Frequency Of Uterine Contractions Research Articles

Optimal starting dosing regimen of intravenous oxytocin for labor induction based on the population kinetic-pharmacodynamic model of uterine contraction frequency.

Intravenous oxytocin is commonly used for labor induction. However, a consensus on the initial dosing regimen is lac with conflicting research findings and varying guidelines. This study aimed to develop a population kinetic-pharmacodynamic (K-PD) model for oxytocin-induced uterine contractions considering real-world data and relevant influencing factors to establish an optimal starting dosing regimen for intravenous oxytocin. This retrospective study included pregnant women who underwent labor induction with intravenous oxytocin at Peking University Third Hospital in 2020. A population K-PD model was developed to depict the time course of uterine contraction frequency (UCF), and covariate screening identified significant factors affecting the pharmacokinetics and pharmacodynamics of oxytocin. Model-based simulations were used to optimize the current starting regimen based on specific guidelines. Data from 77 pregnant women with 1095 UCF observations were described well by the K-PD model. Parity, cervical dilation, and membrane integrity are significant factors influencing the effectiveness of oxytocin. Based on the model-based simulations, the current regimens showed prolonged onset times and high infusion rates. This study proposed a revised approach, beginning with a rapid infusion followed by a reduced infusion rate, enabling most women to achieve the target UCF within approximately 30 min with the lowest possible infusion rate. The K-PD model of oxytocin effectively described the changes in UCF during labor induction. Furthermore, it revealed that parity, cervical dilation, and membrane integrity are key factors that influence the effectiveness of oxytocin. The optimal starting dosing regimens obtained through model simulations provide valuable clinical references for oxytocin treatment.

MANFAAT PEMBERIAN JUS NANAS DAN MADU TERHADAP PENURUNAN NYERI DESMINORE PADA REMAJA PUTRI DI SMP YP SINGOSARI DELITUA

Dysmenorrhea is abdominal pain caused by uterine contractions and occurs during menstruation. Dysmenorrhea occurs due to increased secretion of prostaglandin F2a during the luteal phase of the menstrual cycle. Increased secretion of prostaglandin F2 alpha increases the frequency of uterine contractions and as a result can cause abdominal pain in women. The effects of primary dysmenorrhea include disruption of activities, such as absence from school or work, and limitations in social life, school performance, and athletic activities. Non-pharmacological pain management includes warm compresses, drinking lots of fluids, taking regular exercise breaks, consuming nutritious food, pain relief activities such as yoga, and using herbal medicine supplements which are effective in reducing menstrual cramps. Community service was carried out at YP Singosari Delitua Middle School with a total of 20 respondents. According to the results of most students who took part in consultations at YP Singosari Deli Tua Junior High School regarding the effect of pineapple juice and honey in reducing menstrual pain in young women, the level of knowledge is still low due to lack of socialization by providing education regarding the effectiveness of pineapple juice and honey in reducing menstrual cramps. , it is hoped that students can handle this dysmenorrhoea

Recognition of Chorioamnionitis on the Cardiotocograph (CTG): The role of the “Chorio Duck Score”

