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PubMed1998

Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or Cesarean section.

The aim of the present study was to investigate if personality profiles reflecting anxiety and social interaction of mothers who delivered by Cesarean section (CS) or by the vaginal route (VD) differed in early postpartum and to investigate whether these personality traits were correlated with hormonal data. Seventeen women delivered by emergency CS and 20 by the vaginal route were selected for this study. The amount of milk transferred to the baby was measured. Blood samples were collected during the second breast-feeding on the second day after delivery. The samples were analysed for oxytocin and prolactin. After breastfeeding, the mothers were asked to fill in the personality inventory, Karolinska Scales of Personality (KSP). The scores were compared between the two groups and with a normative group of women. Each scale on the personality inventory was correlated with hormonal parameters. The KSP showed significant differences between the delivered mothers and the normative group in variables related to anxiety and socialization. The VD mothers deviated more than the CS mothers from the normative group. Correlations with hormonal data indicated that anxiety was inversely related with basal levels of oxytocin and prolactin in the CS mothers, whereas the pulsatility of oxytocin was related to social desirability in both groups. Social desirability and oxytocin pulsativity were also correlated with the amount of milk transferred from the mother to the baby. The correlations indicate that central oxytocin, as reflected by basal plasma levels and patterns, may be involved in behavioral adaptations to the maternal role.

Adult↗

PubMed2005

Pregnancy complicated by Myasthenia gravis - twelve years experience.

OBJECTIVE: The aim of the study was to evaluate the effect of Myasthenia gravis (MG) on the course of pregnancy, labor and delivery, and the condition of neonate. DESIGN AND SETTINGS: Retrospective chart review of pregnant patients with MG hospitalized in tertiary care center over 12 year period was performed. Course of MG before and during pregnancy, mode of delivery, and condition of the newborn were analyzed. RESULTS: There was 42 913 deliveries in the Polish Mother's Research Institute in Lodz during analyzed period. Thirteen patients with MG were identified, giving the incidence of 3/10 000 live births. Mean age of the patients was 28 years, range 18 - 36 years. Average time since diagnosis was 9 years. Eleven women with MG delivered at term (one twin pregnancy), and two babies were born prematurely. In seven patients pregnancy was ended via normal spontaneous vaginal delivery (NSVD), one was forceps extraction, four patients had elective Cesarean Section (CS), and two had emergency CS. Indications for CS were purely obstetrical. Spontaneous vaginal deliveries were speedy. None of the patients had exacerbation of MG during current pregnancy. Mean birth weight of the newborns was 3014,3 g, range 1730 g to 3700 g. Mean Apgar score was 8,7 at 1 minute and 8,9 at 5 minutes. Only one neonate (second twin) developed Transient Neonatal Myasthenia Gravis (TNMG). CONCLUSIONS: Myasthenia gravis did not have significant effect on the course of pregnancy or mode of delivery. In the twin pregnancies it is possible that only one twin will present with the symptoms of TNMG.

Adolescent↗

PubMed2003

Comparison of potassium currents in human decidua before and after the onset of labor.

The human decidua plays a prominent role in the signaling between maternal and fetal tissues. It also secretes a plethora of molecules that modulate uterine function. Ion-channel activity underpins many cellular functions; however, the channels in human decidua have not been characterized in any detail. We have used the whole-cell recording mode of the patch-clamp technique to carry out current-clamp and voltage-clamp recordings of membrane properties and whole-cell potassium (K+) currents of freshly isolated decidual stromal cells. Decidual tissue was obtained from women after spontaneous vaginal delivery (SVD) or elective cesarean section (CS). Cells from both groups generated action potentials, the overshoots and durations of which were dependent on extracellular calcium levels, inhibited by cobalt and enhanced by barium. Potassium current (IK) density was higher in the CS than in the SVD group. Outwardly directed currents were heterogeneous with respect to their activation/inactivation profiles and exhibited outward rectification. The main difference between the SVD and CS group was the presence of a sustained current component in CS cells that is tetraethylammonium chloride-resistant and appears to be unaffected by E-4031. No evidence for the activation of any calcium-activated K+ currents was obtained. We propose that human parturition is associated with subtle changes in K+ channel remodeling, reflecting the transition from uterine quiescence to activation and stimulation. An understanding of the signal transduction events underlying these process may eventually lead to novel approaches to prevent preterm labor via decidual rather than myometrial intervention.

