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Fibromyomas and uterine contractions.

BACKGROUND: Women with uterine fibromyomas may suffer from dysmenorrhea, menorrhagia or infertility, which all may be due to an effect of the fibroids on uterine activity. The effect of myomectomy on uterine contractility is unknown. METHODS: In women undergoing myomectomy because of dysmenorrhea, menorrhagia or infertility, intrauterine pressure was recorded before and three months after the operation on corresponding days of the menstrual cycle. Records were obtained during spontaneous uterine activity as well as after oxytocin and vasopressin challenge by intravenous bolus injections of 10 pmol/kg body weight. The area under the recording curve (AUC), maximal amplitude of uterine contractions and deformation index of uterine pressure recordings were measured. RESULTS: In six women, in whom recordings could be obtained before and after operation on corresponding days of late follicular phase of the menstrual cycle, the AUC and maximal amplitude of contractions increased after myomectomy. The effect of oxytocin injection also varied, whereas no difference was seen in effect of vasopressin. CONCLUSIONS: It is suggested that women with uterine fibromyomas may have disturbed uterine spontaneous contractions and responsiveness, which may be regulated by myomectomy.

Adult↗

A prospective masked observational study of uterine contraction frequency in twins.

OBJECTIVE: This study was undertaken to compare uterine contraction frequency in twins versus singletons and to determine if contraction frequency can be an efficient predictor of spontaneous preterm birth in twin gestations. STUDY DESIGN: Fifty-nine twin and 306 singleton gestations were enrolled between 22 and 24 weeks at 11 centers. Contraction frequency was recorded with a home uterine activity monitor (HUAM) 2 or more times per day on 2 or more days per week until delivery or 36-6/7 weeks. Masked HUAM data were interpreted according to standard protocol. Repeated measures analyses were used to determine whether mean or maximum uterine contraction frequency per hour differed between singleton and twin gestations across gestational age, by time of day, and by delivery before 35 weeks or beyond. Uterine contraction frequency was also evaluated by logistic regression and receiver operator characteristic (ROC) curves as tests to predict spontaneous preterm birth. RESULTS: There were 34,908 hours of HUAM data recorded by the 306 singleton gestations and 5,427 hours by the 59 women with twins. Uterine contraction frequency was significantly greater in twins (P = .002) compared with singletons, regardless of gestational age. Contraction frequency in twins increased significantly with gestational age and time of day (1600-0359 hours); but was not associated with spontaneous preterm birth. Maximum uterine contraction frequency was associated with preterm birth less than 35 weeks but only in the morning (am) recording (0400-1559) and at the 29- to 30-week gestational age interval. This relationship was modest (odds ratio 1-2) and not consistent across gestational age or between the am and afternoon/evening (pm) monitoring sessions. ROC analysis revealed no contraction frequency that efficiently identified twins who delivered prematurely at any 2-week gestational age interval. CONCLUSION: Mean uterine contraction frequency was significantly higher for twin gestations than singletons throughout the latter half of pregnancy and between 1600 and 0359 hours but was not higher among twins who delivered less than 35 weeks' gestation. Neither maximum am or pm contraction frequency predicted spontaneous preterm birth less than 35 weeks' gestation in twin pregnancies.

Adult↗

[Studies on the relation between the uterine contraction and the fetoplacental function (author's transl)].

Uterine contractions were recorded with external tocodynamometer in the 2nd and the 3rd trimesters and their connections with various fetoplacental parameters were studied in view of maternal urinary E3, plasma P-LAP, CAP, E3, AFP and HSAP. The obtained results were summarized as follows; 1) During normal pregnancy, r between uterine contraction and gestational weeks was +0.45 (p less than 0.01). 2) Fetoplacental functions improved as gestational weeks advanced. 3) A relation between any two of the above-mentioned fetoplacental parameters during normal pregnancy was statistically significant except the one between urinary E3 and AFP. 4) The partial coefficient correlation between uterine contraction and urinary E3 was -0.36, while the partial coefficient correlation between gestational weeks and urinary E3 was +0.69. 5) In the threatened abortion or labor, the uterine contractions were more frequent (T0 = 5.4) and the urinary E3 was lower (T0 - 2.2) than in the normal pregnancy. 6) As for the within-day variations, when uterine contractions were frequent, urinary E3 was found decreased (X0 2 = 7.59). 7) Use of beta-2 stimulant lowered plasma E3, but its withdrawal increased the E3 level.