Chorioamnionitis refers to the inflammation of the chorion and amnion by the bacteria and their toxins as well as by the inflammatory cytokines. Therefore, it is a fetal disease with the bacteria, their toxins as well as the fetal immunological responses involving inflammatory cytokines (interleukins, interferons, and tumour necrosis factor-alpha) exerting their detrimental effects within the fetal compartment (i.e., amniotic fluid, fetal membranes, the placenta, and fetal tissues and organs). The vast majority of fetal inflammation occurs as a result of an ascending infection (i.e., entry of the bacteria from the maternal genital tract through the cervix). Therefore, maternal signs (tachycardia and pyrexia) may not be observed until the late stages of the disease. Cardiotocograph (CTG) trace was introduced into clinical practice in the 1960s as a tool to timely recognise ongoing fetal hypoxic stress so that immediate action could be taken to avoid hypoxic ischaemic encephalopathy (HIE) and/ or intrapartum hypoxia-related perinatal deaths. Unfortunately, the CTG was introduced into clinical practice without any prior randomised controlled trials, which resulted in panicking and reacting to the observed morphology of fetal heart rate decelerations, which reflect an ongoing fetal compensatory response to reduce the myocardial workload. A sudden and reflex reduction of the heart rate in response to ongoing intermittent hypoxic stress (i.e., repetitive compression of the umbilical cord or interruptions in uteroplacental oxygenation due to uterine contractions) would ensure a reduction in myocardial oxygen demand and maintenance of aerobic metabolism to avoid the onset of anaerobic metabolism and production of lactic acid within the myocardium. Lack of understanding of fetal compensatory responses resulted in the illogical approach of grouping arbitrary features into different categories and then randomly combining them to classify the CTG traces into “Normal, Suspicious, and Pathological”. The same parameters were used in fetuses with chorioamnionitis with an alternative, inflammatory pathway of neurological injury. The international consensus guidelines of physiological interpretation of CTG produced by 44 CTG experts from 14 countries in 2018 ensured a paradigm shift and recommended classification of CTG traces based on the type of fetal hypoxia and fetal response to stress, by applying the knowledge of fetal physiology whilst interpreting CTG traces. During the last 5 years, research has highlighted CTG features in fetal neuro-inflammation, which include an absence of fetal heart rate cycling, the ZigZag Pattern, and sinusoidal patterns. The proposed “Chorio Duck Score” is a scoring system based on recently published scientific evidence on CTG features in subclinical and clinical chorioamnionitis to enable timely diagnosis of fetal systemic inflammatory response syndrome (FIRS). This will help avoid the continuation of super-imposed hypoxic stress (i.e., progressive increasing frequency, duration, and strength of uterine contractions) on the background fetal inflammation, to prevent fetal neurological injury.

Indicators of uterine contractile activity in highly productive sows using supraphysiological doses of oxytocin

The use of large doses of oxytocin to sows in the early postpartum period is indicated to normalize lactogenesis, increase immune proteins in colostrum and transitional milk, prevent postpartum complications, and increase the viability of the offspring. However, the effect of these doses of myotropic drug on the contractile activity of the uterus is not shown. The aim of the work was to study the contractile function of the uterus of highly productive sows in the early postpartum period and the peculiarities of its reaction to supraphysiological doses of oxytocin. Scientific and production experience was carried out on the basis of a large pig breeding complex. The object of the study was highly productive sows 16 hours after the completion of normal labor. The hormonal drug oxytocin was administered intra-muscularly to animals at a supraphysiological dose of 75 units. Hysterograms of uterine contractions were recorded by internal hysterography before and immediately after administration of the myotropic drug, as well as one hour after injection. On hysterograms, spontaneous contractile activity of the uterus in highly productive sows was characterized by regular, short-term contractions of the optimal amplitude. Activation of the contractile function of the myometrium occurs 5-7 minutes after injection of the drug. After administration of oxytocin, an increase in the amplitude of contraction of uterine smooth muscle cells was noted by 39.17% (p<0.05), while a longer period of contractions was recorded by 31.64%. The frequency of uterine contractions increased 2.0 times (p<0.01). The contract index was significantly 3.66 times (p<0.05) higher than that in relation to the initial level. After 1 hour after oxytocin administration, an increase in the contraction period by 5.42% was noted, with a decrease in amplitude by 37.87% (p<0.01) and the number of contractions by 49.91% (p<0.01), the contractional index decreased by 3.05 times (p<0.01) relative to the previous level. In relation to the initial level, the contract index was 20.0% higher. At the same time, an increase in the duration of contractions by 38.78% and a decrease in their amplitude by 13.53% were noted. Consequently, oxytocin at a dose of 75 ME not violate the contractile ability of the myometrium. The response of the smooth muscle cells of the uterus to the supraphysiological dose of oxytocin is maximally manifested in the first hour after the administration of the myotropic drug.

Oxytocin: physiology, pharmacology, and clinical application for labor management

Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.

