intercostal space. Hydrophone measurements were used to estimate the in situ mechanical index (MIIS) at the lung surface. Lung samples were scored for PCH area, and PCH volumes were estimated. At 100% AO, the PCH areas were 73 ± 19 mm2 for the 3.3 MHz 3Sc probe (4 cm lung depth), 49 ± 20 mm2 (3.5 cm lung depth) or 96 ± 14 mm2 (2 cm lung depth) for the 3.0 MHz C1-5 probe and 7.8 ± 2.9 mm2 for the 7 MHz L4-12t (1.2 cm lung depth). Estimated volumes ranged from 378 ± 97 mm3 for the C1-5 at 2 cm to 1.3 ± 1.5 mm3 for the L4-12t. MIIS thresholds for PCH were 0.62, 0.56 and 0.48 for the 3Sc, C1-5 and L4-12t, respectively. Comparison between this study and previous similar research in neonatal swine revealed the importance of chest wall attenuation. Neonatal patients may be most susceptible to LUS PCH because of thin chest walls.

168 Elevated Intracranial Pressure is Associated With Memory Dysfunction in Intraventricular Hemorrhage Animal Model

INTRODUCTION: Survivors of nontraumatic intraventricular hemorrhage are often left with memory impairment, however, underlying mechanisms of this dysfunction remain to be elucidated. METHODS: The experimental design included two groups of Sprague Dawley rats (n=30): intraventricular hemorrhage (control) and intraventricular hemorrhage with sustained high intracranial pressures (experimental). The autologous intraventricular blood injection model was used. In the experimental group the intracranial pressure was artificially elevated. Ten days following surgery, each rat underwent Morris water maze. T test was used with a p value of &lt; 0.05 considered statistically significant. RESULTS: The average maximum intracranial pressure in the experimental group was 75.6 ± 17.5 mmHg compared to 66.5 ± 17.3 mmHg in the control group (p = 0.260). The experimental group experienced elevated intracranial pressure for two hours following induction of intraventricular hemorrhage, whereas the intracranial pressure normalized within minutes in the control group. The mean cerebral perfusion pressure tended to be lower in the experimental group (20 ± 25.6 mmHg) compared to the control group (30 ± 19.4 mmHg) (p = 0.302). In Morris water maze, the experimental group needed more time to reach the platform (37.3 ± 21.8 seconds) compared to the control group (19.7 ± 14.3 seconds) (p = 0.041). The experimental group also spent less time in 5% and 10% target quadrants, 2.4 ± 1.8 and 5.7 ± 3.9 seconds, respectively (p = 0.004) compared to the control group, 5.3 ± 2.2 and 10 ± 3 seconds, respectively (p &lt; 0.001). CONCLUSIONS: Animals who have prolonged elevated intracranial pressures following intraventricular hemorrhage perform poorly in spatial memory and learning. The authors suggest that a rise in intracranial pressure might be the driver for activating pathways responsible for subsequent memory dysfunction.

Pattern of weight gain in pregnant women and effect on maternal and neonatal outcome in Abuja, Nigeria: A longitudinal multicentre study

Background: Normal pregnancy is usually associated with weight gain. Abnormal weight gain in pregnancy could result in adverse neonatal and maternal outcome. Studies related to this in Nigeria are limited.Objective: The aim was to evaluate the pattern of weight gain in pregnancy and the feto-maternal outcome among women with different body mass indices attending antenatal clinic in the Federal capital territory (FCT).Study design: This was a longitudinal, multicentre study.Materials and Methods: Two hundred and twenty participants were recruited from 6 general hospitals in the FCT. Their body mass indices were calculated and they were categorized as underweight, normal weight, overweight and obese accordingly. They were followed up till 2 weeks postpartum. Maternal outcome sought included gestational hypertension, gestational diabetes and mode of delivery, postpartum haemorrhage, retained placenta and perineal injury. Neonatal outcomes included macrosomia, low birth weight, neonatal hypoglycaemia, shoulder dystocia, stillbirth and admission into special care baby unit (SCBU).Result: The mean age of participants was 28.8 years ±4.7 with parities ranging from 0-8. The majority of them (39%) were overweight. While most of the women (118, 56.2%) had normal weight gain (NWG) in pregnancy, 15(7.1%) had low weight gain (LWG) and 77(36.6%) had high weight gain (HWG). Most (95%) of the HWG was among the overweight and obese women. There was a higher induction rate and postpartum haemorrhage among HWG women and postdate among the obese group. There was no difference in neonatal outcome among the groups.Conclusion: This study demonstrated that HWG and LWG have more adverse pregnancy outcomes than NWG. Younger women (20-24years) with normal BMI at booking tend to gain suboptimal weight in pregnancy. HWG in pregnancy was commoner among overweight and obese women with increased induction of labour and postpartum haemorrhage among them. Post-date pregnancy was higher among the obese group. There was no difference in neonatal outcomes among the groups.

