A comparative study of transdermal nitroglycerine patch and oral nifedipine in preterm labor.

Background: Currently, the main goal for the use of tocolytic therapy is to delay the birth so as to allow the use of corticosteroids for accelerating fetal lung maturity and maternal transfer to a tertiary care center and thereby reducing neonatal morbidity and mortality. Aims and Objectives: The aims amd objectives were to compare the safety and efficacy of transdermal nitroglycerine patch with oral nifedipine as a tocolytic agent to arrest preterm labor and prevent preterm birth. Materials and Methods: Based on the selection criteria, 50 patients were selected randomly in Group A and Group B. Group A women were given transdermal nitroglycerin patch, which delivered 10 mg Nitroglycerin (NTG) over 24 h and it was applied to the woman's abdomen followed by another patch of 10 mg after 1 h if contractions persisted. After 24 h, it was replaced by a fresh patch. Group B women were given an oral loading dose of nifedipine 20 mg followed by a similar dose if contractions persisted after 1 h. A maintenance dose of 10 mg thrice daily was given if contractions were suppressed. Patients were monitored from the time of admission to the time of discharge. Results: The mean duration of prolongation of pregnancy in Group B (3.68 ± 1.91 days) was significantly more than Group A (2.78 ± 1.39 days). Headache was seen significantly more in Group A (42%) than group B (6%). Tachycardia, hypotension, and palpitation showed no statistically significant difference between them. There was no statistically significant difference in the birth weight of the babies in both the groups. Conclusion: Nifedipine is a safe and effective drug in prolonging preterm labor and has minimal maternal and neonatal side effects.

RésuméContexte: Actuellement, le principal objectif de l'utilisation de la thérapie tocolytique est de retarder la naissance afin de permettre l'utilisation de corticostéroïdes pour accélérer la maturité pulmonaire fœtale et le transfert maternel vers un centre de soins tertiaires et ainsi réduire la morbidité et la mortalité néonatales. Buts et objectifs: Les buts et objectifs étaient de comparer l'innocuité et l'efficacité du timbre transdermique de nitroglycérine avec la nifédipine par voie orale comme agent tocolytique pour arrêter le travail prématuré et prévenir l'accouchement prématuré. Matériel et méthodes: Sur la base des critères de sélection, 50 patientes ont été sélectionnées au hasard dans les groupes A et B.Les femmes du groupe A ont reçu un patch transdermique de nitroglycérine, qui a administré 10 mg de NTG en 24 h et appliqué sur l'abdomen de la femme suivi d'un autre patch de 10 mg après 1 h si les contractions ont persisté. Après 24 h, il a été remplacé par un nouveau patch. Les femmes du groupe B ont reçu une dose de charge orale de 20 mg de nifédipine suivie d'une dose similaire si les contractions persistaient après 1 h. Une dose d'entretien de 10 mg trois fois par jour était administrée si les contractions étaient supprimées. Les patients ont été suivis du moment de l'admission au moment de la sortie. Résultats: La durée moyenne de prolongation de la grossesse dans le groupe B (3,68 ± 1,91 jours) était significativement plus élevée que dans le groupe A (2,78 ± 1,39 jours). Les céphalées étaient significativement plus observées dans le groupe A (42%) que dans le groupe B (6%). La tachycardie, l'hypotension et les palpitations n'ont montré aucune différence statistiquement significative entre elles. Il n'y avait pas de différence statistiquement significative du poids à la naissance des bébés dans les deux groupes. Conclusion: La nifédipine est un médicament sûr et efficace pour prolonger le travail prématuré et a des effets secondaires maternels et néonatals minimes.

Relief of pain due to uterine cramping/involution after birth.

