Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

BACKGROUND: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop. OBJECTIVE: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor. METHOD: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth. RESULTS: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group (p < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group (p < .05). CONCLUSION: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.

Impact of additional risk factors on the incidence of preterm delivery among pregnant women diagnosed with short cervix.

OBJECTIVE: Additional risk factors for preterm delivery in pregnant women with cervical shortening are not fully understood; however, mid-trimester cervical shortening is accepted as a risk factor for preterm delivery. This study aimed to identify risk factors associated with subsequent preterm delivery among patients with short cervix detected after late mid-trimester. MATERIALS AND METHODS: This was a retrospective study of medical data from a single perinatal tertiary facility. We identified 134 asymptomatic women with singleton pregnancies where cervical shortening (≤25 mm) was detected during routine universal screening at 22-33 weeks. Statistical analyses were conducted to identify causal relationships between the incidence of preterm delivery and known risk factors for preterm delivery. RESULTS: Incidence of preterm delivery was 27.6% (37/134) and preterm premature rupture of membrane was preceded in 46.0% (17/37) of the women with preterm delivery. Using logistic regression analysis, we identified uterine contractions [aOR 4.25, 95% confidence intervals (CI):1.68-12.1] and increased C-reactive protein (CRP) and increased white blood cell (WBC) in blood test (CRP: aOR 3.45, 95% CI:1.50-9.71; WBC: aOR 1.28, 95% CI: 1.08-1.55) as risk factors which significantly increased the risk of preterm delivery among women diagnosed with short cervix. Preterm delivery occurred in 91% of women positive for both uterine contractions and CRP >0.5 mg/dl. CONCLUSIONS: Uterine contraction and elevated CRP were additional risk factors for preterm delivery among women with short cervix. These results might be clinically useful to evaluate subsequent risk for preterm delivery in asymptomatic pregnant women presenting with short cervix in mid-pregnancy.

Is there an association between subclinical hypothyroidism and preterm uterine contractions? A prospective observational study.

OBJECTIVE: To investigate the association between subclinical hypothyroidism and preterm contractions. METHODS: Prospective observational study among women at 23 + 0/7 and 34 + 6/7 weeks of gestation, with no known thyroid function abnormality, and preterm uterine contractions (PTC). All patients underwent laboratory evaluation of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4). Patients with and without PTC were compared. RESULTS: No association was found between PTC and subclinical hypothyroidism. Rate of spontaneous preterm delivery (PTD) was comparable between women with abnormal and normal thyroid function tests. Excluding indicated PTD, patients in the study group had a higher rate of spontaneous PTD (24.7% versus 9.6%, p = 0.03). Patients with past PTD and preterm contractions had higher rates of hypothyroxinemia compared with patients without past PTD (54.6% versus 19.0% and 31.2%, p = 0.001), and patients with past PTD (regardless of the presence or absence of PTC) had higher rate of subclinical hypothyroidism compared with patients with PTC and without PTD (59.1% and 66.7% versus 31.6%, p = 0.017). CONCLUSIONS: No association was found between PTC and subclinical hypothyroidism in the entire cohort, except for patients with preterm contractions and a history of past PTD. This specific group of patients might benefit from thyroid function evaluation.

High uterine contraction rates in births with normal and abnormal umbilical artery gases.

OBJECTIVE: To determine if the incidence of high contraction (HC) rates and associated decelerations were different in term births with metabolic acidemia (MA) compared to those with normal gases (N) over the last 4 h of labor. METHODS: MA included 316 babies with cord base deficits (BD) over 12 mmol/L N - 3,320 babies with BD under 8 mmol/L. HC rates were defined as >5/10 min. RESULTS: One or more episodes of HC occurred in 43.7% of MA and 36.6% of N. (p = 0.015) In both groups the HC rates rose from about 1 in 30 patients at the beginning to 1 in 7 to 9 patients at the end. MA showed a different transition of the deceleration response over time. At the beginning the average ratio of decelerations to uterine contractions was similar in both groups but over the final 140 min MA showed a consistently higher ratio. CONCLUSIONS: Although HC rates were more frequent in the MA, it was not uncommon in N. On average MA showed more decelerations at every level of contractions and had a persistently higher level of decelerations per contraction for more than 2 h before birth.

