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Dexamethasone inhibition of cyclooxygenase expression in bovine term placenta.

Since both prostaglandin (PG) F2 alpha and corticosteroids are elevated in mammals before the onset of parturition, we studied the effect of the synthetic corticosteroid dexamethasone on PGF2 alpha accumulation and cyclooxygenase (prostaglandin synthase, PGS) expression in the bovine fetal placenta. Cultures were prepared from cotyledons at different stages of gestation. The effect of dexamethasone on PGF2 alpha accumulation and PGS expression was determined by radioimmunoassay and [35S]methionine metabolic labeling followed by immunoprecipitation with specific anti-cyclooxygenase antibodies, respectively. Data demonstrate that in fetal placental cells at term, both PGF2 alpha accumulation and cyclooxygenase expression are significantly inhibited after 18 hours of dexamethasone treatment (150 nM). In contrast, neither first nor second trimester cells were sensitive to dexamethasone treatment. Dexamethasone inhibition of PGF2 alpha synthesis in fetal cells at term was abolished in the presence of RNA or protein synthesis inhibitors (actinomycin D or puromycin, 10 micrograms/ml each). Neither progesterone nor 17 beta-estradiol accumulation were affected by dexamethasone treatment at any stage of gestation. Data suggest that corticosteroids play a role in parturition through PGF2 alpha synthesis regulation by fetal placental cells. Since abnormalities during parturition e.g. retained placenta, are common following dexamethasone induction of labor in cows, we postulate that the local inhibition of PGF2 alpha accumulation by cotyledon cells after corticosteroid administration, may be involved in placental retention.

Animals↗

Induction of parturition, progesterone secretion, and delivery of placenta in beef heifers given relaxin with cloprostenol or dexamethasone.

Sixty primiparous beef heifers from a crossbreeding study were used to examine the effects of inducing parturition with relaxin (3,000 U/mg) combined with cloprostenol (500 micrograms, i.m., n = 30) or dexamethasone (20 mg, i.m., n = 30) at Day 273, 10 +/- 1 days before expected parturition (Day 283). Heifers were assigned at random within cloprostenol and dexamethasone groups to receive relaxin (1 mg, n = 5/treatment), i.m. or in the cervical os (OS), at 0 h (the same time as cloprostenol and dexamethasone) or 24 h later. Eleven and six first-calving heifers and sixteen and nine second-calving cows also received cloprostenol + relaxin and cloprostenol + phosphate-buffered saline, respectively. Radioimmunoassay of daily plasma samples indicated an abrupt decrease in progesterone with time (p less than 0.001), from 7.5 +/- 0.50 to 1.0 +/- 0.30 ng/ml (mean +/- SE) within 48 h for all groups. The mean rate of progesterone decrease (ng/ml in 24 h) was accelerated (p less than 0.01) in relaxin-treated heifers (5.3 +/- 0.36), in contrast to dexamethasone- and cloprostenol-treated control heifers (2.8 +/- 0.40). Relaxin combined with cloprostenol or dexamethasone shortened the calving period in these heifers by reducing the interval between treatment and calving (33 vs. 56 h; p less than 0.01). The incidence and duration of retained placenta were reduced by 22 vs. 75% and 14 vs. 34 h for relaxin combined with cloprostenol or dexamethasone as compared with cloprostenol- or dexamethasone-treated controls, respectively (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Effects of ethanol extract of Moringa stenopetala leaves on guinea-pig and mouse smooth muscle.

The fresh leaf ethanol (LE) extract of Moringa stenopetala was tested in guinea-pig ileum and mouse duodenum and in uterus strips. There were significant dose and time dependent reductions of the acetylcholine (AC) response with initial stimulatory effects in both the guinea-pig ileum and the mouse duodenum preparations. Spontaneous rhythmic contractions were greatly reduced, suggesting an antispasmodic property of the crude LE extract. The LE extract showed some oxytocic activity on uterus strips of guinea-pigs and mice. The results are indicative of the traditional use of the leaves of Moringa stenopetala for stomach pain and to expel retained placentae by women.

