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Streptococcus agalactiae, or Group B Streptococcus (GBS), is a leading cause of neonatal sepsis. Materno-fetal transmission of the microorganisms present in the lower genital tract/perineum is considered to be the most frequent mode for acquisition of infection. It has also been proposed that, in a subset of cases, GBS causes acute chorioamnionitis, intraamniotic infection, and fetal/neonatal sepsis. However, the evidence to support this ascending pathway is derived from microbiologic studies that rely on cultivation methods, which do not have the resolution to determine if the microorganisms causing neonatal sepsis are the same as those found in the amniotic fluid and the vaginal ecosystem. We used whole genome sequencing of the microorganisms isolated from the vagina, amniotic fluid, chorioamniotic membranes, and neonatal blood (four isolates) in a case of early neonatal sepsis. Using hybrid genome assembly, we characterized the genomic features including virulence factors and antimicrobial resistance in four isolates from the same mother, placenta, and newborn. Whole genome sequencing revealed that the microorganisms in the four clinical isolates corresponded to S. agalactiae sequence type 1, clonal complexes 1, and serotype Ib. Comparative genomic analysis illustrated similar DNA sequences of the four genomes. This study presents the first evidence of the genomic similarity of microorganisms in the vaginal ecosystem, the space between the chorioamniotic membranes of the placenta, amniotic fluid, and neonatal blood. [ABSTRACT FROM AUTHOR]

Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict a successful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. This prospective study included consecutive nulliparous pregnant women whose gestational age was 41 weeks and 1–6 days (late-term). The AoP was measured at least three times and their means were calculated. During the study period, data of 150 women were included in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration of labour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100° is associated with a high rate of vaginal delivery. [ABSTRACT FROM AUTHOR]

Aim: To compare the effectiveness of 50 and 100 μg of carbetocin with 10 IU of oxytocin for the prevention of postpartum hemorrhage (PPH). Methods: This was a triple‐blind, non‐inferiority trial involving pregnant women recruited at term. We compared two doses of carbetocin (50 and 100 μg) with 10 IU of oxytocin administered as uterotonic agent after vaginal or cesarean delivery. Uterine contractility was assessed at 2‐ and 5‐min after uterotonic administration. The association between adequate uterine tone and PPH with the patients' characteristics were examined using the chi‐square test. Effect of the drugs on the odds of developing PPH was examined using logistics regressions. All analyses were conducted using STATA (StataCorp L.L.C.) with a significance level set at 0.05. Results: In total, 324 women (50 μg carbetocin group‐111, 100 μg carbetocin group‐106, and oxytocin group‐107) participated in the study. There was a significantly higher proportion of women with adequate uterine tone in those that had 100 μg carbetocin relative to 50 μg and 10 IU oxytocin at 5 min (p < 0.001). Patients who received oxytocin had a higher average blood loss than women that had either 50 or 100 μg carbetocin (p = 0.128). There was a significant difference in the need for additional uterotonic, with a higher proportion of participants among those who received 10 IU of oxytocin (p < 0.001). Conclusion: Patients that had 100 μg of carbetocin had a better adequate uterine tone at the fifth minute compared to those who had 50 μg and 10 IU of oxytocin. Generally, carbetocin use was less likely associated with risk of PPH and use of additional intervention. [ABSTRACT FROM AUTHOR]

Estradiol (E2) and relaxin (Rln) are steroid and polypeptide hormones, respectively, with important roles in the female reproductive tract, including myometrium. Some actions of Rln, which are mediated by its membrane receptor RXFP1, require or are augmented by E2 signaling through its cognate nuclear steroid receptor, estrogen receptor alpha (ERα). In contrast, other actions of Rln act in opposition to the effects of E2. Here we explored the molecular and genomic mechanisms that underlie the functional interplay between E2 and Rln in the myometrium. We used both ovariectomized female mice and immortalized human myometrial cells expressing wild-type or mutant ERα (hTERT-HM-ERα cells). Our results indicate that Rln modulates the genomic actions and biological effects of estrogen in the myometrium and myometrial cells by reducing phosphorylation of ERα on serine 118 (S118), as well as by reducing the E2-dependent binding of ERα across the genome. These effects were associated with changes in the hormone-regulated transcriptome, including a decrease in the E2-dependent expression of some genes and enhanced expression of others. The inhibitory effects of Rln cotreatment on the E2-dependent phosphorylation of ERα required the nuclear dual-specificity phosphatases DUSP1 and DUSP5. Moreover, the inhibitory effects of Rln were reflected in a concomitant inhibition of the E2-dependent contraction of myometrial cells. Collectively, our results identify a pathway that integrates Rln/RXFP1 and E2/ERα signaling, resulting in a convergence of membrane and nuclear signaling pathways to control genomic and biological outcomes. [ABSTRACT FROM AUTHOR]

Background: Oxytocin is a widely used uterotonic agent to prevent postpartum hemorrhage in cesarean sections. However, its administration method can influence hemodynamic stability. This study compares the hemodynamic effects of low dose Bolus followed by continuous Intravenous (IV) infusion versus Continuous IV Infusion during cesarean sections. Methodology: Sixty participants undergoing elective cesarean delivery were divided into two groups: Group IB (2 IU IV bolus with 8 IU infusion) and Group I (10 IU IV infusion). Hemodynamic parameters, including systolic (SBP) and diastolic blood pressure (DBP), pulse rate (HR), and mean arterial pressure (MAP) were measured at different time intervals. Linear analogue scale (LAS) scores were used to assess uterine contractions, and surgeon satisfaction was evaluated. Results: There was no statistically significant difference between the SBP or DBP between the two groups. The fall in MAP in Group IB (bolus group) was higher than that in the Group I (Infusion group) at all time intervals but was not statistically significant. The linear increase in Heart rate was significantly higher in Group IB compared to Group I at 5 minutes and 15 minutes of administration of oxytocin. While Group IB exhibited a better Uterine contraction as assessed by LAS scoring at 5 and 10 minutes of Oxytocin administration which was statistically significant. There was no statistically significant difference in Blood loss between the two groups. Conclusion: While both administration methods of oxytocin in cesarean sections induce hemodynamic changes, low dose bolus-continuous injection of oxytocin resulted in slightly more hemodynamic changes than the continuous injection but had a greater effect on uterine contraction. [ABSTRACT FROM AUTHOR]

Problem: Uterine contractions signal labor onset, with elevated pro‐inflammatory cytokines playing a pivotal role. Prior studies have explored their effects on prostaglandins, oxytocin, and signaling pathways, but have overlooked their direct effects on uterine contractions. Here, we aim to investigate the direct effects of interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNF‐α) on contractions to ascertain if they have immediate observable effects like those reported for lipopolysaccharide (LPS) and other effects. Method of Study: Tension recordings were used to assess the direct effects of cytokines and/or LPS on mouse uterine contractions. Calcium imaging was employed to observe calcium oscillations in cytokine‐pretreated myometrial smooth muscle cells (MSMCs) in response to oxytocin. The release of inflammatory cytokines and chemokines from uterine explants after LPS and/or cytokines application was investigated using Luminex. Results: IL‐1β, IL‐6, and TNF‐α rapidly enhanced contractions of term pregnant mouse uterus. LPS combined with TNF‐α intensified contractions compared to LPS alone, although this effect was not statistically significant in our results (p > 0.050). Pretreatment of MSMCs with IL‐1β, IL‐6, or TNF‐α increased calcium oscillations in response to oxytocin. LPS and/or cytokine significantly stimulated the release of IL‐1β, IL‐6, TNF‐α, Chemokine (C‐X‐C motif) ligand 1 (CXCL1), and monocyte chemoattractant protein‐1 (MCP1) from uterine explants in vitro. Conclusions: Inflammatory cytokines have short‐term and long‐term effects on mouse uterine contractions, which together contribute to progressively stronger contractions during labor. [ABSTRACT FROM AUTHOR]

