Onset Of Spontaneous Contraction Research Articles

A Pilot Randomized Controlled Trial to Evaluate Isosorbide Mononitrate (IMN) Efficiency for Cervical Ripening Prior to Labor Induction in Iranian Pregnant Women.

Our aim was to examine the effect and cost-effectiveness of isosorbide mononitrate (IMN) for outpatient (at home) cervical ripening in Iranian women with term pregnancy. Term pregnant women were randomly selected to receive either 15 mg vaginally administered IMN or placebo. Patients were advised to take the second dose at home 24 h later and return to the hospital for admission after the next 24 h if the onset of spontaneous contraction does not occur. Cervical status, maternal blood pressure, maternal pulse rate, fetal heart rate and various side effects were examined. IMN induced a significant increase in cervical Bishop Score; headache, nausea, and dizziness were seen in 8 of 28 participants of IMN group; although, all had normal vital signs and normal FHR, they had to be hospitalized and receive medication to relieve the unpleasant symptoms. Vaginal administration of 15 mg of IMN induced cervical ripening in term pregnant women. However, the administration of IMN for cervical ripening is not recommended as it produced headache in significant number of Iranian pregnant women.

Vaginal administration of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy: a randomized controlled trial

Introduction: Induction of labor is commonly practiced intervention in modern Obstetrics. The aim of induction of labor is to initiate labor when maternal and fetal conditions necessitate delivery before the onset of spontaneous contraction with purpose to achieve safe vaginal delivery. Induction of labor is one of the most commonly practiced interventions in the Department of Obstetrics and Gynecology every day. The success of this obstetric practice is highly dependent upon the condition of the cervix which is assessed with Bishop‟s Score and it is well known that unfavorable cervix is associated with failure of induction and cesarean section. In the recent years, there has been a considerable interest in the use of nitrous oxide donors for cervical ripening and labor induction.Objective: To evaluate whether isosorbide mononitrate administered vaginally prior to induction in postdated pregnancy is effective for pre-induction cervical ripening and thus, improves the process of induction of labor.Methods: One hundred and twenty women scheduled for labor induction were recruited and assigned randomly to isosorbide mononitrate or placebo followed by misoprostol 25μg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labor and delivery.Results: The groups were comparable with respect to age, gestational age and Bishop‟s score. Women receiving isosorbide with misoprostol didn‟t show any improvement in the Bishop‟s score compared to misoprostol and placebo. There was no significant difference between the two groups regarding time of delivery and onset of active stage of labor from induction. Cesarean delivery rates were similar between the two groups; however, the indications of the cesarean section were different between the two groups which were significant statistically. Neonatal outcome were similar between the two groups.Conclusion: The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and didn‟t help in improving pre-induction cervical score.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, page: 51-58

Is x‐ray compulsory in pubic symphysis diastasis diagnosis?

SirWe read with great interest your case of postpartum symphy-sis pubis separation (1). We would like to present a case ofpubic symphysis diastasis that we diagnosed with a differentapproach.A 36-year-old gravida 1 para 0 at 39.6 weeks’ gestation wasadmitted with the onset of spontaneous contraction. After threehours and 18 min she delivered a 3170 g baby without compli-cations.Three hours after delivery, she complained of severe pain inthe symphysis pubic region. On examination, there was localtenderness in that region. We performed an ultrasound exami-nation, which revealed a 15.2-mm gap in the region of the sym-physis pubis (Figure 1), diagnosed as pubic symphysis diastasis.She was given analgesics and advised bed rest. The patient wasdischarged six days after delivery and advised to maintain activeambulation and start physiotherapy. Three months later she wasseen at the outpatient clinic. She was able to walk independentlyand was no longer experiencing any pain.Although the case presented is not particularly impressive inseverity, it still offers the opportunity to inform all cliniciansabout the possibility of diagnosing this condition with the useof the ultrasonography alone. The reported incidence of pubicsymphysis diastasis varies widely in the literature, from 1 in 300to 1 in 30 000 deliveries (2,3). Generally, it is a rare complica-tion and for this reason it is very difficult to perform random-ized controlled trials to compare different diagnostic tools. Thediagnosis is based primarily on clinical findings. The most con-sistent finding is pain in the symphyseal region that radiates tothe lower back and thighs and is exacerbated by leg movement(4). In addition, many women will have difficulty walking, infact the gait is described as waddling, or potentially be unableto stand or walk due to pain (3). Symptoms may be noted dur-ing labor and up to 48 h postpartum. Often the first diagnostictest used to identify the pubic diastasis is antero-posterior radi-ography. However, we think that ultrasound might be a goodchoice as an initial imaging study, rather than x–ray, due toabsence of exposure to ionizing radiation and its ease of opera-tion, and as it presents an optimal assessment of the extent ofsymphysis separation (3–5). We performed ultrasonography inthe following way: we placed the probe in transverse orientationon the pubic symphysis (identified by palpation) with an approx-imately 30° caudal scanning plane, with the purpose of measuringthe width of the symphyseal joint at its upper margin.Pubic symphysis diastasis is an uncommon injury that shouldbe considered when evaluating patients in the peripartum periodwho are experiencing suprapubic, sacroiliac or thigh pain. In addi-tion we would like to bring to the general attention the usefulnessof ultrasound in the diagnosis and management of this rare condi-tion. The literature is inconsistent on this topic, due to the lack ofrandomized controlled trials, but good suggestions are present (3–5). In our experience, ultrasound is simple, reproducible and with-out side effects, and should be used as an initial imaging studybecause the accuracy is at least as good as that of x-rays for esti-mating the width of the symphysis pubis diastasis.Alessandro Svelato