4-Aminopyridine↗

PubMed1993

Endothelin 1-21 plasma levels on the first and fourth postpartum day in normal full-term neonates.

Endothelins (ETs), recently discovered and highly vasoactive substances, have been implicated in the pathogenesis of various perinatal problems, such as preeclampsia, intrauterine growth retardation, intraventricular hemorrhage, pulmonary hypertension and necrotizing enterocolitis. Although fetal ET levels have been measured at birth, reference ET values for healthy newborns in the first days of life have not been established. The purpose of this study was to determine in normal healthy neonates ET 1-21 plasma values on day 1 and 4 postpartum and to investigate possible changes after adaptation of the newborn to extrauterine life. The study comprised 20 healthy full-term neonates, born after vaginal delivery (n = 10), or cesarean section (CS; n = 10) because of a previous CS. Venous blood was drawn on day 1 and 4 from all neonates and ET 1-21 levels were determined in the plasma by radioimmunoassay (Amersham kit RPA 5559). ET 1-21 values were on day 1 11.83 +/- 2.39 pmol/l (n = 20) and on day 4 9.45 +/- 1.88 pmol/l (n = 20). The statistical analysis showed a significant reduction of plasma ET levels on day 4 (p = 0.004), but no influence of the mode of delivery on plasma ET levels. In conclusion irrespective of the mode of delivery the high ET 1-21 plasma levels on day 1 postpartum are significantly reduced on day 4 of life.

Cesarean Section↗

PubMed2000

[Application of Hyaluricht in the treatment of wounds].

The aim of the present study is to evaluate the effectiveness of the drug Hyaluricht-Richter in the treatment of uncomplicated and complicated wounds in the obstetrical surgical practice. 54 women were included in the study. 47 of them were operated with Cesarean section (CS) and there were 7 cases were parlus normalis with episiotomy. The operative wounds of 30 of the patients with CS were clinically clean while the rest 17 were contaminated. All 7 episiotomies were problematic. The treatment of the wounds was performed 4 times daily in minimum beginning from the 2-3 postoperative day. In all problematic cases the treatment ended with limited complications, healing of the partial cicatricle dehiscence, elucidation of wound secretions, fast and new granulation and healing per secundam for about 10 days. Hyaluricht has a definite antiexudative, vasoprotective and fibrinoprotective effect. The drug is easy for application, it does not irritate the skin and it is suitable in the ambulatory practice for treatment of uncomplicated wounds and some selected problematic wounds.

Adult↗

PubMed1993

Protein kinase-C stimulatory activity in human amnion cytosol.

Cytosolic preparations from human amnions at term were tested for the presence of endogenous modulators of protein kinase-C (PKC) activity. Tissues were obtained from 14 patients undergoing cesarean section (CS) and 14 patients after spontaneous delivery (SL). PKC activity was significantly greater in cytosols from CS than SL amnion (1.65 +/- 0.04 vs 0.73 +/- 0.2 pmol/min, respectively; mean +/- SE; n = 14 CS; n = 14 SL; P < 0.05). When amnion cytosols were mixed with a control preparation of PKC (rat brain cytosol partially purified on diethylaminoethyl), PKC activity was significantly increased compared to the control value (control, 12.81 +/- 2.1; control + CS, 22.19 +/- 1.5; control + SL, 21.98 +/- 0.7 pmol/min). The stimulation of PKC was dose dependent. The PKC stimulatory factor in amnion cytosol was stable to heat treatment at 80-90 C for 2 min (control + heat-treated CS, 23.20 +/- 1.2; control + heat-treated SL, 24.49 +/- 1.0 pmol/min) and substituted for phosphatidylserine and diacylglycerol in the PKC assay (control, no lipids, 0.05 +/- 0.04 pmol/min; control + amnion cytosol, no lipids, 9.60 +/- 1.06 pmol/min). The PKC stimulatory factor was calcium dependent, was not extractable in organic solvents, and was greater then 100,000 mol wt. Thus, the human amnion contains a PKC stimulatory factor which may modify or mediate the cellular response to extracellular stimulators of the PKC pathway.

Amnion↗

PubMed2006

Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study.