Background: Misoprostol is a synthetic version of prostaglandin E1, unlike its naturally occurring counterpart. Prostaglandins enhance the contractions of the myometrium, resulting in a decrease in bleeding from the myometrium. Objective: To assess the effect of preoperative sublingual misoprostol versus a placebo on intraoperative blood loss during abdominal myomectomy. Patients and methods: This case control study conducted on 100 patients at Damanhour Medical National Institute from October 2023 until March 2024. Results: There was no discernible disparity in the use of Vasopressin among laparoscopic & open myomectomy (p-value = 0.15) or Tranexamic Acid (pvalue = 0.39). In terms of postoperative complications, in the misoprostol group, 8% of patients had nausea, 4% had vomiting, and 8% had shivering, while in the control group, 4% of patients had nausea, 6% of patients had vomiting, and 4% of patients had shivering. There was no discernible disparity in complications between the groups. Conclusions: Our study concluded that there was a significant disparity in blood loss during surgery amongst the two groups. Our findings also indicate that administering sublingual misoprostol before surgery is an easy, easily implemented, and comfortable approach to decreasing intraoperative blood loss throughout abdominal myomectomy. [ABSTRACT FROM AUTHOR]

Pregnancy monitoring is always essential for pregnant women and fetuses. According to the report of WHO (World Health Organization), there were an estimated 287,000 maternal deaths worldwide in 2020. Regular hospital check-ups, although well established, are a burden for pregnant women because of frequent travelling or hospitalization. Therefore, home-based, long-term, non-invasive health monitoring is one of the hot research areas. In recent years, with the development of wearable sensors and related data-processing technologies, pregnancy monitoring has become increasingly convenient. This article presents a review on recent research in wearable sensors, physiological data processing, and artificial intelligence (AI) for pregnancy monitoring. The wearable sensors mainly focus on physiological signals such as electrocardiogram (ECG), uterine contraction (UC), fetal movement (FM), and multimodal pregnancy-monitoring systems. The data processing involves data transmission, pre-processing, and application of threshold-based and AI-based algorithms. AI proves to be a powerful tool in early detection, smart diagnosis, and lifelong well-being in pregnancy monitoring. In this review, some improvements are proposed for future health monitoring of pregnant women. The rollout of smart wearables and the introduction of AI have shown remarkable potential in pregnancy monitoring despite some challenges in accuracy, data privacy, and user compliance. [ABSTRACT FROM AUTHOR]

Successful pregnancy highly depends on the complex interaction between the uterine body, cervix, and fetal membrane. This interaction is synchronized, usually following a specific sequence in normal vaginal deliveries: (1) cervical ripening, (2) uterine contractions, and (3) rupture of fetal membrane. The complex interaction between the cervix, fetal membrane, and uterine contractions before the onset of labor is investigated using a complete third-trimester gravid model of the uterus, cervix, fetal membrane, and abdomen. Through a series of numerical simulations, we investigate the mechanical impact of (i) initial cervical shape, (ii) cervical stiffness, (iii) cervical contractions, and (iv) intrauterine pressure. The findings of this work reveal several key observations: (i) maximum principal stress values in the cervix decrease in more dilated, shorter, and softer cervices; (ii) reduced cervical stiffness produces increased cervical dilation, larger cervical opening, and decreased cervical length; (iii) the initial cervical shape impacts final cervical dimensions; (iv) cervical contractions increase the maximum principal stress values and change the stress distributions; (v) cervical contractions potentiate cervical shortening and dilation; (vi) larger intrauterine pressure (IUP) causes considerably larger stress values and cervical opening, larger dilation, and smaller cervical length; and (vii) the biaxial strength of the fetal membrane is only surpassed in the cases of the (1) shortest and most dilated initial cervical geometry and (2) larger IUP. [ABSTRACT FROM AUTHOR]

Relative uteroplacental insufficiency of labor (RUPI‐L) is a clinical condition that refers to alterations in the fetal oxygen "demand–supply" equation caused by the onset of regular uterine activity. The term RUPI‐L indicates a condition of "relative" uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI‐L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post‐term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI‐L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications. [ABSTRACT FROM AUTHOR]

Vaginal childbirth is the final phase of pregnancy when one or more fetuses pass through the birth canal from the uterus, and it is a biomechanical process. The uterine active contraction, causing the pushing force on the fetus, plays a vital role in regulating the fetus delivery process. In this project, the active contraction behaviors of muscle tissue were first modeled and investigated. After that, a finite element method (FEM) model to simulate the uterine cyclic active contraction and delivery of a fetus was developed in LS-DYNA. The active contraction was driven through contractile fibers modeled as one-dimensional truss elements, with the Hill material model governing their response. Fibers were assembled in the longitudinal, circumferential, and normal (transverse) directions to correspond to tissue microstructure, and they were divided into seven regions to represent the strong anisotropy of the fiber distribution and activity within the uterus. The passive portion of the uterine tissue was modeled with a Neo Hookean hyperelastic material model. Three active contraction cycles were modeled. The cyclic uterine active contraction behaviors were analyzed. Finally, the fetus delivery through the uterus was simulated. The model of the uterine active contraction presented in this paper modeled the contractile fibers in three-dimensions, considered the anisotropy of the fiber distribution, provided the uterine cyclic active contraction and propagation of the contraction waves, performed a large deformation, and caused the pushing effect on the fetus. This model will be combined with a model of pelvic structures so that a complete system simulating the second stage of the delivery process of a fetus can be established. [ABSTRACT FROM AUTHOR]

Prostaglandins have many roles in the equine reproductive tract, including but not limited to luteolysis, luteal support, ovulation, transport through the uterine tube, uterine contraction, embryonic mobility, inflammation, and fibrosis. Altered secretion of inflammatory proteins are likely to disrupt the balance of endometrial function and could impair fertility. Our overall goal was to measure the expression of several prostaglandin- and inflammation-related genes in mares with different degrees of endometrial histological changes. Our hypothesis was that mares with neutrophilic and lymphocytic plasmocytic inflammation, fibrosis, or different biopsy grades would have altered concentrations of prostaglandin E2 (PGE2) and F2α (PGF2α), as well as altered expression of inflammation- and prostaglandin-related genes, compared to mares with minimal to no histological changes on biopsy evaluation. Forty-five endometrial biopsies from estrous mares were assessed by a reproductive pathologist for the degree of neutrophilic inflammation, lymphocytic and plasmocytic inflammation, and fibrosis, and a biopsy grade was assigned based on the Kenney-Doig system. A low-volume uterine lavage was collected from a subset of twenty-six mares prior to biopsy collection and was used to measure PGE2 and PGF2α concentrations via ELISA. Total RNA was extracted from biopsies and mRNA expression was evaluated for twenty-five genes of interest. A restricted maximum likelihood linear model was used to compare differences of mRNA expression, with a statistical significance set at P < 0.05. There was no difference in the abundance of PGE2 or PGF2α between any of the variables tested. Mares with endometrial biopsy grade I had lower expression of NF-kB, PTGS1 and HPGD compared to grade IIA or IIB (P < 0.05). Mares with neutrophilic inflammation had decreased expression of NF-kB, PTGS1, PTGER4, CBR1, mPGES2 and PTGIS compared to mares without inflammation. Mares with mild or minimal endometrial fibrosis had increased expression of mPGES2 and PTGIS , compared to mares with moderate endometrial fibrosis. In conclusion, several genes were identified to be differentially expressed in mares with histological changes compared to mares with no to minimal histological changes. The presence of inflammation and fibrosis may alter the concentration of prostaglandins in endometrial tissue, which could impair many of the uterine reproductive and immune functions during estrus, affecting early embryo survival. • Prostaglandins were differentially expressed based on histological assessment. • Prostaglandin expression was increased in IIA and IIB endometrial biopsies. • mPGES2 and PTGIS relative expression were decreased with moderate fibrosis. • Endometrial biopsies with inflammation had decreased prostaglandin expression. [ABSTRACT FROM AUTHOR]

Objectives: External cephalic version (ECV) is an alternative to caesarean section for abnormal fetal position. ECV is recommended by the most important scientific committees in the world. ECV complications are rare and occur in 6.1% of cases, however severe complications requiring urgent caesarean section are found in less than 0.4%. Our aim was to demonstrate the effectiveness and safety of ECV and to present our own experience with the procedure of ECV. Material and methods: ECV was performed on 62 patients (32 nulliparas and 30 multiparas). Qualification criteria included: singleton gestation, gestational age > 36 + 6, longitudinal pelvic lie, no uterine contractions, intact membranes. Indications for immediate cesarean section within 24 hours of ECV were considered a procedural complication. In patients with complications, the condition of the newborn was checked according to the APGAR score and the day of discharge of the mother and child from the maternity ward was analyzed. Results: ECV finished successfully in 66.1% (nulliparas 56.2% and multiparas 76.7%). Patients with a successful ECV were significantly older and had higher median gestational age. ECV was more often successful when placenta was located on the posteriori wall. In our patients, there were 4 cases of complications requiring delivery at the time of ECV. No serious consequences associated with increased maternal or neonatal morbidity or mortality were reported. Conclusions: ECV seems to be a safe alternative for women wishing to deliver vaginally, as this procedure does not increase the risk of adverse obstetric outcomes. [ABSTRACT FROM AUTHOR]