Relationship between contractions of the uterus and concentration of PGF2α in uterine venous blood after luteolysis in gilts.

The origin and physiological significance of high pulses of prostaglandin F2α (PGF2α) in uterine venous blood that occur 2-3 days after luteolysis are not well understood. We studied the relationship between contractions of the uterus evoked by exogenous oxytocin (OT) and PGF2α concentration in uterine venous blood on day 17 of the porcine oestrous cycle. The infusion of OT into the uterine artery produced an immediate increase in the uterine intraluminal pressure (UIP) (p < 0.001) and a simultaneous elevation in PGF2α concentration in uterine venous blood (p < 0.0001). The infusion of indomethacin (IND) into the uterine artery slightly decreased PGF2α concentration in uterine venous blood, but it did not suppress uterine contraction or the rapid increase in PGF2α concentration in uterine venous blood just after OT infusion (p < 0.0001), which was lower that in gilts not treated with IND. We conclude that the spikes of PGF2α concentration in uterine venous blood occurring after OT infusion on day 17 of the porcine oestrous cycle are mainly caused by the excretion with venous blood from the remodelled uterus and that PGF2α synthesis may contribute to this. These results suggest that the high spikes in PGF2α concentration that occur 2-3 days after luteolysis in pigs, sheep, cows and mares all have a similar origin.

Fetal ductus venosus, middle cerebral artery and umbilical artery flow responses to uterine contractions in growth-restricted human pregnancies.

OBJECTIVE: To explore fetal ductus venosus (DV) flow velocity changes relative to umbilical artery (UA) blood flow and brain-sparing flow (BSF) during uterine contractions. METHODS: Forty-five term fetuses suspected of having growth restriction were exposed to an oxytocin challenge test (OCT) with simultaneous Doppler velocimetry in the UA, middle cerebral artery (MCA) and DV. Basal BSF was defined as a MCA-to-UA pulsatility index (PI) ratio of < 1.08, and de novo BSF as a decrease in MCA-PI of > or = 1 SD (equivalent to a value of 0.24 units) during the OCT. RESULTS: Basal DV flow velocities were lower in the BSF group (n = 7) than they were in the non-BSF group (n = 38). During the OCT, DV flow velocity parameters changed in neither group but MCA-PI decreased in the non-BSF group. A crude de novo BSF was not associated with DV flow velocity changes, but when UA-PI changes were considered, a serial relationship was found between decreased UA-PI, increased DV flow velocity, and decreased MCA-PI. When UA-PI increased, the MCA-PI still decreased (though not significantly) but DV flow velocity parameters remained unchanged. CONCLUSIONS: Established fetal BSF is associated with low DV flow velocities, but in an acute sequence there might be two contrasting courses along which BSF develops: one with an increase and one with a decrease in the UA vascular flow resistance. In the former situation the DV flow velocity increases, while in the latter situation the role of the DV in the acute redistribution of fetal blood flow is unclear.

Free fetal DNA concentration in maternal plasma during normal labour at term.

OBJECTIVE: Our aim was to investigate the effect of uterine contractions on free fetal DNA concentration in maternal plasma at term. STUDY DESIGN: Nine pregnant women were admitted for elective induction of labour between 38 and 40 weeks of gestation. All patients carrying male fetuses and without history of pre-term labour and membrane rupture were selected. Maternal venous blood samples were serially collected every hour during labour, one hour after delivery and 24 h after delivery. In order to amplify fetal and total free DNA, primers for SRY and GAPDH genes were respectively chosen. Real- time PCR analysis was performed with an GeneAmp 5700 Sequence Detection System (Applied Biosystems Foster City, USA). Statistical significance was determined using the Wilcoxon test. RESULT: Median concentration of fetal DNA in plasma before labour was 3081 copies/mL (Range 812-15 864 copies/mL). No significant difference between the number of copies per millilitre before any contractions and during labour was demonstrated. One hour after delivery, significant decrease in the fetal DNA rate was observed with a median concentration of 293 copies/mL (Range 0-2037 copies/mL) (p-value: 0.04). This drop was more significant 24 h after delivery with a median concentration of 0 copies/mL (Range 0-95 copies/mL) (p-value: 0.02). CONCLUSIONS: During labour, no changes in free fetal DNA in maternal plasma were demonstrated. This suggests that labour does not have effect on free fetal DNA release in maternal circulation at term.

