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The effect of nicotine on in vitro contractility of term pregnant human myometrium
TUESDAY,
SEPTEMBER
5
P2.02.07 INFLUENCE OF EPIDURAL ANALGESIA ON LABOR, DELIVERY AND EARLY NEONATAL STATUS AND DEVELOPMENT OF NEWBORN S. Dept. OB/GYN, University Hospital, Comenius University, Martin, Slovak Republic. Objective: The aim of our study was to investigate the effect of epidural analgesia on duration of the first and second stage of labor, number of cesarean deliveries and vaginal instrumental deliveries. Fetal factors noted were the birth weight less than 3OOOg, APGAR scores less than 7 at l* minute and Sh minute after delivery. We investigated the effect of epidural analgesia on the fetal heart rate, variability, incidence of variable, late and early decelerations. Study Methods: 200 women, who reached the second stage of labor, were included in this retrospective study. All cases had a singleton cephalic presentation at term (37’h to 42”d week) following an uncomplicated pregnancy. Women were divided into 2 groups: Group A (n=lOO) had an epidural analgesia and Group B (n=lOO) had labor without epidural analgesia and using only spasmolytics, which were administered in. Results: Epidural analgesia, available on request, was provided by a trained anesthesiologist-obstetrician using 0.125% bupivacain with fentanyl following a 500 - 1000 ml fluid preload. An incidence of instrumental vaginal deliveries (forceps) and cesarean deliveries was higher in Group A (6% vs. O%, resp. 10% vs. 5%). A significantly greater number of nulliparous was in Group A (76%) vs Group B (34%). Cases with a 1-min APGAR score less than 7 had significantly greater incidence in Group A - 11% vs 1% in Group B. APGAR score in 5’h minute in Group A was 5% and in Group B 1%. A variable and late decelerations during last hour of labor were associated with significantly higher rate in Group A. Difference in variability and accelerations between both groups was not significant. Conclusion: Epidural analgesia during labor is the best method for pain relief during labor. Administration of epidural is associated with some maternal and fetal differences against deliveries without using this method. Longer first and second stages of labor are, in our opinions, due to both high rate of nulliparous in Group A, which had longer and painful latent phase of labor and no active management of labor. We are sure that and active management/early amniotomy application of oxytocin and administration of epidural analgesia in active part of labor will decrease duration of labor. Any anesthesiological and neurological complications during epidural analgesia were not present in our study.
P2.02.08 ACTIVE VERSUS PHYSIOLOGICAL MANAGEMENT OF THE THIRD STAGE OF LABOR: A RANDOMIZED CONTROLLED TRIAL A. Baheiraei (l), M. Mahmoody (2), L. Salehy (l), F. Vasegh (l), Tehran University of Medical Sciences, Tehran, Iran. (1) Dept. Midwifery, Faculty of Nsg & Midwifery (2) Dept. Vital Statistics Objectives: Our purpose was to compare active management of the third stage with a method of physiological management in women at low risk to hemorrhage. The primary outcome was the incidence of postpartum hemorrhage. Secondary outcomes included duration of third stage, frequency of retained placenta and side effects of oxytocin. Study Methods: A total of 94 women who were delivered vaginally were randomly allocated during labor to the active management group (n=47). In the active management group, women received oxytocin, 10 units in 500 ml of normal saline solution was given in an intravenous infusion after delivery of the baby, after which the placenta was delivered actively by controlled cord traction (Brandt-Andrews method). In the physiological method group, the placenta was delivered by maternal pushing and received lml placebo in 500 ml of normal saline solution was given intravenous infusion. Results: The incidence of postpartum hemorrhage (blood loss greater than 500 ml) was 14.5 in the physiologic group and 10.6 in the active group. The incidence of retained to placenta (2 30 minutes) was 6.3% in the active group and 4.2% in the physiologic group. In the active management group incidence of nausea, vomiting and severe birth pains were 4.3%, 4.3%, 38.3% respectively. In the physiologic group, incidence of nausea, vomiting and severe birth pains were 4.3%, 2.1%,
109
29.7%, respectively. Conclusion: The routine use of oxytocin during the third stage of labor in women at low risk of hemorrhage doesn’t appear to be necessary.
P2.02.09 CHANGES IN MATERNAL LIPID PEROXIDATION LEVELS AND ANTIOXIDANT ENZYMATIC ACTIVITIES BEFORE AND AFTER DELIVERY A. Nakai, A. Oya, H. Kobe. H. Asakura, H. Miyake, A. Yokota, T. Koshino, T. Araki, Dept. OB/GYN, Nippon Medical School, Tokyo, Japan. Objective: Our goal was to characterize the changes in maternal lipid peroxidation levels and antioxidant enzymatic activities before and after delivery. Study Methods: Predelivery and 1, 24, and 48 hours post partum blood samples were collected from 25 women with uncomplicated pregnancies. Plasma concentration of malondialdehyde, a metabolite of lipid peroxides detectable in plasma, was measured as an indicator of lipid peroxidation. Erythrocyte enzyme superoxide dismutase, glutathione peroxidase and catalase were measured as intracellular antioxidant markers. Results: Plasma concentration of mlondialdehyde increased slightly from predelivery to 24 hours post partum and then decreased significantly at 48 hours post partum. At one hour post partum erythrocyte enzymes superoxide dismutase and catalase levels increased significantly to about 125% and 170% of predelivery, respectively. Thereafter, these values decreased significantly from one hour to 48 hours post partum. Changes in glutathione peroxidase activity were qualitatively similar to those in superoxide dismutase and catalase, but these changes did not reach significance. The relative changes in superoxide dismutase and catalase levels at one hour post partum compared to predelivery values correlated significantly with the duration of labor. However, malondialdehyde and glutathione peroxidase did not correlate significantly with any of the clinical parameters. Conclusion: The results suggest that the uncontrolled lipid peroxidation caused by reactive oxygen species, which are produced in consequence of tissue reoxygenation, may occur during labor and that prolonged labor may develop maternal oxidative stress.
