Cerebrospinal fluid and plasma concentrations of oxytocin and vasopressin during parturition and vaginocervical stimulation in the sheep

Simultaneous blood and cerebrospinal fluid (CSF) samples were taken from conscious sheep before, during and after parturition. Concentrations of plasma and CSF oxytocin were significantly elevated during contractions and particularly at birth. Mean prepartum CSF concentrations of oxytocin were around 55% of those found in plasma but postpartum they were up to 2-fold higher than those in plasma. Plasma concentrations of oxytocin were only significantly elevated, compared to prepartum levels, for 15 min postpartum whereas those in CSF were increased for the whole of the 120 min postpartum sampling period. Plasma, but not CSF, concentrations of arginine-vasopressin (AVP) were significantly raised during contractions and birth, and for 15 min postpartum. During the prepartum period CSF AVP concentrations were 67% of those found in plasma whereas at birth plasma levels were 10-fold higher than in CSF. In a separate experiment it was shown that 5 min of mechanical vaginocervical stimulation also stimulated significant increases in CSF and plasma oxytocin concentrations and in plasma vasopressin. Results support previous work suggesting an important role for central oxytocin release in the postpartum induction of maternal behavior and demonstrate that elevated concentrations of oxytocin in the CSF are present for a greater period than in blood. Elevated plasma AVP concentrations during contractions, birth or vaginocervical stimulation may be stimulated by stress associated with these stimuli.     

Development of nocturia in relation to health, age and the menopause

Objectives:To analyse the relationship between nocturia, age, the menopausal transition, parturition and hormone replacement treatment (HRT) in women.Material and methods:A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about health, the occurrence of somatic diseases and symptoms, habits, health care and medication.Results:In univariate analyses age, menopausal state and HRT, but not parturition, were associated with increased nocturia. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes versus no more than one episode were: health, poor versus good 2.9 (2.1–3.8); <5 years after the menopause versus before 1.8 (1.3–2.5); 5–9 years after the menopause versus before 2.1 (1.5–3.0); ≥10 years after the menopause versus before 3.1 (2.3–4.2). Age and HRT were deleted by the logistic regression model.Conclusion:The present data indicate that menopausal state, but not age, parturition and HRT are independent correlates of nocturia in 40–64-year-old women.     

Birth ball use for women in labor: A systematic review and meta-analysis

ObjectiveTo evaluate, with the best level of evidence, the possible benefits of using birth balls during labor in maternal and neonatal outcomes.MethodsThis research was made using MEDLINE/PubMed, LILCAS, CINAHL, CENTRAL, and SCOPUS databases, with no period or language restrictions. The terms "labor" and "birth ball" were used. Clinical trials (randomized and non-randomized) were included when compared a group with parturients using birth ball with control group under usual care. The following primary outcomes were: maternal outcomes: pain intensity; length of first and second stage; perineal trauma and episiotomy. Neonatal outcomes: APGAR score, admission to neonatal intensive care unit and delivery room resuscitation. The quality of evidence was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applies whenever possible.ResultsSeven studies were included. The pain outcome showed differences in the subgroups of 20/30 min on the birth ball (mean difference) −1,46; 95% Confidence Interval: 2,15 to −0,76, p < 0.0001), 60 min (mean difference −1,95; 95% Confidence Interval: 2,68 to −1,22; p < 0.00001) and 90 min (mean difference −1,72; 95% Confidence Interval: 2,44 to −1,00; p < 0.0001), based in a moderated quality of evidence. Other outcomes did not showed differences between groups after the interventions, with a low and very low level of evidence.ConclusionsUse the birth ball reduced pain after 20–90 min of use and there was no difference in the other outcomes. The low quality of the studies included in this meta-analysis suggests that new trials with better methodology quality are necessary.     

First Demonstration of an Increased Serum Level of Reactive Oxygen Species During the Peripartal Period in the Ewes

Reactive Oxygen Species (ROS) are produced during oxidative metabolism, and regulate many biological processes. The acute inflammation characterizing parturition induces many physiological changes. Among them, there is evidence that ROS affect the synthesis of many factors involved in parturition. Our study aims to determine serum levels of ROS in periparturient ewes, as well as to establish a value of reference of their physiological concentration.

ROS determination was performed on blood collected every 12 hours in periparturient twin pregnant ewes. Our results will show a significant increase in ROS concentrations from the beginning to the end of the experiment. This increase may be due to the inflammatory process establishing during parturition.     

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study

ObjectivesTo describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.MethodsA convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.ResultsEighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.ConclusionsFear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.     