The evaluation of uterine contraction offers significant information regarding the progression of labour. The occurrence of deliveries before the expected dates leads to undesirable consequences for the mother and fetus. Electrohysterography (EHG) is a non-invasive monitoring scheme generally preferred to detect preterm delivery and reduce the hostile consequences. This paper proposed a novel term and preterm prediction method for predicting preterm deliveries by employing EHG signals. The proposed scheme involves three phases: pre-processing, feature extraction and prediction. Initially, the acquired EHG signals are pre-processed using a band pass filter and wavelet transform to remove noise and artefacts from the EHG signal. The second stage is feature extraction, where the representative features, including Shannon energy, median frequency, time-varying centroid frequency, etc., are extracted. At last, the prediction is carried out using an enhanced sheep flock optimized hybrid extreme artificial neural learning network (ESFHEANL). ESFHEANL is the combination of a hybrid extreme artificial neural learning network (HEANL) and enhanced sheep flock optimization (ESFO) algorithm. It assists in diagnosing the term and preterm birth more accurately. The proposed scheme is implemented in the Python platform and assessed the performance in terms of accuracy, recall, specificity and f-measure using the term-preterm EHG (TPEHG) database. Finally, the experimental outcomes evidenced that the proposed scheme achieved better performance and was employed to diagnose term and preterm births accurately. [ABSTRACT FROM AUTHOR]

Contractions of the uterus play an important role in menstruation and fertility, and contractile dysfunction can lead to chronic diseases such as endometriosis. However, the structure and function of the uterus are difficult to interrogate in humans, and thus animal studies are often employed to understand its function. In rats, anatomical studies of the uterus have typically been based on histological assessment, have been limited to small segments of the uterine structure, and have been time‐consuming to reconstruct at the organ scale. This study used micro‐computed tomography imaging to visualise the muscle structures in the entire non‐pregnant rat uterus and assess its use for 3D virtual histology. An assessment of the rodent uterus is presented to (i) quantify muscle thickness variations along the horns, (ii) identify predominant fibre orientations of the muscles and (iii) demonstrate how the anatomy of the uterus can be mapped to 3D volumetric meshes via virtual histology. Micro‐computed tomography measurements were validated against measurements from histological sections. The average thickness of the myometrium was found to be 0.33 ± 0.11 mm and 0.31 ± 0.09 mm in the left and right horns, respectively. The micro‐computed tomography and histology thickness calculations were found to correlate strongly at different locations in the uterus: at the cervix, r = 0.87, and along the horn from the cervical end to the ovarian end, respectively, r = 0.77, r = 0.89 and r = 0.54, with p < 0.001 in every location. This study shows that micro‐computed tomography can be used to quantify the musculature in the whole non‐pregnant uterus and can be used for 3D virtual histology. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to develop an innovative approach for monitoring and assessing labor pain through ECG waveform analysis, utilizing machine learning techniques to monitor pain resulting from uterine contractions. Methods: The study was conducted at National Taiwan University Hospital between January and July 2020. We collected a dataset of 6010 ECG samples from women preparing for natural spontaneous delivery (NSD). The ECG data was used to develop an ECG waveform-based Nociception Monitoring Index (NoM). The dataset was divided into training (80%) and validation (20%) sets. Multiple machine learning models, including LightGBM, XGBoost, SnapLogisticRegression, and SnapDecisionTree, were developed and evaluated. Hyperparameter optimization was performed using grid search and five-fold cross-validation to enhance model performance. Results: The LightGBM model demonstrated superior performance with an AUC of 0.96 and an accuracy of 90%, making it the optimal model for monitoring labor pain based on ECG data. Other models, such as XGBoost and SnapLogisticRegression, also showed strong performance, with AUC values ranging from 0.88 to 0.95. Conclusions: This study demonstrates that the integration of machine learning algorithms with ECG data significantly enhances the accuracy and reliability of labor pain monitoring. Specifically, the LightGBM model exhibits exceptional precision and robustness in continuous pain monitoring during labor, with potential applicability extending to broader healthcare settings. Trial registration: ClinicalTrials.gov Identifier: NCT04461704. [ABSTRACT FROM AUTHOR]

Background: Pain from postoperative cesarean section stitches can cause physiological stress, thereby disrupting mobility and affecting the uterine involution process postpartum. Acupuncture at points LI4 and SP6 has been reported to stimulate uterine contractions and reduce pain. Objective: To look into how electroacupuncture (EA) stimulation works at particular places LI4, SP6, and the combination of LI4 & SP6 with frequencies of 30, 50, and 100 Hz on the increase in oxytocin levels postpartum cesarean section. Method: The number of respondents was 144 postpartum cesarean section patients who met the inclusion criteria, divided using the randomized controlled trial (RCT) method into 8 intervention and control groups. Oxytocin levels were analyzed through blood samples using the ELISA method, comparing results before and after the intervention as well as with the control group. Result: The electroacupuncture intervention group's analysis at points LI4 and SP6 showed a substantial (P<0.05) rise in oxytocin levels when compared to the control group. Conclusion: The findings of this research suggest that electroacupuncture intervention following a cesarean section can induce a rise in the levels of the hormone oxytocin. [ABSTRACT FROM AUTHOR]

This case report describes the findings of craniofacial anomalies associated with dystocia in a mixed‐breed bitch. A bitch in labour was presented for evaluation of dystocia, and an emergency caesarean section was performed. Two pups with craniofacial abnormalities were delivered by hysterotomy. One pup was stillborn, with congenital anomalies including palatoschisis (cleft palate), cheiloschisis (cleft lip), an open fontanelle, and a narrow teardrop‐shaped skull. The second pup was delivered alive and had cheiloschisis. Craniofacial malformations are a reported cause of dystocia in the dog, usually due to obstruction. However, dystocia in the reported case is presumed to have developed because the pup's craniofacial malformations prevented stimulation of uterine contractions. To the authors' knowledge, this is the first case report to describe craniofacial abnormalities affecting 100% of the litter and is the first known report to describe the relationship between craniofacial abnormalities and presumptive primary uterine inertia. [ABSTRACT FROM AUTHOR]

Background: It has been reported globally that many females died of severe bleeding following their delivery with postpartum hemorrhage being a common cause of maternal death. It is mainly caused by uterine atony. To manage this, the third stage of labor needs to be managed actively. Generally, oxytocin is used for uterus contraction following delivery. However, it has a shorter life, more side effects, and less contraction time, hence, recently Carbetocin has been used with lesser side effects and prolonged acting time. Aim: The present study aimed to assess the safety and efficacy of oxytocin to Carbetocin in managing the third stage of labor at an Indian healthcare center. Methods: The study assessed 100 subjects based on the inclusion and exclusion criteria of the study. In all the subjects, per abdomen examination was done along with the general examination. An ultrasound examination was also done. The data gathered were analyzed statistically. Results: Baseline demographics and data were not comparable in the two study groups. In the majority of the subjects from both groups, mild anemia was seen. No side effects were noted in the Carbetocin group. In the oxytocin group, abdominal pain and nausea were seen. Mean blood loss was higher in the oxytocin group compared to Carbetocin group. Conclusions: The present study concludes that carbetocin has higher efficacy compared to oxytocin as it maintains the tone of the uterus adequately and prevents blood loss and postpartum hemorrhage in females undergoing vaginal delivery. Hence, carbetocin is considered a good alternative to oxytocin in the active management of third-stage labor. [ABSTRACT FROM AUTHOR]

