Fetal death during a negative contraction stress test.
This report describes a fetal death during a negative antepartum contraction stress test, without oxytocic stimulation, at 34 weeks' gestation in a woman with Class B diabetes mellitus.
Adult↗
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Ketalar its use by a single operator.
Ketalar (Ketamine Hydrochloride) was used as the sole anaesthetic agent by a single operator in fifty cases of uterine evacuation. The procedure was easy in use, and safe. It was noted that Ketalar caused a significant increase in tone of the uterine musculature, obviating the need for oxytocic drugs. The incidence of emergence phenomena was low. The patients, and staff were well pleased with the outcome.
Abortion, Incomplete↗
Anesthesiological problems related to the use of beta-sympathomimetic drugs for chronic and acute tocolysis.
Pregnant women treated with intravenous beta-sympathomimetics for acute or chronic tocolysis often show cardiovascular side-effects, mainly tachyarrhythmias, and electrolyte disorders, mainly hypokaliemia. Both create a potential hazard at the moment of induction of general anesthesia. For these patients one will use drugs exhibiting minimal hemodynamic side-effects and no oxytocic activity. Barbiturates as induction agent, and intravenous analgesics for maintenance of anesthesia after extraction of the neonate represent the safest solution. A short delay of ten minutes between administration of the beta-mimetic and induction of anesthesia avoids the coincidence of the maximal cardiovascular effects of the beta-mimetic with the stress of induction, and allows adequate preoxygenation of the patient.
Adrenergic beta-Agonists↗
Kininogenase activity of tonin.
Tonin, known for its specific and direct generation of angiotensin II, was highly purified from rat submaxillary gland and investigated for kininogenase activity. For the substrate, heat-treated plasma from ox blood, and highly purified low-molecular-weight (LMW) and high-molecular-weight (HMW) kininogens, were used. The reaction product formed at pH 8.0 well satisfied the characteristics of kinin, i.e., depressor and oxytocic activities and reactivity with antibradykinin antiserum. Kinin formed by tonin from purified LMW kininogen was identified with bradykinin in high performance liquid chromatography and radioimmunoassay. The results revealed tonin's new capability of forming kinin in addition to the hitherto known pressor angiotensin II, indicating tonin, too, is a member of the "kinin- tensin enzyme system."
Animals↗
Catastrophic uterine rupture.
Twenty-three cases of major rupture of the pregnant uterus in which the life of the mother and/or fetus were endangered are presented. Fourteen cases (61.3%) resulted from rupture of a previous cesarean section scar. Rupture of an intact pregnant uterus in nine cases (38.7%) was related to oxytocic drug administration, obstetric manipulation, labor disorders, or external trauma. These most devastating cases were associated with grande multiparity. Rupture of the intact uterus was characterized by increased blood loss and need for transfusion. When compared with rupture of the scarred uterus, however, operating times and mortality rates were similar. Fetal mortality was 35% (eight of 23) and there were no maternal deaths.
Adult↗
Puerperal uterine inversion: report of nine cases.
Acute puerperal inversion of the uterus is considered to be rare. In one institution there were nine cases during an 11-year period, a rate of one for every 2176 vaginal deliveries. Analysis of these cases failed to identify any contributing factors occurring during the first or second stage of labour. Six cases were directly attributable to failure to administer an oxytocic preparation or, particularly, failure to await uterine contraction before attempting to expel the placenta by fundal pressure or cord traction. Although active management of the third stage of labour may reduce the incidence of postpartum hemorrhage, incomplete application of its principles is extremely hazardous. Immediate uterine replacement was efficacious in seven cases, but the inadvisability of removing the placenta prior to replacement was demonstrated.
Acute Disease↗
[Diversity of symptoms in uterine rupture].
We analyzed 5 cases of uterine rupture observed in our clinic in the last 8 years (= 0.36 per 1000 deliveries) because spontaneously appearing ruptures of a normal uterus often have symptoms which may mislead our efforts like amniotic fluid infusion or clotting defects. All our 5 cases were multiparous women, in 4 cases oxytocic drugs were applied and only in one case there was a histologic damage of the myometrium. In no case classic sharp pain and cessation of contractions could be observed, only in one case painful abdomen and tenderness of the uterus. On the other hand shock could be seen in every case, vaginal bleeding in 4 cases and alteration of fetal heart frequency in 3 of 4 cases with primary living fetus. The different symptoms may occur as to time in a variable sequence. Therefore the right diagnosis is made often very late. In accordance with the literature a digital control of the uterine cavity is proposed in every case of an acute event during childbirth, especially evidence of shock, also if another diagnosis than rupture of the uterus is more probable.