P-514 Uterine Contractility during Follicle Aspiration and Embryo Transfer and IVF/ICSI Outcomes: the WAVES study

Abstract Study question What is the influence of uterine contractility of in-vitro fertilisation (IVF) patients at follicle aspiration (FA) and embryo transfer (ET) on clinical pregnancy outcomes? Summary answer At time of embryo transfer, a lower contraction frequency, and increased contraction coordination is associated with more favourable chances of ongoing pregnancy after IVF/ICSI treatment. What is known already Uterine peristalsis is the rhythmic, wave-like motion of the subendometrial layer of the uterus. Various subjective methods using visual interpretation suggest that uterine peristalsis features are different in the various stages of the menstrual cycle, and they are thought to be important for fertility and early embryo implantation. Recently, a new automated quantitative method to measure uterine contractility was validated in a small number of IVF patients to analyse uterine peristalsis on transvaginal ultrasound (TVUS) recordings with speckle-tracking. With this method a new contraction feature – coordination – can be assessed alongside frequency, direction, amplitude. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating uterine contractility on TVUS. Our study included patients undergoing IVF/ICSI treatment with good quality TVUS recordings from 2017 to 2023. Patients received fresh ET on Day 3 or Day 5. Participants/materials, setting, methods 128 IVF/ICSI patients undergoing fresh ET were included from participating centres. Patients underwent TVUS within 1 hour prior to FA(n = 61/128), and/or within one hour before ET (n = 67/128). Uterine contraction frequency (CF), amplitude, velocity and coordination were measured by applying dedicated speckle tracking and strain analysis. The primary outcome was ongoing pregnancy (OP, viable pregnancy >10 weeks gestational age). The independent T-test and Mann-Whitney U test were applied to compare features between groups. Main results and the role of chance 39.1% of the IVF/ICSI patients (50/128) achieved ongoing pregnancy. Most patients underwent IVF/ICSI treatment due to a male factor (29.0%) or idiopathic subfertility (31.9%). Age, BMI and embryo quality were comparable for the pregnant vs. non-pregnant groups (p > 0.05 for all). CF was significantly higher during FA vs. ET (1.70±0.26 vs. 1.54±0.23,[RC(1] p < 0.001), as well as contraction velocity (0.79±0.22 vs 0.63±0.16, p < 0.001). Contraction amplitude was also lower during ET vs. FA (0.06 IQR 0.03 vs. 0.08 IQR 0.04, p < 0.001[RC(2] ). During FA, no significant differences were seen in contraction features for pregnant vs. non-pregnant groups (all p > 0.05). At ET, a lower mean CF was significantly associated with OP(1.46 ±0.18 vs. 1.57±0.19 [RC(3] contraction/min, p = 0.016), as well as presence of more coordinated uterine contractions (0.22 ±0.09 vs. 0.33±0.14, p < 0.001[RC(4] ). No significant differences were found for the features of amplitude and velocity. Limitations, reasons for caution Further validation of these results is ongoing, including expansion of the sample size. No sub-analysis has yet been done to assess the effect of additional IVF/ICSI treatment characteristics (i.e. stimulation protocol, type of subfertility) on uterine contractility and chance of pregnancy. Wider implications of the findings Uterine contractility changes its character depending on the timing of IVF treatment, with different characteristics seen at FA vs. ET. The most favourable contraction profile for ongoing pregnancy after ET seems to be uterine contractions with relatively low frequency and good coordination. These findings may support decision-making at ET. Trial registration number not applicable

O-267 Uterine contractility in women with adenomyosis differs significantly from healthy control women - the waves study