Introduction - Preterm labour refers to the initiation of labour prior to 37 weeks and after 28 weeks of gestation, characterised by consistent uterine contractions that result in gradual cervical modifications. Urinary tract infection (UTI) is one of the several causes of preterm labour. The aim of this study is to evaluate first trimester urinary tract infection and risk of preterm labour pain. Material and methods- The present cross-sectional hospital based study was conducted at department of obstetrics and gynecology among 100 women with preterm labour pain during the study period of one year. Midstream urine samples were collected from all and culture test was performed. Results were analyzed using SPSS version 25.0 Results- Maximum patients were in the age group of 25 to 29 years (50%). 92% of them live in rural area. 70% of patients had normal urine examination and 30% were suffering from UTI. 3% of women had pyleonephritis and 97% had no complications. Organisms isolated from urine culture and sensitivity were : E.coli (68%), cogaulase negative staph (11%), S.aureus (10%), Klebsiella (6%) and GBS (5%). Conclusion – Untreated urinary tract infection (UTI) can be linked to obstetric problems and lead to preterm birth. The predominant bacterial illness that occurs during pregnancy is urinary tract infections (UTIs). It is recommended that all women undergo screening for urinary tract infections (UTIs) during their initial antenatal appointment. Upon diagnosis, it is crucial to rapidly administer an appropriate antibiotic that is both effective and safe. [ABSTRACT FROM AUTHOR]

• Transvaginal uterine artery clamp (TVUAC) and vacuum-assisted uterine contraction using a suction cannula (SC) outperform condom tamponade (CT), suggesting better effectiveness. • TVUAC and SC show quicker application in postpartum haemorrhage (PPH) scenarios than CT. • Combined use of TVUAC and SC significantly hastens the arrest of severe bleeding in cases of PPH. • TVUAC and SC have distinct strengths and limitations in massive atonic and lower segment atony PPH. While there have been numerous innovations recently for the management of postpartum haemorrhage (PPH), a limited body of research supports their application during this critical complication, which contributes significantly to maternal mortality worldwide. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of three interventions – transvaginal uterine artery clamp (TVUAC), vacuum-assisted uterine contraction using a suction cannula (SC), and condom tamponade (CT) – in the management of atonic PPH. An open-label RCT was conducted among women who delivered vaginally and developed atonic PPH at a tertiary care obstetric facility. Block randomization with sealed envelopes was used to allocate eligible participants into three interventional arms with a 1:1:1 ratio. The exclusion criteria were twin deliveries, haemodynamically unstable patients, and individuals who did not provide informed consent. The primary outcome variables assessed were blood loss post-application, total blood loss, time taken for application, and time required to achieve haemostasis within each trial arm. The secondary outcomes were the need for a second instrument or surgical intervention to control bleeding, and requirement for blood transfusion. Effectiveness outcomes were analysed as intention-to-treat, whilst safety outcomes were analysed as as-treated. Sixteen participants were randomized to each intervention group (n = 48). TVUAC and SC demonstrated comparable outcomes, while CT lagged in all examined parameters. Following device application, blood loss was similar in both the TVUAC (235 ± 187 ml) and SC (246.5 ± 189 ml) groups. However, following the use of CT, there was blood loss of 431 ± 427 ml, although this difference was not significant (p = 0.113). When considering total blood loss, the TVUAC group (903 ± 234 ml) showed slightly higher values than the SC group (887 ± 184 ml). However, the CT group exhibited notably higher total blood loss (1068 ± 455 ml) than the TVUAC and SC groups. In terms of application time, both TVUAC (1.8 ± 1.1 min) and SC (1.6 ± 0.9 min) significantly outperformed CT (3 ± 1.3 min) (p = 0.002). Furthermore, the time interval from the diagnosis of PPH to achieving haemostasis (defined as the time taken for active haemostasis) was significantly shorter in the TVUAC group (6 ± 4 min) and the SC group (5.7 ± 1.6 min) compared with the CT group (9.7 ± 3.8 min) (p = 0.002). TVUAC and SC are more effective for the management of PPH than CT. However, both TVUAC and SC have advantages and disadvantages. While these results suggest a potential preference for TVUAC and SC over CT for the management of PPH, further research is necessary to validate these findings. [ABSTRACT FROM AUTHOR]

Objective: This comprehensive review aimed to assess perineal management strategies during labor and their effectiveness in preventing perineal tears while enhancing maternal well-being. Methods: A three-part review was conducted, covering labor pain causes and management, perineal tears and episiotomy, and preventive strategies with a focus on warm compresses. Existing literature and studies were synthesized to offer a holistic perspective on perineal management. Results: Understanding Labor Pain: Labor pain arises from uterine contractions, perineal and cervical stretching, and pelvic pressure. Management options, including pharmacological and nonpharmacological techniques, such as massage, hydrotherapy, and acupuncture, effectively alleviate pain. Perineal Tears and Episiotomy: Perineal tears, including Obstetric Anal Sphincter Injuries (OASIS), are frequently linked to instrumental delivery, prolonged labor, and fetal positioning. Episiotomy, while at times necessary, carries specific indications and potential complications. Preventive Strategies with Warm Compresses: Studies consistently demonstrate the effectiveness of warm compresses applied during the second stage of labor in reducing perineal tears and enhancing perineal integrity, thereby decreasing the need for sutures. Conclusion: Effective perineal management during labor is essential to ensure maternal well-being and reduce the risk of perineal trauma. Nonpharmacological pain management techniques provide viable options, while perineal tears and episiotomy complications emphasize the importance of preventive strategies. Warm compresses, thoughtfully applied during labor, consistently contribute to maintaining perineal integrity. Nurses play a pivotal role in implementing these strategies, offering holistic care, and ensuring safe and satisfying childbirth experiences. [ABSTRACT FROM AUTHOR]

Septic abortion can lead to severe maternal morbidity and mortality. The management of septic abortion can be complicated by a history of radical trachelectomy and transabdominal cerclage placement. A 33-year-old G1P0 at 17 weeks and 6 days gestation presented in severe septic shock after being diagnosed 6 days prior with previable rupture of membranes at an outside hospital and managed expectantly. History was notable for cervical adenocarcinoma status post radical trachelectomy and transabdominal cerclage placement. Due to uterine occlusion from the cerclage, the patient underwent emergent uterine evacuation via an abdominal approach. The risks and benefits of expectant management of pre-viable rupture of membranes in patients with abdominal cerclage should be weighed very cautiously. Among women with abdominal cerclage for whom uterine evacuation is indicated, a transabdominal approach may be necessary. [ABSTRACT FROM AUTHOR]

Cardiotocography (CTG) is used to assess the health of the fetus during birth or antenatally in the third trimester. It concurrently detects the maternal uterine contractions (UC) and fetal heart rate (FHR). Fetal distress, which may require therapeutic intervention, can be diagnosed using baseline FHR and its reaction to uterine contractions. Using CTG, a pragmatic machine learning strategy based on feature reduction and hyperparameter optimization was suggested in this study to classify the various fetal states (Normal, Suspect, Pathological). An application of this strategy can be a decision support tool to manage pregnancies. On a public dataset of 2126 CTG recordings, the model was assessed using various standard CTG dataset specific and relevant classifiers. The classifiers' accuracy was improved by the proposed method. The model accuracy was increased to 97.20% while using Random Forest (best classifier). Practically speaking, the model was able to correctly predict 100% of all pathological cases and 98.8% of all normal cases in the dataset. The proposed model was also implemented on another public CTG dataset having 552 CTG signals, resulting in a 97.34% accuracy. If integrated with telemedicine, this proposed model could also be used for long-distance "stay at home" fetal monitoring in high-risk pregnancies. [ABSTRACT FROM AUTHOR]

AbstractFinite element models ranging from single to multiscale models have been widely used to gain valuable insights into the physiological delivery process and associated complication scenarios. However, the fetus descent simulation with the active uterine contraction is still challenging for validation and uncertainty quantification issues. The present study performed a fetus descent simulation using the active uterine contraction. Then, simulation outcomes were evaluated using theoretical and in vivo MRI childbirth data. Moreover, parameter uncertainty and propagation were also performed. A maternal pelvis model was developed. The active uterine contraction was modeled using a transversely isotropic Mooney–Rivlin material. Displacement trajectories were compared between simulation, theoretical and in vivo MRI childbirth data. Monte Carlo (M.C) and Polynomial Chaos Expansion (PCE) methods were applied to quantify uncertain parameters and their propagations. Obtained results showed that fetal descent behavior is consistent with the MRI-based observation as well as the theoretical trajectory (curve of Carus). The head downward vertical displacement ranges from 0 to approximately 47 mm. A reduction of 50% in uterine size was observed during the simulation. Three high-sensitive parameters (C1,C2,Ca0) were also identified. Our study suggested that the use of the active uterine contraction is essential for simulating vaginal delivery but the global parameter sensitivity, parameter uncertainty, and outcome evaluation should be carefully performed. As a perspective, the developed approach could be extrapolated for patient-specific modeling and associated delivery complication simulations to identify risks and potential therapeutic solutions. [ABSTRACT FROM AUTHOR]

