Uterine Contractions Research Articles

Cervical clamping: An innovative adjunct for management of postpartum haemorrhage

Postpartum haemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Traditional methods for acute management, such as uterotonics, uterine massage, and surgical interventions, may prove insufficient, prompting the search for alternative techniques. This article reviews the innovative use of cervical clamping as an adjunct to the critical first line care of patients with PPH, evaluating its efficacy, safety, and potential future implications1. The review highlights how mechanical pressure to the cervix may facilitate innate physiological reflexes to improve uterine contraction, promising a noninvasive alternative to control severe obstetric bleeding. The findings suggest that cervical clamping could be particularly beneficial in resource-limited settings where pharmacological and advanced surgical options are not readily available2.

A multimodal deep learning-based algorithm for specific fetal heart rate events detection.

This study aims to develop a multimodal deep learning-based algorithm for detecting specific fetal heart rate (FHR) events, to enhance automatic monitoring and intelligent assessment of fetal well-being. We analyzed FHR and uterine contraction signals by combining various feature extraction techniques, including morphological features, heart rate variability features, and nonlinear domain features, with deep learning algorithms. This approach enabled us to classify four specific FHR events (bradycardia, tachycardia, acceleration, and deceleration) as well as four distinct deceleration patterns (early, late, variable, and prolonged deceleration). We proposed a multi-model deep neural network and a pre-fusion deep learning model to accurately classify the multimodal parameters derived from Cardiotocography signals. These accuracy metrics were calculated based on expert-labeled data. The algorithm achieved a classification accuracy of 96.2 % for acceleration, 94.4 % for deceleration, 90.9 % for tachycardia, and 85.8 % for bradycardia. Additionally, it achieved 67.0 % accuracy in classifying the four distinct deceleration patterns, with 80.9 % accuracy for late deceleration and 98.9 % for prolonged deceleration. The proposed multimodal deep learning algorithm serves as a reliable decision support tool for clinicians, significantly improving the detection and assessment of specific FHR events, which are crucial for fetal health monitoring.

Successful Delayed Interval Delivery in Twin Pregnancy After Early Premature Rupture of Membranes of a Leading Fetus: A Case Report

A 36-year-old primigravida conceived dichorionic diamniotic twins via in vitro fertilization. The first twin experienced premature rupture of membranes at 18 weeks and 5 days of gestation. Despite antibiotic treatment, the first fetus suffered intrauterine fetal death and was delivered three days later at 19 weeks and 1 day. Using ritodrine, the remaining umbilical cord was repositioned, and an emergency cerclage was performed. Ritodrine was continuously administered post-surgery but discontinued at 24 weeks and 3 days due to improved uterine contractions. The patient later delivered a healthy baby via cesarean section at 38 weeks due to decreased fetal movement and breech presentation. This rare case of premature rupture of membranes in one of the twins before the viability term, followed by a successful delayed delivery, is presented here.

Enriched marine oil supplements in pregnancy for the modulation of maternal inflammatory- associated causes of preterm delivery

Preterm birth is a major cause of perinatal complications and neonatal deaths. Furthermore, in the field of obstetrics many clinical entities like uterine contractions or the occurrence of pre- eclampsia remain to be serious complications during pregnancy and represent a major psychological, financial, and economic burden for society. Several published guidelines, studies and recommendations have highlighted the importance of supplementation of omega-3 long chain polyunsaturated fatty acids (PUFAs) during pregnancy. This narrative review aims at giving an overview on the modern perception of inflammatory processes and the role of specialized pro-resolving mediators (SPMs) in their resolution, especially in obstetrics. Additionally, we highlight the possible role of SPMs in the prevention of obstetric complications through oral supplementation using enriched marine oil nutritional’s. The intake of PUFAs may result in an overall improvement of pregnancy outcomes by contributing to fetal brain growth and neurological development but more importantly though modulation of inflammation-associated pathologies. Especially the use of SPMs represents a promising approach for the management of obstetric and perinatal complications. SPMs are monohydroxylates derived from enriched marine oil nutritional’s that involve certain pro-resolutive metabolites of omega-3 long chains PUFAs and may contribute to an attenuation of inflammatory diseases. This may be obtained through various mechanisms necessary for a proper resolution of inflammation such as the termination of neutrophil tissue infiltration, initiation of phagocytosis, downregulation of pro-inflammatory cytokines or tissue regeneration. In this way, acute and chronic inflammatory diseases associated with serious obstetrical complications can be modulated, which might contribute to an improved pregnancy outcome.

