The dynamics of epidural and opioid analgesia during labour

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Purpose: To investigate the association of analgesia, opioids or epidural, or the combination of both with labour duration and spontaneous birth in nulliparous women. Methods: A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), and combined application (n = 229). Labour duration was compared by Cox regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate the association between the administration of different types of analgesia and mode of birth. Results: Most women in the combined application group were first to receive opioid analgesia. Women with no analgesia had the shortest duration of labour (log rank p < 0.001) and highest chance of a spontaneous birth (p < 0.001). If analgesia was administered, women with opioids had a shorter first stage (p = 0.018), compared to women with epidural (p < 0.001) or women with combined application (p < 0.001). Women with opioids had an increased chance to reach full cervical dilatation (p = 0.006). Women with epidural analgesia (p < 0.001) and women with combined application (p < 0.001) had a prolonged second stage and decreased chance of spontaneous birth compared to women without analgesia. Conclusions: Women with opioids had a prolonged first stage, but increased chance to reach full cervical dilatation. Women with epidural analgesia and women with both opioid and epidural analgesia had a prolonged first and second stage and a decreased chance of a spontaneous birth

Ovarian steroid hormones: Effects on immune responses and Chlamydia trachomatis infections of the female genital tract

Female sex hormones are known to regulate the adaptive and innate immune functions of the female reproductive tract. This review aims to update our current knowledge of the effects of the sex hormones estradiol and progesterone in the female reproductive tract on innate immunity, antigen presentation, specific immune responses, antibody secretion, genital tract infections caused by Chlamydia trachomatis, and vaccine-induced immunity

Response of nitrogen dynamics in semi-natural and agricultural grassland soils to experimental variation in tide and salinity

In the framework of rehabilitation efforts to enhance the ecological value of closed-off estuaries, we studied the effects of restoring a tidal movement and seawater incursion on soil nitrogen conversion rates and vegetation response of semi-natural and agricultural grasslands in an outdoor mesocosm experiment. Intact soil monoliths including vegetation were collected in June 2004 on two locations on the shores of the Haringvliet lagoon in the south-western part of the Netherlands, which used to be a well-developed estuary before closure in 1970. For more than 1 year, soil monoliths were continuously subjected to a full-factorial combination of tidal treatment [stagnant/tidal (0.20 m amplitude)] and water type [(freshwater, oligohaline (salinity = 3)]. Soil, soil moisture and water nitrogen concentrations were monitored for a year, as well as vegetation response and nitrogen conversion rates in the soil. As expected, nitrogen mineralization rates were enhanced by the tidal treatment in comparison with the stagnant treatment. Denitrification rates however, were much less affected by tide and were even lower in the tidal treatments after 3 months in the agricultural grassland soils, implying that in general, soils were more oxic in the tidal treatments. Oligohaline treatments had virtually no effect on soil nitrogen conversion rates compared to freshwater treatments. Vegetation performance, however, was lower under saline conditions, especially in the semi-natural grassland. No further significant differences in response to the tidal and oligohaline treatments were found between the two soils although they differed strongly in soil characteristics. We conclude that if the rehabilitation measures in the former Haringvliet estuary are carried out as planned, drastic changes in soil nitrogen processes and vegetation composition will not occur.