Strong Uterine Contractions Research Articles

Application Of Pbm-Nir Therapy For Postpartum Mother's Discomfort In Maternity Nursing Care

Normal post partum is post partum discomfort due to uterine involution. Uterine involution in patients can cause pain in the uterus called afterpains. Discomfort caused by uterine involution requires various treatments to minimize the pain felt by the mother so that the mother's comfort can return. This can be overcome with non-pharmacological pain management strategies through innovative near infrared phototherapy or near infrared photobiomodulation (PBM NIR). The aim of this research is to analyze the results of implementing pain management with non-pharmacological PBM NIR therapy in normal post-partum mothers with post-partum discomfort nursing problems. Case study that focuses on the implementation of non-pharmacological nursing pain management techniques with PBM NIR therapy. The case study subjects were 3 normal post-partum maternal patients with the same problem, namely post-partum discomfort in the obstetrics room at the Muhammadiyah Hospital in Palembang. The results of the study showed that the implementation of non-pharmacological pain management techniques with PBM NIR therapy had an effective effect on dealing with post-partum discomfort with complaints of decreased discomfort, decreased moaning, and strong uterine contractions. Implementation of pain management can improve the comfort status of normal postpartum mothers. This study makes an important contribution to understanding of the role of nonpharmacological techniques in postpartum pain management, as well as highlighting the importance of implementing innovative therapies for labor, as well as highlighting the importance of implementing innovative therapies to improve the quality of care in postpartum mothers.

Descriptive study of Feto maternal outcomes of obstructed labour in a tertiary care hospital

Introduction: Labour is considered abnormal when the presenting part of the foetus cannot progress in to the birth canal, despite strong uterine contractions which leads to various maternal or foetal complications. Obstructed labour accounts for about 8% of all maternal deaths in developing countries like India. Obstructed labour is the single most important cause of maternal death and is one of the leading causes of perinatal mortality. Materials and methods: This prospective study of obstructed labour was conducted from September 2021 to May 2022 (9 months) in the Department of obstetrics and Gynaecology of M.G.M Medical College, Jamshedpur. All patients admitted with obstructed labour were included in the study. Detailed history regarding age, socioeconomic status, parity, previous obstetric history, past history, antenatal care, duration of labour, details of referral and management were recorded. During admission, the general condition of mother was assessed as well as fetal lie, presentation, position and heart sounds were recorded. Results: During the 9 months study period, there were total of 5845 deliveries of which 100 cases were diagnosed to have obstructed labour, incidence being 1.71%.

Review: Physiology and nutrition of late gestating and transition sows.

The physiology during late gestation and the transition period to lactation changes dramatically in the sow, especially during the latter period. Understanding the physiological processes and how they change dynamically as the sow approaches farrowing, nest building, giving birth to piglets, and producing colostrum is important because these processes greatly affect sow productivity. Glucose originating from assimilated starch accounts for the majority of dietary energy, and around farrowing, various organs and peripheral tissues compete for plasma glucose, which may become depleted. Indeed, physical activity increases shortly prior to farrowing, leading to glucose use by muscles. Approximately ½ to 1 d later, glucose is also needed for uterine contractions to expel the piglets and for the mammary gland to produce lactose and fat for colostrum. At farrowing, the sow appears to prioritize glucose to the mammary gland above the uterus, whereby insufficient dietary energy may compromise the farrowing process. At this time, energy metabolism in the uterus shifts dramatically from relying mainly on the oxidation of glucogenic energy substrates (primarily glucose) to ketogenic energy supplied from triglycerides. The rapid growth of mammary tissue occurs in the last third of gestation, and it accelerates as the sow approaches farrowing. In the last 1 to 2 wk prepartum, some fat may be produced in the mammary glands and stored to be secreted in either colostrum or transient milk. During the first 6 h after the onset of farrowing, the uptake of glucose and lactate by the mammary glands roughly doubles. Lactate is supplying approximately 15% of the glucogenic carbon taken up by the mammary glands and originates from the strong uterine contractions. Thereafter, the mammary uptake of glucose and lactate declines, which suggests that the amount of colostrum secreted starts to decrease at that time. Optimal nutrition of sows during late gestation and the transition period should focus on mammary development, farrowing performance, and colostrum production. The birth weight of piglets seems to be only slightly responsive to maternal nutrition in gilts; on the other hand, sows will counterbalance insufficient feed or nutrient intake by increasing mobilization of their body reserves. Ensuring sufficient energy to sows around farrowing is crucial and may be achieved via adequate feed supply, at least three daily meals, high dietary fiber content, and extra supplementation of energy.