Fetal endocrine responses to chronic placental embolization in the late-gestation ovine fetus.

OBJECTIVE: The purpose of this study was to examine the effect of chronic fetal placental embolization on the fetal corticotropin, cortisol, and catecholamines concentrations and on myometrial contractility pattern. STUDY DESIGN: Fourteen fetal sheep were studied (seven embolized, seven controls) for 10 days between 0.84 and 0.91 of gestation. Daily injections of nonradioactive microspheres were performed to decrease fetal arterial oxygen content by 30% to 35% of the preembolization value. Umbilical artery Doppler flow velocity waveforms were measured daily. RESULTS: Chronic fetal placental embolization produced progressive fetal hypoxemia (p < 0.001) with changes in umbilical artery Doppler flow velocity waveforms indicative of a 25% increase in placental vascular resistance (p < 0.01). In response to chronic fetal hypoxemia there was a progressive increase in baseline fetal plasma norepinephrine concentration (p < 0.001). There was a transient fourfold to fivefold increase in baseline fetal plasma cortisol levels concomitant with a significant decrease in baseline immunoreactive corticotropin between days 7 and 9 of embolization (both p < 0.05), with a return to control values by day 10. There was a 57% increase in myometrial contracture frequency in the embolized group when compared with controls (p = 0.001). CONCLUSIONS: During repetitive chronic placental damage that led to fetal hypoxemia, the fetal endocrine environment changed with time in a direction that would prevent the onset of premature activation of the hypothalamic-pituitary-adrenal axis and premature delivery.

Stimulation of release of beta-endorphin and oxytocin by prostaglandin F2 alpha in cattle at parturition.

Concentrations of beta-endorphin and oxytocin were measured in plasma of cows before, during and after parturition. The effect of the PGF2 alpha analogue cloprostenol on beta-endorphin and oxytocin release was investigated. During parturition, there were marked, parallel increases in beta-endorphin and oxytocin concentrations. Both hormones were released in an episodic manner in conjunction with uterine and abdominal contractions. It is therefore likely that factors stimulating oxytocin release also enhance beta-endorphin secretion. This suggests a role of labour or labour-associated hormones in stimulating peripheral beta-endorphin release. Cloprostenol caused an immediate, pronounced increase in plasma beta-endorphin and oxytocin concentrations.

Uterine contractile activity in rats induced by mifepristone (RU 486) in relation to changes in concentrations of prostaglandins E-2 and F-2 alpha.

Pregnant rats were injected with mifepristone (RU 486) on Day 15 of pregnancy. The force and frequency of uterine contractions, recorded by a microballoon technique, were significantly greater at 12, 24 and 36 h in treated than in control rats (11.9 +/- 1.9 vs. 8.9 +/- 1.2 units, 17.7 +/- 3.0 vs. 10.5 +/- 2.3 units and 16.8 +/- 2.9 vs. 8.8 +/- 1.8 units for force and 51.3 +/- 9.1 vs. 29.4 +/- 3.8/h, 35.4 +/- 6.4 vs. 22.1 +/- 4.9/h and 35.6 +/- 3.2 vs. 24.6 +/- 4.6/h for frequency, respectively). There was no significant difference in concentrations of prostaglandin (PG) E-2 or PGF-2 alpha between treated and control rats at 12 h and 24 h after injection. At 36 h, 7 of 12 rats were aborting and uterine PG concentrations in these were significantly greater than in the others (1.5 +/- 0.2 vs. 0.9 +/- 0.2 ng PGE-2/g and 38.6 +/- 19.2 vs. 16.9 +/- 5.4 ng PGF-2 alpha/g), but there was no significant difference between control and treated rats that were not aborting. Concentrations of PGE-2 and PGF-2 alpha were significantly higher at 48 h when abortion had occurred in all animals (6.5 +/- 2.6 vs. 2.4 +/- 1.7 ng PGE-2/g and 30.4 +/- 8.9 vs. 9.3 +/- 5.6 ng PGF-2 alpha/g). Thus, the increase in uterine contractile activity induced by mifepristone preceded significant changes in concentrations of PGE-2 and PGF-2 alpha in the uterus and so could not have been caused by these changes.

