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Packing of lower uterine segment for control of postcesarean bleeding in instances of placenta previa.

Hemorrhage remains a serious obstetric complication with uterine atony as its most common cause. Postpartum atony is controlled with oxytocics and prostaglandins. Uterine arterial ligation is used to decrease the degree of postpartum hemorrhage. Hypogastric arterial ligation and hysterectomy are used when conservative measures fail. With placenta previa accreta, the aforementioned techniques are often not successful in the control of bleeding in the lower segment. The technique of packing of the lower uterine segment is described for use when local control of bleeding points is unsuccessful and hysterectomy is contemplated. Preservation of reproductive potential may be accomplished with this technique with minimal maternal morbidity.

Cervix Uteri↗

[Effects of beta-adrenoceptor blockade on parturition and fetal cardiovascular and metabolic system].

Beta-adrenoceptor blockade (beta-blocker) has recently been introduced for use in treating hypertension of pregnancy. The aim of this investigation is to determine the effects of beta-blocker (alprenolol and labetalol) on parturition and on the fetal cardiovascular and metabolic system in normotensive pregnant rats. The continuous administration of alprenolol to pregnant Wistar rats revealed the following: a small placenta intrauterine growth retardation delayed parturition intrauterine death (21.8%) morbidity (30.3%) and, hypoglycemia of neonates. In the cases which received the administration of both labetalol and alprenolol, the growth of fetuses was retarded. However, there was twice as much growth retardation of the fetuses treated with alprenolol. No other abnormalities were observed. The administration of alprenolol in pregnant rat uteri (in vitro) resulted in stimulation of myometrial contractility (oxytocic reaction) and lowered the c-AMP levels in the bath medium. However, when labetalol was administered, uterine activity was reduced in a dose-dependent manner (tocolytic reaction) with a concurrent rise in c-AMP levels in the bath medium. The effect of alprenolol on rat uterine blood flow using the thermocouple method resulted in a decrease of 18-30 percent but with labetalol there was only a slight decrease (0-5%).

Adrenergic beta-Antagonists↗

Natriuretic action of neurohypophysial peptides: effects of agonists and antagonists and implication of natriuretic receptor.

Neurohypophysial peptides possess natriuretic activity. Although it has been shown that the natriuretic action of these peptides can be dissociated from their antidiuretic activity (a V2-receptor mediated response), it is not known whether the V1-receptor or yet a third receptor type mediates the natriuretic response. Also, it has not been studied what effects V1- and V2-antagonists may have on urinary sodium excretion. To define this, we have studied the effects of four oxytocin (OT) agonists: arginine-vasopressin, OT, [Leu4]OT and [cyclo-Leu8]OT; two V1-receptor antagonists: [penicillamine1,Phe(Methyl)2,Thr4,Orn8]OT and [penicillamine1,D-Phe(Ethyl)2,Thr4,Orn8]OT and one V2-receptor antagonist: d-(CH2)5[D-Ile2,alpha-aminobutyric acid4]arginine-vasopressin on renal excretion of water and electrolytes in anesthetized rats under water diuresis. We also studied the effects of the antagonists on the OT-induced antidiuretic and natriuretic responses. Only the agonists, but not the antagonists, were found to have natriuretic activity. The natriuretic potency was not related to the peptide's antidiuretic activity, but was in the same rank order as their oxytocic activity (a V1-agonist effect). The effects of the antagonists on the OT-induced renal responses were studied at two dose levels, representing a strong and near maximal of their respective V1 and V2 inhibitory doses. The V1-antagonist had no effect on the antidiuretic response to OT but inhibited the natriuretic response in a dose-dependent manner. The antinatriuretic effect was also long-lasting as its antioxytocic activity. The V2-antagonist inhibited the antidiuretic response to OT in a dose-dependent manner but only the high dose inhibited the natriuretic response. These results indicate that the natriuretic action of OT was not mediated by V2-receptors and antinatriuresis was not specific for V1-antagonist.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The hypothalamic and neurohypophysial vasopressin and oxytocin content under various states of adrenergic transmission in dehydrated and subsequently rehydrated rats.

