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PubMed1996

[Intracervical prostaglandin E2 as pre-inducer of labor in patients with preterm fetal death].

A comparative study was undertaken to evaluate the effect of a single dose of 0.5 mg of PGE2 on the uterine cervix and the subsequent progress of labor induction, from february 1992 to december 1993 in The Instituto Nacional de Perinatología. The obstetric results obtained from women with antepartum fetal death, were divided in two groups: group A women between 21 to 27 weeks gestation, group B from 28-36 weeks gestation, and a control group without PGE2 aplication. Dinoprostone 0.5 mg in a new gel form given intracervically in a single dose. In Group A induction-to-delivery interval were about 12 h compared with the control group about 24 h, this difference is statistically significant (P < 0.001). In Group B induction-to-delivery interval were about 9 h, and a control group about 16.5 h, this difference is satistically significant (P < 0.001). In conclusion, the PGE2 (dinoprostone 0.5 mg) in gel, is a drug with high effectiveness when used for labor preinduction as applied in this study.

Adolescent↗

PubMed1979

Infant outcome following labor induction.

A matched control study was undertaken in which 156 children were examined between ages 23 and 62 months after births associated with spontaneous labor, oxytocin-induced labor, or prostaglandin E2 (PGE2)--induced labor. Physical development was not adversely affected by labor induction based on height and weight percentiles. The frequency of neurologic or developmental abnormalities not attributable to postdelivery events was the same overall in induced and spontaneous labors (19.2 per 1,000), but those abnormalities occurring after labor induction all followed use of oxytocin. None followed PGE2 despite case-selection criteria which specifically chose PGE2 cases from among those with documented adverse drug-related reactions.

Abnormalities, Drug-Induced↗

PubMed1995

Morphometric analysis of gap junctions in nonpregnant and term pregnant human myometrium.

BACKGROUND AND METHODS: Some structures in the human myometrium, namely; caveolae, extracellular space and gap junctions were quantified in tissues from nonpregnant women, women who were not in labor, and women in spontaneous labor or oxytocin-induced labor, in order to reveal morphologic differences that would contribute to explaining the events leading to labor. Transmission electron micrographs taken from tissues from twenty-four pregnant and ten nonpregnant women were studied. RESULTS: Differences were observed in cell growth which was accompanied by enlargement of the extracellular space, and in gap junctions. Gap junctions were demonstrated in nonpregnant women, and even in one postmenopausal woman. Their frequency and size increased gradually between groups of pregnant women in the order of non-labor, oxytocin-induced labor and spontaneous labor. The increase in size of the junctions was less than the increase in number. CONCLUSIONS: Gap junctions are most frequently found in human myometrial cells in spontaneous labor, which strongly suggests a role for these structures in the termination of pregnancy. The effect of oxytocin on the appearance of gap junctions was negligible; hence, the contribution of oxytocin to establish myometrial contractile synchronicity is thought to be minor. Caveolae are probably not relevant for the initiation of labor as their distribution did not differ between the groups.

Adolescent↗

PubMed2006

Alterations in uterine sodium pump abundance may contribute to the onset and progression of term and preterm labor in mice.

OBJECTIVE: Other investigators have shown that reductions in active sodium pump units increase uterine contractility. Therefore, our goal was to determine whether uterine sodium pump abundance is decreased in mouse models of term and preterm labor. STUDY DESIGN: Mice were studied during the final one-third of pregnancy. Other pregnant mice had preterm labor induced with lipopolysaccharide and were studied at timed intervals thereafter. Uterine sodium pump alpha3-isoform messenger RNA and protein were measured. Data were analyzed by analysis of variance. RESULTS: Uterine sodium pump alpha3-isoform messenger RNA fell significantly from day 14 to day 18 and remained low on the day of birth. Uterine sodium pump alpha3-isoform protein levels decreased significantly also. In lipopolysaccharide-induced preterm labor, uterine sodium pump alpha3-isoform protein, but not messenger RNA, decreased significantly. CONCLUSION: Sodium pump alpha3-isoform protein levels decreased in uterus before term labor and lipopolysaccharide-induced preterm labor. These findings are similar to those in humans, which suggests that this mouse model may be useful in the study of the sodium pump in human pregnancy. Reductions in sodium pump number can increase uterine contractile force and may contribute to labor.