BACKGROUND: Women may experience differing types of pain and discomfort following birth, including cramping pain (often called after-birth pain) associated with uterine involution, where the uterus contracts to reduce blood loss and return the uterus to its non-pregnant size. This is an update of a review first published in 2011. OBJECTIVES: To assess the effectiveness and safety of pharmacological and non-pharmacological pain relief/analgesia for the relief of after-birth pains following vaginal birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 October 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials comparing two different types of analgesia or analgesia versus placebo or analgesia versus no treatment, for the relief of after-birth pains following vaginal birth. Types of analgesia included pharmacological and non-pharmacological. Quasi-randomised trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, conducted 'Risk of bias' assessment, extracted data and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: In this update, we include 28 studies (involving 2749 women). The evidence identified in this review comes from middle- to high-income countries. Generally the trials were at low risk of selection bias, performance bias and attrition bias, but some trials were at high risk of bias due to selective reporting and lack of blinding. Our GRADE certainty of evidence assessments ranged from moderate to very low certainty, with downgrading decisions based on study limitations, imprecision, and (for one comparison) indirectness. Most studies reported our primary outcome of adequate pain relief as reported by the women. No studies reported data relating to neonatal adverse events, duration of hospital stay, or breastfeeding rates. Almost half of the included studies (11/28) excluded breastfeeding women from participating, making the evidence less generalisable to a broader group of women. Non-steroidal anti-inflammatory drugs (NSAIDs) compared to placebo NSAIDs are probably better than placebo for adequate pain relief as reported by the women (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.45 to 1.91; 11 studies, 946 women; moderate-certainty evidence). NSAIDs may reduce the need for additional pain relief compared to placebo (RR 0.15, 95% CI 0.07 to 0.33; 4 studies, 375 women; low-certainty evidence). There may be a similar risk of maternal adverse events (RR 1.05, 95% CI 0.78 to 1.41; 9 studies, 598 women; low-certainty evidence). NSAIDs compared to opioids NSAIDs are probably better than opioids for adequate pain relief as reported by the women (RR 1.33, 95% CI 1.13 to 1.57; 5 studies, 560 women; moderate-certainty evidence) and may reduce the risk of maternal adverse events (RR 0.62, 95% CI 0.43 to 0.89; 3 studies, 255 women; low-certainty evidence). NSAIDs may be better than opioids for the need for additional pain relief, but the wide CIs include the possibility that the two classes of drugs are similarly effective or that opioids are better (RR 0.37, 95% CI 0.12 to 1.12; 2 studies, 232 women; low-certainty evidence). Opioids compared to placebo Opioids may be better than placebo for adequate pain relief as reported by the women (RR 1.26, 95% CI 0.99 to 1.61; 5 studies, 299 women; low-certainty evidence). Opioids may reduce the need for additional pain relief compared to placebo (RR 0.48, 95% CI 0.28 to 0.82; 3 studies, 273 women; low-certainty evidence). Opioids may increase the risk of maternal adverse events compared with placebo, although the certainty of evidence is low (RR 1.59, 95% CI 0.99 to 2.55; 3 studies, 188 women; low-certainty evidence). Paracetamol compared to placebo Very low-certainty evidence means we are uncertain if paracetamol is better than placebo for adequate pain relief as reported by the women, the need for additional pain relief, or risk of maternal adverse events (2 studies, 123 women). Paracetamol compared to NSAIDs Very low-certainty evidence means we are uncertain if there are any differences between paracetamol and NSAIDs for adequate pain relief as reported by the women, or the risk of maternal adverse events. No data were reported about the need for additional pain relief comparing paracetamol and NSAIDs (2 studies, 112 women). NSAIDs compared to herbal analgesia We are uncertain if there are any differences between NSAIDs and herbal analgesia for adequate pain relief as reported by the women, the need for additional pain relief, or risk of maternal adverse events, because the certainty of evidence is very low (4 studies, 394 women). Transcutaneous nerve stimulation (TENS) compared to no TENS Very low-certainty evidence means we are uncertain if TENS is better than no TENS for adequate pain relief as reported by the women. No other data were reported comparing TENS with no TENS (1 study, 32 women). AUTHORS' CONCLUSIONS: NSAIDs may be better than placebo and are probably better than opioids at relieving pain from uterine cramping/involution following vaginal birth. NSAIDs and paracetamol may be as effective as each other, whereas opioids may be more effective than placebo. Due to low-certainty evidence, we are uncertain about the effectiveness of other forms of pain relief. Future trials should recruit adequate numbers of women and ensure greater generalisability by including breastfeeding women. In addition, further research is required, including a survey of postpartum women to describe appropriately their experience of uterine cramping and involution. We identified nine ongoing studies, which may help to increase the level of certainty of the evidence around pain relief due to uterine cramping in future updates of this review.

Complementary therapies in labor: randomized clinical trial. / Terapias complementares no trabalho de parto: ensaio clínico randomizado.

OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Terapias complementares no trabalho de parto: ensaio clínico randomizado / Terapias complementarias en el trabajo de parto: ensayo clínico randomizado / Complementary therapies in labor: randomized clinical trial

Resumo OBJETIVO: Avaliar o efeito do banho quente de chuveiro e exercício perineal com bola suíça isolados e de forma combinada, sobre a percepção da dor, ansiedade e progressão do trabalho de parto. MÉTODO: Ensaio clínico randomizado e controlado com 128 parturientes alocadas em três grupos de terapias, banho, bola, isolados e combinados. A percepção da dor e ansiedade foi avaliada antes e trinta minutos após a intervenção terapêutica por meio de escala visual analógica (EVA). RESULTADOS: Houve aumento no escore de dor e redução da ansiedade em todos os grupos, sobretudo quando utilizaram banho de chuveiro. A dilatação cervical, aumentou em todos os grupos de intervenção (p<,001) bem como o número de contrações uterinas, principalmente quem utilizou banho e bola associados como também mostrou menor duração do tempo de trabalho de parto. CONCLUSÃO: As terapias estudadas contribuem para adaptação e bem-estar materno e favorecem a evolução do trabalho de parto.

Resumen OBJETIVO: Evaluar el efecto de la ducha caliente y del ejercicio perineal con pelota suiza, separadamente y de forma combinada, sobre la percepción del dolor, la ansiedad y la progresión del trabajo de parto. MÉTODO: Ensayo clínico aleatorizado y controlado junto a 128 parturientes asignadas en tres grupos de terapias, ducha caliente, pelota suiza separadamente y de forma combinada. La percepción de dolor y de ansiedad se evaluó antes y treinta minutos después de la intervención terapéutica por medio de escala visual analógica. RESULTADOS: Hubo un incremento en la puntuación de dolor y una reducción de la ansiedad en todos los grupos, sobre todo cuando se utilizó la ducha. La dilatación cervical aumentó en todos los grupos de intervención (p<,001) así como el número de contracciones uterinas, principalmente en el grupo que utilizó las dos terapias combinadas, ducha caliente con pelota suiza. Asimismo se constató menor duración del tiempo de trabajo de parto. CONCLUSIÓN: Las terapias estudiadas contribuyen a la adaptación y el bienestar materno y favorecen la evolución del trabajo de parto.

Abstract OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

The effect of chamomile odor on contractions of the first stage of delivery in primpara women: A clinical trial.

PURPOSE: In this study, the effect of chamomile odssor on some parameters of pregnancy was examined. METHOD: This is a randomized clinical trial conducted on 130 primpa women. In the group of aromatherapy, women smell chamomile essence. The investigator recorded duration, number and intensity of contractions and level of satisfaction after the delivery. RESULTS: Duration of contractions, number of contractions were similar in all times in intervention and control groups (p > .05). In dilatation of 5-7 cm, intensity of contractions in the intervention group was significantly lower than the control group (p = .004). Level of satisfaction was significantly higher in the intervention group (p < .001). CONCLUSION: Aromatherapy using chamomile essence has no effect on the duration and number of contractions. It decreases the intensity of contractions in dilatation of 5-7 cm. Results also show greater satisfaction in women who received chamomile intervention.

Selenoprotein N Was Required for the Regulation of Selenium on the Uterine Smooth Muscle Contraction in Mice.

Selenium (Se) is an essential micronutrient affecting various aspects of health. The balance of the Se concentration has an important protective and promoter effect on physiological function in inducing muscular disorders in smooth muscle. Selenoprotein N (SelN) is closely related to Ca2+ release. The present study aimed to determine the effects and mechanism of action of dietary Se on uterine smooth muscle contraction via SelN using a mouse model. Quantitative polymerase chain reaction (qPCR) analysis was performed to detect mRNA levels. Western blotting was performed to detect protein levels. The results of the immunohistochemical analysis showed that Se had an effect on the uterine smooth muscle. The Se-supplement increased the release of Ca2+, Ca2+-calmodulin (CaM) expression, myosin light chain kinase (MLCK) expression, and myosin light chain (MLC) phosphorylation but did not affect ROCK and RhoA in uterine smooth muscle. Furthermore, the lack of Se showed an opposite impact. The effects of Se regulation were closely related to SelN. The interference of mouse SelN was performed on the uterine smooth muscle cell. Additionally, the results displayed the regulation of Se on the release of Ca2+, CaM expression, MLCK expression, and MLC phosphorylation were significant inhibited, and there was no effect on ROCK and RhoA. In conclusion, Se played an important role in regulating the process of contraction in uterine smooth muscle with SelN.