Cyclic ADP‐ribose (cADPR) has emerged as a calcium‐regulating second messenger in smooth muscle cells. CD38 protein possesses ADP‐ribosyl cyclase and cADPR hydrolase activities and mediates cADPR synthesis and degradation. We have previously shown that CD38 expression is regulated by estrogen and progesterone in the myometrium. Considering hormonal regulation in gestation, the objective of the present study was to determine the role of CD38/cADPR signaling in the regulation of intracellular calcium upon contractile agonist stimulation using immortalized pregnant human myometrial (PHM1) cells. Western blot, immunofluorescence, and biochemical studies confirmed CD38 expression and the presence of ADP‐ribosyl cyclase (2.6 ± 0.1 pmol/mg) and cADPR hydrolase (26.8 ± 6.8 nmoles/mg/h) activities on the PHM1 cell membrane. Oxytocin, PGF2α, and ET‐1 elicited [Ca2+]i responses, and 8‐Br‐cADPR, a cADPR antagonist significantly attenuated agonist‐induced [Ca2+]i responses between 20% and 46% in average. The findings suggest that uterine contractile agonists mediate their effects in part through CD38/cADPR signaling to increase [Ca2+]i and presumably uterine contraction. As studies in humans are limited by the availability of myometrium from healthy donors, PHM1 cells form an in vitro model to study human myometrium. [ABSTRACT FROM AUTHOR]

Determining the female animal cycle is crucial in preclinical studies and animal husbandry. Changes in hormone levels during the cycle affect physiological responses, including altered contractility of the visceral smooth muscle. The study aimed to identify estrus and anestrus using smooth muscle electromyographic (SMEMG) measurements, in vivo fluorescent imaging (IVIS) and in vitro organ contractility of the uterus and cecum. The study involved sexually mature female Sprague-Dawley rats, aged 10–12 weeks. The rats received a daily injection of cetrorelix acetate solution for 7 days, while another group served as the control. The animals were subjected to gastrointestinal and myometrial SMEMG. The change in αvβ3 integrin activity was measured with IVIS in the abdominal cavity. Contractility studies were performed in isolated organ baths using dissected uterus and cecum samples. Plasma samples were collected for hormone level measurements. A 3-fold increase in spontaneous contraction activity was detected in SMEMG measurements, while a significant decrease in αvβ3 integrin was measured in the IVIS imaging procedure. Cetrorelix reduced the level of LH and the progesterone / estradiol ratio, increased the spontaneous activity of the cecum rings, and enhanced KCl-evoked contractions in the uterus. We found a significant change in the rate of SMEMG signals, indicating simultaneous increases in the contraction of the cecum and the non-pregnant uterus, as evidenced by isolated organ bath results. Fluorescence imaging showed high levels of uterine αvβ3 integrin during the proestrus-estrus phase, but inhibiting the sexual cycle reduced fluorescence activity. Based on the results, the SMEMG and IVIS imaging methods are suitable for detecting estrus phase alterations in rats. [ABSTRACT FROM AUTHOR]

Introduction: Uterine contractions during delivery cause pain. Though it is a natural concern, this is one of the most common complaints from expectant women. The aim of this study was to investigated the relationship between acupressure and labor pain severity. Materials and methods: This study was experimental design with a pre-posttest control group. When labor entered the active phase, the treatment group began getting acupressure, whereas the control group was maintained under observation and given aromatherapy using frangipani until the cervical opening ended. Midwives in Bali undertook autonomous practices in the working regions of the Sukawati and Gianyar Health Centers from August to November 2020 and 44 respondents were included by systematic random sampling technique. Both univariate and bivariate data analysis methods were applied at a 95% significance level. Results: Study found there was no difference in the degree of labor pain before receiving acupressure or aromatherapy with frangipani (p=0.185). Acupressure and aromatherapy of frangipani have an impact on pain intensity in the groups receiving them, although statistically, acupressure is more significant. Values of p = 0.000 and 0.029 respectively follow acupressure and frangipani aromatherapy. Conclusion: The intensity of labor pain during the initial active phase is decrease by acupressure. Acupressure is best applied by those who are trained. The recommendation should be having the midwives trained accordingly to know how to use acupressure. [ABSTRACT FROM AUTHOR]

The article focuses on the case of presumed perinatal stroke of an infant whose mother complained of abdominal pain during pregnancy. Topics discussed include the sequence captured on a video taken by the patient's mother, the patient's encounter with a lawyer when the baby was one year old, and an analysis of the problem in identifying the timing and mechanism of infant stroke.

Aim: To develop algorithms as decision support tools for identifying, managing and monitoring abnormal uterine activity during labour. Population: Women with singleton, term (37–42 weeks) pregnancies in active labour at admission. Setting: Institutional birth settings in low‐ and middle‐income countries (the algorithm may be applicable to any health facility). Search strategy: PubMed was searched up to January 2020 using keywords. We also searched The Cochrane Library, and international guidelines from World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG) and French College of Gynaecologists and Obstetricians (CNGOF). Case scenarios: Algorithms were developed for two case scenarios: uterine hypoactivity and excessive uterine contractions. Key themes in the algorithm are: diagnosis, identification of probable causes, assessment of maternal and fetal condition and labour progress, monitoring and management. Conclusion: The algorithms for uterine hypoactivity and excessive uterine contractions have been developed to facilitate safe and effective management of abnormal uterine activity during labour. Research is needed to assess the views of healthcare professionals and women accessing healthcare to explore the feasibility of implementing these algorithms, and impact on labour outcomes. An evidence‐based algorithm to support clinical management of abnormal uterine activity during labour. An evidence‐based algorithm to support clinical management of abnormal uterine activity during labour. [ABSTRACT FROM AUTHOR]

Preterm birth is a major public health concern, requiring a deeper understanding of its underlying inflammatory mechanisms and to develop effective therapeutic strategies. This review explores the complex interaction between inflammation and preterm labor, highlighting the pivotal role of the dysregulation of inflammation in triggering premature delivery. The immunological environment of pregnancy, characterized by a fragile balance of immune tolerance and resistance, is disrupted in preterm labor, leading to a pathological inflammatory response. Feto-maternal infections, among other pro-inflammatory stimuli, trigger the activation of toll-like receptors and the production of pro-inflammatory mediators, promoting uterine contractility and cervical ripening. Emerging anti-inflammatory therapeutics offer promising approaches for the prevention of preterm birth by targeting key inflammatory pathways. From TLR-4 antagonists to chemokine and interleukin receptor antagonists, these interventions aim to modulate the inflammatory environment and prevent adverse pregnancy outcomes. In conclusion, a comprehensive understanding of the inflammatory mechanisms leading to preterm labor is crucial for the development of targeted interventions in hope of reducing the incidence of preterm birth and improving neonatal health outcomes. [Display omitted] • Preterm labor pathways are initiated and maintained by inflammation. • Inhibiting the inflammatory response associated to preterm labor with emerging anti-inflammatory therapeutics shows promise in preventing preterm birth. • The collaboration between regulatory institutions, clinicians, advocates, and researchers is necessary to bring awareness to this unmet medical need and to develop effective therapeutics destined to prevent preterm birth. [ABSTRACT FROM AUTHOR]