P43.07: Prenatal MR imaging of fetal teratomas: Intracranial, oropharyngeal and sacrococcygeal locations. A series of 7 cases

24years-old nullipara was referred at 23 weeks of gestation because absent cavum septum pellucidum was noticed at a routine ultrasound scan. Ultrasonography showed complete absence of septum pellucidum resulting in box like frontal horns and a mild form of holoprocencephaly. No other abnormalties were detected. An MRI image at 25 weeks has confirmed absent septum pellucidum without fusion of frontal lobes ruling out the diagnosis of lobar holoprocencephaly. Bilateral atrophy of optic nerve with hypoplasia of optic chiasm was seen on coronal 3D image. A normal male karyotyping was found. The fetus was followed up on 4-weekly basis. At 41 weeks gestation, following the onset of spontaneous contractions, an emergency caesarean section was performed for fetal distress. A 3650-g male baby was delivered with Apgar scores of 9, 10 and 10 at 1, 5 and 10 min, respectively. No resuscitation or respiratory support was required. Neonatal dilation fundoscopy examination at 3 months of age has revealed slightly small right optic nerve head and normal left one. Neonatal MRI at 4 months of age has confirmed complete absence of the septum pellucidum, low lying fornices, hypoplasia of cerebral white matter and mild ventriculomegaly. The posterior fossa, anterior visual pathway and optic nerves were normal. A hydrocortisone day curve at 4 months of age revealed low endogenous cortison level, which was replaced. the neonate has normal milestone. He was followed up until age of 14 months when he required a growth hormone replacement and his vision was normal. In conclusion, prenatal diagnosis of septo-optic dysplasia should involve MRI examination in order to outline the diagnosis followed by neonatal MRI and ophthalmological examination to help define the extent of optic-nerve lesion and therefore the prognosis. Neonatal multidisciplinary care is crucial for satisfactory outcome

The regulation of acetylcholinesterase by cis‐elements within intron I in cultured contracting myotubes

The onset of spontaneous contraction in rat primary muscle cultures coincides with an increase in acetylcholinesterase (AChE) activity. In order to establish whether contractile activity modulates the rate of AChE transcript synthesis, and what elements of the gene are determinant, we examined the promoter and intron I in contracting muscle cultures. Ache genomic fragments attached to a luciferase reporter were transfected into muscle cultures that were either electrically stimulated or paralyzed with tetrodotoxin to enhance or inhibit contractions, respectively. Cultures transfected with intron I-containing constructs showed a 2-fold increase in luciferase activity following electrical stimulation, compared to tetrodotoxin treatment, suggesting that this region contains elements responding to contractile activity. Deleting a 780 bp distal region within intron I, containing an N-box element at +890 bp, or introducing a 2-bp mutation within its core sequence, eliminated the contraction-induced response. In contrast, mutating an N-box element at +822 bp had no effect on the response. Furthermore, co-transfecting a dominant negative GA-binding protein (GABP), a transcription factor known to selectively bind N-box elements, reduced the stimulation-mediated increase. Our results suggest that the N-box within intron I at +890 bp is a regulatory element important in the transcriptional response of Ache to contractile activity in muscle.

Importance of oxytocin sensitivity for the spontaneous onset of human labor

The significance of oxytocin for the onset of labour in humans is disputed, mainly because there is no increase in oxytocin concentration in the peripheral maternal blood before onset of labour. However, Fuchs et al. have recently shown that the concentration of oxytocin receptors in the myometrium is significantly higher directly before onset of labour than at the onset of spontaneous contractions. To establish a correlation with the clinical sensitivity to oxytocin, the authors determined the oxytocin sensitivity by means of intravenous administration of 3 X 10 m I.U. of oxytocin with continuous tocographic recording. Parallel to this determination, the cervical score was measured according to Bishop. The patients were 26 healthy pregnant women in whom both parameters were determined daily until onset of spontaneous labour pains. The sensitivity to oxytocin increased significantly during the last few days before spontaneous onset of labour. On the day before onset of pains, almost all of the pregnant women showed maximum sensitivity to oxytocin. Parallel to this, the cervical, scores also increased; on the day before onset of labour pains, almost all pregnant women had a cervical score of 5 or more than 5. On the basis of these results, which concur accurately with the results of measurement of oxytocin receptor concentrations, it is definitely possible to refute the arguments that oxytocin is irrelevant for the onset of labour because its concentration in the maternal plasma does not increase before the pains begin.(ABSTRACT TRUNCATED AT 250 WORDS)