Rats dehydrated for 8 days and subsequently rehydrated were given intracerebroventricularly (i.c.v.) methoxamine hydrochloride (MX) or dihydroergotamine methanosulphonate (DHE), each in a daily dose of 10 micrograms dissolved in 10 microliter of 0.9% sodium chloride. A single dose of MX injected to normally hydrated animals increased the release of hypothalamic and neurohypophysial vasopressin but did not affect significantly the oxytocic activity in the hypothalamus as well as in the neurohypophysis. Under conditions of dehydration MX did not influence the hypothalamic vasopressin content but it stimulated the neurohypophysial vasopressin depletion. On the contrary, MX distinctly inhibited the decrease of hypothalamic and neurohypophysial oxytocin content in dehydrated animals. In rehydrated animals MX restrained some what the renewal of hypothalamic vasopressin and oxytocin storage but intensified this process in the neurohypophysis. A single dose of DHE decreased the vasopressin content in the hypothalamus as well as the oxytocin content both in the hypothalamus and neurohypophysis. Under conditions of dehydration DHE stimulated the depletion of hypothalamic vasopressin and oxytocin. On the contrary, DHE strongly inhibited the depletion of oxytocin in the neurohypophysis of dehydrated rats. DHE restrained the renewal of hypothalamic vasopressin and oxytocin stores as well as intensified this process in the neurohypophysis of subsequently rehydrated rats.

Adrenergic Fibers↗

Active pharmacologic management of the third stage of labor. A comparison of oxytocin and ergometrine.

Postpartum hemorrhage is a common and serious complication of the third stage of labor resulting in anemia and increased morbidity in the puerperium. Administration of uterotonic drugs and suitable mechanical assistance in delivery of the placenta may significantly reduce this hazard. Ergometrine and oxytocin have been used for a long time in markedly different doses and by various routes of administration with varying success. In order to compare these two oxytocics with regard to their hemostatic effects as well as their possible interference with the physiologic placental separation mechanism, three groups (ergometrine, oxytocin, and control) of women have been studied during a 2-year period. Ergometrine (0.2 mg) and oxytocin (10 IU) administered in the stated doses and as single intravenous injections are comparable with regard to hemostatic efficiency, but oxytocin seems to promote placental separation and expulsion better and thereby reduces the risk of partial retention and trapping with bleeding reguiring further emergency measures as a frequent consequence.

Adult↗

Postpartum hemorrhage.

Postpartum hemorrhage is usually unexpected, and blood loss can be massive. Excessive bleeding after delivery may result from uterine atony, disruption of the genital tract, placental abnormalities, coagulation disorders and miscellaneous obstetric complications. Prompt treatment is imperative. Treatment options include oxytocics, prostaglandins, uterine exploration, uterine packing and, occasionally, surgery.

Ergonovine↗

Synthesis and some pharmacological properties of two new antagonists of oxytocin.

Two new 1-beta,beta-disubstituted analogues of [1-deamino]-oxytocin dOT: [1'-(1'-thio-4'-methylcyclohexane)-acetic acid1]-oxytocin (MeCAOT), and [1'-(1'-methyl-4'-thiopiperidine)-acetic acid1]-oxytocin (MePAOT), were synthesized to determine some of the structural features that account for antioxytocic potency. The protected precursors required for these analogues were synthesized by a combination of solid phase and 8 + 1 couplings in solution. MeCAOT is an effective antagonist of oxytocic response to oxytocin (pA2 = 7.3).

Animals↗

Changes in plasma oxytocin, prostaglandin E1, and 13,14-dihydro-15-keto-prostaglandin F2 alpha during labor induced by prostaglandin E2 or F2 alpha and spontaneous labor.

To observe the changes in endogenous oxytocics during spontaneous and induced labor, the plasma concentrations of oxytocin, prostaglandin E1 (PGE1) and 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) were measured during labor in 9 cases of spontaneous labor (group 1), 10 of PGE2-induced labor (group 2), and 7 of PGF2 alpha-induced labor (group 3). Unextracted samples were used for radioimmunoassay of oxytocin. PGE and PGF were extracted and separated for radioimmunoassays of PGE1 and PGFM. Although oxytocin levels in groups 1 and 3 did not change during labor or slightly increased toward delivery, those in group 2 decreased as labor progressed. The mean oxytocin in group 2 was significantly lower at the times of established labor (15.3 +/- 3.2 microU/ml, mean +/- SE) and crowing of the fetal head (10.8 +/- 2.0 microU/ml) than before labor (52.7 +/- 14.8 microU/ml). Plasma PGE1 levels in groups 1 and 3 were low and did not change during labor. Plasma PGFM levels in groups 1 and 2 gradually rose toward delivery. These results suggest that exogenous PGE2 suppresses oxytocin secretion during labor and stimulates endogenous PGF2 alpha production, that endogenous PGE1 may not play an important role in the progress of spontaneous and PGF2 alpha-induced labor, and that endogenous PGF2 alpha may participate in the promotion of all kinds of labor.