The vulnerable air-tissue interface: Summary of ultrasound related bioeffects on lung and their implications for the use of different imaging modes and applications beyond

Introduction: Lung tissue is sensitive to mechanical stress. Animal studies showed induction of pulmonary capillary hemorrhage (PCH) in lung in the diagnostic regime at intensities. Therefore, this work summarizes novel findings regarding the interaction of ultrasound at the alveolar epithelium-gas interface. Method: Literature research related to ultrasound bio-effects on lung was carried out. Furthermore, recent studies reporting thresholds of PCH induction depending on imaging mode and duration will be discussed. Results: Ventilated lung tissue is more vulnerable to mechanical forces than solid tissue. From peak negative pressure below 1.5 MPa the likelihood of PCH induction increases with exposure time. Such PCH is asymptomatic but can falsify the diagnostic outcome. The causes remain still unknown but is not related to cavitation or thermal effects. The extent of PCH in lung is depending of physiological beside acoustic parameters. The extend of PCH is, therefore, not entirely predictable. In addition, observational studies on humans could not confirm the findings as investigated on pathological level on animal models. Conclusion: The vulnerability of lung should become aware in the lung ultrasound community. Current recommendations for output limitations given by AIUM and EFSUMB should be followed and only increased for diagnostics needs.

Lung Ultrasound Induction of Pulmonary Capillary Hemorrhage in Neonatal Swine.

This study investigated induction of pulmonary capillary hemorrhage (PCH) in neonatal pigs (piglets) using three different machines: a GE Venue R1 point-of-care system with C1-5 and L4-12t probes, a GE Vivid 7 Dimension with a 7L probe and a SuperSonic Imagine machine with an SL15-4 probe and shear wave elastography (SWE). Female piglets were anesthetized, and each was mounted vertically in a warm bath for scanning at two or three intercostal spaces. After aiming at an innocuous output, the power was raised for a test exposure. Hydrophone measurements were used to calculate in situ values of mechanical index (MIIS). Inflated lungs were removed and scored for PCH area. For the C1-5 probe at 50% and 100% acoustical output (AO), a PCH threshold of 0.53 MIIS was obtained by linear regression (r2=0.42). The L4-12t probe did not induce PCH, but the 7L probe induced zones of PCH in the scan planes. The Venue R1 automated B-line tool applied with the C1-5 probe did not detect PCH induced by the C1-5 probe as B-line counts. However, when PCH induced by C1-5 and 7L exposures were subsequently scanned with the L4-12t probe using the automated tool, B-lines were counted in association with the PCH. The SWE induced PCH at push-pulse positions for 3, 30 and 300 s of SWE with PCH accumulating at 0.33 mm2/s and an exponential rise to a maximum of 18.4 mm2 (r2=0.61). This study demonstrated the induction of PCH by LUS of piglets, and supports the safety recommendation for use of MIs <0.4 in neonatal LUS.

Influence of neurovascular anatomy on perforation site in different mouse strains using the filament perforation model for induction of subarachnoid hemorrhage.

BackgroundFilament perforation is a widely-used method to induce subarachnoid hemorrhage (SAH) in mice. Whereas the perforation site has been assumed to be in the branching of middle cerebral artery (MCA) and anterior cerebral artery (ACA), we recently observed more proximal perforations.MethodsFilament perforation was performed in CD1- (n = 10) and C57Bl/6N-mice (n = 9) ex vivo. The filament was left in place and the perforation site was microscopically assessed. Digital subtraction angiography (DSA) was performed in CD1- (n = 9) and C57Bl/6J-mice (n = 29) and anatomical differences of the internal carotid artery (ICA) were determined.ResultsWhereas in C57Bl/6N-mice perforation occurred in the proximal intracranial ICA in 89% (n = 8), in CD1-mice the perforation site was in the proximal ICA in 50% (n = 5), in the branching between MCA and ACA in 40% (n = 4), and in the proximal ACA in 10% (n = 1). DSA revealed a stronger angulation (p<0.001) of the ICA in CD1-mice (163.5±2.81°) compared to C57Bl/6J-mice (124.5±5.49°). Body weight and ICA-angle showed no significant correlation in C57Bl/6J- (r = -0.06, pweight/angle = 0.757) and CD1-mice (r = -0.468, pweight/angle = 0.242).ConclusionFilament perforation in mice occurs not only at the hitherto presumed branching between MCA and ACA, but seems to depend on mouse strain and anatomy as the proximal intracranial ICA may also be perforated frequently.