Thailand has reported a high rate of cesarean delivery (45%–55%), prompting global concern about an increase in cesarean delivery rates. Fear of labor pains is one of the most common reasons pregnant women opt for cesarean delivery. Labor pain is associated with cervix dilation and fetal descent into the birth canal, which is exacerbated by ischemic pain caused by uterine contraction. Modern medical and non-medical techniques have demonstrated efficacy in reducing pain and ensuring safety during labor and delivery. Neuraxial labor analgesia is a highly effective medical pain relief method but has no effect on the rate of cesarean or assisted vaginal delivery. Medication administration for pain relief during labor, using a combination of a local anesthetic and an opioid, was observed to be transmitted across the placenta to the fetus, but had no significant effects on fetal outcomes in mothers who chose epidural analgesia. There are several techniques for administering neuraxial labor analgesia that can be customized for each pregnant woman. To achieve the most wonderful feasible labor and delivery experience, effective epidural labor analgesia is a crucial technique for reducing anxiety and suffering about labor pain. It is safe, widely used world-wide, and effective. Implementing a policy to increase public and medical providers awareness and acceptance of labor pain relief, as well as establishing a safe obstetric anesthesia service provided by obstetric anesthesiologists, could improve maternal and neonatal safety while significantly lowering the rate of unnecessary cesarean deliveries. [ABSTRACT FROM AUTHOR]

Leonurine is an alkaloid unique to the Leonurus genus, which has many biological activities, such as uterine contraction, anti-inflammation, anti-oxidation, regulation of cell apoptosis, anti-tumor, angiogenesis, anti-platelet aggregation, and inhibition of vasoconstriction. This paper summarizes the extraction methods, synthetic pathways, biosynthetic mechanisms, pharmacokinetic properties, pharmacological effects in various diseases, toxicology, and clinical trials of leonurine. To facilitate a successful transition into clinical application, intensified efforts are required in several key areas: structural modifications of leonurine to optimize its properties, comprehensive pharmacokinetic assessments to understand its behavior within the body, thorough mechanistic studies to elucidate how it works at the molecular level, rigorous safety evaluations and toxicological investigations to ensure patient wellbeing, and meticulously conducted clinical trials to validate its efficacy and safety profile. [ABSTRACT FROM AUTHOR]

Dysmenorrhea is the most common pathology women of childbearing age face. It is defined as painful uterine cramping associated with menstruation. Primary dysmenorrhea occurs in the absence of an organic cause, whereas secondary dysmenorrhea is pelvic pain associated with an underlying pelvic pathology. The purpose of this review is to discuss the pathophysiology of dysmenorrhea and provide a discussion of pharmacologic and non-pharmacologic treatment options. Prostaglandins play a large role in the pathophysiology of dysmenorrhea by causing myometrial contraction and vasoconstriction. The first-line treatment for dysmenorrhea is with nonsteroidal anti-inflammatory drugs due to the inhibition of cyclooxygenase enzymes, thereby blocking prostaglandin formation, as well as hormonal contraception. Other pharmacologic treatment options include Paracetamol, as well as Gonadotrophic Release Hormone Analogs, which are typically used in the treatment for endometriosis. Non-pharmacologic treatments with strong evidence include heat therapy and physical exercise. There are less evidence-based data behind other modalities for treating dysmenorrhea, such as dietary supplements, acupuncture, and transcutaneous nerve stimulation, and these methods should be used in conjunction with first-line therapy after a discussion of risks and benefits. Lastly, for women who fail medical management, surgical options include endometrial ablation, presacral neurectomy, and laparoscopic uterosacral nerve ablation. Further research is needed to measure the socioeconomic burden of dysmenorrhea on the healthcare system and to evaluate the efficacy of treatment combinations, as a multi-modal approach likely provides the most benefit for women who suffer from this condition. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to clarify the relationship between fluctuations in uterine stiffness during the third stage of labor and blood loss upon placenta delivery using shear wave elastography. Methods: This prospective cohort study enrolled consecutive singleton pregnant women above 37 weeks of gestation who delivered infants transvaginally at a single perinatal center. Shear wave velocities (SWV) were continuously measured during the third stage of transvaginal labor using transabdominal ultrasound and these values were compared between groups with large (≥500 g) and small amounts of bleeding during this stage. Results: In total, 8 cases of large bleeding and 47 cases of small bleeding were compared. The large amount of bleeding group had a significantly lower median of minimum SWV values (0.97 [0.52–1.01] m/s than the small amount of bleeding group (1.25 [1.04–1.48] m/s p = 0.02). However, no significant differences were observed between the two groups in terms of median, mean, and maximum SWV values. The time from delivery of the infant to placental delivery was significantly longer in the large amount of bleeding group (median time: 370.5 s vs. 274 s, p < 0.05). Conclusion: Ultrasound quantification of uterine stiffness using shear wave elastography demonstrated that uterine contractions may influence the biological hemostasis of the uterus during the third stage of labor. Baseline uterine stiffness was weak and a longer duration of placental separation might be associated with cases of large amounts of bleeding during this stage. [ABSTRACT FROM AUTHOR]

Background: Obstetric hemorrhage is the most prevalent cause of maternal death. Uterine atony accounts for around 80% of postpartum hemorrhage (PPH) cases. Objectives: This study aimed to compare between oxytocin and carbetocin in the prevention of PPH in Caesarean section (CS). Methods: This prospective observational study was carried out on 100 female participants with risk factors of PPH delivered by CS at the Obstetrics and Gynecology Department, Menoufia University Hospitals. They were divided into 2 groups: Group 1 that included 50 pregnant women who received 100 mcg/ml of carbetocin and group 2 that included 50 pregnant women who received 10 IU of oxytocin infusion (8ml/m over one hour). All participants were subjected to full medical history and full clinical examination. Vital signs, intraoperative blood loss estimation, routine investigations (CBC, ABO, Rh, RBS, Coagulation profile, S. creatinine & urinalysis and LFT), and obstetric US were done for all females. Results: Overall 100 participants that were recruited, there was no significant difference regarding demographic data. Group 2 (oxytocin) had significantly lower hemoglobin levels and hematocrit l2 hours & 24 hours postoperatively. Group 1 had better uterine contractions than group 2. There were 17 cases in group 2 that needed additional uterotonic drugs with a p-value <0.001. There were 6 cases in group 2 that developed PPH and 4 of them needed blood transfusion. Conclusion: A single intravenous injection of carbetocin (100 mcg) was more effective than a continuous intravenous infusion of oxytocin (10 IU) for maintaining uterine tone and prevention of PPH. [ABSTRACT FROM AUTHOR]

Preterm delivery is associated with perinatal outcomes such as neonatal complications and deaths. Uterine contraction suppressants are administered to treat. In Japan, ritodrine hydrochloride (ritodrine) and magnesium sulfate (magnesium) are covered by insurance. However, ritodrine was withdrawn from the United States market in 2011, and in Europe, its administration was only limited for short-term use in 2013. In this study, we analyzed in the use of ritodrine and magnesium using the NDB Open Data Japan and annual trends in the number of births issued by the Ministry of Health, Labor, and Welfare for 2019-2021. Ritodrine prescribed per birth decreased from 2019 to 2020, while the level 2021 was the same as 2020. Magnesium decreased between 2019 and 2021. The ages were administered ranged from 15-49 years. The results of this study suggest that ritodrine and magnesium are still frequently used in Japan for the treatment of preterm labor. Recently, the American College of Obstetricians and Gynecologists advocated the use of calcium antagonists such as nifedipine as the first choice. We extracted trends in the use of nifedipine, in the target age group for the treatment of imminent preterm labor. The number of nifedipine prescriptions increased every year. However, nifedipine has no indication for the treatment of imminent preterm labor in Japan, it should be noted that this is not accounting for the treatment of impending preterm labor because the prescriptions were classified as vasodilators in the NDB Open Data. [ABSTRACT FROM AUTHOR]

The article presents a case study of a newborn admitted to a small community medical center with complications following delivery. Topics include the mother's prenatal challenges and the diagnosis of placental abruption, the newborn's critical condition with evidence of meconium aspiration and respiratory distress, and the delayed response in care that led to the eventual need for intubation and transport to a more advanced facility.