Estriol↗

Effects of physical activity and life-style factors on uterine contraction frequency.

In this cohort study, uterine contractions were recorded in 81 low-risk pregnant women who wore ambulatory tocodynamometers continuously during three 72-hour periods at advancing gestational ages. During these periods, they also recorded their daily activities in a diary. Examination of the data, in general, revealed no association between uterine contraction frequency and habits such as smoking, alcohol consumption, or drinking caffeinated beverages. Physical activities, such as prolonged standing, heavy housework, lifting, or organized exercise also did not appear to affect uterine contraction rates. Only climbing stairs and walking were associated with increased contraction frequencies, but this effect, although statistically significant, was relatively small in magnitude and was present only during the last gestational age period monitored (30 to 33 weeks).

Cohort Studies↗

[Inhibition of premature uterine contractions].

Various drugs used to stop premature uterine contractions are discussed in the paper. Particular attention is paid to beta-mimetic drugs. The results of ming Partusisten, one of beta-mimetic drugs, is presented on the material of 104 patients with threatening immature and premature labour. Partusisten was administered in the form of intravenous drip infusion or tablets. During treatment monitoring of the uterine contractility and of foetal heart rate took place. Inhibition of the uterine contraction activity was successful in 100 per cent of cases. In 60,9 per cent in the group of threatening immature labour and in 38,1 per cent in the group threatening premature labour, the delay of delivery was more then 28 days. The delay of delivery by 48 hours was 87 per cent and 84 per cent in both groups respectively. Tachycardia was one of the first side effects observed in 15,2 per cent of cases. There is also presented an example of pregnancy when delivery was delayed by 21 days in spite of premature outflow of amniotic fluid (at a high rupture of membrane). The authors are of the opinion that Partusisten is very effective and gives little side effects, preventing premature uterine contractions. Dosage should be individualized according to the case and labour advancement, and should be based on topographic evaluation of uterine contraction. Negative influence of the drug on foetuses was not observed.

Abortion, Spontaneous↗

Uterine contraction pressures with oxytocin induction/augmentation.

Uterine contraction pressures were quantified (in Montetevideo units) in 109 women at term gestation who received oxytocin for induction or augmentation of labor and whose labor resulted in a spontaneous vaginal delivery. Newborn five-minute Apgar scores were greater than or equal to 8 in 108 of the 109 neonates, and no immediate neonatal morbidity was attributable to the oxytocin stimulation of labor. Women undergoing oxytocin induction had significantly greater uterine contraction pressures than those with oxytocin augmentation. During oxytocin induction 91% of women achieved at least 200 to 224 Montevideo Units and 40% at least 300 Montevideo units versus 77 and 7.7%, respectively, during augmentation of labor. With concurrent fetal monitoring these levels of uterine activity should be sought before consideration of a cesarean delivery because of presumed cephalopelvic disproportion or failure to progress.

Drug Administration Schedule↗

Phospholipase-mediated inhibition of spontaneous oscillatory uterine contractions by lindane in vitro.

