Traditional analgesic agents: are parenteral narcotics passé and do inhalational agents still have a place in labour?

Systemic labour pain treatment with opioids and inhaled nitrous oxide has for many decades frequently been used in medically developed countries. Self-administered nitrous oxide (50% in oxygen) has never gained the same popularity in the USA as in the UK or Scandinavia but the use of opioids, mainly pethidine, has generally been widespread in spite of well-known negative effects on the postnatal adaptation of the newborn. Since the often very intense labour pain seems to respond very poorly even to highly sedating doses of parenteral opioids, their frequent use during delivery and parturition has to be questioned. Self-administered inhalation of nitrous oxide 50% in oxygen also has a limited efficacy for relieving labour pain but because it is mainly devoid of adverse effects on the baby or on the parturient its future use in obstetrics can be defended more easily, either as a sole agent in women with low labour pain scores or in early labour preceding epidural analgesia.     

Oral agents for ovulation induction – clomiphene citrate versus aromatase inhibitors

The purpose of this review is to compare clomiphene citrate (CC) with aromatase inhibitors (AI) as the first-line therapy for WHO Group II (eu-oestrogenic) infertility. For the past 45 years CC has been the first-line therapy, as it is a simple, cheap treatment, almost devoid of side effects, and yields ovulation in 73%, pregnancy in 36% and a singleton live birth rate of 25%. The gap between ovulation and pregnancy rates has mainly been attributed to its anti-oestrogen effects on endometrium. AI block oestrogen production, not oestrogen receptors, and would therefore be expected to produce superior conception rates and less multiple pregnancies. AI have yet to undergo further large, robust clinical trials in order to fulfill this promise as a feasible alternative to CC in this role, but some preliminary trials have shown at least equality and some superiority.     

Is a cause of postpartum hemorrhage of using of tocolytic agents in preterm delivery?

Objective: Tocolytic agents are used to inhibit uterine contraction in preterm. The authors undertook this study to determine whether using of tocolytic agents before delivery is associated with increase postpartum hemorrhage in preterm delivered women.

Method: 296 singleton pregnancies delivered preterm from 24?+?1 to 37?+?0 weeks gestation were retrospectively reviewed. Hemoglobin (HB) and hematocrit (HCT) levels were checked before and after delivery to access postpartum blood loss. Multivariate logistic regression analysis was performed to determine whether delivery within the half-lives of tocolytic agents was associated with decreased HB and HCT levels.

Results: After adjusting for maternal age, parity, gestational age at delivery, birth weight, delivery method, and induction of labor, postpartum HB and HCT levels of those delivered within half-lives of tocolytic agents were found to be significantly diminished (HB: OR 3.306, 1.308–8.356 95% CI, p?=?0.011; HCT: OR 2.692, 1.077–6.726 95% CI, p?=?0.034). In addition, blood transfusion rates were elevated for deliveries made within the half-lives of tocolytic agents, (p?=?0.006).

Conclusions: Delivery within half-lives of tocolytic agents was found to be associated with low HB and HCT levels after delivery and higher blood transfusion rates in preterm delivered women.     

Adhesion reduction agents in gynaecological procedures: can NHS aff ord it? An economic cost efficiency analysis

We examined the total costs to the National Health Service (NHS, UK) paid to treat adhesion complications and determine the theoretical savings and cost-effectiveness incurred if anti-adhesion agents were adopted. Using Healthcare Resource Groups (HRG) codes, we calculated the costs incurred through Payment by Results (PbR) and then calculated the financial savings that could be realised through the use of anti-adhesion agents. There were 62,186 adhesion-related consultant episodes between 2004 and 2008 encountered within the NHS. If an anti-adhesion agent cost ￡110 per usage, and can reduce adhesions in 25% of patients undergoing surgery, assuming that 25% of patients were readmitted in the first year after the primary surgery, the financial cost to the health service is, at best, savings of more than ￡700,000 and at worst, cost neutral to the NHS.     

The effect of anesthetic agents for oocyte pick-up on in vitro fertilization outcome: A retrospective study in a tertiary center

ObjectiveGeneral anesthesia is used in most in vitro fertilization (IVF) clinics for oocyte pick-up (OPU), however, there is no consensus on type of anesthetic agent use among clinicians performing OPU. Therefore, we aimed to evaluate the effects of propofol, ketamine, or combination of propofol and ketamine (P + K) for OPU on IVF outcome.Material and methodsThree hundred and thirty three women (n = 333) undergoing IVF treatment were retrospectively included and were evaluated in three groups depending on whether they received propofol (n = 217), or ketamine (n = 60), or P + K (n = 56) for anesthesia during OPU.ResultsBaseline characteristics and duration of anesthesia of each group were comparable except lower motile sperm percentage in the ketamine group compared to the propofol group (p = 0.002). Fertilization rate (FR) was decreased with ketamine compared to propofol (p = 0.013) and P + K (p = 0.008). After adjustment for sperm motility, this negative effect of ketamine on FR persisted. Implantation, clinical pregnancy, take-home baby rates, and oocyte retrieval parameters (number of total retrieved oocyte, metaphase II oocytes, embryo and methaphase II rate, and embryo quality) did not differ between the groups. Extended anesthesia duration (>30 min) was associated with low implantation (p = 0.04) and clinical pregnancy rates (p = 0.02).ConclusionKetamine use during OPU can affect FR compared to propofol and P + K. Long durations of anesthesia also seem to decrease implantation and clinical pregnancy rates.     

Meta-analysis of data from human ex vivo placental perfusion studies on genotoxic and immunotoxic agents within the integrated European project NewGeneris

In the E.U. integrated project NewGeneris, we studied placental transport of thirteen immunotoxic and genotoxic agents in three ex vivo placental perfusion laboratories. In the present publication, all placental perfusion data have been re-analyzed and normalized to make them directly comparable and rankable. Antipyrine transfer data differed significantly between the studies and laboratories, and therefore normalization of data was necessary. An antipyrine normalization factor was introduced making the variance significantly smaller within and between the studies using the same compound but performed in different laboratories. Non-normalized (regular) and normalized data showed a good correlation. The compounds were ranked according to their transplacental transfer rate using either antipyrine normalized AUC120 or transfer index (TI120(%)). Normalization generated a division of compounds in slow, medium and high transfer rate groups. The transfer rate differed slightly depending on the parameter used. However, compounds with passage similar to antipyrine which goes through the placenta by passive diffusion, and good recovery in media (no accumulation in the tissue or adherence to equipment) were highly ranked no matter which parameter was used. Antipyrine normalization resulted in the following ranking order of compounds according to AUC(120NORM) values: NDMA ≥ EtOH ≥ BPA ≥ IQ ≥AA ≥ GA ≥ PCB180 ≥ PhIP ≥ AFB1 > DON ≥ BP ≥ PCB52 ≥ TCDD. As the variance in all parameters within a study decreased after antipyrine normalization, we conclude that this normalization approach at least partially corrects the bias caused by the small methodological differences between studies.