Adolescent Reproductive Health: The Role Of Sex Education In Raising Awareness

The first stage of labor often takes a long time and causes discomfort for the mother, so methods are needed to accelerate it. This study aims to evaluate the effectiveness of microcontroller-based nipple stimulation in accelerating the labor process by stimulating the release of the hormone oxytocin which increases uterine contractions and accelerates cervical opening. Microcontroller technology is used to ensure the stimulation is done automatically and measured according to the mother's physiological needs. This study involved two groups, namely the group that received stimulation and the control group that did not receive stimulation. The results showed that the stimulated group experienced shorter labor times than the control group and were less likely to require medical interventions such as induction with drugs. Close monitoring is still required to ensure safety, especially regarding the risk of uterine hyperstimulation that may affect the condition of the mother and fetus. Further research is needed to test the long-term effectiveness and safety of this method before it is widely applied in obstetric practice. Based on the total library, 600 were identified and as many as 100 additional articles were identified. A total of 630 studies failed to meet the inclusion criteria and 70 articles were read in their entirety, so that as many as 11 publications were used as references. Microcontroller-based nipple stimulation offers an innovative solution that can improve the efficiency of labor while providing a better quality of health care.

Use of uterine electromyography in the prediction of preterm birth after transvaginal cervical cerclage

BackgroundPreterm birth (PTB), complications of which account for approximately 35% of deaths among neonates, remains a crucial issue. Cervical insufficiency (CI) is defined as the inability of the utrine cervix to retain a pregnancy, leading to PTB. Cervical cerclage is an efficient surgery for CI patients by preventing the cervix from being further mechanically shortened. Unfortunately, a certain number of patients who had cerclage still delivered prematurely, raising the urgent need to accurately assess the risk of PTB in patients with cerclage. Uterine electromyography (uEMG) is an emerging technology that characterizes uterine contractions by describing the actual evolution process of uterine activity and has been used to predict PTB in recent years.MethodIn this single-center retrospective case-control study, singleton pregnancy women who received cervical cerclage and uEMG assessment between January 2018 and January 2022 at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled.Results32 PTBs were observed of the 69 women who underwent assessment. Based on multivariate logistic regression analysis, PTB after cerclage was significantly associated with previous PTB history or mid-trimester pregnancy loss (OR: 2.87, 95%CI: 1.49–5.54) and contraction frequency detected by uEMG (OR: 2.24, 95%CI: 1.44–3.49). The AUC of contraction frequency (0.766, P<0.001) was observed, and the optimal cut-off value suggested by Youden Index was 1.75 times per hour. Combined with previous preterm history and cervical length, the AUC of contraction frequency reached 0.858. After stratification by contraction frequency, the median duration was 11 weeks in the high frequency group (> 1.75 times per hour) and 15 weeks in the low frequency group (≤ 1.75 times per hour) (P<0.001).ConclusionsThe uEMG effectively predicts PTB after transvaginal cervical cerclage and provides a new method for clinicians to evaluate the pregnancy outcome of CI patients.