Association between interleukin-6 levels in amniotic fluid after rupture of membranes during labour at term pregnancy and successful vaginal delivery: a prospective cohort study

We compared the mean interleukin-6 (IL-6) level in the amniotic fluid after rupture of membranes during labour at term pregnancy according to the delivery methods through prospective cohort study. Cases with premature rupture of membranes, multifetal pregnancy, and major congenital anomalies were excluded. Amniotic fluid was obtained from vaginal canal immediately after spontaneous rupture of membranes. A total of 47 cases were analysed, and 72.3% (34/47) had successful vaginal delivery. The mean concentration of IL-6 in the amniotic fluid was significantly higher in the vaginal delivery group than in the caesarean section group (5,229 pg/mL vs. 1,702 pg/mL, p = .022). The concentration of IL-6 from the amniotic fluid tended to increase as the cervical dilatation increased. The association between high IL-6 level (>2,500 pg/mL) and successful vaginal delivery was not significant after adjusting the degree of cervical dilatation in multivariate logistic regression analysis. IMPACT STATEMENT What is already known on this subject ? Multiparity, active and strong uterine contractions, dilated cervical os, and the position of foetal head are known clinical factors affecting the successful vaginal delivery. There are few studies on markers for successful vaginal delivery in patients with labour. What do the results of this study add ? The mean value of IL-6 concentration from the amniotic fluid collected from vagina immediately after rupture of membranes was significantly higher in the patients who had resulted in successful vaginal delivery than those who had failed. What are the implications are of these findings for clinical practice and/or further research ? Measurement of IL-6 concentration in the amniotic fluid from vaginal canal in patients with labour might help to predict the successful vaginal delivery and shorten the time before decision of caesarean section.

The Effects of Delayed Pushing During the Second Stage of Labor on Postpartum Fatigue and Labor Results

Objective: The study was made to examine the effects of delayed pushing during the second stage of labor and pushing on postpartum fatigue and labor results.Method: This is a randomized controlled experimental study. The sampling of the research is comprised of 48 primiparous women (23 in the delayed pushing group and 25 in the control group). The pushing of control group was initiated when strong uterine contraction appeared when the fetal head rotation was completed. Different from the control group, when the fetal head was “+1” inside the pelvis, considering the desire to push, pregnant were asked to delay the pushing until the feeling of powerful and involuntary pushing reflex in the delayed pushing group. As a data collection tool, “Pregnant Identification Form”, “Follow-up Form”, “Partograph” and, “Visual Analogue Scale for Fatigue” was used.Results: The mean duration of the second stage of labor was 38.34 ± 17.84 minutes in the delayed pushing group and 13.52 ± 5.29 minutes in the control group. It was observed that a statistically significant difference was found between the delayed pushing and control group women in terms of the mean duration of the second stage of labor, the mean pushing time, the average fatigue, and energy scores in the first hour after labor (p <0.05).Conclusion: It was found out that delayed pushing prolonged the time of the second stage of labor but reduced the pushing time and significantly affected the fatigue at the first one hour of postpartum.