Purpose: To evaluate the utility of a novel ultrasound index "combined utero-cervical index (CUCI)" in the prediction of preterm delivery. Methods: The present prospective cohort study was conducted in Ankara Bilkent City Hospital Perinatology Clinic between January 1, 2023, and March 31, 2023. Pregnant women with uterine contractions between 24 and 36th gestational weeks but did not have dilatation or effacement were included. CUCI was calculated as: (utero-cervical angle)/(anterior cervical lip thickness + fundal thickness + lower uterine segment thickness + cervical length). In the presence of cervical funneling, one point was added to the final result. A ROC analysis was conducted to determine the potential of CUCI in predicting delivery <37 weeks of gestation, <34 weeks of gestation, and <4 weeks after the first admission to the hospital for uterine contractions, respectively. Results: Optimal cut-off values of CUCI were found to be 1.4 (67.1% sensitivity, 67.2% specificity) for predicting delivery at <37th weeks, 1.7 (72.7% sensitivity, 65.7% specificity) for predicting delivery at <34th weeks, and 1.4 (62.5% sensitivity, 61.7% specificity) for predicting delivery at <4 weeks. Conclusion: CUCI may be used in the prediction of preterm delivery for pregnant women admitted to hospital with preterm uterine contractions. [ABSTRACT FROM AUTHOR]

Mule duck is vitally important to the production of global duck meat. Here, we present two high-quality haplotypes of a female mule duck (haplotype 1 (H1):1.28 Gb, haplotype 2 (H2): 1.40 Gb). The continuity (H1: contig N50 = 14.90 Mb, H2: contig N50 = 15.70 Mb) and completeness (BUSCO: H1 = 96.9%, H2 = 97.3%) are substantially better than those of other duck genomes. We detected the structural variations (SVs) in H1 and H2. We observed a positive correlation between autosome length and the number of SVs. Z chromosome was some deficient in deletions and insertions, but W chromosome was some excessive. A total of 1,451 genes were haplotype specific expression (HSEs). Among them, 737 specifically expressed in H1, and 714 specifically expressed in H2. We found that H1 and H2 HSEs tended to be involved in similar biological processes, such as myometrial relaxation and contraction pathways, muscle structure development and phosphorylation. Our haplotype-resolved genome assembly provides a powerful platform for future functional genomics, molecular breeding, and genome editing in mule duck. [ABSTRACT FROM AUTHOR]

Background: The placenta is a transient organ critical for fetal development. Disruptions of normal placental functions can impact health throughout an individual's entire life. Although being recognized by the NIH Human Placenta Project as an important organ, the placenta remains understudied, partly because of a lack of non-invasive tools for longitudinally evaluation for key aspects of placental functionalities. Objective: Our goal is to create a non-invasive preclinical imaging pipeline that can longitudinally probe murine placental health in vivo. We use advanced imaging processing schemes to establish functional biomarkers for non-invasive longitudinal evaluation of placental development. Methodology: We implement dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) and analysis pipeline to quantify uterine contraction and placental perfusion dynamics. We use optic flow and time-frequency analysis to quantify and characterize contraction-related placental motion. Our novel imaging and analysis pipeline uses subcutaneous administration of gadolinium for steepest slope-based perfusion evaluation, enabling non-invasive longitudinal monitoring. Results: We demonstrate that the placenta exhibits spatially asymmetric contractile motion that develops from E14.5 to E17.5. Additionally, we see that placental perfusion, perfusion delivery rate, and substrate delivery all increase from E14.5 to E17.5, with the High Perfusion Chamber (HPC) leading the placental changes that occur from E14.5 to E17.5 Discussion: We advance the placental perfusion chamber paradigm with a novel, physiologically based threshold model for chamber localization and demonstrate spatially varying placental chambers using multiple functional metrics that assess mouse placental development and remodeling throughout gestation. Conclusion: Our pipeline enables the non-invasive, longitudinal assessment of multiple placenta functions from a single imaging session. Our pipeline serves as a key toolbox for advancing research in mouse models of placental disease and disorder. [ABSTRACT FROM AUTHOR]

Parturition is a complex physiological process that must occur in a reliable manner and at an appropriate gestation stage to ensure a healthy newborn and mother. To this end, hormones that affect the function of the gravid uterus, especially progesterone (P4), 17β-estradiol (E2), oxytocin (OT), and prostaglandins (PGs), play pivotal roles. P4 via the nuclear P4 receptor (PR) promotes uterine quiescence and for most of pregnancy exerts a dominant block to labor. Loss of the P4 block to parturition in association with a gain in prolabor actions of E2 are key transitions in the hormonal cascade leading to parturition. P4 withdrawal can occur through various mechanisms depending on species and physiological context. Parturition in most species involves inflammation within the uterine tissues and especially at the maternal-fetal interface. Local PGs and other inflammatory mediators may initiate parturition by inducing P4 withdrawal. Withdrawal of the P4 block is coordinated with increased E2 actions to enhance uterotonic signals mediated by OT and PGs to promote uterine contractions, cervix softening, and membrane rupture, i.e., labor. This review examines recent advances in research to understand the hormonal control of parturition, with focus on the roles of P4, E2, PGs, OT, inflammatory cytokines, and placental peptide hormones together with evolutionary biology of and implications for clinical management of human parturition. [ABSTRACT FROM AUTHOR]

This study evaluated the relationship between CL features assessed by ultrasound (luteal tissue area and blood flow, BF) or rectal palpation (size), uterine tone (UT), plasma progesterone (P4) concentration on Day 7 (D7) and subsequent pregnancy outcomes in bovine embryo recipients. A total of 163 cows and heifers were included in this study. The expected day of ovulation after the synchronization protocol was designated as D0. On D7, ovaries and uterus were examined by ultrasonography and rectal palpation, and subjective scores (1–3 scale) were assigned for CL size, area and BF, and for UT. Blood samples were collected for further P4 analysis. Each embryo recipient then received a grade I frozen–thawed in vivo‐produced blastocyst, which was transferred to the uterine horn ipsilateral to the CL. Pregnancy diagnosis was performed on D35, and the results were retrospectively compared with the assigned scores for CL and UT. We observed a significant (p <.02) interaction between CL size and UT, with a progressive increase in the likelihood of pregnancy for recipients bearing a large CL among those with turgid UT. Ultrasound scoring of the CL using B‐mode and Doppler‐mode did not significantly predict pregnancy rates on D35 (p <.6 and p <.5, respectively). However, logistic regression analysis revealed a trend towards a quadratic effect (p <.08 and p <.06) indicating that the probability of pregnancy varied according to the area of luteal tissue and P4 concentrations, respectively. No significant (p >.05) association was found between the probability of pregnancy and the BF area of the CL. In summary, UT before embryo transfer may reflect successful recipient synchronization. Elevated P4 levels, assessed by CL size, may offset uterine contractility, mitigating adverse effects. Additionally, the CL area may be more important than its vascularization area when evaluating recipients D7 after ovulation. [ABSTRACT FROM AUTHOR]

Labor induction during the late trimester of pregnancy is a common option of terminating pregnancy by inducing uterine contractions through medication or cervical mechanical dilation. However, there are few researches on the factors influencing the effectiveness of cervical ripening balloon combined with oxytocin in inducing labor. To explore factors affecting the efficacy of cervical ripening double balloon combined with oxytocin in labor induction. Methods: Using a convenient sampling method, this study retrospectively collected the clinical data of 230 pregnant women who underwent cervical ripening double balloon combined with oxytocin for labor induction in our hospital from September 2021 to August 2022. The included subjects were divided into a vaginal delivery group (n = 180) and a cesarean section group (n = 50) based on the delivery mode for comparing relevant indicators between the two groups. Results: The presence of acute chorioamnionitis (OR = 1.456, 95% CI: 1.257– 2.112), fetal distress (OR = 1.371, 95% CI: 1.331– 2.633), and the placement of cervical ripening balloon catheter for > 12h (OR = 1.563, 95% CI: 1.231– 3.263) were risk factors for successful application of cervical ripening double balloon combined with oxytocin for labor induction in pregnant women; while multi-gravidity (OR = 0.736, 95% CI: 0.455– 0.875) was a protective factor. In addition, evaluation of the predictive value revealed that acute chorioamnionitis, fetal distress, the placement of cervical ripening balloon catheter for > 12h, and gravidity all had certain predictive value for the failure of cervical ripening double balloon combined with oxytocin for labor induction, with the highest predictive value found through joint predictive (AUC: 0.931, 95% CI: 0.714– 0.811). Conclusion: Cervical ripening double balloon combined with oxytocin for labor induction may have a high success rate in multigravida. Acute chorioamnionitis, fetal distress, and prolonged placement of the balloon may have a negative impact on the success rate of cervical ripening double balloon combined with oxytocin for labor induction. [ABSTRACT FROM AUTHOR]