Animals↗

Vaginal misoprostol vs. concentrated oxytocin plus low-dose prostaglandin E2 for second trimester pregnancy termination.

OBJECTIVE: To examine the efficacy of vaginal misoprostol for mid-trimester pregnancy termination. METHODS: This randomized trial compared misoprostol, 200 microg per vaginum q 12 h to a protocol of concentrated oxytocin plus low-dose vaginal prostaglandin E2 suppositories (10 mg q 6 h). Success was defined as an induction-to-delivery interval < or =24 h. RESULTS: Interim analysis of the first 30 (15-misoprostol, 15-concentrated oxytocin) women demonstrated that the 2 groups were similar with regard to indication for delivery, gestational age, and demographic characteristics. Misoprostol was associated with a lower success rate (67 vs. 87%, P = .2), a longer induction-delivery interval (22 h vs. 18 h, P = .09), a higher rate of retained placenta requiring curettage (27 vs. 13%, P = .65), and a higher live birth rate (50 vs. 0%, P = .006). CONCLUSIONS: Compared to a regimen of concentrated oxytocin plus low-dose prostaglandin E2, misoprostol administered as vaginal tablets in a dose of 200 microg q 12 h is not satisfactory for mid-trimester pregnancy termination in an unselected population.

Abortion, Induced↗

Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study.

OBJECTIVE: Velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies, has been associated with several obstetric complications including fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding and retained placenta. The aim of this study was to determine the feasibility of identifying velamentous insertion of the umbilical cord during routine obstetric ultrasound. DESIGN: This was a prospective, cross-sectional ultrasound study in 832 unselected second- and third-trimester singleton pregnancies. Color Doppler ultrasound was routinely performed to identify the placental cord insertion site. The role of three-dimensional (3D) ultrasound in evaluating the placental cord insertion site was also studied in a subset of 50 pregnancies from this population. RESULTS: The placental cord insertion site was identified in 825/832 (99%) cases. Visualization was not achieved in seven third-trimester pregnancies with a posterior placenta. A velamentous insertion was suspected prenatally in eight cases, seven of which were confirmed after delivery as velamentous and one as markedly eccentric (battledore placenta). 3D ultrasound performed poorly at evaluating placental cord insertion site, being less efficient due to poor-quality resolution and far more time-consuming than the combined use of gray-scale and color Doppler ultrasound. CONCLUSIONS: Velamentous insertion of the umbilical cord can reliably be detected prenatally by gray-scale and color Doppler ultrasound. 3D imaging had limited value in the evaluation of the placental cord insertion site in our subset of patients. Systematic assessment of the placental cord insertion site at routine obstetric ultrasound has the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications including vasa previa.

Adult↗

alpha-Thalassemia hydrops fetalis: clinical and ultrasonographic considerations.

Five pregnant Southeast Asian women presenting during a 14-month period with microcytic anemia, preeclampsia, and size-date discrepancies were all ultimately diagnosed as carrying fetuses with homozygous alpha-thalassemia hydrops fetalis. The perinatal complications of this hemoglobin disorder are unique to persons of this ethnic background and include uniform fatality for the affected infant, maternal preeclamptic morbidity, and retained placenta. In this report the obstetric ultrasound findings are presented and the clinical manifestations are discussed, with recommendations made to reduce this emerging public health problem in the United States.

Adult↗

Utilization of red blood cell transfusion in an obstetric setting.

The transfusion experience for a 1-year period (September 1985 to August 1986) at a tertiary referral obstetric hospital was reviewed retrospectively. During the review period 7731 mothers were delivered and 6003 patients (83%) underwent type-and-screen procedures. A total of 1057 units of red blood cells were crossmatched, and 362 of these 1057 units were transfused to 100 parturient women so that the overall crossmatch/transfusion ratio was 2.9:1. Five percent of transfused patients received 1 unit; 52% of patients received 2 units, 19% received 3 units and 24% received greater than or equal to 4 units of packed red blood cells. Major indications for transfusion were uterine atony, 27%; retained placenta, 17%; trauma, 17%, placenta previa, 7%; and abruptio placentae, 5%. In 12% of patients transfusions were done because of anemia. This study shows the value of audit and confirms that the type-and-screen procedure is an effective way of reducing the crossmatch/transfusion ratio without compromising patient care, even in high-risk patients.