English

Intact amniotic fluid membranes may serve to protect the extremely fragile preterm infant from some of the mechanical shearing forces caused by strong uterine contraction. A “caul” delivery occurs when part of the amniotic sac is still stuck to the neonate at the time of delivery, usually attached to the cephalic end or podalic end. An “en caul” delivery is a subtype of caul delivery, which occurs when the entire intact amnion (amniotic fluid sac) is delivered with the neonate inside.1,2 This article introduces the technique of “en caul” Caesarean delivery and reviews our experience. Abdominal (or Caesarean) en caul deliveries can be performed intentionally with surgical technique, on contrary to vaginal en caul deliveries, which occur spontaneously; as a result, vaginal en caul deliveries are considered to be rarer though exact statistics are difficult to determine. According to some estimates, caul deliveries would be 1 - 2 %, or roughly 1 in 80,000, of all vaginal deliveries if no membranes were artificially ruptured (ARM / Amniotomy).2,3 Most en caul births are low gravida, premature and low birth weight (LBW). Prematurity is a significant risk factor for various postpartum complications and is hazards. Previous case reports have poorly described pertinent maternal information beyond gestational age at birth (e.g., past medical history, past surgical history, familial history, and demographic data) which could be used to analyse additional risk factors for en caul birth.

Primary complete colporrhexis

Primary spontaneous colporrhexis is rare a condition characterised by rupture of the upper one third of the vaginal wall without extension from uterus or cervix in a parous women with an unscarred uterus. In our case the colporrhexis was also a complete one with rupture of the entire vaginal wall layers.A 31-year old, second gravida was booked in our hospital at 36 wks of gestation. She had no comorbities. She had previous full term normal vaginal delivery of an alive baby weighing 2.75kg.At 39 weeks and 4 days gestation she was admitted for induction of labour as she had borderline liquor. Induction was done with 2 doses of misoprostol 25mcg kept vaginally 4 hrs apart. 2 hours after placing the 2ndmisoprost she had spontaneous rupture of membranes with clear liquor draining PV. With strong uterine contractions. She delivered within 45 minutes a live healthy baby of 3kg weight. Placenta was delivered by AMTSL. Bleeding per vagina was within normal limits. During visualization of cervix and vagina prior to closure of episiotomy, omentum was seen coming out of upper part of posterior fornix of vagina. An irregular transverse rent was found and felt behind the cervix. Cervix was intact Uterus had contracted well. There was no excessive bleeding from vagina. Patients vitals were stable. Vagina was immediately packed and patient was shifted to OT after explaining about the unexpected complication and obtaining informed consent from patient and her relatives. Under anaesthesia, Visualisation of cervix and Examination of uterus was done. They were found to be intact. No extension of episiotomy seen. There was a transverse tear of 5 cm involving the posterior fornix. The left edge of the tear was found to be extending slightly upwards for about 2 cm. Omentum was seen protruding through the rent. The edges were dilineated, omentum was pushed inside. The delineated edges of the rent were sutured with 1-0 vicryl with intermittent sutures in two layers. Complete hemostasis was ensured.

Diagnosis of HIV infection in breastfed infants of mothers on antiretroviral therapy.