Although regulation of uterine contractility is fundamental for parturition, mechanisms by which toxicants modify uterine muscle contractions remain poorly understood. In a previous cumulative concentration-response study, 10 microM lindane (gamma-hexachlorocyclohexane) reduced contraction force and 30 microM lindane abolished contractions in Gestation Day 10 rat uterine strips when lindane was added to muscle baths at 10-min intervals. Other studies showed that brief (<10 min) exposures to 10-100 microM lindane inhibit gap junctions and activate phospholipase pathways in rat myometrial cells in culture. Consequently, lindane was used as a prototype toxicant with known uterine activity to investigate the hypothesis that activation of a specific phospholipase pathway provides a mechanistic link between inhibition of uterine contraction and inhibition of myometrial gap junctions. Uterine tissue and cells were pretreated with phospholipase pathway inhibitors to evaluate the role of phospholipase pathways in lindane's actions in the uterus. Concentrations of inhibitors were selected based on previous reports of effective concentrations for the enzyme activity and on pilot toxicity studies of the inhibitors on uterine contraction and gap junction communication. To monitor uterine contractions, longitudinal uterine strips were excised from Gestation Day 10 rats and suspended in isometric muscle baths, consistent with previous experiments. Exposure in vitro for 60 min to 10-50 microM lindane, an effective concentration range for the uterine responses of interest, revealed that 30 microM lindane rapidly abolished contractions. Subsequently, uterine strips were pretreated with phospholipase pathway inhibitors and then challenged with 30 microM lindane, the lindane concentration that elicited maximal inhibition of uterine contraction. Pretreatment with 20-50 microM of the phosphatidylinositol-specific phospholipase C inhibitor 1-O-octadecyl-2-O-methyl-sn-glycerol-3-phosphorylcholine (ET-18-OCH(3)) reversed lindane-induced inhibition of spontaneous uterine contractions. Gap junction intercellular communication was monitored by injecting the fluorescent dye Lucifer yellow into rat myometrial cells grown in culture and assessing dye transfer to adjacent cells using epifluorescence microscopy. Similar to uterine contraction, pretreatment of cell cultures with phospholipase C inhibitors (30 microM ET-18-OCH(3), 50 microM tricyclodecan-p-yl-xanthogenate.K [D609] or 50 microM tricyclodecan-p-yl-xanthogenate.K or 2-nitro-4-carboxyphenyl-N,N-dophenylcarbamate [NCDC]) partially reversed inhibition of dye transfer by 100 microM lindane, a lindane concentration previously shown to abolish myometrial Lucifer yellow dye transfer under similar culture conditions. In contrast, pretreatment with 20 microM of bromoenol lactone (BEL) to inhibit the calcium-independent phospholipase A(2) or 100 mM ethanol to interrupt the phospholipase D pathway failed to prevent inhibition of spontaneous uterine contractions and inhibition of Lucifer yellow dye transfer by lindane (100 microM). These data suggest that lindane inhibits myometrial gap junctions and spontaneous oscillatory contractions by a phospholipase C-mediated pathway.

Animals↗

[The effect of dolantin used during labor on the fetal heart rate and uterine contraction].

OBJECTIVE: To investigate the effect of dolantin on fetus and uterine contraction. METHODS: Thirty pregnant women under stress, restless or fatigue were given dolantin 100 mg i.m. during the latent phase of labor. Internal fetal heart rate (FHR) monitoring and intrauterine pressure measuring were carried out at 30 minutes, 1 hour and 2 hours after medication. RESULTS: The baseline FHR showed a decrease 30 minutes after dolantin, and decreased further at 1 and 2 hours though still within normal range. At the same time, the baseline of intrauterine pressure decreased as well at 30 minutes, so hypertonic uterine contractions were improved. One hour later the incoordinate uterine contraction was relieved and the frequency and strength of uterine contraction were enhanced (P < 0.01). CONCLUSION: During labor, especially in latent phase, the use of dolantin may improve the general condition of the women. In spite of the decrease of FHR, no fetal distress occurred. Besides, it may enhance the frequency and strength of uterine contraction and relieve the incoordinate uterine contraction.

Adult↗

Controlled trial of hydration and bed rest versus bed rest alone in the evaluation of preterm uterine contractions.