Effect of Vipera berus berus and Vipera berus nikolskii Venom on Proteolytic Balance in the Tissue of the Adrenal Glands and Testicles of Rats

Background: Vipera berus berus and Vipera berus nikolskii are the most widely spread Old World vipers in Europe, who contribute to almost all cases of snakebites on this territory. Their venoms are known to cause proteolysis, thrombocytopenia, induction of neurotoxicity and haemorrhage, among which proteolytic action constitute to the possible affection of all metabolic pathways in the targeted organs and in the whole organism. Methods: The influence of the viper venoms on the adrenal glands and testicles of injected rats was studied through the analysis of the concentration of proteins (Bradford method), evaluation of the qualitative protein profile (disc electrophoresis), distribution of active proteolytic molecules in the studied tissues (enzyme electrophoresis) and estimation of the appearance of low molecular weight molecules. Results: The decline of the number of the total protein, the alterations of the protein composition and the enzymatic redistribution were declared to appear in these organs under the action of the studied venoms proving the assumption of the proteolysis activation. Whereas, the increase in the level of low molecular weight molecules has emerged showing the onset of the state of toxicity. Conclusion: the study of the influence of the V. berus berus and V. berus nikolskii venoms on the protein balance of adrenal glands and testicles was performed, showing the impact on the amount of total proteins, its redistribution and connection with toxicity and proving the onset of pathological process.

Elective Induction of Labor and Postpartum Hemorrhage in Females Presenting for Normal Vaginal Delivery at Term

Background: Labor induction is the process or treatment that stimulates childbirth and delivery. Induction of labor without a medical indication is termed elective induction of labor and appears to be increasing even more rapidly than induction of labor as a whole. Postpartum hemorrhage (PPH) leads to prominent causes of maternal death. Uterine massage is a simple first line treatment as it helps the uterus to contract to reduce bleeding. Objectives: To determine the frequency of elective induction of labor in females undergoing normal vaginal delivery at term and to compare the frequency of postpartum hemorrhage with spontaneous versus elective induced labor in females presenting for normal vaginal delivery at term. Study Design: Descriptive case series study Place and Duration of Study: Department of Obstetrics &amp; Gynecology, Shaikh Zayed Women Hospital, Larkana from 1st October 2021 to 31st March 2022. Methodology: Two hundred females were enrolled. They were divided in two groups; elective induction or spontaneous delivery. Females who had active labour without oxytocin with no membrane rupture before labour, labeled as having spontaneous labour otherwise. Results: The induced delivery was noted in 35(17.50%) females and spontaneous type of delivery was noted in 165(82.50%) females, the postpartum hemorrhage was noted among 23(11.50%) females. The postpartum hemorrhage is not associated with type of delivery (p=0.249). Conclusion: The elective induction of labor in females undergoing normal vaginal delivery at term was 17.50% patients and postpartum hemorrhage was 11.50% patients. Keywords: Postpartum hemorrhage, Postpartum hemorrhage (PPH), Spontaneous, Induced, Labour, Delivery

Placenta previa and bladder varicosities—a clinical conundrum

A 34-year-old G4T3P0A0L2 was referred to the Division of Maternal Fetal Medicine (MFM) at 28+4 weeks’ gestation for antepartum bleeding with placenta previa and possibly percreta. The patient had 3 previous vaginal deliveries. The third was complicated by postterm induction of labor, shoulder dystocia, postpartum hemorrhage, and uterine rupture into the broad ligament requiring laparotomy and repair.

Effects of Misoprostol on Induction of Labour in Patients with Hypertensive Disorders of Pregnancy: A Meta-Analysis.

Objective Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for clinical decisions, we systematically reviewed the effects of misoprostol on induction of labour in HDP patients. Methods PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for relevant literature from 2010 to 2020. Subsequently, a meta-analysis was performed to compare the effective rate of induction of labour and reducing postpartum hemorrhage (PPH) between the intervention group (n = 544, misoprostol) and the control group (n = 543, oxytocin). Results A total of 10 studies with 1087 patients were included. The 10 studies compared the effective rate of induction of labour between the two groups and confirmed that the effective rate in the intervention group was significantly higher than that in the control group (OR = 4.37; 95% CI: 2.73, 7.00). Seven studies compared PPH between the groups and showed that it was significantly reduced in the intervention group compared to the control group (SMD = −1.32; 95% CI: −2.05, −0.59; P < 0.0001). Conclusion Misoprostol has a high effective rate of induction of labour in HDP patients and is an effective uterotonic agent in reducing PPH. This meta-analysis provides clinicians with meaningful information to help them make evidence-based decisions.