We read with interest the article by Strehlau et al. [1] on the diagnosis of two children infected with HIV in a recent issue of AIDS. On the basis of the findings that two breastfed children who showed positive results of nucleic acid amplification tests (NAAT) of HIV within 1 month after birth, became negative NAAT and had no detectable viral load for several months, and finally turned out to be infected with HIV with definite evidence after weaning around 1 year of age, the authors hypothesized that breast milk from the mothers of these two children had HIV-specific or HIV-nonspecific factors that caused the undetectability of HIV in these two children until cessation of breastfeeding. However, we consider that the results should be cautiously interpreted, and that the persistent negativity of repeated HIV tests was possibly true and these two children were likely infected postnatally, because of the two following reasons. First, it has been demonstrated that strong uterine contractions during delivery can cause mother-to-fetus transfusion, leading to transfer of maternal circulation cells and other constituents into fetus [2]. The initial positive results of HIV in the first month of life in these two children [1] were probably caused by the exposure to maternal HIV. In other words, the virus detected in the first month of life was derived from their mothers, but not produced by the babies themselves. The fact that neonatal use of antiretroviral agents, such as zidovudine or nevirapine can prevent mother-to-child transmission indicate that infants have been exposed to, but not yet infected with HIV. Virtually all infants born to HIV-infected mothers are exposed to the maternal virus during birth process, regardless of detectable HIV in newborns; detectability means exposure to a relatively large amount of virions, and undetectability means, a relatively small amount of virions below the detection limits. Second, these two children received breastfeeding, which can increase mother-to-child transmission of HIV [3]. Although HIV was not detectable in the breast milk supernatant of one child's mother, HIV exposure by breastfeeding was highly possible. Breastfeeding requires at least several times per day for a period of several months, during which bloody milk and nipple bleeding are not uncommon. Undetectability of HIV in one milk sample cannot reflect the actual scenarios. Additionally, as the authors mentioned, cell-associated HIV in breast milk is known to be strongly correlated with postnatal transmission [1]. Thus, although the maternal postpartum antiretroviral therapy probably delayed the transmission, the HIV infection in these two children was highly associated with breastfeeding. WHO recommends that breastfed infants should continue antiretroviral prophylaxis for 1 week after complete cessation of breastfeeding [4]. However, these two children did not continue to receive antiretroviral agent while they were breastfed. To differentiate whether these two children had been infected with HIV from early life or around 1 year of age, we consider that determination of anti-HIV titers in the longitudinal serum or plasma samples from the children can provide valuable information. As maternal IgG antibodies can transplacentally transfer to fetus and the maternal antibodies in infants can persist for as long as 18 months, anti-HIV is not tested in children less than 18 months age to define HIV infection. However, based on the half-life of maternal IgG antibodies being 21–24 days, anti-HIV titers in an infant who has not been infected with HIV will progressively decline to an expected level after a known period of time, whereas anti-HIV titers in an infant who has been infected will be relatively constant, or will initially decrease and then increase, or will present an increasing trend, depending upon the time of HIV infection. Thus, observation of dynamic changes of anti-HIV levels in these two children can differentiate the time of HIV infection, if serial serum samples collected at different times are available. Acknowledgements Conflicts of interest There are no conflicts of interest.

Pimpinella anisum extract attenuates spontaneous and agonist-induced uterine contraction in term-pregnant rats

Ethnopharmacology relevancePimpinella anisum is a well-known traditional medicinal herb which has been used in folk medicine as an antiulcer, anticancer, antibacterial and as a muscle relaxant. Aim of the studyThis study was performed to explore the modulatory effects of Pimpinella anisum on term-pregnant rat uterine contractility and to investigate its possible underlying mechanisms. Material and methodsIntact uterine strips without endometrial layer were isolated from female term-pregnant Wistar rats (22 days of gestation) and mounted in a tissue bath apparatus for in vitro isometric force recording. The effects of different concentrations of Pimpinella anisum extract (PAE) (1, 3, 5, and 7 mg/mL) were examined on uterine contractions generated spontaneously or induced with oxytocin (5 nmol/L), Bay K8644 (1 μmol/L), and carbachol (10 μmol/L). In some experiments, PAE was applied on depolarized myometrium in the presence of high-KCl solution (60 mmol/L). The effect on Ca2+ release was also examined. ResultsApplication of PAE significantly reduced uterine contractions generated spontaneously or induced with oxytocin, Bay K8644, and carbachol in a concentration-dependent manner (n = 7; P < 0.01). In depolarized myometrium, PAE significantly reduced the tonic force induced by high-KCl solution (n = 7; P < 0.01). PAE prevented oxytocin-induced transient contraction in the entire absence of external calcium (n = 7; P < 0.01). ConclusionThe present findings demonstrate the potentials of PAE to relax pregnant uterine contractions possibly by blocking Ca2+ entry via L-type calcium channels and inhibiting Ca2+ release from the internal store. The tocolytic effects of PAE may be a potential adjuvant against strong premature uterine contractions which threaten early pregnancy although clinical studies are required.