Patients who are seen with uterine contractions but without documented change in cervical dilation or effacement are often treated with intravenous hydration before the initiation of intravenous tocolytic therapy. This is done with the intention of stopping uterine activity in patients with false preterm labor. A prospective randomized study was conducted to evaluate the effect of hydration on preterm uterine contractions in patients without proved preterm labor. A total of 28 patients were treated with bed rest and an intravenous bolus and subsequent continuous infusion of 5% dextrose in lactated Ringer's solution. A control group of 20 patients were treated with bed rest alone. Uterine activity and arrest of uterine contractions were compared between the two groups. Contractions stopped in 54% of the patients treated with hydration, whereas contractions stopped in 40% of the patients in the control group. This difference was not statistically significant. As a crossover study, those in the control group with contractions that continued after the initial observation period were subsequently treated with intravenous fluids. Only one patient in this group stopped contracting. Of all patients whose contractions with either therapy, 18% eventually were delivered of preterm infants. This included 20% of the hydration group and 14% of the control group. The use of hydration as a pretherapy indicator to differentiate true preterm labor from false preterm labor could not be supported by this study. In addition, patients whose contractions stopped with either hydration or bed rest are at increased risk of subsequent preterm delivery.

Bed Rest↗

Evaluation of an impedance measurement technique for uterine contraction recording.

An electronic system for the detection of uterine contractions by impedance measurement was evaluated in 30 subjects during the first stage of labor. The advantage of the system was patient comfort and ease of application of the recording electrodes. Simultaneous recordings of uterine contraction activity with conventional extra- or intra-uterine recording systems were made. The available evidence from this study indicated that 82 to 84% of the uterine contractions were accurately detected and that the onset and end of each uterine contraction is a reliable parameter of impedance measurement.

Adolescent↗

Uterorelaxing effects of vaginal progesterone: comparison of two methodologies for assessing uterine contraction frequency on ultrasound scans.

OBJECTIVE: To assess the changes in uterine contractility induced by increasing doses of P administered to estrogenized women and to compare two methodologies for assessing uterine contraction frequency from ultrasound scans. DESIGN: Prospective double-blind parallel study. SETTING: Academic tertiary center. PATIENT(S): Infertile women aged 21-39 years with premature ovarian failure. INTERVENTION(S): P support set to duplicate the luteal phase was provided every 2 days by application of 1.125 g of Crinone 4% and 8% or 2.25 g of Crinone 8%, containing 45, 90, and 180 mg of P per application, respectively. MAIN OUTCOME MEASURE(S): Changes in uterine contraction frequency following exposure to three doses of vaginal P on ultrasound scans analyzed by visualizing accelerated image sequences and using a previously described three-dimensional (3D)-derived approach. RESULT(S): A decrease in uterine contraction frequency reached statistical significance on the third day of exposure to P without differences between the three dose groups. The two methods for measuring uterine contraction frequency on ultrasound scans were equivalent. CONCLUSION(S): At all three doses studied, the vaginal P gel Crinone administered to estrogenized women induced a profound decrease in uterine contraction frequency that duplicated the changes in contractility described in the luteal phase of the menstrual cycle. Analyzing uterine contraction frequency on accelerated image sequences is as effective as our more complex approach based on identifying contractions on time mode graphs electronically reconstructed using 3D-software.

Administration, Intravaginal↗

The effect of disopyramide on uterine contractions during pregnancy.

To evaluate the effect of disopyramide on uterine contractions during pregnancy, the drug was given for 48 hours to 10 women with indications for labor induction. Placebo was given to 10 other women with the same indications for induction. During the study period, regular uterine contractions occurred in 10 women in the study group, as compared with none in the control group (p less than 0.0001). Eight women in the study group were delivered of infants within 48 hours, as compared with none in the control group (p less than 0.0001). The mean time until the appearance of regular uterine contractions in the study group (4.15 +/- 1.76 hours) was significantly shorter (p less than 0.001) than that in the control group (56.13 +/- 5.28 hours). Patients who were not delivered of infants within 48 hours received other medications (prostaglandin E2, oxytocin). The mean maternal blood level of disopyramide at the time of appearance of uterine contractions was 1.52 +/- 0.9 mg/ml. The mean maternal level at delivery was 0.93 +/- 0.43 mg/ml and the cord blood level at the time of delivery was 0.33 mg/ml (cord blood/maternal level ratio = 0.36, r = 0.73, p less than 0.05). These results indicate that disopyramide should not be used in pregnancy for antiarrhythmic purposes because it may induce uterine contractions and delivery.

