Weeks Of Labor Research Articles

Permissive intrapartum glucose control: an equivalence randomized control trial (PERMIT)

BackgroundThere is limited high quality data to determine best practices for maternal blood glucose management during labor. ObjectiveWe compared permissive care (target maternal blood glucose 70–180 mg/dL) to usual care (blood glucose 70–110 mg/dL) among laboring individuals with diabetes. Study DesignThis was a two-site equivalence randomized control trial for individuals with diabetes (pregestational or gestational) at ≥ 34 weeks in labor. Individuals were randomly allocated to usual care or permissive care. Maternal blood glucose was evaluated by capillary blood glucose monitoring in latent and active labor every 4 and 2 hours. Insulin drip was initiated if maternal blood glucose exceeded the upper bounds of the allocated target. The primary outcome was first neonatal heel stick glucose within two hours of birth before feeding. We assumed a mean first neonatal blood glucose of 50 ±10 mg/dL. To ensure that the use of permissive care did not increase or decrease the first neonatal blood glucose >10 mg/dL (two-tailed, α= 0.05, β= 0.1), 96 total participants were required. We calculated adjusted relative risk (aRR) and 95% confidence intervals (CI) in an intention-to-treat analysis. A Bayesian analysis was preplanned to estimate the probability of equivalence with a neutral informative prior. ResultsOf 511 deliveries with diabetes assessed for eligibility (10/2022 - 6/2023), 280 (54.8%) met eligibility criteria, and 96 (34.3%) agreed and were randomized. In the usual care group, 17% required an insulin drip compared to none in permissive care. There was equivalence in the primary outcome between usual and permissive care (57.9 vs. 57.1 mg/dL, adjusted mean difference -0.72, 95% CI -8.87,7.43). Bayesian analysis indicated 98% posterior probability of mean difference not being greater than ±10 mg/dL. The rate of neonatal hypoglycemia was 25% in the usual care group and 29% in permissive group (adjusted relative risk 1.14, 95% CI 0.60, 2.17). There was no difference in other neonatal or maternal outcomes. ConclusionIn this randomized control trial, while almost 1 in 6 individuals with diabetes required an insulin drip with usual intrapartum maternal blood glucose care, permissive care was associated with equivalent neonatal blood glucose.

Understanding the factors affecting the postpartum depression in the mothers of Isfahan city.

Background and Objective:Depression is one of the most common and specific problems during pregnancy and after it. Maternal postpartum depression compromises mother's health and affects social relationship, and has negative effect on infant development. The aim of this study was to investigate the prevalence of postpartum depression and its related factors in Isfahanian mothers.Materials and Methods:This is a cross - sectional study. The study populations were 133 women who at the last 8-4 weeks of labor referred to Isfahan health centers. Demographic information and obstetric and Beck Depression Inventory were applied. Three categories emerged according to the degree of scale: Mild, moderate, and severe depression. Statistical analysis was used with the Pearson correlation and linear regression in SPSS version 18.Results:A total of 73 mothers had mild depression (10-19) and 56 had moderate depressions (20-29). Among the factors related to depression such as maternal education, financial status, unwanted pregnancy, premenstrual syndrome, and maternal occupational history, there was a significant correlation with postpartum depression (P > 0.05). Variables in the regression analysis include maternal education, financial status, unwanted pregnancy, history of premenstrual syndrome, maternal occupation, type of delivery, history of miscarriage, and having a satisfaction with baby gender. And, a total of 27.7% variance explains the postpartum depression. Among these factors, the predictive variables of maternal education, type of delivery, financial condition, unwanted pregnancy, premenstrual syndrome, and maternal occupational history were significant in the meantime; the prediction of unplanned pregnancy was more than other variables (ß = 0.24).Conclusions:With attention to factors associated with postpartum depression, the healthcare planner will help to better manage the problem. The results of this study will help to better understand the factors influencing mothers in the labor process, and mothers in the labor process, experiences minimum mental health disorders.