Abstract Study question Description of uterine contractility characteristics in adenomyosis patients compared to healthy controls and according to degree of dysmenorrhoea measured by quantitative 2D transvaginal ultrasound (TVUS). Summary answer Women with adenomyosis show differences in uterine contraction patterns (frequency, amplitude, velocity, and contraction coordination) compared to healthy controls and depending on degree of dysmenorrhoea. What is known already The natural contraction pattern of the uterus changes throughout the menstrual cycle in response to cyclic changes in hormones. In abnormal uteri, such as adenomyotic uteri, this response may be different. Adenomyosis can cause dysmenorrhoea, menorrhagia, dyspareunia, and subfertility. These symptoms could be explained by different contraction patterns of the uterus, however, this has not yet been objectively quantified due to the absence of a suitable measurement tool. Recently, speckle-tracking and strain analysis of 2D TVUS was used to assess differences in contraction coordination, frequency, velocity, and direction, depending on the phase of the menstrual cycle in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating uterine contractility in TVUS recordings. Our study includes the TVUS recordings of 31 women with adenomyosis and 106 women with healthy uteri. Patients were included in 3 centres from 2017 to 2023 (Netherlands, Greece, Italy). Participants/materials, setting, methods 31 women with sonographic suspicion of adenomyosis and 106 women with healthy uteri with natural menstrual cycles were included. Uterine contraction frequency, amplitude, velocity, and coordination were assessed by applying a dedicated speckle tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. Degree of dysmenorrhoea was measured according to visual analogue score (VAS). Women with suspicion of adenomyosis were compared to women with healthy uteri according to the phase of their menstrual cycle. Main results and the role of chance Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p < 0.05). Uterine contractility differed between women with adenomyosis and healthy controls during the periovulatory phase, revealing lower frequency (1.50±0.25 vs. 1.75±0.35, p = 0.031), higher amplitude (0.076±0.039 vs. 0.046±0.018, p = 0.001), and lower velocity (0.64±0.18 vs. 0.84±0.22, p = 0.020) of uterine contractions in the group with adenomyosis patients. In the late luteal phase, women with adenomyosis showed higher amplitude (0.050±0.02 vs. 0.035±0.01, p = 0.039) and lower velocity (0.51±0.11 vs. 0.72±0.16, p = 0.032) than the healthy controls. During menstruation, women with adenomyosis showed a trend towards higher contraction amplitude (0.044± 0.01 vs. 0.037±0.01, p = 0.051) compared to healthy controls. During the menstrual, periovulatory and late luteal phase, women with adenomyosis showed reduced contraction coordination (p = 0.047, p = 0.015 and p = 0.011, respectively) compared to healthy controls. Increased dysmenorrhoea (VAS score) in overall adenomyosis patients was associated with lower contraction velocity (p = 0.043) and a tendency towards lower frequency (p = 0.160) and higher amplitude (p = 0.154). Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis characteristics (i.e. adenomyosis severity, adenomyosis type, adenomyosis location). Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound images. Women with adenomyosis were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings Uterine contractility differs between patients with adenomyosis versus healthy women throughout the menstrual cycle. More dysmenorrhoea in adenomyosis patients was also associated with a different contractility pattern. This suggests an aetiological mechanism for the clinical presentation of adenomyosis (i.e. dysmenorrhoea and subfertility) and presents potential therapeutic markers. Trial registration number NL52466.100.15

Abstract #1402502: Hypercalcemia of Malignancy in Pregnancy, a Management Dilemma

Hypercalcemia of Malignancy (HCM) is a complication that is typically managed with bisphosphonates (BP). However, BP are not studied in pregnant patients with HCM and avoided due to potential adverse outcomes on mother and fetus thus limiting available options to manage hypercalcemia in pregnancy. We describe a case of HCM in a pregnant patient managed with Zoledronic acid. 36-year-old female, 32 weeks pregnant diagnosed during pregnancy with stage IV Breast cancer with liver and bone metastases, was admitted with hypercalcemia with no previous history. She did not have renal stones, polyuria, constipation, bone pain, fractures or taking calcium supplements. Lab data showed high calcium 12.9mg/dl, low PTH 5pg/ml, 25-OH vitamin D 15.5ng/ml, 1,25 OH vitamin D 70.28pg/ml, high PTHrP 6.1pmol/L. She received IV fluids and calcitonin with minimal benefit. After weighing risks and benefit and discussion with other teams, she was given IV Zoledronic acid. With chemotherapy and hypercalcemia, she developed severe emesis and decreased oral intake resulting in dehydration, low magnesium and phosphorus. She developed arrhythmia, frequent uterine contractions and fetal tachycardia and was treated for preterm labor with steroids, penicillin prophylaxis, aggressive hydration, and electrolyte replacement. Preterm delivery was safely avoided. After 4 days of BP dose, calcium normalized to 8.2 mg/dL and she was stable to be discharged home. She later received second cycle of chemotherapy and had uncomplicated vaginal delivery at 38 weeks with no neonatal complications. There are few studies on use of BP in pregnancy showing no increased risk of serious adverse effects. A systematic review of 51 cases with exposure to BP before or during pregnancy did not result in skeletal abnormalities or congenital malformations in the infants. In another case control study of 36 women with BP exposure, no major teratogenic effects were found but rates of neonatal complications were increased in women with systemic diseases, as were spontaneous abortions for women with bone disease. One case of 24 weeks pregnant female with metastatic breast cancer, pamidronate improved HCM and uterine contractions with no adverse effects on neonate. In our patient, treating hypercalcemia was necessary to avoid severe complications. We treated her with zoledronic acid as it is more effective then pamidronate at normalizing calcium and has similar safety profile. We optimized hydration status and monitored electrolytes to mitigate risk of side effects expected from BP use with good maternal and fetal results. More studies are required to determine safe use of BP in pregnant patients to guide management and avoid complications of HCM in mother and fetus.