Mental Health Management Strategies in Pregnant Women and The Impact on Infant Health

The first stage of labor often takes a long time and causes discomfort for the mother, so methods are needed to accelerate it. This study aims to evaluate the effectiveness of microcontroller-based nipple stimulation in accelerating the labor process by stimulating the release of the hormone oxytocin which increases uterine contractions and accelerates cervical opening. Microcontroller technology is used to ensure the stimulation is done automatically and measured according to the mother's physiological needs. This study involved two groups, namely the group that received stimulation and the control group that did not receive stimulation. There are shortcomings in studies examining the effectiveness of interventions implemented at the organisational level in reducing stigma and improving mental health support. A variety of strategies can be used to address stigma, including proper education, awareness campaigns, and training for managers and employees on the importance of mental health. The development of inclusive policies and the provision of easy and non-discriminatory access to mental health services are essential. Consistent managerial support also plays a key role in creating a supportive work environment. Creating a positive and inclusive organizational culture will help companies improve employee mental health and well-being, while also increasing workforce productivity and retention. Reducing stigma and increasing support can create a healthier work environment, which ultimately supports individual development and the long-term success of the company.

Study of Association of PPH due to Uterine Atonicity and Serum Calcium levels

Background: Uterine atonicity stands out as a primary and leading factor contributing to maternal morbidity and mortality. Postpartum hemorrhage (PPH) resulting from uterine atony poses a life-threatening risk. Oxytocic drugs, by elevating intracellular calcium, enhance uterine tonicity, with optimal calcium levels playing a crucial role in facilitating effective uterine contractions. The study aimed to explore the relationship between the concentration of calcium in the bloodstream and the occurrence of PPH associated with inadequate uterine contractions admitted during the 1st and 2nd stages of labour at a tertiary care facility such as the Combined Military Hospital in Dhaka. The study likely involved analyzing data to identify any patterns or connections between serum calcium levels and the incidence of uterine atony-related PPH. Methods: The study follows a randomizing controlled trial (RCT) design within the Department of Obstetrics and Gynecology at Combined Military Hospital, Dhaka. The study duration spans from January 2016 to January 2019, involving a total of 306 subjects. Group A includes those with serum calcium levels between 8-10.4 mg/dl without uterine atonicity, while Group B comprises individuals with serum calcium levels below 8 mg/dl experiencing uterine atonicity, either post cesarean or vaginal delivery. Atonicity features include a soft, distended uterus with a lack of muscle tone. Results: A total of 306 patients were included in the study, with 153 having serum calcium levels exceeding 8 mg/dl and another 153 having levels below 8 mg/dl. Among women with serum calcium levels below 8 mg/dl, 37 patients experienced uterine atonicity. In contrast, it was observed that among women with serum calcium levels exceeding 8 mg/dl, only one patient experienced uterine atonicity. This highlights a potential association between higher serum calcium levels and a reduced likelihood of developing uterine atony in the studied population. Conclusions: The study findings indicate a strong association between low calcium levels and reduced uterine tonicity, establishing low calcium as a significant risk factor for uterine atony. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 28-34

Exploring the effects of yoga on dysmenorrhea: A narrative review

ABSTRACT Dysmenorrhea, commonly known as menstrual pain, is characterized by painful uterine cramps during menstruation and significantly impacts a woman’s physical, mental, and emotional health. Elevated prostaglandin levels cause dysrhythmic uterine contractions, reducing blood flow, leading to uterine hypoxia, and producing anaerobic metabolites that activate pain receptors. This study aims to review the effectiveness of yoga as an alternative treatment for primary dysmenorrhea. A search of English-language literature published from 2010 to 2023 was conducted across Scopus, PubMed, and Google Scholar using keywords “Yoga” AND “Menstrual Pain” OR “Dysmenorrhea.” The inclusion criteria were limited to randomized controlled trials examining the impact of yoga on dysmenorrhea symptoms. From 111 identified studies, 6 met the selection criteria and were included in the review. The review investigates yoga’s potential to alleviate primary dysmenorrhea’s physical and mental health effects. The literature indicates that yoga, including asanas, pranayama, and Yoga Nidra, is effective in reducing dysmenorrhea symptoms. Findings suggest that various yoga practices can significantly reduce menstrual pain and discomfort, improving overall health outcomes. However, the reviewed studies have limitations, such as small sample sizes and variations in study design. To establish yoga as an evidence-based solution for menstrual health issues, further research with rigorous scientific methods and larger sample sizes is needed. More high-quality trials focusing on a yogic approach are necessary to confirm yoga’s effectiveness as a primary management option for women with primary dysmenorrhea.