P2.02.10 THE EFFECT OF NICOTINE ON IN VITRO CONTRACTILITY OF TERM PREGNANT HUMAN MYOMETRIUM A.Atke (l), M. Bertelsen (l), B. Ottesen (l), T. Engstroem (2), H. Vilhardt (1) Dept. OB/GYN, Hvidovre University Hospital. Copenhagen, Denmark. (2) Department of Medical Physiology, Div. Of Endocr. & Metabol., University of Copenhagen, Denmark. Objectives: Several effects of smoking have been described on placental function and fetal development. In the present study we have investigated the effect of nicotine and its major metabolite cotinine on contractility and responsiveness of human term pregnant myometrium in vitro. Study Methods: Strips of human term pregnant myometrium were obtained from the lower segment of the uterus of 10 non-smokers during planned cesarean section at week 37+ to 42 and isometric contractions were recorded in vitro. Contractions were characterized by maximal tension (g) times mean duration (min) and expressed as g x min. Responsiveness to oxytocin (OT) and prostaglandinF2alfa (PGF2a) was recorded in absence and presence of nicotine (1 mg/l) or cotinine (5mg/I), and expressed as maximal response (Emx) and the dose giving half maximal response (EC50). Results: All strips included exhibited spontaneous contractions that were not altered by nicotine or cotinine. All strips responded dose dependently to OT and PGF2a, but these responses, as characterized by EC50 and Emax values, were not significantly affected by nicotine or cotinine (t-test, p=O.O5) Conclusion: In conclusion, no significant effect of nicotine or cotinine on spontaneous or simulated myometrial activity could be demonstrated in vitro. However, long term effects may exist, and similar studies will be performed including heavy smokers as well.
SEPTEMBER
5
P2.02.07 INFLUENCE OF EPIDURAL ANALGESIA ON LABOR, DELIVERY AND EARLY NEONATAL STATUS AND DEVELOPMENT OF NEWBORN S. Dept. OB/GYN, University Hospital, Comenius University, Martin, Slovak Republic. Objective: The aim of our study was to investigate the effect of epidural analgesia on duration of the first and second stage of labor, number of cesarean deliveries and vaginal instrumental deliveries. Fetal factors noted were the birth weight less than 3OOOg, APGAR scores less than 7 at l* minute and Sh minute after delivery. We investigated the effect of epidural analgesia on the fetal heart rate, variability, incidence of variable, late and early decelerations. Study Methods: 200 women, who reached the second stage of labor, were included in this retrospective study. All cases had a singleton cephalic presentation at term (37’h to 42”d week) following an uncomplicated pregnancy. Women were divided into 2 groups: Group A (n=lOO) had an epidural analgesia and Group B (n=lOO) had labor without epidural analgesia and using only spasmolytics, which were administered in. Results: Epidural analgesia, available on request, was provided by a trained anesthesiologist-obstetrician using 0.125% bupivacain with fentanyl following a 500 - 1000 ml fluid preload. An incidence of instrumental vaginal deliveries (forceps) and cesarean deliveries was higher in Group A (6% vs. O%, resp. 10% vs. 5%). A significantly greater number of nulliparous was in Group A (76%) vs Group B (34%). Cases with a 1-min APGAR score less than 7 had significantly greater incidence in Group A - 11% vs 1% in Group B. APGAR score in 5’h minute in Group A was 5% and in Group B 1%. A variable and late decelerations during last hour of labor were associated with significantly higher rate in Group A. Difference in variability and accelerations between both groups was not significant. Conclusion: Epidural analgesia during labor is the best method for pain relief during labor. Administration of epidural is associated with some maternal and fetal differences against deliveries without using this method. Longer first and second stages of labor are, in our opinions, due to both high rate of nulliparous in Group A, which had longer and painful latent phase of labor and no active management of labor. We are sure that and active management/early amniotomy application of oxytocin and administration of epidural analgesia in active part of labor will decrease duration of labor. Any anesthesiological and neurological complications during epidural analgesia were not present in our study.