Adult↗
[Ripening processes of the uterine cervix and their significance for parturition].
The uterine cervix is to be seen as a biochemical, physical and anatomic unit with a good correlation to the uterine corpus. The function of the cervix for the protection of the pregnancy depends from many biochemical processes, in which collagen has a very important role, influenced by structural and biochemical changing of the connective tissue and by the balance of biosynthesis and destruction of collagen. The controlling function of Estrogen, Progesterone and Corticoids seems to be demonstrated. Prostaglandins have a direct influence on the ripening processes of the cervix and correlation to the oxytocic influence of the uterine contraction. In clinical management and for examination of premature labour, cervical ripeness at term and post-term situations and for indicated initiation of labour we must use a cervix-score with different evaluation of its parameters as length, consistency, position and dilatation of the cervix as well as the station of the fetal head.
Adrenal Cortex Hormones↗
Hypertonic saline as an abortifacient in a select group of patients.
The clinical course of 40 patients with a uterine scar who were undergoing second-trimester abortion induced with either hypertonic saline or prostaglandin F2 alpha, was reviewed. In the 38 patients with a previous cesarean scar, and in the 2 patients with a hysterotomy scar, the uterine contents were evacuated with no evidence of uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical multiparous uterus was more prone to rupture if oxytocin was used in conjunction with or a few hours after instillation of the abortifacient, or if oxytocin was used continuously for more than 12 hours. Although rupture after use of prostaglandin in a previously scarred uterus has been reported, there is no case reported of rupture after use of hypertonic saline. This review and the authors' experience lead them to conclude that hypertonic saline is a safe abortifacient during the second trimester, especially between 18 and 22 weeks' gestation, in a previously scarred uterus when careful monitoring is employed and oxytocic agents are used judiciously.
Abortifacient Agents↗
Probable amniotic fluid embolism after first-trimester pregnancy termination. A case report.
A patient collapsed immediately after dilatation and curettage for pregnancy termination. Disseminated intravascular coagulation supervened rapidly. Although the diagnosis of amniotic fluid embolism has remained unproven, it is the most likely explanation for the chain of events. We recommend rupture of the membranes prior to curettage or the administration of an oxytocic agent.
Abortion, Induced↗
[Uterine ruptures overseas].
Obstetrical hysterorrhexis, accident that has been described for a long time, is still of special concern in rural villages where sufficient health care facilities are not available. This accident is always serious, leading to the death of the newborn baby and, too frequently, to the death of the mother. A number, however, could be avoided with a better training of the paramedical staff, so that neither inadequate actions nor uncontrolled use of oxytocics be done. The author advocates to perform a systematic examination of the uterus after every difficult or outlasting delivery or having required either manual or instrumental help. That remains the best way to save the uterus of the mother and sometimes her life itself.
Adult↗
[Changing risks in uterine rupture].
Between 1975 and 1981 7 cases of rupture of the uterus were observed at this department with an incidence of 1:1200. In all cases therapy consisted of hysterectomy: There was no maternal death, one child died within 24 hours after delivery. Rupture of the uterus remains a serious complication. Careful attention to risk factors, the avoidance of traumatizing obstetric operations and the judicious use of oxytocics should further reduce the incidence of rupture of the uterus.
Adult↗
The quantitative effect of lumbar analgesia on uterine work output.
The effect of lumbar epidural analgesia on uterine work output was studied in 36 women during labour. During the first 10 minutes after administration of the local anaesthetic agents there was a 46% loss of uterine activity. In 72% of patients uterine activity returned to normal within 30 minutes. Seventeen per cent of patients required additional oxytocic stimulation.
Anesthesia, Epidural↗
Treatment of postpartum uterine atony with prostaglandin E2 vaginal suppositories.
When severe postpartum hemorrhage secondary to uterine atony is unresponsive to medical management, including oxytocic drugs and/or ergonovine and its derivatives, surgical intervention becomes necessary. This case of postpartum uterine atony, with several features suggesting persistent myometrial dysfunction which did not respond to usual medical measures, responded to treatment with intravaginal prostaglandin E2 (PGE2) suppositories. Prostaglandin E2 vaginal suppositories may be useful in the treatment of persistent postpartum uterine atony.