Alprostadil↗

Methylergometrine: comparison of plasma concentrations and clinical response of two brands.

There were no significant differences between the two brands of methylergometrine (methylergonovine), Methergin and Myomergin, in the radioimmunologically measured serum concentrations nor in the AUC after an oral 0.250 mg dose determined on the third or sixth postpartum day during a continuous treatment with methylergometrine 0.125 mg t.i.d., nor were there significant differences in the clinical response to this oxytocic drug. Peak serum concentrations were obtained at 3 hours (Methergin 6.3 nmol/1 and Myomergin 6.0 nmol/1), indicating a delayed gastrointestinal absorption in postpartum females in comparison with healthy male volunteers [6]. Spontaneous complaints of side-effects were rare and mild.

Adult↗

[Telemetric labor monitoring using the fetal monitor BMT 941-1].

Recommendation of a telemetric system for the direct fetal monitoring using the monitor BMT 914-1 (Zwönitz). The free movement of parturients during labor is more comfortable and involves an increasing uterine activity, a labor progress and a decrease of oxytocic infusion rate.

Electrocardiography↗

[The effect of antibiotic prophylaxis in vaginal obstetric procedures (author's transl)].

202 cases of vaginal obstetric procedures (forceps and vacuum extraction, breech delivery and manual removal) were reviewed with regard to assessing the value of prophylactic administration of antibiotics. Criteria for the evaluation were fever post partum, duration of stay in hospital and involution of the uterus. The results showed that the prophylactic administration of antibiotics had no significant effect on these parameters, with or without the simultaneous administration of oxytocics. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in vaginal obstetric procedures. Scrupulous aseptic precautions during all vaginal or intrauterine procedures are considered essential for the prevention of infection.

Adult↗

[Severe postpartum hemorrhage].

The authors report 95 cases of post-partum haemorrhage estimated at one litre or more seen in the Department of Obstetrics between 1979 and 1982 for 11 662 deliveries. Classical treatment combining artificial delivery or uterine manual evacuation-oxytocics led to the arrest of bleeding in 73 cases. Severe haemorrhage persisted in 22 cases, including 13 patients who were found to be suffering from a coagulopathy. Treatment of these severe forms is based upon: local haemostasis (in the presence of inertia, prostaglandins must be used before surgery) and correction of the coagulation disorder by substitution therapy providing the missing factors.

Female↗

Structural changes in the contractile apparatus of the myometrium during estrus and pregnancy.

The ultrastructure of the smooth muscle of the uterus of cats was studied at estrus and at several periods during pregnancy. For the pregnancy studies myometrium was observed at 10, 14, 17, 21, and 50 days postcoitus (PC) as well as in five animals close to term (60-63 days PC). Both thick and thin filaments are observed at estrus in five of the six animals studied and also in all of the animals up to 14 days PC. There is a variable occurrence of thick filaments between 14 and 21 days PC at which time thick filaments are not observed over the implantation site but are observed in myometrial tissue taken away from the nidus. Only thin filaments are observed in the myometrium of the pregnant cat after 21 and before 60 days PC. Prior to term there is again a variable occurrence of thick filaments with thick filaments observed in only one of the five animals studied between 60-63 days PC. These results may implicate the fetoplacental complex in the assembly and disassembly of the thick filaments of uterine smooth muscle. The relationship between thick filament assembly, phosphorylation and the parameters regulating uterine contractility are complex and the variable occurrence of thick filaments at the end of term may implicate factors other than hormonal fluctuations, such as stretch and oxytocics, in this process.

Animals↗

[Acupuncture in obstetrics].