Incidence and Outcomes of Pregnant Trauma Patients With Positive Urine Toxicology: A Southern California Multicenter Study.

Background: The use of illicit substances during pregnancy has increased 4-fold in the past two decades, negatively impacting both mother and fetus. The rate and clinical outcomes of substance use in pregnant trauma patients (PTPs) are not well studied. We sought to evaluate clinical outcomes of PTPs with positive urine toxicology, hypothesizing a higher rate of in-hospital maternal complications for PTPs with a positive urine toxicology ((+)Utox) compared to those testing negative ((-)Utox). Methods: PTPs (≥18years old) were included in this multicenter retrospective study between 2016 and 2021. We included patients with known urine toxicology results and compared (+)Utox vs (-)Utox PTPs. Results: From 852 PTPs, 84 (9.8%) had a (+)Utox with the most common illicit substance being THC (57%) followed by methamphetamine (44%). (+)Utox PTPs had higher rates of blunt head injury (9.5% vs 4.2%, P = .028), extremity injury (14.3% vs 6.5%, P = .009), domestic violence (21.4% vs 5.9%, P < .001), suicide attempt (3.6% vs 0.3%, P < .001), and uterine contractions (46% vs 23.5%, P < .001). Abnormal fetal heart tracing, premature rupture of membranes and placental injury were similar between groups (all P > .05). The rate of maternal complications was similar in both groups (all P > .05). Conclusion: In this study, the rate of (+)Utox in PTPs was 9.8%. The (+)Utox group had similar rates of maternal complications but more commonly experienced uterine contractions which may be related to the physiology of drugs such as methamphetamines. PTPs with (+)Utox also more commonly were victims of domestic violence and suicide attempt, which merits further prevention research efforts.

Dystocia due to Twin Pregnancy in HF Crossbred Cattle- A Case Report

Background: Freemartinism is one of the most commonly found intersex conditions in cattle, although it may also occur in small ruminants. The freemartin phenotype appears in a dizygotic twin pregnancy where one twin is a male and the other is a female. Due to precocious anastomoses between the placental vascular systems of the two fetuses, masculinising molecules reach the female twin and disrupt the normal sexual differentiation. In cattle, this condition is observed in 90 to 97% of twin pregnancies. A freemartin is, by definition, a genetically female fetus masculinised in the presence of a male co-twin, giving rise to a sterile heifer. Methods: A HF crossbred cow of 2nd parity was presented at Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Mhow (M.P) with the history of difficulty in calving, uterine contraction since last night, restlessness, uterine fluid discharge from vagina and swollen vulva. Per vaginal examination revealed presence of two fetuses in the uterus one being in anterior while other being in posterior presentation. Result: Dystocia was resolved by manual intervention per vaginum resulting in birth of one male and one female calf. The male calf was strong and active, while the female calf was weak as compare to male.

MEDIAN EPISIOTOMY APPROACH IN A MINIATURE POMERANIAN WITH VULVAL HYPOPLASIA: A CASE REPORT

This case report details the episiotomy approach employed in managing vulval hypoplasia in a two year old Miniature Pomeranian bitch. The animal was presented to the Teaching Veterinary Clinical Complex, Veterinary Gynaecology and Obstetrical Unit, Madras Veterinary College, displaying a history of greenish black discharge and continuous straining for two hours. The animal was bred before 64 days. Physical examination revealed a small vaginal opening, measuring approximately 1.5 cm in length. Digital examination indicated fetal hind limbs and tail extending into the vaginal passage, while all other vital parameters were within the normal range. Attempts to induce uterine contractions using Inj. Oxytocin and 10 % Calcium gluconate in 5 % DNS proved unsuccessful. Therefore, under local anesthesia (2 % Lignocaine injection), median episiotomy was made and a single live male puppy was successfully delivered with mild traction. Closure of the incision site was accomplished using PGA 1/0 with a simple interrupted suture pattern. The patient had uneventful recovery after 5 day treatment regimen, involving a single dose of subcutaneous Inj. Cefovecin (antibiotic) and anti-inflammatory drugs, along with meticulous wound management.