The Effect of Uterine Contractions on Fertility Outcomes in Frozen Embryo Transfer Cycles: A Cohort Study.

The relationship between uterine peristalsis before embryo transfer and the success of assisted reproductive techniques (ARTs) has not been properly investigated. In this study, the effect of uterine contractions on embryo implantation in frozen embryo transfer (FET) cycles was investigated to determine whether the frequency of uterine contractions can be used as a quantitative marker to assess endometrial receptivity. In this cohort study of 68 eligible FET candidates, one hour before embryo transfer (ET), frequency of uterine contractions was assessed with transvaginal ultrasonography. Patients were followed up for 20 weeks. The association between FET outcomes including clinical pregnancy, abortion, and ectopic pregnancy with uterine contractions was evaluated. Binary logistic regression was conducted to test the association between clinical pregnancy outcomes in different groups. The p<0.05 were considered statistically significant. Of 68 patients, 25 (36.8%) experienced clinical pregnancy. Multiple logistic regression for omitted confounders (age, BMI, duration, type and cause of infertility) revealed that patients with uterine peristaltic wave frequency less than 2≤ wave/min had higher chance of successful pregnancy compared to those with ≥4 wave/min (odds ratio: 10.8; 95% confidence interval: 1.5-79.4, p=0.019). The Pearson's correlation showed a statistically significant relationship between the frequency of uterine contraction and endometrial thickness (r= 0.42, p=0.002). Patients with uterine peristalsis of <4.0 wave/min before embryo transfer had a higher chance of successful implantation and pregnancy compared with those with higher contraction frequencies. It seems that measuring uterine contraction frequency before embryo transfer might help to predict pregnancy outcomes.

“Effectiveness of Ambulation During First Stage of Labor on Maternal Parameters Among Primi Mothers in A Selected Hospital at Mangaluru”

Introduction: The birthing women experiences, many demanding sensation and discomfort during labour and child birth. The childbearing women commonly tensed about childbirth and delivery. Ambulation during first stage of labour eases the process and it became a popular measure during this phase. Ambulation has also been found to increase foeto-maternal circulation which in turn increases the well-being of the new-born as well. Through the literature review, movement in labour to facilitates the progress of labour and enhance child birth satisfaction. This consciousness made the researcher to supply or issue the method of ambulation during the first stage of labour. With this aim, the study was conducted to assess the effectiveness of ambulation on maternal parameters in first stage of labor among the primi mother.&#x0D; Materials and Methods: A quasi experimental posttest only control group design was adopted to evaluate the efficacy of ambulation during first stage of labor on maternal parameters among primi mothers. Non probability purposive sampling technique was used to recruit 40 primi mothers who are in first stage of labor and were assigned into experimental group and control group. A structured questionnaire was used to collect the demographic variable; Numerical pain rating scale was used to assess the intensity of pain, Tool to assess the frequency and duration of uterine contraction, Stethoscope to assess the foetal heart rate and opinionnaire on ambulation was used to assess the maternal parameters. Tool was administered for 20 minutes at different time interval for experimental group only. Mothers in the control group underwent routine treatment. The data obtained was analyzed and interpreted using descriptive and inferential statistics.&#x0D; Results: The study findings showed that there is significant difference in the pain level in both groups. The mean and standard deviation in 2nd post intervention in experimental group is 3.35+0.48 and in control group 2.95+ 0.22. There was significant difference and comparison of cervical dilatation among both the groups. The mean and standard deviation in 2nd post intervention in experimental group is 2.20 +0.41 and in control group 2.10 + 0.30. The comparison of frequency of contraction among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 2.20 + 0.41 and in control group 2.10 + 0.00. The comparison of duration of contraction among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 2.05 + 0.68 and in control group 2.00 + 0.00 was statistically significant. The comparison of FHR among both the groups is significant. In this mean and standard deviation in 2nd post intervention in experimental group is 3.80 + 0.41 and in control group 3.75 + 0.63. There is no significant difference in control group. There was no significant association between the selected demographic variables with maternal parameters such as pain, cervical dilatation, frequency of contraction, duration of contraction in experimental and control group. There is a significant association between age and fetal heart rate in experimental group.&#x0D; Conclusion: The study concluded that the ambulation technique is effective to reduce the duration of labor in first stage among primi mothers. The mothers in the experimental group who were administered ambulation technique experienced reduction in the duration of labor.