Acupuncture has been used in China as a treatment modality for one thousand years and is becoming increasingly important in the western world. Through a special effect on the reticular formation, acupuncture is becoming a first choice among the various methods available to relieve pain, especially in the pregnant woman. It can be useful, in fact, during the three periods of a pregnancy: before delivery: it can effect all the functional and psychiatric problems a pregnant woman may develop; during delivery: there is a definite analgesic and oxytocic effect; after delivery: it can be beneficial in all difficulties with breast feeding. Acupoints used in obstetrics are not very numerous. There are approximately thirty which are located along the body meridians or on the ear.

Acupuncture Therapy↗

Pelvic dimensions and the outcome of trial labour in Shona and Zulu primigravidas.

Pelvic contraction is very prevalent in Africa while radiological facilities to assess pelvic size and shape are seldom available. A trial of labour using simple guidelines on a cervicograph can enable the midwife to detect dysfunctional labour and can help medical staff to manage these problems. Radiological checks in 116 Black primigravid patients with dysfunctional labour demonstrated that an active trial of labour is accurate in determining which of these patients have marked disproportion requiring caesarean section, minimal disproportion requiring assisted delivery, or primary uterine inertia responding to oxytocic stimulation. The role of radiological pelvimetry in African obstetrics is discussed, and the radiological features of the Shona and Zulu pelves in this series are described.

Black or African American↗

Inhibition of the contractile action of bradykinin on isolated smooth muscle preparations by derivatives of low molecular weight peptides.

The carbonyl terminal tripeptide sequence of bradykinin (Pro-Phe-Arg) is molecularly manipulated to obtain agents with potent antagonistic activity towards the smooth muscle contractile activity of bradykinin. Screening of various peptide derivatives revealed that heptyl amides or esters of H-D-Pro-Phe-Arg, and H-D-Phe-Phe-Arg possessed relatively stronger antibradykinin activity on the isolated smooth muscle preparation. The parent tripeptides, H-D-Pro-Phe-Arg-OH, and H-D-Phe-Phe-Arg-OH, and their amino acid components, i.e. D-Proline, D-Phenylalanine, L-Phenylalanine and Arginine, did not possess any antibradykinin activity in concentrations of up to 10(-4) M. When the heptyl derivatives of these peptides were incubated with either heparinized or citrated whole blood or plasma, the antibradykinin activity was not lost. Incubation of these peptide derivatives with either carboxypeptidase A or B did not result in any loss of the pharmacological effect. However, pancreatic protease extract produced a significant loss of the anti-oxytocic action on the isolated rat uterus preparation. H-D-Pro-Phe-Arg-NH-lauryl derivative also blocked the action of bradykinin and this effect sustained for a longer period of time comparative to the blockade with H-D-Pro-Phe-Arg-NH-heptyl derivative. In concentrations of 10(-7) M and 10(-8) M and 1 min incubation, which blocked the contractile action of bradykinin (1 nmole) on the isolated guinea pig ileum, these peptide derivatives did not block the action of acetylcholine, histamine, and serotonin. However, in concentrations of about 10(-6) M and higher with 5 min. incubation histamin is also blocked. On the isolated rat uterus preparation the contractile action of acetylcholine, angiotensin, oxytocin and vasopressin was blocked at concentrations of 10(-6) M. These findings warrant a differential pharmacological evaluation and in vivo testing of these peptide derivatives to investigate their therapeutic potential.

Acetylcholine↗

[Experience from use of Cardiff system (author's transl)].

Reported in this paper are 128 tocometrically controlled oxytocin infusions, using the Cardiff system. The oxytocic intervals were clearly shorter in comparison to conventional oxytocin drip infusion. However, more deliveries had to be completed surgically for foetal emergency situations, which, probably, was attributable to excessive rapid increase in oxytocin infusion rate due to the instruments used.

Female↗

[From ergot alkaloids to nicergoline/Chemical points of view (author's transl)].

The author reports the rationale of a line of research that has led to pharmacologically active ergoline derivatives from the more complex ergot alkaloids. Specific compounds showing oxytocic, alpha-adrenolytic and antiserotoninic activity were synthesized and the relationship between structure and activity discussed. Out of the compounds, 10-methoxy-1,6-dimethyl-ergoline-8 beta-methanol-(5-bromonicotinate) (nicergoline) was chosen as the most interesting product for a detailed further development.

Chemical Phenomena↗