The Mechanism Involved in the Inhibition of Resveratrol and Genistein on the Contractility of Isolated Rat Uterus Smooth Muscle

Purpose: This study aimed to compare the effects of the phytoestrogens resveratrol (RES) and genistein (GEN) on the contractility of isolated uterine smooth muscle from rats, focusing on both spontaneous and stimulated contractions, and to investigate the underlying mechanisms. Methods: Uterine strips were suspended vertically in perfusion chambers containing Kreb’s solution, various concentrations of RES and GEN were added to the ex vivo uterine strips, and contractions were measured before and after incubation with RES or GEN. Results: (1) Both RES and GEN inhibited K+-induced contractions in a dose-dependent manner; the β/β2-adrenoceptor antagonist propranolol (PRO), ICI118551, the ATP-dependent K+ channel blocker glibenclamide (HB-419) and the NO synthase inhibitor N-nitro-L-arginine (L-NNA) diminished the inhibitory effects of RES and GEN on K+-induced contractions. (2) RES and GEN also dose-dependently inhibited PGF2α-induced uterine contractions. (3) The inhibitory effects of RES and GEN were observed in spontaneous contractile activities as well; PRO, ICI118551, HB-419 and L-NNA attenuated the inhibitory effects of RES and GEN on the spontaneous contractions of isolated uterine muscle strips. (4) RES and GEN significantly decreased the cumulative concentration response of Ca2+ and shifted the Ca2+ cumulative concentration–response curves to the right in high-K+ Ca2+-free Kreb’s solution. (5) RES and GEN markedly reduced the first phasic contraction induced by oxytocin, acetylcholine, and prostaglandin F2α but did not alter the second phasic contraction caused by CaCl2 in Ca2+-free Kreb’s solution. Conclusions: RES and GEN can directly inhibit both spontaneous and activated contractions of isolated uterine smooth muscle. The mechanisms underlying the inhibitory effects of RES and GEN likely involve β adrenergic receptor activation, reduced Ca2+ influx and release, the activation of ATP-dependent K+ channels and increased NO production.

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...

A Wireless and Wearable Multimodal Sensor to Non-Invasively Monitor Transabdominal Placental Oxygen Saturation and Maternal Physiological Signals.

Poor placental development and placental defects can lead to adverse pregnancy outcomes such as pre-eclampsia, fetal growth restriction, and stillbirth. This study introduces two sensors, which use a near-infrared spectroscopy (NIRS) technique to measure placental oxygen saturation transabdominally. The first one, an NIRS sensor, is a wearable device consisting of multiple NIRS channels. The second one, a Multimodal sensor, which is an upgraded version of the NIRS sensor, is a wireless and wearable device, integrating a motion sensor and multiple NIRS channels. A pilot clinical study was conducted to assess the feasibility of the two sensors in measuring transabdominal placental oxygenation in 36 pregnant women (n = 12 for the NIRS sensor and n = 24 for the Multimodal sensor). Among these subjects, 4 participants had an uncomplicated pregnancy, and 32 patients had either maternal pre-existing conditions/complications, neonatal complications, and/or placental pathologic abnormalities. The study results indicate that the patients with maternal complicated conditions (69.5 ± 5.4%), placental pathologic abnormalities (69.4 ± 4.9%), and neonatal complications (68.0 ± 5.1%) had statistically significantly lower transabdominal placental oxygenation levels than those with an uncomplicated pregnancy (76.0 ± 4.4%) (F (3,104) = 6.6, p = 0.0004). Additionally, this study shows the capability of the Multimodal sensor in detecting the maternal heart rate and respiratory rate, fetal movements, and uterine contractions. These findings demonstrate the feasibility of the two sensors in the real-time continuous monitoring of transabdominal placental oxygenation to detect at-risk pregnancies and guide timely clinical interventions, thereby improving pregnancy outcomes.