The effect of acupressure on the initiation of labor: A randomized controlled trial.

BACKGROUND: Induction of labor is a common obstetric procedure. Acupressure is a natural method that is used for inducing uterine contractions. Nevertheless, few studies have examined the impact of acupressure on the induction of labor. AIM: The aim of this study was to evaluate the effect of acupressure on the initiation of labor. MATERIAL AND METHODS: In this randomized clinical trial, 162 nulliparous pregnant women were admitted to the hospital. They were categorized into 3 groups; acupressure, sham acupressure and control. Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the researcher every other day between 9 am and 11 am. The intervention was carried out on women in the afternoon and the following day. Subjects were examined to determine the initiation of labor symptoms48 and 96h after the start of intervention and at the time of hospitalization. Data were analyzed using the ANOVA, Kruskal-Wallis and Chi-square tests (p<0.05). RESULTS: There was no significant difference among the groups for spontaneous initiation of labor within 48h (P=0.464), and 49-96h after beginning the intervention (P=0.111) and 97h after beginning the intervention to the time of hospitalization for the spontaneous initiation of labor (P=0.897). There were no significant differences in the secondary outcomes between the groups. CONCLUSION: According to the finding of this study, it seems that acupressure treatment was not effective in initiating labor as compared with the sham acupressure and the routine care groups.

A Systematic Review of the Uterine Relaxant Effect of Herbal Sources.

BACKGROUND: Preterm birth is a worldwide tragedy with a high incidence. Several medications are used to inhibit acute preterm labor, but tocolysis by these medicines do not extend pregnancy beyond 1-2 days. OBJECTIVES: The purpose of this study was to discover new medications from plant extracts or their active compounds which inhibit the uterine contractions in order to treat preterm labor. DATA SOURCES: PubMed, Google Scholar, Scopus and IranMedex databases were searched up to 1st February 2012 with the most relevant keywords. STUDY SELECTION: All studies in which plant extracts or their active compounds inhibited the uterine contractions both in vivo and in vitro were included. THE RESULTS: Of initial search, 259 records were reviewed and finally 72 were included among which only 31 studies isolated an active compound from the plants extract belonging mostly to classes of flavonoids and terpenes classes. Flavonoids have been known as a phosphodiesterase (PDE) and a protein kinase C (PKC) inhibitor. It seems that the uterolytic activity of reviewed flavonoids such as naringenin, kaempferol and quercetin, especially in a calcium free solution, was via these inhibitory pathways. CONCLUSION: Laboring uterus response to dissimilar tocolytics differs from that of non-laboring uterus. In order to find a treatment for preterm labor, future studies should focus on the laboring uterus and also determine the structure activity relationship of the different tocolytics. This systematic review was registered to the PROSPERO with code number CRD42015027551.

Preterm uterine contractions ultimately delivered at term: safe but not out of danger.

OBJECTIVES: Patients with pregnancies complicated with premature uterine contractions (PMC), but delivered at term are considered as false preterm labor (PTL), and represent a common obstetric complication. We aimed to assess obstetric and neonatal outcomes of pregnancies complicated with PMC, but delivered at term, as compared to term normal pregnancies. STUDY DESIGN: Obstetric, maternal and neonatal outcomes of singleton pregnancies complicated with PMC between 24-33(6)/7 weeks (PMC group), necessitating hospitalization and treatment with tocolytics and/or steroids, during 2009-2014, were reviewed. The study group included only cases who eventually delivered ≥37 weeks, which were compared to a control group of subsequent term singleton deliveries who had not experienced PMC during pregnancy. Neonatal adverse composite outcome included: phototherapy, RDS, sepsis, blood transfusion, cerebral injury, NICU admission. RESULTS: The PMC group (n=497) was characterized by higher rates of nulliparity (p=0.002), infertility treatments (p=0.02), and polyhydramnios (p<0.001), as compared to controls (n=497). Labor was characterized by higher rates of instrumental deliveries (p=0.03), non-reassuring fetal heart rate tracings (p<0.001) prolonged third stage of labor (p=0.04), and increased rate of post-partum maternal anemia (Hb<8g/dL) p=0.004, in the PMC group as compared to controls. Neonates in the PMC groups had lower birth weights compared to controls, 3149g±429 vs. 3318g±1.1, p<0.001, respectively. By logistic regression analysis, PMC during pregnancy was independently associated with neonatal birth-weight <3rd percentile (adjusted OR 4.6, 95% CI 1.5-13.7). CONCLUSIONS: Pregnancies complicated with PMC, even-though delivered at term, entail adverse obstetric and neonatal outcomes, and may warrant continued high risk follow up.