Nifedipine-associated pulmonary complications in pregnancy

Pulmonary edema (PE) is a known side effect of tocolytic agents. Recently the first case of PE associated with oral nifedipine (Adalat Bayer Germany) was reported. Two cases are added; one is a twin gestation who presented at 31-6/7 weeks in labor with ruptured membranes (ROM). Forty hours after starting betamethasone antibiotics and 40-mg nifedipine every 6 h she developed dyspnea. Arterial blood gases (ABG) revealed Pa/O2=52mmHg and saturation=88%. Bilateral crackles were detected. Chest X-ray revealed mild haziness over the left lower lobe; nifedipine was discontinued. Oxygen facemask and 3 doses of 20-mg furosemide (Lasix; Sanofi-Aventis U.S.A.) resulted in mild improvement. One episode of 38.3 °C temperature was recorded 8 h after discontinuing nifedipine so a cesarean delivery was performed. The second patient presented at 27-5/7 weeks in labor. She received betamethasone penicillin and 40-mg nifedipine every 6 h. Twenty hours later she had ROM and a temperature of 38°C. On day 3 contractions intensified; nifedipine was discontinued and MgS/O4 was given for 3 h. Three hours later she developed cough and dyspnea. Bilateral fine crackles were noted. Mg level was 5.7 mg/ dl. ABG revealed Pa/O2=45mmHg and saturation=81%. Chest X-ray revealed congestion. Duplex scan of the lower extremities was negative. She received 5 doses of 40-mg furosemide but saturation remained between 77 and 84% despite oxygen nasal-cannula and therapeutic heparin. A cesarean delivery was done. Postoperative chest X-ray suggested hilar pneumonia. Saturation improved on day 2 postoperatively. (excerpt)

Investigating differences in gene expression in term laboring myometrium compared to preterm laboring and failed post-date induction myometrium

MYOMETRIUM COMPARED TO PRETERM LABORING AND FAILED POST-DATE INDUCTION MYOMETRIUM KIMBERLY PILKINTON, STEVEN ALLEN, KEVIN HUDDLESTON, THOMAS KUEHL, Texas A&M Health Science Center System, Temple, Texas, Scott & White, Temple, Texas, Texas A&MUniversity SystemScott & White Memorial Hospital, Obstetrics and Gynecology, Temple, Texas, Texas A&M University, Obstetrics & Gynecology, Temple, Texas OBJECTIVE: To compare gene expression differences between term laboring myometrium and preterm laboring and failed 41-week induction myometrium. STUDY DESIGN: A 100mg sample of myometrium from the lower uterine segment of patients undergoing C-section was obtained from consenting patients and frozen in liquid nitrogen. Cohorts included: 4 patients >37 weeks in labor, 2 patients !3 4 weeks in non-induced preterm labor, and 4 patients >41 weeks with failed induction. Isolation of mRNA and gene expression analysis by microarray was performed by Clontech labs. cDNA probes were generated, labeled, and hybridized in pairs to 12,000 gene arrays. Computer analyses produced gene expression profiles for each sample. Results were normalized and data compared to identify gene expression that is up or down regulated by at least 5-fold comparing the term laboring versus the preterm laboring cohort and the term laboring to the failed induction cohort. RESULTS: The most common mRNAs in the 10 samples were gamma 2 actin, heat shock 27kD protein 1, and light polypeptide 9 myosin. Compared to term laboring myometrium 2 transcripts were up-regulated more than 5-fold in the preterm cohort, and 40 transcripts were down-regulated. A transcription factor gene, FOXO1A, was upregulated by 44 fold in the preterm cohort compared to the term cohort. Fibronectin 1 was also up-regulated (2.1 fold). Compared to the term laboring cohort 11 genes were up-regulated and 27 genes were downregulated by 5-fold in the post-date cohort. CONCLUSION: Using microarray techniques, differences in term laboring myometrium compared to preterm laboring myometrium have been described. Differences in the myometrium of post-date induction patients that have failed induction compared to term laboring patients are also described. This study reveals new insight into potential genetic changes that take place in preterm laboring patients and gives insight into differences in patients who must be induced and still fail to labor effectively.

Virtual Prototyping of Scherk-Collins Saddle Rings

The author discusses a computer program that he developed to visualize different configurations of saddle ring surfaces with different numbers of holes and different amounts of twist. Users can experiment with different parameter values at interactive speeds. Such virtual prototyping can save weeks of labor needed to build physical prototypes and may result in new and more optimized configurations that one would not be likely to find if all prototypes had to be built manually from physical matter. The author’s program design was inspired by some of sculptor Brent Collins’s recent works (described in the companion article, “Evolving an Aesthetic of Surface Economy in Sculpture”), which can be understood geometrically as rings of saddle surfaces resulting from a toroidal warping of a truncated Scherk minimal surface.