A Pragmatic Approach to Fetal Monitoring via Cardiotocography Using Feature Elimination and Hyperparameter Optimization.

Cardiotocography (CTG) is used to assess the health of the fetus during birth or antenatally in the third trimester. It concurrently detects the maternal uterine contractions (UC) and fetal heart rate (FHR). Fetal distress, which may require therapeutic intervention, can be diagnosed using baseline FHR and its reaction to uterine contractions. Using CTG, a pragmatic machine learning strategy based on feature reduction and hyperparameter optimization was suggested in this study to classify the various fetal states (Normal, Suspect, Pathological). An application of this strategy can be a decision support tool to manage pregnancies. On a public dataset of 2126 CTG recordings, the model was assessed using various standard CTG dataset specific and relevant classifiers. The classifiers' accuracy was improved by the proposed method. The model accuracy was increased to 97.20% while using Random Forest (best classifier). Practically speaking, the model was able to correctly predict 100% of all pathological cases and 98.8% of all normal cases in the dataset. The proposed model was also implemented on another public CTG dataset having 552 CTG signals, resulting in a 97.34% accuracy. If integrated with telemedicine, this proposed model could also be used for long-distance "stay at home" fetal monitoring in high-risk pregnancies.

7828 First Trimester Serum 11-Deoxycorticosterone Predicts Extreme Premature Childbirth

Abstract Disclosure: E.K. Ronde Salminen: None. S. Schoenmakers: None. B.D. van Zelst: None. S.A. van den Berg: None. First Trimester Serum 11-Deoxycorticosterone Predicts Extreme Premature Childbirth Background: Preterm birth is the leading cause of perinatal mortality and morbidity worldwide. Unfortunately, the prediction of preterm birth remains challenging, causing unnecessary hospital admittance and overexposure to medication. Studies have shown that metabolites of progesterone can influence uterine contractility[1] and serum levels of 11-deoxycorticosterone have been shown to correlate with an increased risk of preterm birth before 32 weeks of gestation2. The aim of this prospective study was to determine whether first trimester measurement of the progesterone metabolites 11-deoxycorticosterone (11-DOC) and 16-alpha hydroxyprogesterone (16-OHP) could be used as a predictive marker for preterm birth. Methods and results: A cohort of 386 pregnant women were included at 12 weeks of gestation between 2014-2016. Their obstetric histories and comorbidities were noted and their plasma was frozen. Of these women, n=26 delivered prior to 32 weeks of gestation and n=286 delivered at term. 11-DOC and 16-OHP were determined using LC-MS/MS. Mann-Whitney U test was used to statistically analyze differences between the groups. There was a highly significant difference in the level of 11-DOC between women delivering prior to 32 weeks of gestation in comparison to women delivering after 37 weeks of gestation (p=0.007). 16-OHP levels tended to be different between the two groups, but this did not reach statistical significance (p=0.062). No difference was found in the ratio 16-alpha hydroxyprogesterone/11-deoxycorticosterone between the two groups (p=0.916). Conclusion: Plasma levels of progesterone metabolites collected late in the first trimester of pregnancy predicts preterm birth prior to 32 weeks of pregnancy.