Study of pharmacological properties of the methanolic extract of Dichrostachys cinerea bark (L.) Wight et Arn (Leguminosae) in isolated myometrium from pregnant rats.

ETHNOPHARMACOLOGICAL RELEVANCE: The use of medicinal plants in Gabon contributes widely to the primary health care of the people of this area of Central Africa. This paper investigates the pharmacological properties of Dichrostachys cinerea, the plant barks are traditionally used by Gabonese and Ivorian populations to treat bronchial asthma, rheumatism, and other various diseases. Although D. cinerea barks have been reported to be used by population to facilitate childbirth, to the best of our knowledge no scientific evidence has been published. AIM OF STUDY: In the present study, we investigated the pharmacological properties of D. cinerea methanolic extract, on isolated uterine smooth muscle and compared its effects to those of oxytocin, which is used by obstetricians to facilitate childbirth. We also explored the possible mechanism pathways of the in vitro uterine contraction induced by D. cinerea. MATERIALS AND METHODS: The effects of different concentrations (3.2µg/ml, 16µg/ml, 80µg/ml, 400µg/ml, and 2mg/ml) of the methanolic extract of D. cinerea on isolated strips of the uteri of pregnant rats were studied. These effects were compared to those of oxytocin (8.4×10(-5)µg/ml, 8.4×10(-4)µg/ml, 8.4×10(-3)µg/ml, 8.4×10(-2)µg/ml). The EC (50) and E (max) was determined graphically and statistically analysed using one-way ANOVA and Dunnett post hoc test. RESULTS: Cumulative concentrations of D. cinerea have caused rise in the contractile force of the uterine fragments that were isolated from the pregnant rats, as seen with oxytocin concentrations. We observed contractions amplitude of 30.41mN (12%) at 80µg/ml and amplitude of 39.68mN (14.17%) at 400µg/ml for D. cinerea. In parallel, oxytocin concentration of 8.4×10(-3)µg/ml induced contractions of 45.82mN with the highest concentration (8.4×10(-2)µg/ml) that induced contractions of 55.82mN. CONCLUSIONS: Our results revealed that D. cinerea increased the contractile force and the frequency of muscle contractions. These findings support the use of D. cinerea to facilitate childbirth, as it has been used in traditional medicine.

Effects of skin-to-skin contact and breastfeeding at birth on the incidence of PPH: A physiologically based theory.

BACKGROUND: The importance of optimising maternal/baby psychophysiology has been integrated into contemporary midwifery theories but not in the detail required to really understand the underpinning biological basis. METHOD: The functioning of the autonomic nervous system, as it relates to the uterus is reviewed. The physiology of myometrial cell contraction and relaxation is outlined. The main focus is on the factors that affect the availability and uptake of oxytocin and adrenaline/noradrenaline in the myometrial cells. These are the two key neuro-hormones, active in the 3rd and 4th stages of labour, that affect uterine contraction and retraction and therefore determine whether the woman will have an atonic PPH or not. DISCUSSION: The discussion explains and predicts the physiological functioning of the uterus during the 3rd and 4th stages of labour when skin-to-skin contact and breastfeeding occurs and when it does not. CONCLUSION: This biologically based theory hypothesises that to achieve and maintain eutony and eulochia, midwives and birthing women should ensure early, prolonged and undisturbed skin-to-skin contact for mother and baby at birth including easy access for spontaneous breastfeeding.

Transcutaneous electrical nerve stimulation for the relief of post-partum uterine contraction pain during breast-feeding: a randomized clinical trial.