P2.02.08 ACTIVE VERSUS PHYSIOLOGICAL MANAGEMENT OF THE THIRD STAGE OF LABOR: A RANDOMIZED CONTROLLED TRIAL A. Baheiraei (l), M. Mahmoody (2), L. Salehy (l), F. Vasegh (l), Tehran University of Medical Sciences, Tehran, Iran. (1) Dept. Midwifery, Faculty of Nsg & Midwifery (2) Dept. Vital Statistics Objectives: Our purpose was to compare active management of the third stage with a method of physiological management in women at low risk to hemorrhage. The primary outcome was the incidence of postpartum hemorrhage. Secondary outcomes included duration of third stage, frequency of retained placenta and side effects of oxytocin. Study Methods: A total of 94 women who were delivered vaginally were randomly allocated during labor to the active management group (n=47). In the active management group, women received oxytocin, 10 units in 500 ml of normal saline solution was given in an intravenous infusion after delivery of the baby, after which the placenta was delivered actively by controlled cord traction (Brandt-Andrews method). In the physiological method group, the placenta was delivered by maternal pushing and received lml placebo in 500 ml of normal saline solution was given intravenous infusion. Results: The incidence of postpartum hemorrhage (blood loss greater than 500 ml) was 14.5 in the physiologic group and 10.6 in the active group. The incidence of retained to placenta (2 30 minutes) was 6.3% in the active group and 4.2% in the physiologic group. In the active management group incidence of nausea, vomiting and severe birth pains were 4.3%, 4.3%, 38.3% respectively. In the physiologic group, incidence of nausea, vomiting and severe birth pains were 4.3%, 2.1%,
109
29.7%, respectively. Conclusion: The routine use of oxytocin during the third stage of labor in women at low risk of hemorrhage doesn’t appear to be necessary.
P2.02.09 CHANGES IN MATERNAL LIPID PEROXIDATION LEVELS AND ANTIOXIDANT ENZYMATIC ACTIVITIES BEFORE AND AFTER DELIVERY A. Nakai, A. Oya, H. Kobe. H. Asakura, H. Miyake, A. Yokota, T. Koshino, T. Araki, Dept. OB/GYN, Nippon Medical School, Tokyo, Japan. Objective: Our goal was to characterize the changes in maternal lipid peroxidation levels and antioxidant enzymatic activities before and after delivery. Study Methods: Predelivery and 1, 24, and 48 hours post partum blood samples were collected from 25 women with uncomplicated pregnancies. Plasma concentration of malondialdehyde, a metabolite of lipid peroxides detectable in plasma, was measured as an indicator of lipid peroxidation. Erythrocyte enzyme superoxide dismutase, glutathione peroxidase and catalase were measured as intracellular antioxidant markers. Results: Plasma concentration of mlondialdehyde increased slightly from predelivery to 24 hours post partum and then decreased significantly at 48 hours post partum. At one hour post partum erythrocyte enzymes superoxide dismutase and catalase levels increased significantly to about 125% and 170% of predelivery, respectively. Thereafter, these values decreased significantly from one hour to 48 hours post partum. Changes in glutathione peroxidase activity were qualitatively similar to those in superoxide dismutase and catalase, but these changes did not reach significance. The relative changes in superoxide dismutase and catalase levels at one hour post partum compared to predelivery values correlated significantly with the duration of labor. However, malondialdehyde and glutathione peroxidase did not correlate significantly with any of the clinical parameters. Conclusion: The results suggest that the uncontrolled lipid peroxidation caused by reactive oxygen species, which are produced in consequence of tissue reoxygenation, may occur during labor and that prolonged labor may develop maternal oxidative stress.
P2.02.10 THE EFFECT OF NICOTINE ON IN VITRO CONTRACTILITY OF TERM PREGNANT HUMAN MYOMETRIUM A.Atke (l), M. Bertelsen (l), B. Ottesen (l), T. Engstroem (2), H. Vilhardt (1) Dept. OB/GYN, Hvidovre University Hospital. Copenhagen, Denmark. (2) Department of Medical Physiology, Div. Of Endocr. & Metabol., University of Copenhagen, Denmark. Objectives: Several effects of smoking have been described on placental function and fetal development. In the present study we have investigated the effect of nicotine and its major metabolite cotinine on contractility and responsiveness of human term pregnant myometrium in vitro. Study Methods: Strips of human term pregnant myometrium were obtained from the lower segment of the uterus of 10 non-smokers during planned cesarean section at week 37+ to 42 and isometric contractions were recorded in vitro. Contractions were characterized by maximal tension (g) times mean duration (min) and expressed as g x min. Responsiveness to oxytocin (OT) and prostaglandinF2alfa (PGF2a) was recorded in absence and presence of nicotine (1 mg/l) or cotinine (5mg/I), and expressed as maximal response (Emx) and the dose giving half maximal response (EC50). Results: All strips included exhibited spontaneous contractions that were not altered by nicotine or cotinine. All strips responded dose dependently to OT and PGF2a, but these responses, as characterized by EC50 and Emax values, were not significantly affected by nicotine or cotinine (t-test, p=O.O5) Conclusion: In conclusion, no significant effect of nicotine or cotinine on spontaneous or simulated myometrial activity could be demonstrated in vitro. However, long term effects may exist, and similar studies will be performed including heavy smokers as well.