Objective was to present detailed menstrual cramps information in normally ovulatory versus anovulatory cycles from a single-cycle cohort study during the SARS-CoV-2 Pandemic. Secondly, we reviewed the literature for cohort studies documenting both menstrual cramps and ovulation. Participants and Methods: The Menstruation and Ovulation Study 2 recruited 108 women ages 19– 35 years to a prospective, observational single-cycle study, recording cramps daily (0– 4 scale) in the Menstrual Cycle Diary© and assessing normal ovulation (luteal length ≥ 10 days) by the validated Quantitative Basal Temperature© (Mean Temperature Method). We searched databases for « primary dysmenorrhea » / » menstrual cramps »; « menstrual cycles »; « anovulation », finding four valid publications. Results: In 75 women/cycles during the Pandemic, mean age was 28.5, body mass index 23.5, and higher education (16 years); 40 normally ovulatory and 35 anovulatory cycles had similar lengths (29.5– 30.0 days), respectively (P= 0.571). However, anovulatory cycles recorded significantly worse menstrual cramps versus normally ovulatory cycles; anovulatory median intensity was 1.9 versus 1.6, and Cramp Score was 8 versus 6 in normally ovulatory cycles (P=0.017). Four publications in 273 women (991 cycles) showed cramps in both anovulatory and ovulatory cycles; three were in adolescent/young adult women, one of which documented a significantly greater percentage of cramps in ovulatory cycles. The 694 cycles in premenopausal women (20– 41 years) showed similar percentages of symptomatic cramps in cycles of both ovulatory types. Meta-analysis documented significantly higher cramp prevalence in ovulatory cycles (OR 2.10; 95% CI 1.31, 3.37; P=0.002). Conclusion: This is the first documentation of more intense and frequent cramps in anovulatory cycles. However, meta-analysis showing the presence of symptomatic cramps in both ovulatory and anovulatory cycles documented they were twice as prevalent in ovulatory menstrual cycles. Plain Language Summary: "Worse Menstrual Cramps in Anovulatory Cycles". Medicine has long believed that menstrual cramps only occur in ovulatory menstrual cycles that release an egg and have high progesterone levels that decrease before the next period. The notion was that dropping progesterone levels triggered release of prostaglandins that cause the pain and uterus muscle contractions of menstrual cramps. This research studied 75 community women aged 19– 35 years for a single cycle during COVID-19. Forty women had normally ovulatory cycles and 35 had anovulatory cycles with a similar mean cycle length of 29.7 days. Women in both groups were similar in age, weight, education and other reproductive characteristics. Women recorded Menstrual Cycle Diary© daily experiences for cramp presence and intensity (scored 0– 4). Ovulation was documented by daily first morning temperatures analyzed by the valid Quantitative Basal Temperature© method. Results showed menstrual cramps occurred in both normally ovulatory and anovulatory cycles. Surprisingly, anovulatory compared with ovulatory cycles had cramps that lasted longer (4 rather than 3 days), were more intense (1.9 versus 1.6) and with significantly higher Cramp Scores (of 8 versus 6). We also found four other published studies showing cramps occurred in both anovulatory and ovulatory cycles. A meta-analysis of these, however, showed that cramps were twice as frequent in ovulatory cycles. These results matter because they stimulate the search for more accurate understandings of why menstrual cramps occur. They will likely stimulate more effective therapies for the rare, intense menstrual cramps that currently are not effectively treated by anti-inflammatory medicines such as ibuprofen. [ABSTRACT FROM AUTHOR]

The effects of pomegranate juice (PJ) and its components on uterine smooth muscle are unknown. Hence, this study unequivocally demonstrates that pomegranate juice (PJ) significantly impacts myometrial function, providing crucial insights into its relaxant properties and their potential therapeutic applications for uterine-related disorders. Rat uterine smooth muscle horn strips were suspended in Krebs solution organ baths. Contractions were measured isometrically using a transducer (AD instrument Australia). The effects of PJ were evaluated on contractile activity elicited by potassium chloride (KCl 60 Mm) depolarization. Inhibitors of nitric oxide (L-NAME 3 X 10−4), guanylate cyclase (methylene blue 1 X 10−5), and Prostaglandin I2 (indomethacin 3 X 10−5), as well as Potassium Channels blockers, were determined. The juice at concentrations from 1.5–5 mg/ml significantly decreased the rat uterine horn contraction induced by KCl. The NO, cGMP, and PGI2 inhibitors did not block the relaxation response. Furthermore, the PGI2 inhibitor significantly enhanced the relaxation effects; K+ channel blockers had no inhibitory effects on the relaxation responses. Contrarily, GLIB improved considerably relaxation. Research suggests pomegranate juice's active ingredient may reduce uterine contractions and treat uterotonic disorders, potentially preventing preterm birth and dysmenorrhea. Further research is needed to determine its mechanism of action. Code: AEC-013 [ABSTRACT FROM AUTHOR]

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion. Methods: A cross-sectional ethnobotanical survey was conducted from May – December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software. Results: All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%). Conclusion: Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution. [ABSTRACT FROM AUTHOR]

Parturition in dogs is subjected to complex hormonal regulation, with the involvement of prostaglandin F2α (PGF2α) still not fully understood. To investigate uterine inertia (UI), the most prevalent maternal reason for dystocia in the bitch, a better understanding of undisturbed uterine, especiallymyometrial function, is crucial. Our aim was to gain deeper insights into the role of PGF2α in the canine parturient myometrium. Uterine biopsies were obtained during medically indicated cesarean sections. To test for stimulatory effects of PGF2α in vitro, circular and longitudinal myometrial layer tissue strips were challenged with 50 pM, 0.5 µM, and 50 µM PGF2α. Prostaglandin-endoperoxide synthase 2 (PTGS2) and PGF2α-receptor (PTGFR) mRNA expressions were compared between primary UI (PUI) and obstructive dystocia (OD) samples in isolated parturient myometrium. PTGFR protein expression was assessed in full thickness uterine samples. PGF2α concentrations were analyzed in canine interplacental tissue around term. In the organ bath, the contractile response to PGF2α was limited to the circular layer at the highest dosage. Correspondingly, PTGFR immunohistochemical staining was significantly stronger in the circular layer (p ≤ 0.01). PTGS2 gene expression did not differ between PUI and OD, whereas PTGFR gene expression could not be quantified. Local uterine PGF2α concentrations correlated negatively with serum P4 levels and were the highest during prepartum luteolysis while being significantly lower in PUI. Conclusively, despite the significant increase in local PGF2α concentrations at birth, confirming the interplacental tissue as a production site, our results suggest that PGF2αmight affect uterine contractility during labor, mainly indirectly. [ABSTRACT FROM AUTHOR]

Aims: As uterine extracellular pH decreases during the ischemic conditions of labor, but its effects on myometrial contraction are largely unknown, there is a need to elucidate its physiological effects and mechanisms of action. Furthermore, it is not known if any of the effects of extracellular acidification are affected by pregnancy, thus we also determined how gestation affects the response to acidification. Methods: Nonpregnant, mid‐, and term‐pregnant myometrial strips were obtained from humanely killed mice. Contractions were recorded under spontaneous, depolarized, and oxytocin‐stimulated conditions. The extracellular pH of the perfusate was changed from 7.4 to 6.9 or 7.9 in HEPES‐buffered physiological saline. Intracellular pH was measured using SNARF, and intracellular calcium was measured using Indo‐1. Statistical differences were tested using the appropriate t‐test. Results: Extracellular acidification significantly increased the frequency and amplitude of spontaneous contractions in pregnant, but not nonpregnant, myometrium, whereas alkalinization decreased contractions. Intracellular acidification, via Na‐butyrate, transiently increased force in pregnant tissue. Intracellular pH was gradually acidified when extracellular pH was acidified, but extracellular acidification increased contractility before any significant change in intracellular pH. If myometrial force was driven by oxytocin or high‐K depolarization, then extracellular pH did not further increase force. Intracellular calcium changes mirrored those of force in the spontaneously contracting pregnant myometrium, and if calcium entry was prevented by nifedipine, extracellular acidification could not induce a rise in force. Conclusion: Extracellular acidification increases excitability, calcium entry, and thus force in pregnant mouse myometrium, and this may contribute to increasing contractions during labor when ischemic conditions and acidemia occur. [ABSTRACT FROM AUTHOR]