Adult↗
Herbal medicines used by traditional birth attendants in Malaŵi.
Some herbal medicines used by Traditional Birth Attendants (TBA) in Malaŵi are identified, and the way in which the TBAs use them described. Two of the medicines were found to possess the oxytocic properties which the TBAs claimed for them.
Female↗
[Choice of delivery methods for cases of breech presentation, with particular reference to premature birth (author's transl)].
Overall mortality, stillbirths and neonatal deaths up to the 28th day of age included, were tested together with selected morbidity parameters, depending on delivery methods used (vaginal route or caesarean section). The group of probands included 112 single births on terms and 136 genuine single premature births (31st to 35th weeks of pregnancy), all of them delivered from breech presentation. Caesarean section for breech presentation deliveries on full term was found to be indicated primarily for cases of cephalopelvic disproportionality and severe risk factors and secondarily on account of cardiotocographic monitoring. Caesarean section has been the method of choice from 1979 for premature births from breech presentation, delivery dates being between the 31st and 35th weeks of pregnancy.--Breech presentation delivery goes along with higher morbidity or mortality risk and, therefore, has become a priority problem in the context of prematurity and its prevention. Efforts should be made to achieve vaginal birth on full term by abandonment of oxytocics and with general cardiotocographic monitoring, despite higher risk of acidosis, however, only in the absence of cephalopelvic disproportionally and grave risk factors. Higher mortality and acidosis risks, accumulation of pulmonary complications, and the need for neonatal intensive care for newborns vaginally delivered from breech presentation were all found by more detailed analysis to be concentrated in the period just before the 35th week of pregnancy. In cases of premature births from breech presentation which could not be therapeutically prevented, caesarean section should be performed up to the 35th week of pregnancy. Vaginal delivery of newborns from breech presentation is considered acceptable beyond the 35th week of pregnancy, with due consideration to be given to the selection criteria generally valid for births on term.
Breech Presentation↗
Uterine relaxant effects of mono- and dibenzyloxyindanpropionic acids.
DIPA [5,6-bis(dibenzyloxy)-1-oxo-2-propyl-2-indanpropionic acid] and MIPA (5-benzyloxy-1-oxo-2-butyl-2-indanpropionic acid) were evaluated for relaxant effects on the estrogenized isolated rat uterus. In a concentration-dependent and reversible manner DIPA (10(-5)-3x10(-4)M) inhibited uterine contractions induced by PGF2 alpha, KCl and BaCl2, and MIPA (10(-5)-3x10(-4)M) inhibited the oxytocic effects of PGF2 alpha, PGE2, acetylcholine and BaCl2. Further evaluation of DIPA demonstrated its selectivity for uterine smooth muscle since it did not interfere with carbachol-induced increased tone nor isoproterenol-induced decreased tone of the isolated guinea pig trachea, nor did it inhibit the positive inotropic effects of isoproterenol on the isolated guinea pig atrium.
Animals↗
Clinical pharmacokinetics of methylergometrine (methylergonovine).
Pharmacokinetic studies carried out on methylergometrine (methylergonovine) by a radioimmunoassay are reviewed. After intravenous injection the half-life of the distribution phase was only 1-3 min, explaining the fast and strong oxytocic response in puerperal mothers. The fast tissue uptake was also obtained in the rabbit uterus in situ with a steep dose-response curve. The rate of gastrointestinal absorption appeared to be slower in patients during puerperium (Tmax 3 h) in comparison with healthy male volunteers (Tmax 0.5 h). The bioavailability after administration was about 60%. After intramuscular injection the rate of absorption was rapid (Tmax 0.5 h). The short half-life of the elimination phase (about 0.5-2 h), low apparent volume of distribution (about that of extracellular water of the body), and the relatively high total plasma clearance value (about 120-240 ml/min) were direct evidence of the rapid elimination of the drug from the body. After repeated oral administrations no accumulation was found. Only about 3% of the single oral dose was excreted into urine, indicating hepatic metabolism and elimination. Although methylergometrine had a good penetration into breast milk in dogs, in postpartum women the mild concentrations were hardly measurable and clinically nonsignificant. Apparently there is no correlation between the plasma level and clinical effect of methylergometrine.
Animals↗