Blood Grouping and Crossmatching↗

Conservative management and pregnancy outcome in diethylstilbestrol-exposed women with and without gross genital tract abnormalities.

OBJECTIVES: Our goal was to determine the effect of conservative management on pregnancy outcome in diethylstilbestrol-exposed women with and without gross structural lesions of the genital tract. STUDY DESIGN: The study included a case series of women prospectively enrolled over a 10-year period. RESULTS: Pregnancy outcome and both antepartum and intrapartum events occurring in a case series of 120 conservatively managed pregnancies in 50 diethylstilbestrol-exposed women were reviewed. Group A (n = 34, 89 pregnancies) consisted of women with gross upper or lower genital tract lesions associated with diethylstilbestrol exposure, whereas group B (n = 16, 31 pregnancies) consisted of women whose lesions were limited to colposcopic findings. Cerclage was limited to women with a history of cervical incompetence (n = 1, two pregnancies) or acute cervical change in the second trimester (one pregnancy). Women with cervical change occurring after 25 weeks' gestation were managed with bed rest. Group A experienced more spontaneous first-trimester losses than group B (25.8% vs 12.9%, p < 0.01), whereas group B had a greater gestational age at delivery (39.8 +/- 1.5 vs 37.3 +/- 3.8 weeks, p < 0.01) than group A. Overall, pregnancies surviving the first trimester (n = 94) resulted in delivery of a viable infant discharged home 92.2% of the time; 77.9% of pregnancies reached term. The perinatal loss rate was 1.3%. Preterm labor (6.5%) and preterm rupture of membranes (3.8%) resulted in an overall rate of preterm birth of 9.2%. There were no significant differences in length of any labor stage between groups, nor were there any differences in the use of oxytocin augmentation or cesarean section rates between groups. Postpartum hemorrhage and retained placenta were infrequent complications. CONCLUSIONS: The majority of pregnancy loss in diethylstilbestrol-exposed patients occurs in the first trimester. Cervical incompetence is an infrequent cause of pregnancy loss even in patients with gross structural abnormalities of the genital tract. Patients who had conservative management had good pregnancy outcomes. Prophylactic cerclage for all diethylstilbestrol-exposed patients should not be recommended.

Abnormalities, Drug-Induced↗

Some characteristics of labor in ethnic minorities in Amsterdam.

A retrospective study of labor in immigrants, subdivided into Blacks, Asians and Mediterraneans (Turks and Moroccans) and autochthonous Dutch in Amsterdam over a 10-year period showed definite differences. The second stage was shortest in Blacks and Mediterraneans but they sustained perineal tears and episiotomies less frequently. Differences in positions at birth were small except for occipito-posterior position which was very rare in Asians and Mediaterraneans. The rate of cesarean section was highest and that of instrumental vaginal delivery lowest in Blacks, and latter being highest in Asians. Retained placenta occurred less often in immigrants than in Dutch.

Cesarean Section↗

Mid-trimester abortion using prostaglandin E2 gel.

Nineteen cases of mid-trimester pregnancy were terminated using prostaglandin E2 gel applied intracervically. In this prospective study, 42% were primipara with gestational age at the time of abortion between 16 and 28 weeks. The induction to abortion time was 19.65 +/- 10.37 h with a success rate of 89%. The average number of applications was 1.8 times (range 1-3 times) and the average dosage of prostaglandin required was 5.5 mg (range 3-9 mg). The complications were minimal except retained placenta in 42% of cases. Prostaglandin E2 in form of gel applied intracervically is an effective alternative to the commonly used hypertonic saline or, more recently, to prostaglandin analogues for termination of pregnancy in the second trimester.