AIM: To evaluate transcutaneous electrical nerve stimulation (TENS) used to relieve uterine contraction pain during breast-feeding in multiparous women. METHODS: A controlled and randomized clinical trial was performed with 32 post-partum multiparous women who were breast-feeding. The participants were randomized into an experimental (EG, n = 16) and a control group (CG, n = 16). Pain was assessed using the Numerical Rating Scale and the descriptors of the Present Pain Intensity (PPI - McGill) during two sequential feeds. In the first assessment, the post-partum women in the EG and CG were monitored while breast-feeding and questioned regarding the degree of uterine contraction pain. In the second assessment, which was performed at the next feed, the EG used TENS while the CG was monitored, with pain being reassessed following. In the EG, the TENS electrodes were placed between T10-L1 and S2-S4, with a frequency of 100 Hz, a pulse duration of 75 µs and amplitude adjusted to produce a strong and tolerable sensation for 40 min. A descriptive analysis of the data and comparative intra- and intergroup analyses were performed by means of a non-parametrical test, with a significance level P ≤ 0.05. RESULTS: The level of basal pain was 5.56 in the EG and 5.50 in the CG. In the intragroup analysis, the EG (P < 0.0001) and CG (P = 0.04) presented significant pain reduction. In the intergroup analysis, the EG had significant pain reduction (P < 0.01) in comparison to the CG. In the PPI analysis, a non-significant decrease in pain intensity was observed in the EG. CONCLUSION: TENS was found to be effective in reducing post-partum uterine contraction pain during breast-feeding.

In-VITRo effect of Ficus deltoidea on the contraction of isolated rat's uteri is mediated via multiple receptors binding and is dependent on extracellular calcium.

BACKGROUND: Ficus deltoidea, is a perennial herb that is used to assist labor, firm the uterus post-delivery and to prevent postpartum bleeding. In view of its claimed uterotonic action, the mechanisms underlying plant's effect on uterine contraction were investigated. METHODS: Adult female SD rats were injected with 2 mg/kg 17ß-oestradiol (E2) to synchronize their oestrous cycle. A day after injection, uteri were removed for in-vitro contraction studies. The dose dependent effect of Ficus deltoidea aqeous extract (FDA) on the tension produced by the isolated rat's uteri was determined. The effects of atropine (2×10(-8) M), atosiban (0.5 IU), THG113.31 (10 µM), oxodipine (0.25 mM), EDTA (1 mM), 2-amino-ethoxy-diphenylborate (2-APB) (40 mM) and thapsigargin (1 mM) on the maximum force of contraction (Emax) achieved following 2 mg/ml FDA administration were also investigated. RESULTS: FDA induced in-vitro contraction of the isolated rat's uteri in a dose-dependent manner. Administration of atropine, atosiban and THG113.31 reduced the Emax with atosiban having the greatest effect. The Emax was also reduced following oxodipine and EDTA administration. There was no significant change observed following 2-APB administration. Thapsigargin, however, augmented Emax. CONCLUSIONS: FDA-induced contraction of the isolated rat's uteri is mediated via multiple uterotonin receptors (muscarinic, oxytocin and prostaglandin F2α) and was dependent on the extracellular Ca2+. Contraction, however, was not dependent on the Ca2+ release from the internal stores. This in-vitro study provides the first scientific evidence on the claimed effect of Ficus Deltoidea on uterine contraction.

The effects of watermelon (Citrullus lanatus) extracts and L-citrulline on rat uterine contractility.

In uterine smooth muscle, the effects of watermelon and its citrulline content are unknown. The aims of this study were therefore, to determine the effects of watermelon extract and citrulline on the myometrium and to investigate their mechanisms of action. The effects of extracts of watermelon flesh and rind and L-citrulline (64 µmol/L) were evaluated on 3 types of contractile activity; spontaneous, those elicited by potassium chloride (KCl) depolarization, or oxytocin (10 nmol/L) application in isolated rat uterus. Inhibitors of nitric oxide (NO) and its mechanisms of action, N ω-Nitro-L-arginine methyl ester hydrochloride (L-NAME, 100 µmol/L), LY83583 (1 µmol/L), and tetraethylamonium chloride (5 mmol/L), as well as Ca signaling pathways, were determined. Both flesh and rind extracts significantly decreased the force produced by all 3 mechanisms, in a dose-dependent manner. The extracts could also significantly decrease the force under conditions of sustained high Ca levels (depolarization and agonist) and when the force was produced only by sarcoplasmic reticulum (SR) Ca release. L-citrulline produced the same effects on force as watermelon extracts. With submaximal doses of extract, the additive effects of L-citrulline were found. The inhibitory effects of extracts and L-citrulline were reversed upon the addition of NO inhibitors, and pretreatment of tissues with these inhibitors prevented the actions of both extracts and L-citrulline. Thus, these data show that watermelon and citrulline are potent tocolytics, decreasing the force produced by calcium entry and SR release and arising by different pathways, including oxytocin stimulation. Their major mechanism is to stimulate the NO-cyclic guanosine monophosphate (cGMP) relaxant pathway.