Plasma oxytocin but not prostaglandin F2 alpha metabolite levels at cerclage may predict preterm delivery.

Plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) concentrations were measured in 45 patients admitted for cerclage during the second trimester. Samples were collected before, 3 hours after, and 3 days after the Shirodkar procedure. Uterine activity was recorded by external tocography twice daily for 30 minutes. Twenty-eight women with uncomplicated pregnancy and commensurate gestational age served as controls. Cervical length, measured by ultrasonography, was significantly shorter before cerclage (36 +/- 2 mm) than after cerclage (43 +/- 2 mm) or compared with controls (48 +/- 1 mm). Bishop scores ranged from 3-6 (median 4) in the cerclage group and 0-1 (median 0) in controls. Fifteen cerclage patients and one control delivered preterm 5-22 weeks after the procedure. Initial plasma PGFM levels were significantly higher in cerclage patients than in controls. The cerclage procedure caused an immediate rise in plasma PGFM and a subsequent fall below initial levels to control values. Neither the initial levels of PGFM nor the increments 3 hours after cerclage correlated with the outcome of pregnancy. By contrast, plasma oxytocin levels before cerclage were significantly higher in patients who subsequently delivered preterm than in those who delivered at term. Cerclage resulted in a significant fall in plasma oxytocin at 3 hours in patients with preterm delivery, but after 3 days the oxytocin levels had returned to the precerclage values. Patients who had increased uterine contractions had significantly higher plasma oxytocin levels but lower PGFM levels than those without contractions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemorrheological parameters during normal labor and uterine contraction]. / Paramètres hémorhéologiques pendant l'accouchement normal et la contraction utérine.

Considering the modified fluidity of blood during numerous kind of stress, the authors studied blood rheology during delivery as an example of a particularly severe stress. The authors measured blood and plasma viscosity and erythrocyte aggregation in 77 pregnant at the following stages of delivery: below 4 cm dilatation; more than 4 cm dilatation; during fetus expulsion, during after birth delivery. Apparent blood viscosity and viscosity adjusted to 45% hematocrit rose to reach a peak during expulsion (p less than 0.01) then to become normal again during placenta delivery (p less than 0.01). Hematocrit and plasmatic viscosity showed no changes during labour and expulsion. In addition erythrocyte aggregation was lowering during expulsion and delivery (stage with physiological defibrination). Rising blood viscosity might be explained by a red blood cell rigidification measured by the increasing of "Tk" (p less than 0.01) and by a nonsignificant increase of the filterability index measured by hemorheometer. In conclusion, delivery is accompanied by a blood hyperviscosity essentially related to a transient red blood cell rigidification.

Effect of nipple stimulation on uterine activity and on plasma levels of oxytocin in full term, healthy, pregnant women.

The effect of nipple stimulation on uterine activity, foetal heart rate and plasma oxytocin level in healthy full term pregnant women was studied. Ten women in weeks 38-39 of pregnancy stimulated their nipples for 30 min. Nine of the ten experienced uterine contractions. One woman showed signs uterine hyperactivity (frequent contractions) and foetal heart rate decelerations. Blood samples were drawn at 15 s intervals during 5-6 contractions and oxytocin levels were measured with radioimmunoassay. Oxytocin levels rose significantly during the nipple stimulation and short bursts of oxytocin were recorded during contractions. Nipple stimulation has been used to induce labour and our data may suggest that oxytocin released in response to such stimulation is responsible for the contractions induced.