BACKGROUND: Over the past decade, about one-third of all births nationwide in Taiwan were delivered by cesarean section (CS). Previous studies in the US and Europe have documented the need for risk adjustment for fairer comparisons among providers. In this study, we set out to determine the impact that adjustment for patient-specific risk factors has on CS among different physicians in Taiwan. METHODS: There were 172,511 live births which occurred in either hospitals or obstetrics/gynecology clinics between 1 January and 31 December 2003, and for whom birth certificate data could be linked with National Health Insurance (NHI) claims data, available as the sample for this study. Physicians were divided into four equivalent groups based upon the quartile distribution of their crude (actual) CS rates. Stepwise logistic regressions were conducted to develop a predictive model and to determine the expected (risk-adjusted) CS rate and 95% confidence interval (CI) for each physician. The actual rates were then compared with the expected CS rates to see the proportion of physicians whose actual rates were below, within, or above the predicted CI in each quartile. RESULTS: The proportion of physicians whose CS rates were above the predicted CI increased as the quartile moved to the higher level. However, more than half of the physicians whose actual rates were higher than the predicted CI were not in the highest quartile. Conversely, there were some physicians (40 of 258 physicians) in the highest quartile who were actually providing obstetric care that was appropriate to the risk. When a stricter standard was applied to the assessment of physician performance by excluding physicians in quartile 4 for predicting CS rates, as many as 60% of physicians were found to have higher CS rates than the predicted CI, and indeed, the CS rates of no physicians in either quartile 3 or quartile 4 were below the predicted CI. CONCLUSION: Overall, our study found that the comparison of unadjusted CS rates might not provide a valid reflection of the quality of obstetric care delivered by physicians, and may ultimately lead to biased judgments by purchasers. Our study has also shown that when we changed the standard of quality assessment, the evaluation results also changed.

Adolescent↗

PubMed1996

The occurrence of placental abruption in Norway 1967-1991.

STUDY OBJECTIVE: To study secular trends of placental abruption (PA), the effects of demographic variables and the use of cesarean section (CS) associated with PA. DESIGN: A population based cohort study. SETTING: The Medical Birth Registry of Norway. PATIENTS: 9,592 cases of PA of a total of 1,446,154 births notified, i.e. all births in Norway 1967-1991. MAIN RESULTS: The PA proportion was 6.6 per 1000 births of a gestational age of 16 weeks or more, ranging from 5.3 in 1971 to 9.1 in 1990. Birth order two had the lowest proportion and it increased by maternal age. The PA proportion decreased by gestational age from 86.4 per 1000 below 28 weeks to 3.4 in term pregnancies. The PA proportion per 10,000 pregnancies at risk increased from 1.3 in the 28th week to 14.1 in the 42nd week. A secular trend of a decreasing but still high relative risk of PA in SGA-births at any gestational age increased from 1967 through 1991. The relative risk of PA of Apgar score <7 after five minutes, adjusted for gestational age, was 7.8. CONCLUSIONS: Inspite of an increasing CS rate, an increasing proportion of PA was noted from 1967 through 1991. The proportion was lowest for birth order two and increased by maternal age. To an increasing extent, PA births were centralized. SGA, prematurity and asphyxia were major problems associated with PA. A tendency towards larger infants and a decreasing relative risk of PA in SGA-births might be attributable to improvements in antenatal care.

Abruptio Placentae↗

PubMed2004

Are health expectations of term breech infants unrealistically high?

BACKGROUND: The aim of this study was to compare the effect of fetal presentation and mode of delivery on infant outcome in a nation-wide study. METHODS: In a retrospective observational cohort study, we compared, with the help of Finnish Medical Birth Register and other nation-wide registers, the short-term and long-term outcome of infants born by breech vaginal (n = 1270) or by vertex vaginal delivery (n = 128,683) or through planned cesarean section (CS) in breech (n = 1640) or vertex (n = 4997); the pregnancies were otherwise entirely normal. RESULTS: One perinatal death occurred in the breech vaginal group and 23 deaths in the vertex vaginal group (p = 0.112), but none in either CS group. Breech vaginal delivery was associated with increased risk of Apgar scores 6 or less at age 1 min (OR 7.65, CI 6.41-9.12) and at age 5 min (OR 6.42, CI 4.36-9.45) as compared with vertex vaginal delivery. These odd ratios were also elevated (OR 4.59, CI 3.48-7.08 and OR 7.58, CI 3.09-18.66, respectively) when compared with breech planned CS. Yet the risk for birth trauma of infants in the breech vaginal group was smaller (OR 0.70, CI 0.51-0.96) than that in the vertex vaginal group but this risk was smallest in the planned CS groups. A number of other neonatal complications occurred equally commonly in each group. Breech infants born vaginally needed fewer admissions (OR 0.58, 0.47-0.72) to out-patient departments and the cumulative incidence of long-term morbidity in the breech vaginal group was smaller (OR 0.47, CI 0.28-0.80) to the age of 7 years than that in the breech planned CS. The maturity for starting school and school performance during the first two school years showed no dependence on mode of delivery. CONCLUSION: Apart from Apgar suppression, elective vaginal delivery of a full-term breech fetus in highly selected pregnancies does not cause additional neonatal hazards as compared with full-term vertex deliveries. The immediate outcome was best for breech or vertex infants born through elective CSs.