Báo cáo trường hợp: xoắn tử cung đang mang thai 25 tuần trên sản phụ có hai tử cung tại Bệnh viện Trung ương Huế

Case report: Uterine torsion in pregnant woman of 25 gestational week- age with 2 uterus at Hue Central Hospital Uterine torsion in pregnancy is a rare but very dangerous complication. The diagnosis of uterine torsion is often difficult due to the rare occurrence of this complication and unspecific clinical symptoms. A pregnant woman of 25gestational week came to our hospital with a severe abdominal pain, very strong uterine contraction and dead fetus. Urgent cesarean section surgery is performed with a diagnosis of severe placental abruptionand the malformation of uterus didelphys. During the caesarean section, we found the pregnant uterus on the right siteand the right appendage twisted 180 degrees to the left. The patient was untwisted, undergone the incision in the low part of the uterus to take the dead fetus out, and had a subtotal hysterectomy and rightoophorosalpingectomy after unsuccessful attempt to preserve the uterus. The postoperative condition was stable and the patient was discharged after 5 days. Keywords: Uterine torsion, pregnancy

OXYTOCIN DOSE ANALYSIS OF BREASTMILK PRODUCTION THROUGH INDUCTION LABOR

Breast milk is the only first food that can be consumed by newborns until the age reaches six months. therefore it is very important to know by the mother who is pregnant and will give birth about the importance of breast milk. Oxytocin drugs have similar functions to the natural hormone oxytocin produced by the body. This drug serves to trigger or strengthen the contraction of the uterine muscle. Therefore, oxytocin can be used to stimulate (induce) labor and stop bleeding after childbirth. In addition, this drug can also help stimulate the release of breast milk in breastfeeding mothers. Oxytocin should be avoided by pregnant women who can not give birth normally, for example because it has a narrow pelvis, suffering from placenta previa, or having a too strong uterine contractions. Oxytocin is also prohibited for pregnant women with cephalopelvic disproportion, impaired fetal conditions, uterine damage, or a history of caesarean section. In this study we see whether there is effect of different doses of oxytocin on the quantity of breastmilk produced. oxytocin doses were administered with 3 doses of 5 UI, 10 UI and 15 UI. the dose of oxytocin is administered once per incidence of labor. maternal results obtained by oxytocin induction of 5 UI and 10 UI obtained breastmilk averaging 10 ml in the first 24 hours after delivery. and a mother with oxytocin induction 15 UI received an average breastmilk of 10 ml at 24 hours after delivery.

The strange case of a secondary postpartum hemorrhage caused by Bakri balloon expulsion

A case of postpartum hemorrhage (PPH) faced by obstetric team according to international guidelines is reported. The maternal bleeding was caused by uterine atony and cervical laceration after a vaginal delivery. Uterine atony was managed by uterotonics and Bakri balloon along early skin to skin and breastfeeding. Cervical tear was sutured accordingly. The balloon was pushed out by strong uterine contractions causing mechanical dehiscence of the cervical suture and a new hemorrhage occurred. A new cervical suture was needed to stop the bleeding. Uterine tamponade with balloon is an effective tool to face uterine atony, but special care should be used if a deep cervical laceration is associated. The balloon can be pushed out by uterine contractions causing a new bleeding due to the mechanical dehiscence of the cervical suture.