Adult↗

Inhibition of oxytocin-induced uterine contractions by an oxytocin antagonist in the pregnant baboon.

Uterine contractions were induced with oxytocin in anesthetized pregnant baboons (Papio anubis) at three stages of pregnancy (days 140, 156, and 169; normal gestation length, 184 days). After the contractile activity was greater than two to three contractions every 10 minutes, beta-mercapto-beta, beta-cyclopentamethylenepropionic acid1-[D-Trp2,Phe3,Ile4,Arg8]-oxytocin, a novel oxytocin antagonist produced in our laboratories, was given simultaneously with the oxytocin for 90 minutes. Contractile force (frequency x mean amplitude) was determined for 30 minutes before and for three 30-minute intervals after the oxytocin antagonist was administered. Animals at 140 days' gestation showed a significant (p less than 0.05) decrease in contractile force in the first 30-minute interval after oxytocin antagonist infusion was initiated, whereas those at days 156 and 169 showed decreases (p less than 0.05) at the second 30-minute interval. In addition, in late gestation a higher dose of oxytocin antagonist per unit of oxytocin was required to prevent uterine contractions. In conclusion, these results suggest (1) that an oxytocin antagonist can inhibit oxytocin-induced uterine contractions in the pregnant baboon and (2) that the interval from oxytocin antagonist administration to significant inhibition of uterine contractions appears to increase with advancing gestational age.

Animals↗

Ability of intrauterine bacterial lipopolysaccharide to cause in situ uterine contractions in pregnant rabbits.

BACKGROUND: To investigate the ability of bacterial lipopolysaccharide delivered by the intra-uterine route to cause uterine contractions in rabbits, and to assess the suppressive effect of urinary trypsin inhibitor on them. METHODS: Both pregnant and non-pregnant rabbits were chronically implanted with a force-transducer to make it possible to record isometric uterine contractions under unanesthetized and unrestrained conditions. Lipopolysaccharide (10 micrograms/animal) was administered via a catheter to their uteri; and then, after confirmation of lipopolysaccharide-induced uterine contractions, urinary trypsin inhibitor (3,000 or 10,000 units/animal/time) or saline solution was injected through the catheter, 5 times for pregnant animals or 3 times for non-pregnant animals at 1-hour intervals in both cases. Their uterine contractions were continuously recorded for 3 to 5 hours. Effects of lipopolysaccharide (10 micrograms/ml) and urinary trypsin inhibitor (100 and 1,000 units/ml) on the contraction of isolated uteri from pregnant mice were also measured, as was their production of prostaglandin E2 and prostaglandin F2 alpha by an enzyme immunoassay method. RESULTS: Lipopolysaccharide augmented the in situ uterine contractions in both pregnant and non-pregnant rabbits, as well as the in vitro contractions of isolated uteri from pregnant mice. Lipopolysaccharide also increased the uterine prostaglandin production. Urinary trypsin inhibitor inhibited significantly the lipopolysaccharide-induced uterine contractions and the prostaglandin production. CONCLUSIONS: Lipopolysaccharide enhanced uterine contractions through, at least partly, a direct mechanism via uterine prostaglandin production, which action could explain the onset of preterm delivery due to intrauterine bacterial infection. As urinary trypsin inhibitor suppressed the lipopolysaccharide-induced uterine contractions, this inhibitor may be a hopeful candidate of a drug for prevention of preterm delivery.

Animals↗

The relationship between fetal heart rate accelerations, fetal movements, and uterine contractions.