Apgar Score↗

PubMed1989

Plasma beta-endorphin levels in the umbilical cord blood of preterm human neonates.

Maternal venous (MV) and neonatal umbilical venous (UV) and umbilical arterial (UA) plasma beta-endorphin concentrations were measured at birth in two groups of patients undergoing cesarean section (CS). Patients in group 1 carried a term gestation (n = 12, birth weight 3,640 +/- 150 g, 1 SEM). Patients in group 2 (n = 12) carried a preterm gestation (birth weight 1,956 +/- 150 g). In the term neonate the UV and UA plasma beta-endorphin were 11.5 +/- 4 and 13.5 +/- 4 picomoles/liter, respectively. In the preterm neonate the UV and UA values were 23.6 +/- 4 and 23.5 +/- 5 picomoles/liter, respectively. Both values in the preterm neonate were significantly greater than the corresponding value in the term neonate (p less than 0.05). The MV plasma beta-endorphin did not significantly differ among the two groups. Data suggest that in preterm neonates increased plasma beta-endorphin levels occur at the time of birth.

Cesarean Section↗

PubMed2002

The effect of labor on maternal and fetal vitamins C and E.

OBJECTIVE: This study was conducted to compare maternal and fetal plasma, amniotic fluid, and chorioamnion levels of vitamins C and E in term (>38 weeks' gestation) subjects undergoing elective repeat cesarean section (CS) without labor with values of subjects of similar gestational age and dietary intake undergoing labor and vaginal delivery (VD). STUDY DESIGN: Healthy women undergoing elective repeat CS (n = 5) or uncomplicated VD (n = 5) at term (>38 weeks' gestation) were studied. For CS patients, maternal and fetal (cord) blood, amniotic fluid, and chorioamnion samples were collected at time of surgery. For VD patients, maternal blood and amniotic fluid were obtained at 5 cm cervical dilation and fetal cord blood and chorioamnion were collected at delivery. Each patient completed a nutritional questionnaire. Plasma and membrane vitamin E concentrations were determined by reversed-phase high-performance liquid chromatography and standardized to cholesterol or membrane protein, respectively. Vitamin C was determined with the use of the 2,4-DNPH method. RESULTS: Dietary intakes for vitamins C and E as well as maternal and fetal vitamin E plasma concentrations were similar for CS and VD patients. In both groups, maternal levels were higher than fetal levels(P <.05). Chorioamnion membrane vitamin E measurements in both groups were similar. Vitamin C concentrations in CS and VD patients were highest in amniotic fluid, lower in fetal plasma, and lowest in maternal plasma. However, mean vitamin C concentrations in maternal plasma, amniotic fluid, and fetal plasma of VD patients were significantly lower, being only 20% +/- 6%, 29% +/- 11%, and 22% +/- 2% of values obtained from CS patients. CONCLUSION: During labor in healthy women at term, uterine contractile activity may generate reactive oxygen species (ROS) through the process of repetitive ischemia and reperfusion. With the significant depletion of vitamin C during labor, we speculate that water-soluble vitamin C scavenges ROS in the aqueous phase and recycles lipid-soluble vitamin E to combat ROS-induced tissue damage.

Amnion↗

PubMed2004

Comparison of decidual leukocytes following spontaneous vaginal delivery and elective cesarean section in uncomplicated human term pregnancy.