Late-Term Abortion and Retention of Placenta in Donkey (Equus acinus): A Report of Two Cases

The incidence of equine abortion is higher than that experienced by cattle. Abortion in equine may be infectious or non-infectious. Infectious agents such as bacteria, viruses or fungi may attack the fetus or its membranes, resulting in fetal death and its expulsion. Non-infectious agents such as development of twins, torsion of umbilical cord or congenital anomalies may also result in death of the fetus and abortion (Kocabiyik et al., 2005). Many causes of late-term abortion including infectious agents and placental abnormalities have been reported. Sometimes thorough post-abortion and post-delivery examination of the fetus, placenta and umbilical cord may reveal other causes that are not identified with laboratory procedures. Retention of placenta is probably less common in equine because of simple, diffuse type of placentation and the strong uterine contractions aiding the separation of the villi from their maternal crypts and expelling the detached membranes (Roberts, 2004). Fetal membranes were defined as retained if they were not expelled completely within three hours after delivery in equine and has been regarded as a threat to the uterine health and general health of the equine. The reported sequelae of retained fetal membranes range from none to metritis, laminitis, septicemia and death (Provencher et al., 1988). The present paper reports a successfully managed case of abortion at late-term gestation due to twisting of umbilical cord and retained placenta in a donkey.

Prostaglandin-Endoperoxide Synthase 1 Mediates the Timing of Parturition in Mice Despite Unhindered Uterine Contractility.

Cyclooxygenase (COX)-derived prostaglandins stimulate uterine contractions and prepare the cervix for parturition. Prior reports suggest Cox-1 knockout (KO) mice exhibit delayed parturition due to impaired luteolysis, yet the mechanism for late-onset delivery remains unclear. Here, we examined key factors for normal onset of parturition to determine whether any could account for the delayed parturition phenotype. Pregnant Cox-1KO mice did not display altered timing of embryo implantation or postimplantation growth. Although messenger RNAs of contraction-associated proteins (CAPs) were differentially expressed between Cox-1KO and wild-type (WT) myometrium, there were no differences in CAP agonist-induced intracellular calcium release, spontaneous or oxytocin (OT)-induced ex vivo uterine contractility, or in vivo uterine contractile pressure. Delayed parturition in Cox-1KO mice persisted despite exogenous OT treatment. Progesterone (P4) withdrawal, by ovariectomy or administration of the P4-antagonist RU486, diminished the delayed parturition phenotype of Cox-1KO mice. Because antepartum P4 levels do not decline in Cox-1KO females, P4-treated WT mice were examined for the effect of this hormone on in vivo uterine contractility and ex vivo cervical dilation. P4-treated WT mice had delayed parturition but normal uterine contractility. Cervical distensibility was decreased in Cox-1KO mice on the day of expected delivery and reduced in WT mice with long-term P4 treatment. Collectively, these findings show that delayed parturition in Cox-1KO mice is the result of impaired luteolysis and cervical dilation, despite the presence of strong uterine contractions.

Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience.

The concept of using a frameless intrauterine device (IUD) instead of the conventional plastic framed IUD is not new. Frameless copper IUDs have been available since the late 1990s. They rely on an anchoring system to retain in the uterine cavity. The clinical experience with these IUDs suggests that frameless IUDs fit better as they are thin and, therefore, do not disturb or irritate the uterus. High tolerance and continuation rates have been achieved as complaints of pain are virtually nonexistent and the impact on menstrual blood loss is minimal. Conventional levonorgestrel-releasing intrauterine systems (LNG-IUSs) are very popular as they significantly reduce menstrual bleeding and provide highly effective contraception. However, continuation of use remains problematic, particularly in young users. Total or partial expulsion and displacement of the LNG-IUS also occur too often due to spatial incompatibility within a small uterine cavity, as strong uterine contractions originate, attempting to get rid of the bothersome IUD/IUS. If not expelled, embedment ensues, often leading to chronic pain and early removal of the IUD/IUS. Several studies conducted recently have requested attention to the relationship between the LNG-IUS and the endometrial cavity. Some authors have proposed to measure the cavity width prior to inserting an IUD, as many uterine cavities are much smaller than the currently existing LNG-IUSs. A frameless fibrous drug delivery system fits, in principle, in all uterine cavities and may therefore be preferable to framed drug delivery systems. This review examines the clinical performance, acceptability, and potential of the frameless LNG-IUS (FibroPlant®) when used for contraception, treatment of heavy menstrual bleeding, dysmenorrhea, and endometrial suppression in women using estrogen replacement therapy, endometrial hyperplasia, and other gynecological conditions. The review concludes that FibroPlant LNG-IUS offers unique advantages in reducing side effects.