The association between fetal heart rate (FHR) accelerations and fetal movements during uterine contractions was studied in 52 pregnant women near term or at the beginning of labor. FHR and uterine contractions were recorded by tococardiograph. At the same time, fetal movements, whether associated or not with contractions, were viewed by real-time ultrasound. During uterine contractions, 95.5% of the FHR accelerations were associated with fetal movements. Also, 90.9% of the accelerations which appeared when the uterus was not contracting were associated with fetal movements. Fetal movements were not seen in 91% of uterine contractions which were not associated with FHR accelerations. The suggestion is made that uterine contractions stimulate both fetal movements and FHR accelerations.

Female↗

Changes in the response to adrenergic drugs on mouse uterine contractions during pregnancy.

The effect of isoproterenol (ISO), norepinephrine (NE) and phenylephrine (PHE) on electrically-induced contractions of mice uterine horns was studied during pregnancy. At the different times of gestation adrenergic agonists always inhibited uterine contractions in the following rank order of potency: ISO greater than NE greater than PHE. Cumulative dose-response curves constructed for the effect of these amines during diestrous, and at days 3-7, 10-15, 17-21 of gestation, showed that EC50 values increased gradually as term approached, which could imply a lower capacity of the uterus to respond to adrenergic drugs. Some likely explanations for this phenomenon are proposed. It is suggested that this lower response to catecholamines at the end of pregnancy could be a cause for the reduced success of beta 2-adrenergic drugs to stop premature labor.

Adrenergic Agonists↗

Fetal membranes inhibit prostaglandin but not oxytocin-induced uterine contractions.

OBJECTIVE: Paracrine signaling in fetal membranes and uterus is hypothesized to play a role in the initiation of labor in women. Numerous fetal membrane signals that stimulate uterine contractions have been described. Recently, by means of the dual-chamber, fetal membrane, uterine muscle model we showed that fetal membranes inhibit spontaneous uterine contractions. This study was designed to test whether human fetal membranes can also inhibit agonist-induced uterine contractions. STUDY DESIGN: A rat uterine muscle strip was mounted into the maternal side of a Plexiglas acrylic plastic chamber. Uterine contractions were recorded for 3 hours after the addition of either 50 nmol/L prostaglandin E2 or 0.1 nmol/L oxytocin to the maternal side of the chamber. During the first and third hours no fetal membranes were present (basal condition). At the beginning of the second hour fetal membranes were inserted into the chamber so that they divided the chamber into maternal and fetal compartments. The membranes were removed before the beginning of the third hour. The integrated force of uterine contractions during the second hour, when the muscle was exposed to fetal membranes, was compared with the basal condition (first and third hours) by repeated-measure analysis of variance. RESULTS: Fetal membranes reversibly inhibited prostaglandin E2-induced uterine contractions by 22%. Fetal membranes did not inhibit oxytocin-induced uterine contractions. CONCLUSION: Fetal membranes inhibit agonist-induced uterine contractions. The fetal membrane inhibitory system is agonist selective.

Analysis of Variance↗

Rat uterine contraction by kallikrein and its dependence on uterine kininogen.

Smooth muscle responses to kallikrein (EC 3.4.21.8) are generally considered to result from kinin formation. In the present study, this premise was reexamined with respect to the isolated rat uterus. Rat submandibular gland kallikrein produced contractions of the rat uterus but the contractions disappeared after successive additions of the same dose of the enzyme to the preparation. Kallikrein-induced rat uterine contractions as well as bradykinin-induced contractions were enhanced by rat submandibular gland bradykinin potentiating factor. The incubation of kallikrein with rat uterine extract in the presence of a kininogen-depleted rat uterus produced kinin which elicited the uterine contraction. An extract from uterine horns previously depleted of kininogen was prepared. Incubation of this extract with kallikrein in a bath containing a kininogen-depleted rat uterus did not evoke uterine contraction. The incubation of four rat uterine horns with kallikrein in the presence of a uterine horn previously depleted of kininogen elicited contractions of the depleted uterus. These results suggest that the contraction produced by kallikrein involves kinin release from the uterus.

Animals↗