Severity Assessment in Rats Undergoing Subarachnoid Hemorrhage Induction by Endovascular Perforation or Corresponding Sham Surgery

Introduction: Animal models for preclinical research of subarachnoid hemorrhage (SAH) are widely used as much of the pathophysiology remains unknown. However, the burden of these models inflicted on the animals is not well characterized. The European directive requires severity assessment-based allocation to categories. Up to now, the classification into predefined categories is rather subjective and often without underlying scientific knowledge. We therefore aimed at assessing the burden of rats after SAH or the corresponding sham surgery to provide a scientific assessment. Methods: We performed a multimodal approach, using different behavior tests, clinical and neurological scoring, and biochemical markers using the common model for SAH of intracranial endovascular filament perforation in male Wistar rats. Up to 7 days after surgery, animals with SAH were compared to sham surgery and to a group receiving only anesthesia and analgesia. Results: Sham surgery (n = 15) and SAH (n = 16) animals showed an increase in the clinical score the first days after surgery, indicating clinical deterioration, while animals receiving only anesthesia without surgery (n = 5) remained unaffected. Body weight loss occurred in all groups but was more pronounced and statistically significant only after surgery. The analysis of burrowing, open field (total distance, erections), balance beam, and neuroscore showed primarily an effect of the surgery itself in sham surgery and SAH animals. Only concerning balance beam and neuroscore, a difference was visible between sham surgery and SAH. The outcome of the analysis of systemic and local inflammatory parameters and of corticosterone in blood and its metabolites in feces was only robust in animals suffering from larger bleedings. Application of principal component analysis resulted in a clear separation of sham surgery and SAH animals from their respective baseline as well as from the anesthesia-only group at days 1 and 3, with the difference between sham surgery and SAH being not significant. Discussion/Conclusion: To our knowledge, we are the first to publish detailed clinical score sheet data combined with advanced behavioral assessment in the endovascular perforation model for SAH in rats. The tests chosen here clearly depict an impairment of the animals within the first days after surgery and are consequently well suited for assessment of the animals’ suffering in the model. A definitive classification into one of the severity categories named by the EU directive is yet pending and has to be performed in the future by including the assessment data from different neurological and nonneurological disease models.

The possible role of pedunculopontine tegmental nucleus (PPT) opioid receptors in the cardiovascular responses in normotensive and hemorrhagic hypotensive rats

ABSTRACT Background The pedunculopontine tegmental nucleus (PPT) is involved in cardiovascular regulation. The presence of mu (μ) opioid receptors in the PPT nucleus has been determined. In the present study, the role of this nucleus in normotensive conditions and then the role of these receptors on cardiovascular function in hypotension induced by hemorrhage (HEM) were investigated. Method Animals were divided into the following groups: Group 1: control, Group 2: HEM, Group 3: morphine at dose 100 nmol (a general opioid receptor agonist), Group 4: naloxone at dose 100 nmol (a general opioid receptor antagonist), Group 5: morphine + HEM, and Group 6: naloxone + HEM. After anesthesia, two femoral arteries were cannulated to record the cardiovascular parameters and blood withdrawal. Two minutes after induction of HEM, drugs were injected into the nucleus, and cardiovascular parameters were measured. Changes (Δ) in cardiovascular responses due to drug injection and HEM were calculated and compared to control and HEM groups. Results HEM significantly reduced changes in systolic and mean arterial pressures and increased heart rate changes compared to control. Morphine microinjection in normotensive and HEM rats significantly decreased systolic blood pressure, mean arterial pressure, and heart rate, and naloxone significantly increased all these parameters. Conclusion This study showed that the PPT nucleus plays a role in modulating the cardiovascular responses induced by HEM. The µ opioid receptor of the PPT nucleus in the normotensive and HEM rats have inhibitory effects on blood pressure and heart rate mainly, and these effects are eliminated by naloxone microinjection.

Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009-2016.

BackgroundWomen with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia.MethodsOur sample included all reported live singleton births in Victoria 2009–2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness.ResultsOf all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37–2.43), having gestational diabetes mellitus (1.57, 1.34–1.84), undergoing an unplanned caesarean section (1.17, 1.02–1.33), induction of labour (1.17, 1.05–1.30) and postpartum haemorrhage (1.15, 1.03–1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43–1.80), a low Apgar score at 5 minutes (1.50, 1.19–1.90), preterm birth (1.40, 1.20–1.63), and low birthweight (1.26, 1.06–1.49).ConclusionWomen with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.