Abortifacient Agents, Steroidal↗

Premedication and pain relief with Nubain during second trimester therapeutic pregnancy terminations.

OBJECTIVE: To determine the analgesic efficacy of the opioid agonist-antagonist Nubain during midtrimester therapeutic terminations with intra-amniotic PGF2 alpha or i.m. administration of the PGE2 derivative sulprostone. METHOD: Following osmotic predilatation with laminaria tents patients were given as a premedication 10 mg Valium, 10 mg Nubain and 0.5 mg atropine i.m. prior to prostaglandin treatment, and sequential doses of Nubain during the uterine contractility period. Patients indicated their own perception of uterine pain on a differential graphic rating scale, and the attending physician also evaluated patients' discomfort on a 5-grade scale. RESULT: In 55% of the cases patients experienced only 'mild' or 'moderate' pain. The mean induction-to-abortion interval was short (11.6 +/- 1.3 h). The well known gastrointestinal side-effects of the prostaglandins were avoided. CONCLUSION: Nubain proved effective in stabilizing patients' condition during intra-amniotic instillation of prostaglandin, effectively relieved uterine pain during the myometrial contractility period, prevented the occurrence of prostaglandin-related side-effects, and provided simple and good anesthesia during instrumental removal of the already detached but retained placenta.

Abortion, Therapeutic↗

Factors influencing high rate of 'born-before-arrival' babies in Nigeria--a case control study in Ogbomosho.

The purposes of this study were to examine the records of the birth-before-arrival mothers in order to identify factors which might explain why so few booked for hospital care and also to identify the post-delivery problem which lead them to seek professional help. Data from the hospital records and interviews with some of the 377 born-before-arrival mothers seen at the Baptist hospital, Ogbomosho, Oyo State, Nigeria between 1982 and 1985 were analysed using descriptive statistical methods. Findings indicated that 65% of the mothers attending after delivery outside hospital had been delivered by a traditional birth attendant. Of these 73.7% sought hospital attention following retained placenta with bleeding. The first step towards improving perinatal care will be the official integration of the indigenous midwives into the national health services to enhance organized programmes of training for the traditional birth attendants. The implications of these findings suggest that traditional birth attendants and professional carers in Nigeria should improve liaison and cooperation between themselves so as to correct the imbalance in health service provision between the major cities and rural areas.

Adult↗

Laminaria augmentation of intra-amniotic PGF2 for midtrimester pregnancy termination.

In our hands, intra-amniotic PGF2alpha 40 mg for midtrimester pregnancy termination had a mean infusion to abortion interval of 29.4 hr. However, pretreatment of 230 patients with laminaria tents inserted 14-18 hr before PGF2alpha infusion resulted in a dramatically reduced time to abortion (14.3 hr mean) with a low incidence of gastrointestinal and other side effects. Laminaria tents inserted at the same time as PGF2alpha infusion in 26 patients also resulted in reduced time to abortion (18.6 hr mean). In the laminaria pretreated group, the infusion to abortion interval was indirectly related to the number of laminaria inserted and not to the nulliparous or parous state. Although we have made significant strides in shortening the abortion interval in the hospital, retained placentae and blood loss persist as problems related to the use of prostaglandin for abortion.

Abortion, Induced↗

Artificial induction of twinning in cattle by means of supplemental embryo transfer.

The induction of twins by surgical and nonsurgical transfer was performed 6 - 8 days after Artificial Insemination (A.I.) in a total of 142 cows. Of the 47 heifers, which received surgically transferred embryos, 32 (68%) became pregnant. Of the 95 cows, which received nonsurgically transferred embryos, 58 (61,6%) became pregnant. A total of 90 (63.5%) of the recipient animals became pregnant. Up to date 64 recipients have calved; twins have resulted in 40 and 48,2% resp, from surgical and nonsurgical inductions. Out of a total of 64 calvings 29 (45,3%) were twins, and of these 38% were males, 27% were females, and 34% were mixed births. Female - calves resulted in freemartinism. There was no increase in the incidence of either retained placenta or dystocia. The induction of twinning by means of embryo transfer can be regarded as a useful method for the increase in the reproductive performance cattle.