7828 First Trimester Serum 11-Deoxycorticosterone Predicts Extreme Premature Childbirth

Abstract Disclosure: E.K. Ronde Salminen: None. S. Schoenmakers: None. B.D. van Zelst: None. S.A. van den Berg: None. Background: Preterm birth is the leading cause of perinatal mortality and morbidity worldwide. Unfortunately, the prediction of preterm birth remains challenging, causing unnecessary hospital admittance and overexposure to medication. Studies have shown that metabolites of progesterone can influence uterine contractility[1] and serum levels of 11-deoxycorticosterone have been shown to correlate with an increased risk of preterm birth before 32 weeks of gestation2. The aim of this prospective study was to determine whether first trimester measurement of the progesterone metabolites 11-deoxycorticosterone (11-DOC) and 16-alpha hydroxyprogesterone (16-OHP) could be used as a predictive marker for preterm birth. Methods and results: A cohort of 386 pregnant women were included at 12 weeks of gestation between 2014-2016. Their obstetric histories and comorbidities were noted and their plasma was frozen. Of these women, n=26 delivered prior to 32 weeks of gestation and n=286 delivered at term. 11-DOC and 16-OHP were determined using LC-MS/MS. Mann-Whitney U test was used to statistically analyze differences between the groups. There was a highly significant difference in the level of 11-DOC between women delivering prior to 32 weeks of gestation in comparison to women delivering after 37 weeks of gestation (p=0.007). 16-OHP levels tended to be different between the two groups, but this did not reach statistical significance (p=0.062). No difference was found in the ratio 16-alpha hydroxyprogesterone/11-deoxycorticosterone between the two groups (p=0.916). Conclusion: Plasma levels of progesterone metabolites collected late in the first trimester of pregnancy predicts preterm birth prior to 32 weeks of pregnancy.

A randomized controlled trial on the comparison of two doses of carbetocin with oxytocin for the prevention of postpartum hemorrhage (concert trial).

To compare the effectiveness of 50 and 100 μg of carbetocin with 10 IU of oxytocin for the prevention of postpartum hemorrhage (PPH). This was a triple-blind, non-inferiority trial involving pregnant women recruited at term. We compared two doses of carbetocin (50 and 100 μg) with 10 IU of oxytocin administered as uterotonic agent after vaginal or cesarean delivery. Uterine contractility was assessed at 2- and 5-min after uterotonic administration. The association between adequate uterine tone and PPH with the patients' characteristics were examined using the chi-square test. Effect of the drugs on the odds of developing PPH was examined using logistics regressions. All analyses were conducted using STATA (StataCorp L.L.C.) with a significance level set at 0.05. In total, 324 women (50 μg carbetocin group-111, 100 μg carbetocin group-106, and oxytocin group-107) participated in the study. There was a significantly higher proportion of women with adequate uterine tone in those that had 100 μg carbetocin relative to 50 μg and 10 IU oxytocin at 5 min (p < 0.001). Patients who received oxytocin had a higher average blood loss than women that had either 50 or 100 μg carbetocin (p = 0.128). There was a significant difference in the need for additional uterotonic, with a higher proportion of participants among those who received 10 IU of oxytocin (p < 0.001). Patients that had 100 μg of carbetocin had a better adequate uterine tone at the fifth minute compared to those who had 50 μg and 10 IU of oxytocin. Generally, carbetocin use was less likely associated with risk of PPH and use of additional intervention.

Effectiveness of Use Partograph during Labour among Staff Nurses

Events such as pregnancy and childbirth affect almost every fact of the human experience. Pregnancy alters a woman's body and mind. A partogram, also known as a partograph, is a single sheet of paper that has a composite graphical record of important labor-related data (fetal and maternal) entered against time. Statistics like cervical dilation, fetal heart rate, labor time, and vital signs are examples of pertinent metrics. The partograph is an invaluable tool for identifying indicators of maternal anxiety, irregular labor progress, and fetal distress. The partograph is intended to record the following: the mother's identity, the fetal heart rate, the color of the amniotic fluid, the fetal skull's molding, cervical dilatation, the fetal descent, the uterine contractions, and whether oxytocin was given or not.  Objectives: Determine staff nurses in the experimental and control groups' degree of expertise &amp; efficiency about using partograph during labor.  Methodology:  Research Design: True experimental research design used in study,  Sampling technique &amp; Population. . A basic random sample procedure was used to choose the 60 staff nurses for the study (30 in the experimental group and 30 in the control group). A study was conducted using a standardized interview schedule. .  Result: In experimental group of staff nurses had 70% of adequate knowledge about partograph in post test and in control group 30 % of staff nurses only have adequate knowledge about partograph in post test .  Conclusion The study helped the researcher to finalize the importance &amp; use of partograph in labour among staff nurses in progress of labour. partograph is an invaluable tool for identifying indicators of maternal anxiety, irregular labor progress, and fetal distress.