The aim of this study was to quantify and compare leukocyte populations in term decidua basalis and parietalis obtained after spontaneous vaginal delivery (SVD) or elective cesarean section (CS) without labor. Decidua basalis and parietalis samples were obtained from placentas after SVD (n = 20) and after CS (n = 30). Following mechanical disaggregation, leukocytes were purified and stained with monoclonal antibodies. Percentages of leukocyte subclasses within the CD45(+) cell fraction and activated T cells were determined by flow cytometry. No differences were found in the percentages of CD45(+) cells or CD56(bright)CD16(-) uterine natural killer (NK) cells between decidua basalis from SVD and CS or between decidua parietalis from SVD and CS. In decidua basalis and parietalis from SVD, a significantly higher number of CD56(dim)CD16(+) NK cells was found compared to CS. In decidua basalis from SVD, there was a significantly lower percentage of CD14(+) cells and higher percentage of CD19(+) cells compared to CS. The percentage of CD3(+) T cells expressing CD25 or human leukocyte antigen (HLA)-DR was significantly decreased in decidua basalis and parietalis from SVD compared to CS. Comparison of decidua collected after SVD or CS suggests that labor is associated with dynamic changes in the distribution of decidual leukocytes, specifically NK and T cell subpopulations. In particular, the disappearance of the CD4(+)CD25(+) T cell population, which possibly contains a subpopulation of regulatory T cells, may contribute to the initiation of labor. Further investigation into factors affecting decidual leukocytes may expand our understanding of the immunological events at the maternal-fetal interface.

Antigens, CD↗

PubMed2003

PGE2 induction of labor for consistent decreased perception of fetal movements at term.

OBJECTIVES: To determine the effects of labor induction with vaginal prostaglandin E2 (PGE2) on mode of delivery and immediate neonatal outcome in women with consistent decreased perception of fetal movements at term. METHODS: The study group consisted of 115 women with consistent perception of decreased fetal movements admitted for induction of labor at term. Findings were compared with those of 510 women with normal spontaneous onset of labor. Women with previous cesarean section (CS) were excluded from both the study and control groups. RESULTS: The rate of CS was higher in the study group (14.8%) than in the control group (9%) (not significant). The rates of low 5-min Apgar score (<or=7) and CS performed for non-reassuring fetal heart rate were two-fold higher in the study group than in the control group (2.6% vs. 1.2%, and 6.1% vs. 3.1%, respectively, not significant in both). CONCLUSION: Induction of labor with PGE2 is successful in approximately 85% of the patients with decreased perception of fetal movements at term and apparently with no serious maternal or fetal complications. However, these pregnancies might be at higher risk of perinatal complications. We suggest that active labor induction may be currently considered as the preferred strategy in these pregnancies. Large prospective randomized studies on maternal and neonatal outcome are needed to clarify this issue.

Adult↗

PubMed1989

Fibronectin and postpartum infection in rabbits: an animal model.

A rabbit model was explored in preliminary studies of uterine colonization and infection, following cesarean section (CS), by toxigenic Staphylococcus aureus (Harrisburg) and other bacterial species known to be isolated from traumatized human uteri; effects on host susceptibility of fibronectin prophylaxis were studied. Histological characteristic and plasma fibronectin levels were recorded in double-blinded studies of four groups of rabbits (55 total), all sacrificed 96 h after CS performed at term. Animals which were inoculated without fibronectin prophylaxis, showed stable or slightly elevated plasma fibronectin levels through 96 h. Rabbits inoculated with nontoxigenic S. aureus (Wiley) exhibited stable fibronectin levels and less microscopic evidence of infection. All inoculated animals were colonized, but those that received fibronectin cryoprecipitate intravenously at CS showed less microscopic evidence of infection. Fibronectin levels for rabbits scores as 'seriously infected' were nearly 1.5 times that of controls. This is in contrast to other clinical studies in which chronic infections and poor clinical outcome have been strongly correlated with decreased plasma fibronectin levels. Histochemical studies of antifibronectin binding suggested that less fibronectin is deposited throughout the endometrial stroma of animals that received fibronectin prior to bacterial challenge. An increased polymorphonuclear leukocytic reaction in the stroma near the incisions was observed in animals that received fibronectin prophylaxis, with or without bacterial challenge. This reaction may be characterized as an acute-phase reaction.

Acute-Phase Reaction↗

PubMed2005

Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.

OBJECTIVE: The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. METHODS: A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. RESULTS: During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (<37 weeks gestation) and low birthweight (<2500 g) were found among patients with anemia as compared to the non-anemic women (10.7% versus 9.0%, p < 0.001 and 10.5% versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4% versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95% CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95% CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95% CI 1.1-1.2, p = 0.001). CONCLUSION: Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.