Journal Article↗

Analysis of fertility indices of cows with extended postpartum anestrus and other reproductive disorders compared to normal cows.

An analysis of computerized data on the incidence and consequences of reproductive disorders was performed on 84,818 lactations in more than 100 high producing Kibbutz dairy herds during six semiannual recording periods. The average incidence of primary reproductive disorders, which included retained placenta, abnormal lochia, endometritis, postpartum anestrus, cystic ovaries, negative pregnancy examinations and repeat breeders, was 50.4%. During all recording periods we were able to observe recurrence and repeatability of these reproductive disorders and of the fertility indices consequently seen. Cows with uterine infections diagnosed and treated before Day 20 post partum had better fertility indices than those diagnosed and treated later. The conception rate to first inseminations and the overall conception rate to all inseminations of cows with postpartum anestrus was significantly lower, while the percentage of "problem cows" (not pregnant by Day 150 post partum) was significantly higher, than in normal cows. The incidence of cystic ovaries in cows with a previous diagnosis of reproductive disorders was 2 to 3 times higher when compared to cows without such a diagnosis.

Journal Article↗

Twinning in dairy cattle: A study of risk factors and effects.

Twin calvings on Dutch dairy farms were studied using data collected through a routine herd health and production management program. Over a period of 6.5 yr, 381 twin calvings (762 calves) of a total of 11,951 calvings were recorded on 33 farms. The 381 twin calvings were compared with a referent group of 1,536 calvings that was randomly selected from the orginal 11,951 calvings. Risk factors for twin calvings were parity, season, herd and previous twinning. High cumulative milk production was associated with cows conceiving twins. Treatment for infertility in the preceding lactation was an equivocal risk factor. Twin calvings increased the risk of abortion, retained placenta, fertility-related treatment, as well as the number of days open and the number of inseminations per conception. Although twin calvings resulted in more calves born per dam, the number of available replacement heifers did not increase. After twin calving, cows produced slightly less milk and were culled more often than single calving cows. To adapt appropriate management practices for cows carrying twins, an early and reliable method for detecting twin pregnancies is needed.

Journal Article↗

Factors affecting response of groups of dairy cows managed for different calving-conception intervals.

Factors which positively or adversely affect the response of cow groups to different planned conception periods were analyzed and quantified. Cows were randomly assigned to groups for breeding at postpartum intervals of 35 to 59, 60 to 90 and 120 to 150 days in a research herd, or 60 to 90 and 120 to 150 days in a cooperating commercial herd, with a planned preceding dry period of 60 days in both herds. Breeding at 35 to 59 and 60 to 90 days post partum resulted in a lower conception rate among multiparous cows but had no effect on primiparous cows. Genital disorders such as metritis, retained placenta, vulva inflammation and vaginitis, did not affect the start of luteal activity or length of the subsequent cycles, but caused a significant delay of the first behavioral estrus and, consequently, a delay of the first insemination in the earlier breeding groups. About 30% of the cows in the different categories were inseminated three or more times and were considered to be repeat breeders. Response rates (number of cows conceiving on time/number assigned) in the later breeding group improved due to higher submission rates (number of cows submitted on time/number assigned), and the conception rates were higher (number of cows conceiving on time/number submitted). The rates in all groups were adversely affected by repeat breeding and genital disorders. The latter delayed the first insemination and the conception rate.

Journal Article↗

Fertility, production and culling following cesarean section in dairy cattle.

A population-based historical cohort study design was used to investigate the effects of a cesarean section on calf mortality, fertility, milk production and culling on 35 Dutch dairy farms. The data were collected during a routine herd health and production control program. Cows undergoing a cesarean section had a higher calf mortality rate, a longer interval from first service to conception and a smaller risk for retained placenta than control cows, those with spontaneous deliveries and those with dystocias. Cumulative milk production at 100 days was lower and the risk of being culled was higher for cows with cesarean sections than for the control cows.

Journal Article↗