Quantitative Ultrasound Measurement of Endometrial Waves in Adenomyosis Versus Women with Normal Uteri - the Waves Study

<h3>Study Objective</h3> Measurement and analysis of uterine contractions by quantitative 2D transvaginal ultrasound measurements in women with abnormal uteri due to adenomyosis versus women with normal uteri. <h3>Design</h3> Multi-centre prospective observational cohort study. <h3>Setting</h3> Outpatient gynaecology department of participating centres. <h3>Patients or Participants</h3> 29 women with adenomyosis with a natural menstrual cycle were compared to 70 women with normal uteri and regular menstrual cycles. Patients were included from September 2014 up to January 2022. <h3>Interventions</h3> Patients underwent a 4-minute 2D transvaginal ultrasound of the uterus in mid-sagittal section. Uterine motion analysis was implemented by a dedicated speckle tracking and strain analysis algorithm; with frequency, amplitude, coordination and velocity -related features extracted from the derived signals to characterise the uterine contractions. Measurements were carried out at different points of the menstrual cycle (menstrual, early follicular, periovulatory and early and late luteal phases. <h3>Measurements and Main Results</h3> Results differed most significantly between groups in the periovulatory phase, with women with adenomyosis showing lower frequency (1.44 vs. 1.79 contractions/minute, p=0.025), higher amplitude (0.09 vs. 0.04, p=0.000) and lower velocity of uterine contractions (0.62 vs. 0.83 mm/sec, p=0.0008). In the menstrual phase, women with adenomyosis showed a trend toward higher contraction frequency (1.37 vs, 1.33 contractions/minute, p=0.592), amplitude (0.05 vs. 0.04, p=0.259) and velocity (0.72 vs. 0.67, p=0.456). Across all phases, women with adenomyosis showed a trend towards reduced contraction coordination (0.23-0.34 vs. 0.15-0.26). This being statistically significant in the late luteal phase (p=0.018). <h3>Conclusion</h3> Our results confirm differences in uterine movement in abnormal versus healthy uteri. This could add to the aetiological understanding of clinical symptoms of these conditions (i.e. dysmenorrhoea or infertility). The notable difference between groups regarding coordination identifies this feature as a potential prognostic or therapeutic marker. Further research in women with (other) benign uterine disorders will hopefully lead to a better understanding of the clinical implications of abnormal uterine contractility.

PENGARUH TEKNIK PIJAT AKUPRESUR TERHADAP PENURUNAN INTENSITAS NYERI PADA KALA I FASE AKTIF PERSALINAN DI PUSKESMAS KORBAFO TAHUN 2022

Labor pain is a physiological thing experienced by every mother giving birth. Pain arises from uterine contractions, cervical dilatation and stretching of the birth canal. As the frequency of uterine contractions increases, the pain becomes more intense. If pain is not overcome, it can affect the psychology of the mother in childbirth, namely fear and anxiety. Fear and anxiety have a negative effect on childbirth which can affect the health condition of the mother and fetus. Research on the effect of acupressure massage techniques on reducing pain intensity in the first stage of the active phase of labor was conducted at the Korbafo Puskesmas. This research uses quantitative analytic research with a Quasi Experimental design with a one group pre-test and post-test with control research design. Data collection uses an observation sheet. Acupressure massage is done by pressing on the SP 6 (bilateral) point for 30 times the pressure and BL 32 (bilateral) for 30 times the pressure. The number of samples in this study were 10 mothers who gave birth. The sampling technique used was purposive sampling. The data analysis used is the Wilcoxon test. The results of this study indicate that the majority of respondents before acupressure experienced severe pain, as many as 9 people (90%). The majority of respondents after acupressure experienced mild pain as many as 6 people (60%), ie with a p value = 0.004 (p = &lt;0.05) which means that there is an influence of acupressure massage techniques on reducing labor pain. It is recommended that midwives can apply this as a non-pharmacological alternative that has minimal side effects in reducing labor pain.

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.