Anemia↗

PubMed2006

Neonatal respiratory morbidity after elective cesarean section.

OBJECTIVE: The objective of this study was to examine the rate of respiratory morbidity in neonates delivered by elective cesarean delivery (ECD) at term, with a definite confirmation of gestational age (GA) by 1st-trimester ultrasound. METHODS: Consecutive women carrying a singleton pregnancy and undergoing ECD at term (>38 1/7 weeks), confirmed by 1st-trimester ultrasound, were included in the study group. Multiple gestations, cesarean section (CS) in labor, CS performed after rupture of membranes and induced deliveries were excluded. The control group included women with a singleton pregnancy at term (>38 1/7 weeks) who delivered spontaneously. This group of women was randomly selected during the study period. RESULTS: The study group included 277 women delivered by ECD. The control group consisted of 311 women. Five newborns in the study group and none in the control group were admitted to the neonatal intensive care unit (NICU) due to respiratory disorders (p < 0.02). Excluding diabetic women did not change the results. On multivariate analysis, no other factors were found to independently influence the risk of respiratory complications. CONCLUSION: In our study, the rate of respiratory morbidity was found to be significantly higher in neonates delivered by ECD compared to those delivered vaginally. The fact that GA was confirmed by 1st-trimester ultrasound makes iatrogenic prematurity an unlikely sole cause for this excess morbidity.

Adult↗

PubMed2003

Nitric oxide: does it have an etiological role in pre-eclampsia?

AIM: To determine evidence of nitric oxide (NO) in decidual biopsies and fetal membranes of preeclamptic women. BACKGROUND: Nitric oxide, a potent vasodilator, has been postulated to have a role in the etiology of preeclampsia. Investigations in peripheral blood have led to conflicting results. We therefore decided to study whether immunohistochemically detectable nitric oxide is produced in the decidua and within the fetal membranes. METHODS: Forty-two pregnant women at 28 weeks gestation or more were enrolled. Twenty were normotensive and 22 had preeclampsia. Women with chronic hypertension, diabetes and multiple pregnancies were excluded. Maternal blood samples prior to cesarean section (CS), decidual biopsies during CS, and fetal membrane specimens were obtained. The tissue specimens were fixed immediately (after delivery of the baby and placenta) in formalin, washed, and embedded in paraffin. Immunohistochemical staining for nitric oxide synthases (NOS) I, II, III was performed and reviewed in conjunction with routine hematoxylin and eosin sections, using light microscopy. RESULTS: There was no statistically significant difference in the level of immunostaining of nitric oxide synthases in both normotensive and hypertensive patients. DISCUSSION: The severity of blood pressure did not influence expression of nitric oxide synthases.

Adult↗

PubMedDate not supplied

[Does the suture material and technique have an effect on healing of the uterotomy in cesarean section?].

The aim of the study is to present the influence of different suturing techniques and different materials (catgut plain, Dexon and Vicryl) on healing of lower transverse uterotomy (in further text uterotomy) in Cesarean section (CS). Uterotomies were sutured by four ways: one row interrupted (group A), one row continuous (group B), two rows interrupted (group C), two rows interrupted and continuous (group D). Uterotomies were classfied according to the material used for suturing into the catgut group, Dexon group and Vicryl group. Between January 1983 and December 2001 out of 7830 CSc 1946 (24.8%) patients had repeat deliveries: 1059 (55.0%) had a vaginal delivery and 887 (45.0%) repeat CS. In the same period out of 1946 deliveries 15 (0.8%) uterine ruptures-dehiscences (URD) were diagnosed. In catgut group out of 302 deliveries 11 (3.6%) URD were registered: nine (7.2%) in group D (N = 125) and two (1.7%) in group C (N = 20). No URD was diagnosed in group A (N = 57). In Dexon group (N = 226) URD were diagnosed regardless of the method of suturing the uterotomy. In Vicryl group out of 1486 deliveries four (0.28%) URD were registered: one (0.16%) in group A (N = 615), one (0.3%) in group B (N = 333), one (0.52%) in group C (N = 190) and one (0.35%) in group D (N = 280). The best uterine scar is the one after using one layer interrupted Vicryl and Dexon suture. The worst healing results were obtained after two-row interrupted and continuous sutures using catgut.

Cesarean Section↗