Animals↗

PubMed1979

Platelet function, coagulation and fibrinolysis during termination of missed abortion and missed labor by PGF2 alpha and oxytocin.

In cases of missed abortion and missed labor, labor was induced by PGF2 alpha i.a., i.v. and by oxytocin infusion. Platelet function (methods of Born and Breddin), the coagulation system and fibrinolysis have been studied within the three groups. Using PGF 2 alpha i.v., the initially increased platelet aggregation showed a tendency to become normal. There was no manifestation of activation of the coagulation system. Fibrinolytic activity showed a slight increase during PGF2 alpha i.v. No essential changes in platelet function, coagulation and fibrinolytic system were found after i.a. injection of PGF2 alpha. When inducing labor by oxytocin i.v., both the coagulation and the fibrinolytic system were slightly activated and platelet aggregation increased. The results and their clinical importance for hemostasis as well as therapeutic consequences are discussed.

Abortion, Missed↗

PubMed2002

Bacterially induced preterm labor in the mouse does not require maternal interleukin-1 signaling.

OBJECTIVE: We tested the hypothesis that intrauterine bacterial inoculation induces labor via expression of the inflammatory cytokine interleukin-1 (IL-1) in a murine model. STUDY DESIGN: Pregnant mice on day 14.5 of a 19-20 day gestation were inoculated with killed Escherichia coli or sterile media into either (a) the right uterine horn, (b) the right uterine horn following its surgical isolation from the contralateral horn and cervix, or (c) the kidney. Cytokine levels in gestational tissues and maternal serum were determined by use of enzyme-linked immunosorbent assay (ELISA). In a separate experiment, bacterially induced preterm delivery was compared between mice lacking a functional IL-1 receptor and wild-type control litter mates. RESULTS: Killed E coli induced delivery within 48 hours with similar dose-response curves regardless of inoculation site (intact uterine horn, isolated uterine horn, or kidney). Bacterial inoculation of an isolated right horn caused dramatic increases in local expression of IL-1 and IL-6. However, delivery occurred from the uninjected horn without corresponding upregulation of cytokines, with the exception of a modest rise within fetal membranes. Mice lacking a functional IL-1 receptor were no different from wild-type mice in their susceptibility to bacterially induced delivery. CONCLUSION: Bacterially induced labor in the murine model does not require IL-1 signaling.

Animals↗

PubMedDate not supplied

Increase in prostaglandin H synthase 2, but not prostaglandin F2alpha synthase mRNA in intrauterine tissues during betamethasone-induced premature labor and spontaneous term labor in sheep.

OBJECTIVE: Prostaglandin F synthase (PGFS) catalyzes reduction of prostaglandin H(2) to PGF2alpha. No information exists on PGFS expression and regulation during pregnancy, either mRNA or protein, in relation to labor in uterine tissues in any species. We characterized PGFS mRNA expression in ovine myometrium, endometrium, maternal and fetal placenta in betamethasone-induced premature labor and spontaneous term labor using our cloned ovine PGFS riboprobe. Prostaglandin H synthase (PGHS) 2 mRNA was evaluated simultaneously as a control whose pregnancy related changes are well known. METHODS: Poly-A or total RNA from fetal placenta, myometrium, and endometrium in control ewes at 143-147 days of gestational age (dGA, TCNL, n = 6), and ewes in spontaneous term labor at 145-147 dGA (STL, n = 6) and endometrium and maternal and fetal placenta in early control ewes not in labor (ECNL, n = 6) and betamethasone induced labor at 128-135 dGA (BL, n = 6) were analyzed for PGHS2 and PGFS mRNA. RESULTS: PGFS mRNA did not change at spontaneous term labor in myometrium, endometrium, and fetal placenta. PGFS mRNA decreased during betamethasone-induced premature labor in endometrium and maternal placenta (P < .05), but remained unchanged in fetal placenta and myometrium. PGHS2 mRNA increased in endometrium, placenta, and myometrium during betamethasone-induced premature labor and spontaneous term labor. CONCLUSION: Increased PGHS2, but not PGFS mRNA was tightly associated with the onset of betamethasone-induced premature labor as well as spontaneous term labor in the endometrium, placenta, and myometrium. Transcription of PGFS mRNA may not be the rate-limiting step in the pathway contributing to increased PGF(2alpha) at labor.

Animals↗

PubMed2005

[RNA isolation from human embryonic tissues].

To investigate the method of RNA isolation from human embryonic tissues and the factors influencing the quality of RNA, the RNA from human embryonic tissues obtained with drug-induced labor or non-drug induced labor were isolated by using grind with liquid nitrogen or homogenizer without liquid nitrogen. The results showed that the positive rates of RNA integrity in grind with liquid nitrogen group and in homogenizer without liquid nitrogen group were 68.42% and 29.79% respectively, and there was significant difference between these two groups; however, there was no statistic difference in positive rate of RNA integrity, OD(260)/OD(280) ratio and beta-actin gene expression level between the drug-induced labor group and non-drug induced labor group. It is concluded that pulverize of tissue in liquid nitrogen remains the integrity of RNA isolated and may be applied for RNA isolation from human embryonic tissues. The quality of RNA is not affected by different methods of induction of maternal labor.

Embryo, Mammalian↗

PubMed1978

Interrelationships between maternal and cord prolactin, progesterone, estradiol, 13,14-dihydro-15-keto-prostaglandin F2alpha, and cord cortisol at delivery with respect to initiation of parturition.

Estradiol, progesterone, prolactin, and 13,14-dihydro-15-keto prostaglandin F2alpha (PGFM) were measured in both maternal and cord venous blood obtained at the time of delivery in 24 maternal infant pairs evenly divided among six different physiologic groups. Progesterone and prolactin were significantly higher and estradiol was significantly lower in cord than in maternal blood. There were no significant differences between the groups for cortisol, estradiol, or progesterone in maternal or cord blood. A significant increase in prolactin was demonstrated in women receiving oxytocin for induction of labor. Both estradiol and PGFM were highly correlated between maternal and cord blood. PGFM was significantly higher in cesarean section patients in labor than in those not in labor in both the maternal and cord circulations. Among those delivered vaginally, PGFM tended to be higher in those in spontaneous labor than in those with induced labor. PGFM in induced labor was intermediate between spontaneous labor aptients delivered by cesarean section and those delivered vaginally. Duration of labor was negatively correlated with cord estradiol concentration. The physiologic significance of these findings is discussed.

Animals↗

PubMed2006

Signaling via the type I IL-1 and TNF receptors is necessary for bacterially induced preterm labor in a murine model.

OBJECTIVE: We have shown previously that interleukin 1 (IL-1) signaling is not necessary for bacterially induced preterm delivery in mice. We now test whether combined signaling of IL-1 and tumor necrosis factor (TNF) is critical for this process. STUDY DESIGN: Female mice lacking the type I receptors for IL-1 and TNF (Il1r1/Tnfrsf1a double-knockouts) and normal controls underwent intrauterine inoculation with killed Escherichia coli bacteria on day 14.5 of a 19- to 20-day gestation. Preterm delivery rates within 48 hours were recorded and gene expression was analyzed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Il1r1/Tnfrsf1a double-knockout mice had significantly lower rates of preterm delivery than controls (8% vs 69% with 7 x 10(7) bacteria, P = .002, and 52% vs 81% with 1.4 x 10(8) bacteria, P = .003) and significantly lower myometrial levels of cyclooxygenase (COX)-2, but not COX-1 mRNA. There were no genotype- or treatment-related differences in cervicovaginal and lower uterine expression of mRNAs for a variety of genes associated with cervical ripening. CONCLUSION: The combination of IL-1 and TNF signaling plays a critical role in bacterially induced labor and myometrial COX-2 production in the mouse. Cervical gene expression patterns during bacterially induced preterm labor suggest fundamental differences from spontaneous term labor in the cervical ripening process.

Animals↗

PubMed1980

Fetal heart rate pattern before, during and after amniotomy.

This prospective study concerned the immediate possible effects of low amniotomy on the fetal heart rate pattern of 32 normal term subjects. Artificial membrane rupture was performed early in labour in 16 gravidas and to induce labor in the others. In only 1 fetus was no specific alteration of the heart rate pattern recorded. The type and incidence of fetal heart rate pattern alterations observed during and within 1 h after low amniotomy were comparable in laboring and induced gravidas. The most frequently observed patterns were short-lived FHR acceleration and increased band-width. Short-lived bradycardia was recorded in only 4 patients after amniotomy. The majority of the alterations observed were not indicative of fetal distress as a direct result of artificial membrane rupture.

Female↗

PubMed1987

Visual evoked potential in the management of pituitary tumor during pregnancy.

We examined a pregnant woman with chiasmal syndrome in the late stage of pregnancy. Her vision was determined to be seriously threatened after 31 weeks' gestation. Study of the latency of preoperative visual evoked potentials (VEPs) in other patients with pituitary tumor showed that insofar as latency is not delayed, surgical decompression is expected to be followed by functional improvement of the optic pathway. We monitored optic nerve function by serially recorded VEPs, and labor was induced at 38 weeks because there had been no delayed response up to that time. After a decompressive operation, visual field and visual acuity recovered normally. Serially recorded VEPs can provide a useful monitor along with visual field and acuity tests in guiding therapy for a patient with threatened vision in late pregnancy and in determining whether or when to induce labor.

Adenoma↗

PubMedDate not supplied

Herbal medicine in pregnancy and childbirth.

Pregnant women often use medicinal herbs in an effort to maintain good health and reduce the need for medical intervention. A survey of the scientific and popular literature identified a number of therapeutic herbs used in North America. Three categories are discussed: tonics, herbs for preventing miscarriage, and herbs for inducing labor. Some of these preparations may address women's needs in ways that biomedicine has failed to do. Purported merits and hazards of these medications are discussed.

Abortion, Spontaneous↗

PubMed1983

Induction of labor with oral prostaglandin E2 tablets in high-parity patients.

Labor was induced with two low-dose regimens of prostaglandin E2 (PGE2) tablets in 46 high-parity women at term who had singleton pregnancies with a success rate of 97.8%. Of the successfully induced patients, 42 had vaginal delivery and three were delivered by cesarean section for cephalopelvic disproportion. There was one failure of induction. Both dose regimens (0.5 mg and 0.75 mg hourly) were equally effective in inducing labor. The pattern of labor and mean induction-delivery interval of 5.8 h was similar to a comparable group of high-parity patients with spontaneous labor. It appears from this study that induction of labor with PGE2 tablets is safe in high-parity patients.

Administration, Oral↗

PubMed1987

[Cervix ripening using drugs before oxytocin labor induction. Clinical study of a new prostaglandin E2 triacetin gel].

In an open randomized clinical study, 50 of 100 gravidae with a low Bishop score (less than or equal to 5) at term were treated with prostaglandin E2 (0.5 mg PGE2 in 2.5 ml Triacetin gel. Prepidil, intracervically) 12 hours before the indicated i.v. oxytocin induction. In 50 patients labor was induced intravenously without any pretreatment. In 46 of 50 pretreated women (92%) there was an increase in the Bishop score of at least three points, and of only two points in the remaining four. In the control group no significant increase in the Bishop score was measurable. Sixteen patients delivered within the first 12 hours after PGE2 gel administration, before oxytocin induction. Three women in the untreated control group also delivered during this pre-observation period. In 14 (64%) of 22 women in whom cervical priming with PGE2 was performed and 26 (57%) of 47 patients in whom it was not the first intravenous oxytocin induction was successful. The frequency of cesarean sections was 10% (n = 5) in the PGE2 gel group and 12% (n = 6) in the oxytocin group. The oxytocin dose needed to induce labor was significantly lower after cervical priming. No severe side effects were observed during and after PGE2 treatment, in either the mothers or the children.

Cervix Uteri↗

PubMed2006

Cumulative economic implications of initial method of delivery.

OBJECTIVE: To examine the cumulative costs of hospital care in the first and subsequent pregnancies associated with different methods in the initial delivery of nulliparous women. METHODS: An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared cumulative delivery costs in the first and subsequent pregnancies. Women were identified by initial method of delivery for nulliparous women with singleton cephalic presentation at term undergoing spontaneous or induced labor for planned vaginal delivery, and for nulliparous women undergoing cesarean delivery without labor. Costs that were assessed included nursing hours in antepartum, labor and delivery, postpartum and neonatal intensive care units, physician costs, labor induction agents, consumables, and costs for postpartum hysterectomy, tubal ligation, and dilatation and curettage. RESULTS: A total of 27,613 pregnancies satisfied inclusion and exclusion criteria. When cumulative costs by type of labor at first delivery were considered, induction of labor (7,220 dollars) was more costly than spontaneous onset of labor (6,919 dollars, P = .006). The cumulative costs of assisted vaginal delivery at first delivery (7,288 dollars) and cesarean delivery in labor at first delivery (9,524 dollars) were similar in magnitude and were higher than spontaneous vaginal delivery at first delivery (P < .001). Cesarean delivery in labor in the first delivery was the most costly type of delivery (9,524 dollars), and the differences in cost increased with increasing number of deliveries (P < .05). CONCLUSION: Cesarean delivery in labor in the first delivery is associated with increased cumulative costs compared with other methods of delivery, regardless of the number or type of subsequent deliveries.

Adult↗

PubMed1983

The impact on labor induction of intracervically applied PGE2-gel, related to gestational age in patients with an unripe cervix.

In 54 patients with an unripe cervix in late third trimester, in which gestational age had been properly determined by repeated ultrasound scannings, labor was induced by intracervical application of 0.5 mg PGE2 in viscous gel. It was found that the outcome of the induced labor was not related to the gestational duration, but to the pre-inductive cervical score. Thus, the number of successful inductions was smaller and induction-delivery time longer, the lower the cervical score. Moreover, instrumental deliveries occurred most frequently in nulliparous women, with a low pre-inductive cervical score. Taking into consideration the difficulties of labor induction in the present type of patient, the overall proportion of instrumental deliveries (17%, including 7% cesarean sections) was low. No maternal or fetal side effects were observed. It is concluded that intracervical application a small dose of PGE2 in gel can be recommended for cervical priming and labor induction in pre- and post-term pregnancy.

Adult↗

PubMedDate not supplied

[Tokolysis and dose-dependent effects of beta-blocking with atenolol in the rabbit].

In 11 pregnant rabbits we induced labor by parenteral infusion of Dinoprost (F2) (0.05 mg/min). By application of Fenoterol (0.01 mg/min) we had complete labor inhibition (P). Increasing dosages of Atenolol (T1 = 0.05 mg/min, T2 = 0.10 mg/min, T3 = 0.25 mg/min) followed. We registered systolic, diastolic and mean blood pressure directly after punction of a femoralis, cardiac frequency, and labor by integration of action potentials of uterus. Cardiac frequency decreased with increasing amounts of Atenolol. Mean blood pressure fell significantly under Fenoterol medication. There is no further decrement by additional application of high dosages of Atenolol. A certain dosage of Atenolol could be defined, that does not increase labor activity under Fenoterol medication but does decrease cardiac frequency without influence on mean blood pressure.

Animals↗