Uterine Rupture Due to Arrest of After Coming Head: An Autopsy Case Report

Maternal death is an important health as well as social problem. The Government of India has launched schemes to reduce the maternal mortality by increasing awareness in people and many other measures. Obstructed labour is one of the major causes for maternal mortality in our country. It is a condition when presenting part of foetus cannot progress into birth canal in spite of strong uterine contractions. The most common cause of obstructed labour is cephalo-pelvic disproportion.

From ethnopharmacology to drug design

Nature’s diversity is one of the biggest resources of therapeutic lead compounds. Traditionally-used herbal remedies harbor a variety of bioactive compounds providing researchers with starting points for drug development. Ethnopharmacological investigations of uterotonic plant preparations identified a class of circular and disulfide-rich peptides, called cyclotides, to exhibit strong uterine contractions. In humans one of the physiological regulators of the myometrial contractility is the nonapeptide oxytocin acting on its cognate G protein-coupled receptors. They are considered to represent one of the most promising drug targets with ~30% of all currently marketed drugs acting on these transmembrane receptors. Based on observed similarities regarding the activity and structure of plant cyclotides with human oxytocin we analyzed the pharmacological principle of their action and identified the oxytocin and vasopressin 1a receptors as molecular targets of cyclotides from the Rubiaceae plant Oldenlandia affinis. Using a synthetic approach, the sequence of the native cyclotide kalata B7 was used to design oxytocin-like nonapeptides with nanomolar affinity and selectivity for the oxytocin receptor. This provides formal proof for the use of cyclotides as templates in peptide ligand design. At a more general level, mining of naturally-occurring peptides is a promising tool for the identification and the design of novel G protein-coupled receptor ligands.

Extremely Preterm Cesarean Delivery “En Caul”

Intact amniotic membranes may serve to protect the extremely fragile preterm infant from some of the mechanical forces caused by strong uterine contraction. This article introduces the technique of "en caul" cesarean delivery and reviews the experience of the National Taiwan University Hospital. This is a prospective study carried out to perform the "en caul" cesarean delivery for early preterm labors between October 2007 and December 2008. Cases were included if the estimated birth weight was below 1,500 g or gestational age was = 32 weeks. Twenty women including four twin pregnancies were included, and 23 neonates were born with intact membranes. Preterm labor was indicated in 16 cases, and nine of the cases were due to severe hypertensive disorders during pregnancy. Except in the case of placenta accreta, all underwent lower transverse uterine incision without wound extension. One fetus died after 3 days due to sepsis and the mortality rate was 4.3%. A total of 15 babies had an Apgar score at 5 minutes of more than seven. The value of first arterial pH was 7.278 ± 0.117 and hemoglobin was 16.1 ± 2.1 g/dL. The corrected post-menstrual age at discharge was 277.75 ± 38.56 days. Cesarean delivery en caul is an effective and easy technique for extremely preterm fetuses to protect them from pressure trauma and also results in less uterine injury.

Epidural anaesthesia for pain relief in labour

Epidural anaesthesia for pain relief in labour

Kritische Evaluierung der fetalen Pulsoxymetrie im klinischen Einsatz

Die fetale Pulsoxymetrie als adjuvantes, kontinuierliches fetales Überwachungsverfahren, das die fetale SpO2 (FSpO2) sub partu bei auffälligem CTG misst, befindet sich derzeit noch in der klinischen Erprobung: