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Objective: To describe different methods used in termination of sec- ond trimester pregnancy in those with previous uterine scare(s) and compare their efficacy and safety at a tertiary care center. Patients and Methods: a prospective, randomizedcontrolled com- parative trial conducted at Mansoura University Hospitals, Egypt during February 2018 through March 2019 and involved 105 healthy pregnant women at 14-28 weeks of gestation diagnosed to have missed abortion or intrauterine fetal death with a previous one or more caesarean delivery (CD). They divided into 3 equal groups, GI; received misoprostolalone for termination of pregnancy via ei- ther vaginal or sublingual routes as 400 µg / 6 hours for pregnancy at 14- 20 weeks; 200 µg / 6 hours for pregnancy at 20 -25 weeks or 100 µg / 6hours at 26 -27 weeks; G (II) for whom a Foley’s catheter was inserted under complete aseptic precautions, passed beyond the internal os then its balloon inflated by 20-30 ml normal saline for pregnancy at 14 - 20 weeks; 40-50 ml for pregnancy at 20 - 27 weeks and its position was confirmed by TAS then oxytocin infusion was commenced after the catheter expulsion, GIII; involved women who received a combination of Foley’s catheter inserted intracervical and a misoprostol dose 200 µg for pregnancy from 14-20 weeks or 100 µg for those between 20-27 weeks that was dissolved in 30 ml saline and injected intrauterine through the catheter lumen. Any of the pre- vious method continued for 24 hours otherwise the fetus comes out earlier. All patients in the three groups received oxytocin infusion 20 units in 500 ml normal saline after fetal expulsion to avoid placental retention and post-abortive bleeding.The primary outcome was in- duction-to-abortion interval (IAI) plus the mean time (SD) needed for complete uterine evacuation. Results: The patients’ characteristics and baseline data for the three groups including the age, weight, gravidity, parity, duration of preg- nancy, number of previous scar(s) showed no significant difference (p > 0.05).Studying the mean (SD) of IAI/hourtogether with data ob- served after starting treatment and postoperative complications record- ed a significant difference among the three groups as regard IAI (being shortest in GIII;11.6 ±2.6, longest in GII; 17.3 ±3.4 and in between for GI;15.9 ±3.4 respectively; P< 0.001), the success rate (100% for GIII, 91.4 % for GI and 85.7% for GII, p 0.02) and the occurrence of diar- rhea being lowest in GII (no cases), highest in GI (5 cases) in compare to 1 case only recorded in GIII (P0.024). On the other hand, insignif- icant difference among the study groups was observed as regard the mean (SD) of time/minutes needed for placenta expulsion after the fetal descent being 31.09 ± 5.01, 27.8 ± 7.61 and 26.57 ± 12.17 for the three groupsrespectively, the occurrence of post induction nausea and vomiting, fever or post-evacuation bleeding (p> 0.05). Somecases needed MVA after placental expulsion (6 cases in GI, 7 cases in GII and 4 in GIII) but again with no significant difference. Conclusion:Combined use of misoprostol and Fo- ley’s catheter for termination of mid-trimester preg- nancy with previous uterine scar(s) is found more superior than the use of either method alone regard- ing the success rate and shorter duration with mini- mal non serious complications and side effects.

To characterise the occurrence of fever (≥38.0°C) after treatment for post-partum haemorrhage (PPH) with sublingual misoprostol 800 mcg in Latin America, where elevated rates of misoprostol's thermoregulatory effects and recipients' increased susceptibility to high fever have been documented.A prospective observational study in hospitals in Argentina enrolled consenting women with atonic PPH after vaginal delivery, eligible to receive misoprostol. Corporal temperature was assessed at 30, 60, 90 and 120 min post-treatment; other effects were recorded. The incidence of high fever ≥ 40.0°C (primary outcome) was compared to the rate observed previously in Ecuador. Logistic regressions were performed to identify clinical and population-based predictors of misoprostol-induced fever.Transient shivering and fever were experienced by 75.5% (37/49) of treated participants and described as acceptable by three-quarters of women interviewed (35/47). The high fever rate was 12.2% (6/49), [95% Confidence Interval (CI) 4.6, 24.8], compared to Ecuador's rate following misoprostol treatment (35.6% (58/163) [95% CI 28.3, 43.5], P = 0.002). Significant predictors of misoprostol-induced fever (model dependent) were as follows: pre-delivery haemoglobin 11.0g/dl, rapid placental expulsion, and higher age of the woman. No serious outcomes were reported prior to discharge.Misoprostol to treat PPH in Argentina resulted in a significantly lower rate of high fever than in Ecuador, although both are notably higher than rates seen elsewhere. A greater understanding of misoprostol's side effects and factors involved in their occurrence, including genetics, will help alleviate concerns. The onset of shivering may be the simplest way to know if fever can also be expected.Caractériser la survenue de fièvre (≥ 38,0°C) après traitement d'une hémorragie post-partum (HPP) avec du misoprostol sublingual à 800 mcg en Amérique latine, où des taux élevés d'effets thermorégulateurs du misoprostol et une sensibilité accrue des receveurs à une forte fièvre ont été documentés. MÉTHODES: Une étude observationnelle prospective dans des hôpitaux en Argentine a recruté des femmes consentantes atteintes d'HPP atonique après un accouchement vaginal éligibles pour recevoir du misoprostol. La température corporelle a été évaluée 30, 60, 90 et 120 minutes après le traitement; d'autres effets ont été enregistrés. L'incidence d'une fièvre élevée ≥40,0°C (critère principal) a été comparée au taux observé précédemment en Equateur. Des régressions logistiques ont été effectuées pour identifier les prédicteurs cliniques et ceux basés sur la population de la fièvre induite par le misoprostol . RÉSULTATS: Des frissons transitoires et de la fièvre ont été ressentis par 75% (37/49) des participantes traitées et décrits comme acceptables par les trois quarts des femmes interrogées (35/47). Le taux de fièvre élevé était de 12% (6/49), [intervalle de confiance (IC) à 95%: 4,6, 24,8] contre 35,6% en Equateur après traitement au misoprostol (58/163) [IC95%: 28,3, 43,5], p = 0,002). Les prédicteurs significatifs de la fièvre induite par le misoprostol (selon le modèle) étaient: hémoglobine avant l'accouchement11,0 g/dL, expulsion placentaire rapide et âge plus élevé de la femme. Aucun résultat sévère n'a été signalé avant le sortie d’hôpital.Le misoprostol pour traiter l'HPP en Argentine a entraîné un taux de fièvre élevée significativement plus bas qu'en Equateur, bien que les taux dans les deux pays soient notablement plus élevés que les taux observés ailleurs. Une meilleure compréhension des effets secondaires du misoprostol et des facteurs impliqués dans leur apparition, y compris la génétique, aidera à atténuer les inquiétudes. L'apparition de frissons peut être le moyen le plus simple de savoir si l'on peut également s'attendre à de la fièvre.

Objective: To evaluate continuous monitoring of maternal hemodynamics during labor and delivery utilizing an innovative, noninvasive, reflective photoplethysmography-based device. Study design: The Biobeat Monitoring Platform includes a wearable wristwatch monitor that automatically samples cardiac output (CO), blood pressure (BP), stroke volume (SV), systemic vascular resistance (SVR), heart rate (HR) every 5 s and uploads all data to a smartphone-based app and to a data cloud, enabling remote patient monitoring and analysis of data. Low-risk parturients at term, carrying singletons pregnancies, were recruited at early delivery prior to the active phase. Big data analysis of the collected data was performed using the Power BI analysis tool (Microsoft). Next, data were normalized to visual presentation using Excel Data Analysis and the regression tool. Average measurements were compared before and after rupture of membranes, epidural anesthesia, fetal delivery, and placental expulsion. Results: Eighty-one parturients entered analysis. Epidural anesthesia was associated with a slight elevation in CO (5.5 vs. 5.6, L/min, 10 min before and after EA, p &lt, 0.05) attributed to a non-significant increase in both HR and SV. BP remained stable as of counter decrease in SVR (1361 vs. 1319 mmHg&sdot, min&sdot, mL&minus, 1, 10 min before and after EA, p &lt, 0.05). Fetal delivery was associated with a peak in CO after which it rapidly declined (6.0 vs. 7.2 vs. 6.1 L/min, 30 min before vs. point of delivery vs. after delivery, p &lt, 0.05). The mean BP remained stable throughout delivery with a slight increase at fetal delivery (92 vs. 95 vs. 92.1 mmHg, p &lt, 0.05), reflecting the increase in CO and decrease in SVR (1284 vs. 1112 vs. 1280 mmHg&sdot, 1,p &lt, 0.05)with delivery. Placental expulsion was associated with a second peak in CO and decrease in SVR. Conclusions: We presented a novel application of noninvasive hemodynamic maternal monitoring throughout labor and delivery for both research and clinical use.

In dairy cows, the efficacy of oxytocin treatment for preventing retained fetal membranes (RFM) is controversial. The physiological condition of cows associated with the calving process may affect the action of oxytocin. This study aimed to elucidate the difference in the efficacy of exogenous oxytocin treatment immediately after calving among cows that received various obstetric interventions. The calving ease was recorded using a score of 1-5, and assisted birth was defined as a score of 2 or more. Cows that required calving assistance (assisted, n = 28) due to delayed calving progression had a prolonged time from calving to expulsion of the fetal membrane (P < 0.01), and impaired reproductive performance compared to cows that did not receive calving assistance (unassisted, n = 78). The effect of oxytocin treatment was determined using cows that did not expel their fetal membrane within 3 h after calving. Cows were randomly divided into the control (unassisted, n = 41; assisted, n = 22) or oxytocin group (unassisted, n = 33; assisted, n = 10). Oxytocin (50 IU) was administered intramuscularly to the cows in the oxytocin group between 3 and 6 h after calving, while no treatment was administered in the control group. In cows with assisted birth, oxytocin administration accelerated placental expulsion (P < 0.05) and improved several reproductive parameters, such as the number of services until conception (P < 0.05) and the calving to conception intervals (P < 0.05) compared to the control group. On the other hand, oxytocin administration slightly accelerated placental expulsion (P < 0.05), but failed to improve fertility in cows with unassisted birth. The results indicate that the action of oxytocin varies depending on the calving situation of the cows. Oxytocin administration during the early postpartum period could prevent RFM and improve the decline in reproductive performance associated with calving assistance.

This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary objectives were to evaluate the difference in median myometrial shear wave velocity between each time point, as well as to determine the correlation between myometrial shear wave velocity and patients’ characteristics. 38 women were recruited during the study period, of whom 34 met the study criteria. 1017 SWS measurements were obtained. The median time to perform measurements was 16 s for one value, and 2 min 56 s for ten. For 11 women (32%) it was not possible to achieve ten SWS at T1 as placental expulsion immediately followed the birth of the newborn. One patient experienced placental retention and only measurements at T1 were performed. For all other patients, we were successfully able to obtain all measures as intended. There was no difference in the mean shear wave speed between the three time points. After adjustments for confounders, we observed a significant correlation for total blood loss (correlation coefficient = − 0.26, p p = 0.03), and newborn weight (correlation coefficient = − 0.08, p = 0.001). It is feasible to assess uterine tonicity by shear wave imaging, after placental expulsion. We did not observe a variance in uterine tonicity between the three time points. Women who had higher blood loss, received more units of oxytocin and/or those with newborns of a higher weight exhibited lower shear wave speed measures.

We have shown that dietary supplementation of n-3 polyunsaturated fatty acid (n-3 PUFA)-rich fish oil (FO) around the breeding time improved the utero-ovarian functions in the goat. Here, we investigated the effect of FO supplementation during the periparturient period on serum n-3 PUFA, prostaglandin F2α metabolite (PGFM), placental expulsion, uterine involution, resumption of oestrus and neonatal vigour. Rohilkhandi goat in advanced gestation (n = 16) was divided into two equal groups. One group was supplemented with FO containing 26% n-3 long-chain PUFA at the rate of 156 mg per kg body weight, while the control group was fed isocaloric palm oil (PO) from -3 to +3 week of kidding. Dietary FO increased serum concentration of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) by 7.3- and 6.6-fold, respectively, after 6 weeks of supplementation. Goats in FO group expelled the foetal membranes 99.1 min earlier (p < .01) than those of PO group. Further, dietary FO significantly decreased the serum PGFM on day 7 post-partum. However, no difference was found on uterine involution, which was complete by day 20 post-partum in either group. Resumption of follicular activity by day 5 post-partum was 87.5% in the FO as compared to 25% in the PO group (p < .05). Similarly, occurrence of behavioural oestrus by day 90 post-partum was 57.1% in goats of the FO group while none of does was in the PO group (p < .01) expressed oestrus. It was concluded that feeding FO-rich diet during -3 to +3 weeks of kidding decreased the PGFM till day 7 post-partum, hastened the expulsion of foetal membranes and reduced the time from kidding to first post-partum oestrus in Rohilkhandi does.

Retained placenta after vaginal delivery is diagnosed when a placenta does not spontaneously deliver within a designated amount of time, variably defined as a period of 18-60 mins. It may also be diagnosed if a patient experiences significant hemorrhage prior to delivery of the placenta. Normal placenta delivery requires adequate uterine contractions, with shearing of the placenta and decidua from the uterine wall and expulsion of the tissue. Thus, retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions. History of a prior retained placenta and congenital uterine anomalies also appear to be risk factors. Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, the latter of which can lead to delayed hemorrhage or infection. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately. When a separation plane between the placenta and uterus is particularly difficult to create, PAS should be considered, and preparations should be made for hemorrhage and hysterectomy. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered.

This investigation was carried out on 40 advanced pregnant Jafarabadi buffaloes of 2–4 parity equally divided into two groups, viz., control and treatment groups. The control animals were maintained on standard routine farm feeding, and the animals of the treatment group received additional oral supplements of 50 g chelated mineral mixture and 150 g bypass fat daily along with concentrates for 6 weeks prepartum and 8 weeks postpartum. The bypass fat was given @ 15 g/liter of milk produced limiting up to 200 g/head/day from 15–60 days postpartum. Ten animals in each control and treatment group further received Inj. Stimvet 5 mL (micro-minerals) around day 45 prepartum and on day of calving. Half of these Stimvet treated and control subgroups also received ecbolic Exapar (n = 5) 2 boli/day for 4 consecutive days postpartum. Blood samples were obtained from all animals by jugular vein puncture on the day –45, –30, –7 and 0 (day of calving), 7, 15, 30, 45, 60 peripartum for estimation of plasma trace minerals, viz., zinc, iron, copper, cobalt, and manganese. The plasma zinc and copper concentrations were found to be higher on day 30 prepartum and again on day 7 postpartum in Stimvet injected groups.Moreover, the overall pooled mean concentration of zinc was significantly higher in nutrients supplemented than the control group. The plasma concentrations of iron, cobalt, and manganese did not reveal any specific trend or significant variations between groups or between periods within any of the groups. Further, the peripartum oral nutrients supplementation significantly shortened the periods of placental expulsion time and uterine involution, with early onset of postpartum first estrus, apparently shorter service period and enhanced pregnancy rate in comparison to control group. The influence of Stimvet and Exapar alone or in combination, however, did not show a significant beneficial effect on these traits, except shortened placental expulsion time and higher plasma zinc and cobalt status. Hence, the Jafarabadi buffalo keepers may be advised to provide additional oral nutrients supplementation in the form of bypass fat and chelated minerals over routine feeding to their animals during a transitional period for improved postpartum fertility.

The objective of this work was to determine the repercussion of the metabolic changes that occur in induced subclinical pregnancy toxemia in single- or twin-bearing ewes on the duration of gestation, type and length of lambing, and placental expulsion time. Fifty-one adult Corriedale ewes with a known gestation date and fed in the wild were randomly divided at day 145 of gestation into four groups. Group A included single-bearing ewes, and C twin-bearing ewes, all of which were fed ad libitum . Group B was composed of single-bearing ewes, and D of twin-bearing ewes, all subjected to a 75% feed restriction until glycemic values were compatible with subclinical pregnancy toxemia. Metabolic parameters were determined in all ewes from day 145 of gestation to 72 h postpartum. Likewise, the duration of gestation, type of lambing (eutocic/dystocic), labor length, and placental expulsion time were recorded. Glycemia and β-hydroxybutyrate values compatible with subclinical pregnancy toxemia were achieved after 48 h of feed restriction, being 30.67±2.37 mg/dL and 1.87±0.12 mmol/L in single-bearing ewes and 28.40±3.39 mg/dL and 2.21±0.42 mmol/L in twin-bearing ewes, respectively. It is concluded that subclinical pregnancy toxemia induced by feed restriction at the end of gestation, frequent situation that occurs in flock management, produces mild metabolic changes, which return to normal values after the delivery. These metabolic changes registered before lambing do not modify the gestation length, do not increase the percentage of dystocical deliveries, nor influence labor length or placental expulsion time.

An intensive period of behavioral interaction between the ewe and the newborn lambs occurs during parturition, usually associated with specific physiological changes. This study was conducted to evaluate the maternal–filial behavior of native breeds given concentrate supplementation, prepartum and postpartum, and outcomes for their crossed Dorper lambs. A total of 52 crossbreed lambs from 36 hair ewes, 20 Santa Ines (SI), and 16 Morada Nova (MN), crossed with a Dorper ram were distributed in a completely randomized design in a 2 × 2 factorial arrangement with 2 breeds (MN and SI) and 2 treatments (0.5% and 1.5% of concentrate supplementation based on body weight). There was no effect ( P > 0.05) of breed and concentrate supplementation on total lambing time ( P > 0.05) or placental expulsion time ( P > 0.05). Concentrate supplementation did not influence ( P > 0.05) lamb survival at birth and weaning for either breeds. SI ewes had greater maternal behavior scores (MBSs) than did MN ewes indicating better care at the time of lamb identification. The lower MBS for MN ewes may be attributed to complications during the birth. SI and MN ewes had high similarity in several aspects of maternal and neonatal behavior. The level of concentrate supplementation did not affect the ewe behavior, but 0.5% concentrate promotes similar offspring survival at birth and at weaning compared to 1.5% concentrate supplementation.

Postpartum hemorrhage (PPH) is one of three main causes of maternal mortality and a life-threatening condition throughout the world. PPH can have irreversible complications for the mother even if it does not lead to death. This study was conducted to determine the effect of hydroalcoholic extract of Capsella bursa pastoris on early PPH.The present study was a single-blinded, randomized, clinical trial.The study was conducted in Afzalipour Hospital of Kerman in 2015.The subjects included 100 women who had given vaginal birth and met the study inclusion criteria.The participants were selected and randomly assigned into an intervention group (n = 50) and a placebo group (n = 50). Immediately after placental expulsion, the intervention group was given 10 sublingual drops of the hydroalcoholic extract of Capsella bursa pastoris plus an infusion of 20 U of oxytocin in 1 L of Ringer's solution, and the control group was given 10 sublingual drops of the placebo plus an infusion of 20 U of oxytocin in 1 L of Ringer's solution.The amount of bleeding was assessed in both groups. Hemoglobin and hematocrit levels were measured in all the participants 6 h after childbirth. The statistical analysis of the data was performed in SPSS-17 using the following tests: independent t, paired t, repeated measures ANOVA, Friedman's, Wilcoxon, Mann-Whitney, Fisher's exact, and chi square. P-value0.05 was considered statistically significant.There were no significant differences between groups in baseline characteristics (p 0.05). After the intervention, there was significant decrease in the amount of postpartum bleeding in both groups. However, the mean decrease in the amount of bleeding was significantly more in the Capsella bursa pastoris group (p 0.001).Compared with the mere administration of oxytocin, sublingual Capsella bursa drops appear to be effective in reducing PPH in this study. Further research regarding the efficacy and safety of various doses of Capsella bursa pastoris is required.

Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional.

Aim: The aim of this study was to evaluate the influence of peripartum protein and minerals supplementation on plasma profile of steroid hormones, metabolites, and fertility in rural buffaloes. Material and Methods: A total of 85 advanced pregnant (~8 months) pluriparous buffaloes selected at farmers’ doorstep in three tribal villages of Middle Gujarat were randomly divided into two groups, viz., control (n=45) and nutrients treatment (40). The buffaloes of treatment group (n=40), in addition to farmers feeding schedule/control, received daily 1.5 kg compound concentrate mixture (22% CP) and 50 g of chelated ASMM for 2 months each pre- and post-partum. Further, 15 buffaloes, each of control and treatment group, were injected parentrally (deep i/m) with 5 ml of micro-minerals (each ml containing Se, Zn, Cu and Mn at 5, 40, 15 and 10 mg, respectively), twice 2 months before and on the day of calving, keeping rest of the animals (control, n=30 and treatment, n=25) as controls. Blood sampling was done on days −60, −30, −15, 0, 15, 30, 45, and 60 peripartum for estimation of plasma progesterone and estradiol by standard RIA techniques and other metabolites using assay kits on biochemistry analyzer. The puerperal events and postpartum fertility were monitored through history and by fortnightly palpation per rectum till day 45 and then again at 120 days postpartum for both the groups and subgroups. Results: The mean plasma progesterone concentrations in all groups declined significantly (p0.05). The micro-minerals injection appreciably reduced the incidence of RFMs and significantly (p

The clinical effects of aglepristone treatment to induce parturition in ewes and their newborns were reported. Three experimental groups were defined: group AG5 (n = 5), group AG10 (n = 5), and group CG (n = 5) in which ewes were injected twice with 5, 10 mg/kg of aglepristone, and saline solution of ewes, respectively. Different parameters associated with parturition in ewes and their newborns were investigated. Serum progesterone, oxytocin, and free and conjugated total estrogens were measured after treatments until parturition. No statistical difference was found from first aglepristone administration to onset of lambing between AG5 and AG10 (23.90 +/- 6.20, 40.00 +/- 6.71 hours). Parturition induction in two groups shortened the gestational length significantly compared with the control group (P = 0.003). Dystocia was observed in two ewes in group AG10. The placental weight showed statistically significant difference only between the AG10 and CG (P = 0.039), but no difference was observed in the placental expulsion period between the groups. Decrease in food consumption 24 to 36 hours after parturition in all ewes and skin necrosis in an ewe in group AG5 were observed. Progesterone concentration was significantly lower in AG5 than that in ewes in group AG10 and CG (P < 0.05). No difference was observed in concentrations of free total estrogens and oxytocin between groups. The body temperature of lambs was significantly different between AG10 and CG groups both right after (P = 0.011) and 12 hours after parturition (P = 0.014). The lambs in CG had the highest mean birth weight (4.29 +/- 0.28 kg), which was significantly different from the induced groups. No significant difference of blood pH and blood gases values between groups was identified both at birth and 12 hours after parturition for lambs. Significant differences could clearly be observed in total protein and blood urea nitrogen and total protein findings 12 hours after parturition (P < 0.05), whereas no difference was found in blood glucose, albumin, inorganic phosphor, triglyceride, or total cholesterol parameters. The results of this study show that the administration of aglepristone to induce parturition can precisely control lambing time without any side effects in either mothers or lambs.

Family planning can avert nearly one-third of maternal deaths and 10% of child mortality when couples space their pregnancies more than two years apart.In India 65% women in 1st year of postpartum period have unmet need for FP, but only 26% are using any contraceptive. Delivery may be the only time when they come into contact with health care providers; thereafter the chances of returning for contraceptive advice are uncertain. Insertion of intrauterine contraceptive device (IUCD) at 10 minutes after delivery is appealing. The Copper T 380A intra-uterine contraceptive device (IUCD) is a highly effective, non-hormonal method, long acting reversible and coitus independent contraceptive device that can be safely used by all women regardless of breastfeeding status during this interval. Thus increasing awareness and creating demand for postpartum intra-uterinecontraceptive devices (PPIUCD) is essential. Apart from the fact that its usage has to be increased, follow-up of the cases after insertion is an important factor since complications related to IUCD are extensive and vary with individuals. Thus routine followups and early measure is the base of PPIUCD insertion. Satisfaction related to IUCD insertion varies considerably. The studies also include the input of the husband’s opinion regarding the satisfaction related to IUCD as many problems related to interference in the sexual activity were recorded. We will conduct a study for acceptance, perception, experience and satisfaction of the couple with postpartum intrauterine contraceptive devices (PPIUCD) insertion at our institute.Objectives:1. Acceptability of postpartum intrauterine devices as a contraceptive method among women of reproductive age. 2. To record the experienceduring the procedure and first six weeks after insertion of IUCD. 3. To learn about satisfaction with PPIUCD among the couple. 4. Desire to continue the service in future. Methods: Study design- This will be an open prospective and longitudinal study toassess the acceptance, perception, experience and satisfaction of the 100 couples in the reproductive age group (19-49 years) who are willing for; with postpartum insertion of the Cu T 380 A within 10 minutes of placental expulsion. Couples will be recruited in this study after obtaining written informed consent. Institutional ethical committee clearance will be taken. Exclusion criteria will be severe anemia Hb 38°C during or after labor, and the patients with Postpartum Hemorrhage. Method of insertion: The Copper T model Cu T 380 A will be inserted with all asepticprecautions within 10 minutes of placental expulsion with a sponge holder and fundal placement will be ensured. String will be cut to the level of the cervix. The string will be visible at the cervix after the insertion. Participants will be interviewed prior and after insertion of PPIUCD and then six weeks later. Data collection: Data will be collected from participants using a structured questionnaire that includes basic demographic information, questions related to acceptance and perception of pain on insertion of PPIUCD. After six weeks, PPIUCD clients will again be interviewed using a structured follow-up questionnaire that will collect information about the clients overall satisfaction, problems or any complications, and retention /expulsion of the PPIUCD. In the cases where the client fails to return to the health facility for her follow-up visit, she will be contacted by telephone for the follow-up interview. Data analysis: Continuous variables will be reported using mean (standard deviation) and categorical variables will be reported using percentages. For two group comparisons, wherever applicable a student t-test will be used to compare means of continuous variables, and chi-square tests shall be used to compare categorical variables.Results:1.Acceptance of PPIUCD was 88% after counseling than 46% before counseling. 2. 79.54% did not have any pain during insertion. 3. 17.06% had mild discomfort while insertion and only 03.40% had painful insertion. 4. After 6 weeks 83% women followed-up. Rest 17% could not be contact even through telephones. 5. Major complications encountered were abdominal pain and expulsion 13.6% each than other complications. However 54.5% women had no complications. 6. 75.3% women were willing to continue the PPIUCD, rest demanded removal either due to complications or family opposes being the major reason. 7. Overall satisfaction rate was 78% in women and 73.9% in husbands Conclusions: The study thus concludes that acceptance rate was significantly improved after proper counseling and the complication rate of the PPIUCD were less as compared to the overall benefits.

This study was undertaken on 36 freshly calved cows randomly divided into 6 equal groups under field conditions. Cows of group-VI that shed placenta within 8-12 hours postpartum naturally served as healthy control. The cows with retained fetal membranes (RFM, n = 18) for more than 12 hrs were managed either by manual removal of placenta without antibiotics (group-I), parenteral antibiotic (Ceftiofur 1 g i/m) for three consecutive days (group-II) or a combination of both (group-III). In group-IV and group-V, cows were administered with Inj. Oxytocin @ 50 IU i/m and Inj. Dinoprost tromethamine (PGF2α) @ 25 mg i/m, respectively, immediately after parturition and time of placental shedding was recorded. The overall prevalence of Brucellosis by RBPT was found to be 5.55 % amongst these 36 animals. The placental expulsion in groups following medicinal treatment was found to be 50 (3/6) % in Ceftiofur alone by 3 days (group-II), and 66.67 (4/6) % in Oxytocin (group-IV) and 100 (6/6) % in PGF2α inj. (group-V) groups within 12 hrs. The time of uterine involution in groups I to VI was found to be 42.00 ± 1.94, 39.50 ± 0.99, 40.67 ± 1.39, 38.33 ± 1.55, 37.50 ± 1.02 and 37.33 ± 1.76 days, respectively, while the interval for the appearance of first postpartum estrus was 54.83 ± 2.06, 51.00 ± 1.05, 52.17 ± 1.96, 50.17 ± 2.03, 48.67 ± 1.90 and 49.17 ± 1.55 days, respectively, which did not vary statistically. The mean serum progesterone profile obtained on day 0 and day 21 postpartum was statistically non-significant between groups. However, it was significantly (p less than 0.05) lower on day 0 as compared to day 21 in group-I, II and VI. The levels on day 0 coincided with the time of blood sampling after calving. The high level of serum P4 on day 0 in group-IV and V could be due to sampling immediately after calving. The serum calcium and phosphorus levels were significantly(p less than 0.05) lower on day 0 than on day 21, but not the magnesium. The group effect was however non-significant for any of three minerals. It was observed that manual removal of RFM without parenteral antibiotics, resulted in puerperal metritis, cervicitis, pyometra which ultimately resulted into delayed uterine involution, delayed first postpartum estrus and thus, reduced the postpartum reproductive efficiency. It was inferred that the PGF2α and Oxytocin injections could be used as a treatment of choice for prevention of RFMs in cattle.

A new protocol with aglepristone to induce parturition in ewes with pregnancy toxemia has been reported in the present manuscript. Four experimental groups were defined: Group AG5 (n = 10), Group DEX (n = 10), Group NC (n = 5) and Group PT (n = 5) in which ewes were injected twice with 10 mg/kg of aglepristone and 5 ml dexamethasone in first two groups, respectively; whereas negative control and pregnancy toxemia groups received no treatment for parturition induction. Different clinical parameters associated with parturition in ewes and their newborns were investigated. Blood hematology and biochemical measurements were carried out both in ewes and lambs. Blood pH values of lambs were recorded during the study. The injection time-lambing time, injection time-vaginal discharge intervals, placental expulsion periods, placental weight and vaginal delivery interval between lambs, hematological and biochemical results were not statistically different among the groups (p 0,05). Increased NEFA and β-HBA concentrations accompanied the disease and all ewes in AG, DEX and PT Groups developed clinical pregnancy toxemia (NEFA; P = 0,009) and β-HBA; (P = 0,039). The differences in rectal body temperature of lambs were not significant (p 0,05), whereas birth weight was found statistically significant among groups (p 0,05). Blood pH, biochemical and hematologic measurements of lambs had also significant differences depending on different time points. Parturition pathology by means of incomplete cervical dilatation was severely observed in DEX Group. The results of this study show that aglepristone application in pregnancy toxemia to induce parturition could precisely control lambing time without any side effects in either mothers or lambs. Apart from these, it could be speculated that dexamethasone seems to induce parturition causing crucial pathologies, which results in important and risky changes in newborns' life. Incomplete cervical dilatation and continued ineffective uterine contractions could be a major factor of newborn losses because of placental separation and cessation of blood supply.

Introduction A prolonged third stage of labor is considered to be a risk factor for postpartum hemorrhage. The objective of this study was to determine the ability of acupuncture to reduce the length of the third stage of labor. Methods Seventy-six puerperal women who had a normal spontaneous birth at the Hospital Universitario Principe de Asturias, Alcala de Henares, Spain, were included in a single-blind randomized trial and evaluated by a third party. Women were randomly assigned to receive true acupuncture or placebo acupuncture (also known as sham acupuncture). In the first group, a sterilized steel needle was inserted at the Ren Mai 6 point, which is located on the anterior midline between the umbilicus and the upper part of the pubic symphysis. In the second group, the insertion site was located at the same horizontal level as the Ren Mai 6 point but shifted slightly to the left of the anterior midline. The management of the third stage of labor was the same in both groups. Results Statistically significant differences were found, with an average time to placental expulsion of 15.2 minutes in the placebo group and 5.2 minutes in the acupuncture group. No major complications occurred in either group. Discussion These results confirm that acupuncture at the Ren Mai 6 point can decrease the time to placental expulsion. This treatment represents a simple, safe, and inexpensive way of decreasing the duration of the third stage of labor.

Background: Uterine atony accounts for 80 % of causes of PPH and is one of the important cause of maternal death. Objective: To analyze the efficacy of Dutta’s score for early detection and management of uterine atony during emergency LSCS to prevent PPH. Study methods: This study was undertaken at JNM, NSGN, CN at Kalyani, Nadia, West Bengal India from 1st January 2007 to 31st December 2011. Three hundred cases undergoing emergency LSCS were selected for randomized trial. Clinical observations were made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization and time of placental expulsion. Score of 0, 1, 2 were given on each observation. Three groups are created depending on scoring-Group A (130) -8 to 10, Group B (N-100) -5 to 7 and Group C (N-70) - 500cc were also found to be reduce in group A- 7.6%, group B-14%. In group C intra operative blood loss >500cc were seen in 47.1 % and post operative -32.9% cases. Hemoglobin level

More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. Objective: The study was conducted to assess the safety incidence of perforation/pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Copper T 380A (Cu T 380A) inserted within 10 minutes of placental expulsion both in vaginal and C-section deliveries. Methods: This was an open label, prospective, and multicentric longitudinal study. The study was approved by the Ethics Committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) was easy in 98.76 per cent of subjects after normal delivery, and 100 per cent in all subjects after assisted vaginal and c-section deliveries. The position of the Cu T was in situ in 97.61 per cent of subjects, ultra sonogram was used in 1 per cent to confirm location of IUCD and in 1 per cent of subjects the IUCD was in the cervix. There was no case of perforation in this series and no other major complications. Conclusion: Inserting Cu T 380A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus.

Made available in DSpace on 2018-12-11T17:06:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-07-01. Added 1 bitstream(s) on 2019-10-09T18:30:36Z : No. of bitstreams: 1 S0100-736X2016000700665.pdf: 1333668 bytes, checksum: 79c9ed00e1dbce3f81474539a8853929 (MD5) The placenta is a transitory organ that originates from maternal and fetal tissues, the function of which is transporting nutrients from the mother to the fetus. The aim of this study was describe the histological features of placentas in healthy Thoroughbred mares at foaling and evaluate their relation with the gross placental and data of these mares. For this study 188 Thoroughbred mares were used. It was performed clinical observation for signs of placentitis during daily health checks and ultrasonic examination monthly to assess the fetus and placenta. All of the mares that exhibited clinical signs of placentitis were treated during gestation. The parturition was assisted, the placentas were grossly evaluated and samples were collected immediately after expulsion. The following data were considered for each mare: age, gestational age, number of parturition, time for placental expulsion, umbilical-cord length, placental weight and clinical signs of placentitis. Histological evaluation of the placentas revealed extensive cytoplasmic vacuolization of the epithelial areolar cells, presence of inflammatory infiltrates and hypoplasia-atrophy of the microcotyledons. Most of the gross placental findings were consistent with the histological results. In conclusion the mares with a vacuolated placental chorionic epithelium were older and had experienced a larger number of births. Great part of the mares with inflammatory infiltrates did not showed any clinical signs of placentitis during gestation. Departamento de Clínicas Veterinária Universidade Federal de Pelotas (UFPel), Campus Universitário s/n Departamento de Patologia Animal UFPel, Campus Universitário s/n University of Illinois Urbana-Champaign, 507 E. Green Street Departamento de Reprodução Animal e Radiologia Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Av. Prof. Montenegro, Distrito de Rubião Junior s/n Departamento de Reprodução Animal e Radiologia Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Av. Prof. Montenegro, Distrito de Rubião Junior s/n

Objective. To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. Design. Retrospective observational study. Setting. University teaching hospital. Population. 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011. Methods. Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed. Main outcome measures. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. Results. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. Conclusions. Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.

Background: More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. The study was conducted to assess the safety, incidence of perforation /pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Cu T 380 A inserted within ten minutes of placental expulsion both in vaginal and C-section deliveries. Methods: This was an open label, prospective, and longitudinal study. The study was approved by the ethics committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) at KIMS, Hubli was easy in 99.52% of subjects after normal delivery and 100% in all subjects after assisted vaginal deliveries. The position of the CuT was in situ in 94.78% of subjects, ultra sonogram was used in 24.76 % to confirm location where threads were not visible in the vagina and in 6.19% of subjects the tip of IUCD was in the cervix which was pushed back into the uterus using artery forceps. It was expelled in 5.23% of patients. There was no case of perforation in this series and no other major complications. Conclusions: Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus.

The experiment involved observations of 2,514 Holstein-Friesian cows to determine the effects of environmental factors (cow’s age, calving season, weight and sex of calves, housing system) and genetic factors on gestation length in dairy cattle and the correlation between gestation length and other reproductive traits (calving ease, stillbirth rates and placental expulsion). Genetic parameters were estimated based on the sires of calved cows (indirect effect) and the sires of live-born calves (direct effect). The following factors were found to contribute to prolonged gestation: increasing cow’s age, male fetuses and growing fetus weight. Optimal gestation length was determined in the range of 275–277 days based on calving ease and stillbirth rates. The heritability of gestation length was estimated at 0.201–0.210 by the direct effect and 0.055–0.073 by the indirect effect. The resulting genetic correlations suggest that the efforts to optimize (prolong) gestation length could exert an adverse influence on the breeding value of bulls by increasing perinatal mortality and calving difficulty. The standard errors of the investigated parameters were relatively high, suggesting that any attempts to modify gestation length for the purpose of improving calving ease and reducing stillbirth rates should be introduced with great caution.

Please cite this paper as: Durocher J, Bynum J, Leon W, Barrera G, Winikoff B. High fever following postpartum administration of sublingual misoprostol. BJOG 2010;117:845–852. Objective To explore what triggers an elevated body temperature of ≥40.0°C in some women given misoprostol, a prostaglandin E1 analogue, for postpartum haemorrhage (PPH). Design Post hoc analysis. Setting One tertiary-level hospital in Quito, Ecuador. Population A cohort of 58 women with a fever of above 40°C following treatment with sublingual misoprostol (800 micrograms) for PPH. Methods Side effects were documented for 163 Ecuadorian women given sublingual misoprostol to treat their PPH. Women’s body temperatures were measured, and if they had a fever of ≥40.0°C, measurements were taken hourly until the fever subsided. Temperature trends were analysed, and the possible physiological mechanisms by which postpartum misoprostol produces a high fever were explored. Main outcome measures The onset, duration, peak temperatures, and treatments administered for cases with a high fever. Results Fifty-eight of 163 women (35.6%) treated with misoprostol experienced a fever of ≥40.0°C. High fevers followed a predictable pattern, often preceded by moderate/severe shivering within 20 minutes of treatment. Body temperatures peaked 1–2 hours post-treatment, and gradually declined over 3 hours. Fevers were transient and did not lead to any hospitalisation. Baseline characteristics were comparable among women who did and did not develop a high fever, except for known previous PPH and time to placental expulsion. Conclusions An unexpectedly high rate of elevated body temperature of ≥40.0°C was documented in Ecuador following sublingually administered misoprostol. It is unclear why temperatures ≥40.0°C occurred with a greater frequency in Ecuador than in other study populations using similar treatment regimens for PPH. Pharmacogenetic studies may shed further light on variations in individuals’ responses to misoprostol.

Background Postpartum haemorrhage is one of the most important causes of maternal death. Objectives To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour. Methods A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group ( n =100), 10IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group ( n =100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss. Findings Mean blood loss during the third stage of labour was 216.93±165.16ml and 232.12±150.35ml in the intervention and control groups, respectively; the difference was not significant ( p =0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62±324.7ml and 327.27±255.99ml in the intervention and control groups, respectively; p =0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69±5.51mins and 6.34±5.03mins; p =0.028). Conclusions Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.

Women who have a retained placenta are at high risk of postpartum hemorrhage without prompt treatment. The facilities and skilled personnel needed to perform manual removal of the placenta, the current treatment, are often unavailable to women in rural resource-poor settings, and the case fatality rate is nearly 10% in such settings. Some investigators have suggested that administration of oxytocin via the umbilical vein and placenta is a low-cost low technology method that could increase placental expulsion. A number of small studies reported that umbilical injection of oxytocin was an effective intervention, while a meta-analysis (Cochrane review) suggested that this intervention was effective but the results were of borderline significance Two large, high quality studies found no reduction in the rates of retained placenta compared with expectant management. This double-blind, placebo-controlled multicenter trial investigated the effectiveness of treatment with high-dose umbilical vein oxytocin in women with retained placenta. The study was conducted at teaching hospitals in the United Kingdom, Uganda, and Pakistan between 2004 and 2008. The participants were hemodynamically stable women who had a retained placenta for more than 30 minutes. A total of 577 women were randomly assigned to receive 30 ml saline containing either 50 IU oxytocin (n = 292) or 5 mL water (n = 285) via injection into the placenta through an umbilical vein catheter. The need for manual removal of the placenta was the primary outcome measure. No difference between the groups was found in the need for manual placental removal (oxytocin: 61.3% 179/292 vs. placebo: 62.1% 177/285; Relative Risk = 0.98, 95% confidence interval: 0.87-1.12; P = 0.84). There was a difference between the countries in the need for manual removal; the need was higher in the United Kingdom (69% 250/361) than in Uganda (47% 90/190); or Pakistan (62% 16/26). There was no difference in adverse events between the oxytocin and placebo groups. These findings are consistent with the results of other studies showing that umbilical injection of oxytocin has no clinically significant effect on the need for manual removal of the placenta in women with retained placenta, and suggest that other treatment approaches are necessary.

The influences of nutritional protein and energy during early and mid pregnancy on milk production and postpartum reproductive parameters were determined in 70 beef heifers of two composite breeds (Bos indicus X Bos taurus). At artificial insemination (AI), heifers were divided into four dietary treatment groups identified by the level of protein, and to a lesser extent energy, fed during the first and second trimesters: high/high (HH), high/low (HL), low/high (LH), and low/low (LL). Milk production was lower in the heifers receiving high treatment in first trimester than that in heifers receiving the low treatment (P = 0.01). Milk production was negatively associated with dam body condition score (BCS; P = 0.01), nonesterified fatty acids (P = 0.001), and leptin (P = 0.02) and positively associated with urea (P < 0.001) concentrations during lactation. Increased dietary protein in the first trimester increased or decreased concentrations of colostral protein dependent upon genotype (P = 0.03). Colostral protein was positively associated with bovine pregnancy associated glycoprotein from late gestation (P = 0.007). Milk fat was negatively associated with BCS (P = 0.007) and influenced by genotype (P = 0.003). Dietary treatment did not affect the postpartum reproductive performance of beef heifers. Gestation length (P < 0.001) and the postpartum interval to first estrus (PPI; P = 0.02) were positively associated with calf size. Placental size was negatively associated with placental expulsion time (P < 0.01). Prepartum BCS of the heifers was negatively associated with PPI (P = 0.01). Overall, high levels of nutrition during early gestation are detrimental to milk production in beef heifers.

Normal birth is a common outcome for the ambulance service following an imminent birth dispatch. In 2008, the London Ambulance Service attended over 1000 imminent births calls, with the crew either in attendance for a birth, transporting prior to birth or the infant born before arrival of a crew. The majority were full-term, low risk pregnancies with a normal birth, and the mother having birthed previously (personal communication, London Ambulance Service, 2009). The aim of this paper is to review the issues of normal birth. It will explore the concept of normal birth and encourage practitioners to reflect on care after a normal birth. It discusses the physiology and mechanism of normal labour, birth and physiological placental expulsion. The paper will explore the ambulance clinician's role in securing and maintaining a normal birth outcome and explore care required for the woman, newborn infant and family. This paper will not discuss complications in pregnancy and during labour or in depth discuss birth, postnatal complications or newborn resuscitation. Ambulance personnel must follow the guidelines issued by the Joint Royal Colleges Ambulance Liaison Committee UK Ambulance Service Clinical Practice Guidelines (2006) (JRCALC, 2006).

Objective To determine whether prophylactic intraoperative uterine artery embolization (UAE) reduces blood loss and minimizes morbidity and mortality in cases of placenta accreta, increta, and percreta. Design A prospective, nonrandomized clinical trial. Setting A university-based, high-risk pregnancy unit and department of interventional radiology. Patient(s) Eleven patients who were diagnosed prenatally with placenta accreta, increta, and percreta. Intervention(s) Patients with suspected placenta accreta were treated with prophylactic, intraoperative UAE immediately after fetal delivery and before removal of the placenta. Patients with suspected placenta increta were treated with UAE; the placenta remained in situ, or a hysterectomy was performed. Patients with suspected placenta percreta were treated with UAE, and the placenta remained in situ. Main Outcome Measure(s) Intraoperative blood loss, maternal mortality, fetal mortality, need for hysterectomy. Result(s) Eleven viable fetuses were born with no radiation exposure. There were no maternal or fetal mortalities. Nine of 11 patients had an estimated blood loss between 500 and 2300 mL. Emergency hysterectomy was performed in two patients because of massive bleeding. The complications, including peritonitis and endometritis, occurred in another two patients after embolization. Conclusion(s) Prophylactic, intraoperative UAE before placental expulsion appears to reduce the risk of postpartum hemorrhage, decrease morbidity and mortality, and increase the chance of preservation of the uterus in patients with placenta accreta, increta, and percreta.

The aim of this study was to establish the effectiveness of administration of oxytocin (OT) on placental expulsion after foaling. Four foaling mares with the placentas retained for up 1 hr after foaling received OT (50 IU) administration at 1 hr intervals before expulsion of the placenta. The changes in the plasma concentrations of OT and the PGF2alpha metabolite (PGFM) were investigated, and the influence of OT administration was considered. The results were as follows. The placenta was expelled after one to three OT administrations in all four mares that received OT. In two mares, which expelled the placenta within 30 min after OT administration, the OT concentration increased and remained high. Expulsion of the placenta was delayed in two mares, and one of these mares, which received three doses of OT beginning 1 hr after foaling, showed only a small increase in the OT concentration after the first administration; the other mare did not receive OT until 3 hr after foaling. The OT concentration was increased before placental expulsion in all the mares, and the PGFM concentration also increased in the two mares with retained placentas. In conclusion, we suggest that intramuscular administration of 50 IU of OT at 1-hr intervals beginning 1 hr after foaling is effective for inducing placental expulsion.

application/pdf, The aim of this study was to clarify the relationship between circulating oxytocin (OT) and PGF2α metabolite (PGFM) in mares at the third stage of labor and placental expulsion time in order to investigate a cause of retained placenta of which the incidence increase in a heavy draft mare. Blood was sampled every 5 min from foaling to expulsion of the placenta in 18 heavy draft mares to evaluate circulating OT and PGFM. The relationships between OT and PGFM concentration and recorded placental expulsion times were investigated. The results were as follows (1) The highest level of OT concentration was observed close to foaling in 15 mares. (2) The OT concentrations close to foaling were variable with a large difference from the lowest concentration, 22.1 pg/ml, to the highest concentration, 209.3 pg/ml. (3) The highest level of PGFM was observed close to foaling in 17 mares. (4) During the 60 min following foaling, the OT concentrations of the mares (n=11) that had a shorter placental expulsion time (i.e., 1 h; P

Neonatal effects of drugs administered to mothers before delivery depend on the quantity that crosses the placental barrier, which is determined by the pharmacokinetics of the drug in the mother, fetus, and placenta. Diabetes mellitus can alter the kinetic disposition and the metabolism of drugs. This study investigated the placental transfer of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women with gestational diabetes mellitus (GDM) submitted to peridural anesthesia.A total of 10 normal pregnant women (group 1) and 6 pregnant women with GDM (group 2) were studied, all at term. The patients received 200 mg 2% lidocaine hydrochloride by the peridural locoregional route. Maternal blood samples were collected at the time of delivery and, after placental expulsion, blood samples were collected from the intervillous space, umbilical artery, and vein for determination of lidocaine and MEGX concentrations and analysis of the placental transfer of the drug.The following respective lidocaine ratios between the maternal and the fetal compartments were obtained for groups 1 and 2: umbilical vein/maternal peripheral blood, 0.60 and 0.46; intervillous space/maternal blood, 1.01 and 0.88; umbilical artery/umbilical vein, 0.77 and 0.91; and umbilical vein/intervillous space, 0.53 and 0.51. The following MEGX ratios for groups 1 and 2 were, respectively, fetal/maternal, 0.43 and 0.97; intervillous space/maternal blood, 0.64 and 0.90; umbilical artery/umbilical vein, 1.09 and 0.99; and umbilical vein/intervillous space, 0.55 and 0.78.Gestational diabetes mellitus did not affect the transplacental transfer of lidocaine but interfered with the transfer of MEGX, acting as a mechanism facilitating the transport of the metabolite.

To study the efficacy of 100 μg intravenous shot of carbetocin compared to 20 IU oxytocin intravenous infusion to prevent placental retention in second trimester medical termination of pregnancy.A double-blinded randomized controlled trial was conducted at Ain Shams University Maternity Hospital from 1 April 2013 to 30 November 2013. A total of 132 women between 14 and 24 weeks gestation indicated for termination were randomized to receive either 20 IU oxytocin infusion (n = 66) or 100 μg carbetocin shot (n = 66) after fetal expulsion. Patients were observed for time elapsed between fetal and placental expulsion, presence of placental retention and blood loss.Third stage was 33.4 ± 20.4 min in oxytocin group23.1 ± 16.8 min in carbetocin group (p = 0.002). Eight patients (12.1%) in oxytocin group had complete placental retention versus two patients (3.0%) in carbetocin group (p = 0.05). Eight patients (13.8%) received oxytocin had remnants of placenta compared to four patients (6.2%) received carbetocin (p = 0.04). Sixteen patients (24.2%) received oxytocin and six patients (9%) received carbetocin needed surgical curettage (p = 0.04). Third stage blood loss was 87.2 ± 33.7 ml in carbetocin and 206.9 ± 35.2 ml in oxytocin groups (p = 0.001).Carbetocin is superior to oxytocin infusion for management of placental delivery in second trimester abortion.

The use of cord blood (CB) for transplantation has increased greatly in recent years. The collection strategy is the first step in collecting good-quality CB units. There are two main techniques for collecting CB from the umbilical vein: in the delivery room while the placenta is still in the uterus by midwives and obstetricians or in an adjacent room after placental delivery by CB bank trained personnel. In this study, the benefits and disadvantages between the two different CB collection strategies were evaluated, in order to improve CB bank methodology. Valencia CB bank maintains the two different collection strategies. CB was obtained from 569 vaginal and 70 caesarean deliveries and obstetrical and clinical charts were reviewed. Before processing CB units, volume was calculated and samples were drawn for cell counts. After processing and before cryopreservation samples were drawn for cell counts, CD34+cell analysis, viability, clonogenic assays and microbiology were drawn directly from the bags. We compared the efficiency of the two collection techniques. Obstetric data and umbilical CB were obtained from 569 vaginal (264 collected in utero and 305 collected ex utero) and 70 caesarean deliveries. The proportion of excluded CB units before processing was 33% for vaginal ex utero, 25% for vaginal in utero and 46% for caesarean deliveries. Differences were statistically significant. For vaginal deliveries a larger volume and a higher number of nucleated cells, percentage of CD34+ cells and colony-forming units (CFUs) were harvested in the in utero collection group. There was no statistical difference between CB collected after placental expulsion from vaginal and caesarean deliveries. Comparison between all vaginal and caesarean deliveries did not show any difference. We conclude that the mode of collection influences the haematopoietic content of CB donations. Collection before placental delivery is the best approach to CB collection and allows optimisation of CB bank methodology. Caesarean deliveries seem to contain similar progenitor content to vaginal deliveries.

42 Large Polish White x Polish Landrace sows in the 3 rd and 4th reproductive cycle were divided into four groups. The sows were fed completed pelleted feeds with free access to water. The 2% or 4% sunflower oil (for control groups) and 2 or 4% CLA oil (for experimental groups), were added to the feeds for groups from 90th day of gestation to the parturition. CLA oil contained 61% CLA isomers (EDENOR UKD 6010, Henkel). Colostrum and milk samples (100 ml) were taken 24 hours after placental expulsion and at the 8th and 21 st days of lactation. The fat supplements were found to have no effect on the dry mater, fat, protein and ash content of sows' milk. The colostrum of sows given the dietary 4% supplement of CLA contained more lactose (p< 0.05). Significant differences in quantity of CLA in colostrum, the same for sows receiving in the diet 2% as 4% addition of CLA were observed (p

Background: The concept of contraception is not new, but its widespread application definitely is. Contraceptive availability is paramount for the health of women of reproductive age group. Among the variety of options available, female sterilization and IUCD are the most popular in developing countries. This study was conducted to assess the safety, incidence of complications, expulsion rates and willingness to continue at a 6 weeks’ follow-up period; after insertion of Cu T 380 A within ten minutes of placental expulsion both in vaginal and C-section deliveries.Methods: Prospective study in the Department of Obstetrics and Gynaecology, Cheluvamba Hospital from a period of 1st January 2016 to 31st June 2016. All consenting antenatal cases including referrals, who fulfil all the inclusion criteria were included in the study. Expulsion rates at 6 weeks’ follow-up were measured.Results: Total women counselled were 462, accepted 50, declined 412, lost to follow up 3, followed up 47, expulsion 3, bleeding 11, string problems 5, removal 8, continuation 36.Conclusions: PPIUCD is demonstrably a safe and effective contraceptive with high retention rate in the hands of a skilled caregiver. Strategies to increase public awareness through media sources are the need of the hour. Training of healthcare providers, cash incentives to acceptor, motivator and provider would further promote its use in developing countries like India.

We determined the effect of cord blood collection before placental expulsion on postpartum maternal blood loss in a retrospective study between a group of cord blood donors and a group of non-donors. The study was conducted in a university hospital blood bank and obstetric services and included Spanish women entered in a European study project (EUPHRATES) and who had consented to donate cord blood for public banking purposes. We measured blood volume lost during delivery by a bag collection method, as well as the need for transfusion and postpartum anemia symptoms. Deliveries at which cord blood was collected presented a significant increase in blood loss (321 ± 273 vs. 255 ± 237 ml, p=0.02). Instrumental deliveries were associated with higher postpartum blood loss than spontaneous deliveries. Cord blood collection can increase intrapartum blood loss, especially at instrumental deliveries. Additional staff who handle the collection are required to allow the leading clinician to focus on maternal care.

Objective To assess differences in outcomes of misoprostol with or without mifepristone for second-trimester abortion. Methods A randomized, double-blind, placebo-controlled trial of buccal misoprostol following placebo or 200 mg mifepristone was done in Tunisia among women presenting for abortions at 14–21 weeks of pregnancy between August 2009 and December 2011. Women with a live fetus, a closed cervical os, no cervical bleeding, and no contraindications to study drugs were eligible and underwent randomization (block size 10). Participants returned 24 hours later to receive 400 μg buccal misoprostol every 3 hours until complete fetal and placental expulsion (maximum 10 doses, five per 24-hour period). The primary outcomes were rates of complete uterine evacuation at 48 hours and time to expulsion. Results A total of 120 women were evenly randomized to treatment. Complete uterine evacuation at 48 hours was recorded in 55 (91.7%) women in the combined group versus 43 (71.7%) in the misoprostol alone group (relative risk 1.28; 95% confidence interval 1.07–1.53). Mean time to complete abortion was 10.4 ± 6.6 hours in the group who received mifepristone versus 20.6 ± 9.7 hours in the misoprostol alone group (P Conclusion Adding mifepristone before misoprostol can improve the quality of second-trimester abortion care by making the process faster. ClinicalTrials.gov: NCT00969982.

Background: Recent meta-analyses recommend delayed cord clamping (DCC) after uncomplicated births as well as preterm births, but there is no clear definition of timing and uniform national guidelines are lacking. Objective: We aimed to investigate if guidelines for the timing of cord clamping (CC) are followed and what the national practice entails. Methods: A postal questionnaire concerning CC after uncomplicated vaginal, Caesarean term and preterm deliveries was sent to all midwifery practices (n = 526) and obstetrical departments (n = 94) in the Netherlands. Results: The response rate was 81% (500/620). CC protocols were present in 16 and 38% of midwifery and obstetric practices, respectively. Early cord clamping (ECC) was recommended in 54%, DCC in 33%, 6% indicated a specific time point and 7% did not specify. In current practice, DCC was applied after uncomplicated vaginal term deliveries in 90% and ECC in 6%, and no timing was specified in 4%. Midwives used DCC more often than obstetricians (97 vs. 75%). Cessation of cord pulsations was often (54%) used as a time point, 40% used a fixed time point, 2% waited for placental expulsion and 4% did not specify. ECC was preferred in obstetric practices after Caesarean deliveries (in 81%). In preterm births, ECC was practised by 36%, DCC by 54 and 10% did not specify. Conclusion: In the Netherlands, although often not protocolized, DCC is widely used after uncomplicated vaginal term and preterm deliveries, but not after Caesareans. Cessation of cord pulsation is often used as the time point for CC.

Objective: To determine if the timing of the administration of prophylactic oxytocin influences the incidence of postpartum hemorrhage caused by uterine atony, retained placenta, and third-stage duration. Study Design: Parturients who presented for vaginal delivery were randomized in a double-blinded fashion to receive oxytocin, 20 units in a 500-mL crystalloid intravenous bolus, beginning upon delivery of either the fetal anterior shoulder or placenta. For all patients, the third stage of labor was managed with controlled cord traction until placental expulsion, followed by at least 15 seconds of fundal massage. Patients were excluded if they had a previous cesarean section, multiple gestation, antepartum hemorrhage, or bleeding disorder. Results: A total of 1486 patients were enrolled: 745 in the before-placenta group and 741 in the afterplacenta group. The groups were similar with respect to gestational age, fetal weight, labor duration, maternal age, parity, and ethnicity. The incidence of postpartum hemorrhage did not differ significantly between the two groups (5.4% vs 5.8%; crude OR, 0.92; 95% CI, 0.59 to 1.43). There were no significant differences between the two groups with respect to incidence of retained placenta (2.4% vs 1.6%; OR, 1.49; 95% CI, 0.72 to 3.08), or third-stage duration (7.7 minutes vs 8.1 minutes; P =.23). Conclusions: The administration of prophylactic oxytocin before placental delivery does not reduce the incidence of postpartum hemorrhage or third-stage duration, when compared with giving oxytocin after placental delivery. Early administration, however, does not increase the incidence of retained placenta. (Am J Obstet Gynecol 2001;185: 873–7.)

The incidence of excessive bleeding and endometritis in 145 women who accepted post-placental insertion of a copper T380A intrauterine device (IUD) was compared with that of 157 subjects who did not accept the insertion of the IUD. The subjects delivered at the Maternidade da Encruzilhada, Recife, Brazil in the period from March 30, 1994, to December 15, 1995. A blood sample for hemoglobin was collected before placental expulsion and 10 days after labor. The IUD was inserted up to 10 min after the expulsion of the placenta. There was no difference between the groups in the incidence of excessive bleeding, neither regarding mean hemoglobin concentration before placental expulsion (t = 0.039; p = 0.83) nor at day 10 postpartum (t = 1.04; p = 0.29). There were 5 cases of clinically diagnosed endometritis among the 145 subjects with placental-IUD (3.4%) and 7 cases among the 157 women without IUD (4.6%) (p = 0.40). Post-placental insertion appears to be a convenient approach to IUD initiation, with no observed increase in the incidence of excessive bleeding or endometritis.

To determine the effect of prophylactic tranexamic acid (TA) on calculated and measured blood loss after vaginal delivery in women at low risk of postpartum haemorrhage.In this double-blind randomised controlled trial, 120 women with a singleton pregnancy were randomly allocated to receive either one gram intravenous TA or placebo in addition to 10 IU oxytocin after delivery of the fetus. Calculated blood loss was determined based on haematocrit before delivery and 12-24 h postdelivery. The quantity of blood loss was measured during two time periods: from delivery of the fetus to placental expulsion and from placental expulsion to the end of the second hour after childbirth.The mean (SD) calculated total blood loss (519 (320) vs 659 (402) mL, P = 0.036) and measured blood loss from placental delivery to 2 h postpartum (69 (39) vs 108 (53) mL, P 0.001) was significantly lower in the intervention group compared with the control group. There was no significant difference between groups in terms of blood loss from delivery of the fetus until placental expulsion. The frequency of calculated blood loss 1000 mL was lower in the TA group (7% vs 18%, P = 0.048).Prophylactic TA reduces blood loss after vaginal delivery in women with a low risk of postpartum haemorrhage. The prophylactic use of TA may reduce blood loss complications and enhance maternal health.

A total of 54 Holstein-Friesian cows (13 primiparous and 41 multiparous) was used to study maternal plasma oestrone sulphate (E1S) during pregnancy and its relationship to birth weight and viability of calves and time required for placental expulsion after calving. Plasma samples were obtained from the tail vein of cows once every month from days 90 to 180, every 2 weeks from days 181 to 270, and every day from day 270 of gestation to parturition. The E1S concentrations were measured by radioimmunoassay, and birth weight, placental measurements, neonatal viability and the period from calving to placental expulsion were recorded. E1S concentrations were correlated positively (0.71or = ror = 0.32, P0.05 or P0.01) with calf birth weight and weights of cotyledons, intercotyledonary membranes and total placenta from days 210 of gestation to 1 day prepartum. Calf birth weight was correlated positively (p0.01) with the weight of the cotyledons (r = 0.87), intercotyledonary membranes (r = 0.78) and total placenta (r = 0.88). In addition, E1S concentrations were positively correlated (0.63or = ror = 0.28, P0.05 or P0.01) with the neonatal viability after day 195 of pregnancy, and were negatively correlated (-0.29or = ror = -0.55, P0.05 or P0.01) with the intervals from parturition to placental expulsion after 225 days of pregnancy. The results suggest that variation among dams for circulating E1S levels during late pregnancy may be caused by variation of placental development and ability for oestrogen production and conjugation, and they may influence fetal growth, neonatal viability and retained placenta.

Although a trial of labor after cesarean section (VBAC) is successful and relatively safe, few studies have directly addressed the necessity of routine transcervical revision of uterine scar after prior cesarean section. We performed a longitudinal study of 3469 women who had VBAC. In all patients, uterine scar integrity was examined immediately after placental expulsion. The detection rate of uterine scar dehiscence or rupture was 0.23% (8/3469). Only one woman with complete uterine rupture needed immediate laparotomy for severe hemorrhage. Out of seven patients (0.2%), who had evidence of uterine dehiscence, three underwent explorative laparotomy. In conclusion, the potential benefit of routine examination of uterine scar after VBAC is doubtful. Transcervical revision should be performed only in symptomatic patients.

Using stable isotope, glucose turnover was measured in six normal pregnant women during the various stages of labor; during the latent (A1) and active (A2) phases of cervical dilatation, during fetal expulsion (B), and during placental expulsion (C). These data were compared to measurements made in five postpartum women. Pancreatic hormones and cortisol were also measured. In four other normal women undergoing spontaneous labor, catecholamines and free fatty acids were measured. Plasma glucose increased throughout labor from 4.0 +/- 0.2 (A1) to 5.5 +/- 0.5 mmol/L (C) (P < 0.01), compared to 4.7 +/- 0.1 in the postpartum women. Glucose utilization and production were increased throughout labor at 33.4 +/- 3.1 and 32.8 +/- 3.1 mumol/kg min, respectively, compared to 8.2 +/- 0.9 in postpartum women. Glucose metabolic clearance was also increased to 7.5 +/- 0.8 mL/kg.min compared to that in nonpregnant women (1.8 +/- 0.3). Plasma insulin remained at 59 +/- 5 pmol/L during stages A1, A2, and B, but increased to 115 +/- 15 pmol/L during stage C. Plasma glucagon was increased throughout labor at 127 +/- 7 pg/mL, compared to 90 +/- 4 pg/mL in control postpartum women. Plasma cortisol increased during labor from 921 +/- 136 to 2018 +/- 160 nmol/L, compared to 645 +/- 355 during the postpartum period. Epinephrine and norepinephrine also increased during labor from 218 +/- 132 pmol/L and 1.09 +/- 0.16 nmol/L to 1119 +/- 158 and 3.61 +/- 1.04, respectively. It is concluded that labor is associated with a marked increase in glucose utilization and production. These findings suggest that muscle contraction (uterus and skeletal) independent of insulin is a major regulator of glucose utilization during labor. Furthermore, the increase in hepatic glucose production could be favored by an increase in glucagon, catecholamines, and cortisol.