巨大儿的影响因素及其产前预测

目的探讨巨大儿的影响因素,为临床产前预测巨大儿及选择恰当的分娩方式提供理论依据。方法选择2012年1月至12月于广东省佛山市妇幼保健院产科住院分娩的10 174例产妇中的429例分娩巨大儿（出生体质量≥4 000g）产妇的临床资料为研究对象,并纳入观察组（n=429）;选择同期于本院住院分娩的429例分娩正常足月儿（出生体质量为2 500-4 000g）产妇的临床资料纳入对照组（n=429）。本研究遵循的程序符合广东省佛山市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。分析2007-2012年本院巨大儿发生率变化情况。比较两组产妇基本情况（年龄、身高、产次）、分娩前情况（分娩前末次宫高、腹围、妊娠图曲线异常）、体质量变化情况（孕龄为20孕周时体质量、孕期增重、分娩时体质量）、胎儿情况（胎儿双顶径、股骨长）、妊娠期并发症发生情况[是否合并羊水量过多、妊娠期糖尿病（GDM）等]及分娩情况（分娩孕龄、分娩方式、新生儿Apgar评分结果异常）等因素。结果广东省佛山市妇幼保健院2007-2012年巨大儿发生率呈逐年递增趋势。观察组产妇年龄、身高、分娩孕龄、产次、孕龄为20孕周时体质量、分娩时体质量、孕期增重、宫高、腹围、妊娠图异常曲线、胎儿双顶径、股骨长及合并羊水量过多和及GDM发生率均显著高于对照组,两组比较,差异有统计学意义（P〈0.05）。观察组产妇所分娩男性新生儿发生巨大儿的风险是女性的1.84倍。观察组剖宫产率为69.5%,显著高于对照组（30.8%）,两组比较,差异亦有统计学意义（P〈0.05）。结论产妇年龄、身高、体质量、分娩孕龄、产次、宫高、腹围、合并羊水量过多或（和）GDM是产前诊断巨大儿的影响因素。重视妊娠图曲线?     

第二产程手膝俯卧位分娩对高龄初产妇分娩控制感及分娩结局的影响

【目的】探讨第二产程手膝俯卧位分娩对高龄初产妇分娩控制感及分娩结局的影响。【方法】选择2016年7月至2017年12月本院诊治的高龄初产妇148例,按照随机数表法分为观察组和对照组,每组74例。对照组产妇第二产程采用常规仰卧体位,观察组采用手膝俯卧位,比较两组产妇分娩控制感量表(LAS)、视觉模拟疼痛量表(VAS)、视觉模拟焦虑量表(VAS^A)及分娩结局。【结果】观察组LAS、VAS、VAS^A评分均明显低于对照组(r=12.686,11.322,15.078,P<0.01);第二产程时间明显短于对照组,产后2h出血量明显少于对照组(t=9.496,8.174,P<0.05);自然分娩率、会阴完整率明显高于对照组(90.54%vs75.68%,20.27%vs8.11%)(χ^2=5.824,4.495,P<0.05)。【结论】第二产程手膝俯卧位能缓解高龄初产妇焦虑和疼痛程度,提高分娩控制感,改善分娩结局,值得临床推广应用。     

人工流产术对分娩的影响

目的 探讨人工流产术后再妊娠分娩对产妇的影响.方法 对我院2003年1230例经阴道分娩者就人工流产史、人工流产后再次妊娠的时间、人工流产的次数对产妇分娩时的影响进行了观察.结果 有人工流产史者,胎盘粘连的发生率较高;人工流产术后再次妊娠的时间间隔越短,胎盘粘连的发生率越高;人工流产的次数增加,胎盘粘连的发生率增加;且有人工流产史者其产后出血的发生率较高.结论 人工流产术后对再妊娠分娩有不利影响,是引起胎盘粘连的原因之一,并且也是引起产后出血的原因之一.因此,应积极做好计划生育宣传,尽可能做到首次妊娠分娩,以减少胎盘粘连及产后出血的发生,提高产科质量.     

电子胎心监护Ⅱ类图形反复性变异减速产妇分娩终止时限对新生儿结局的影响

目的 探讨电子胎心监护(EFM)Ⅱ类图形反复性变异减速(VD)产妇的分娩终止时限对新生儿结局的影响.方法 选择2015年1月1日至2018年12月31日在北京市通州区妇幼保健院住院分娩,并且胎儿心率出现EFMⅡ类图形反复性VD的829例产妇为研究对象.其中,胎儿心率发生轻、中、重度反复性VD的产妇分别为392、246及...