Oxytocin in pregnancy and the postpartum: relations to labor and its management.

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown

The dynamics of vaginal and rectal Lactobacillus spp. flora in subsequent trimesters of pregnancy in healthy Polish women, assessed using the Sanger sequencing method

Background Lactobacilli play an important role in maintaining vaginal health and protection against bacterial infections in the genital tract. The aim of this study is to show the dynamics of changes of the vaginal and rectal Lactobacillus flora during pregnancy by using the Sanger sequencing method. Method The study included 31 healthy pregnant women without clinical signs of genitourinary infections. The material was taken in the three trimesters of pregnancy by vaginal and rectal swabs and grown on the MRS agar quantitatively to estimate the number of Lactobacillus spp. [CFU/ml]. Afterwards, 3 to 8 morphologically different lactobacilli colonies were taken for identification. Bacterial species identification was performed by 16 s rDNA sequence fragment analyses using the Sanger method. Results Among the patients tested, the most common species colonizing the vagina in the first trimester were: L. crispatus 29%, L. gasseri 19.4% and L. rhamnosus 16.1%, in the second trimester: L. crispatus 51.6%, L. gasseri 25.8%, L. rhamnosus 19.4% and L. amylovorus 16.1%, and in the third trimester the most common Lactobacillus species were: L. crispatus 25.8%, L. gasseri 25.8% and L. johnsonii 19.4%. In rectal species, the number decreased in the second and third trimesters in comparison to the first trimester (p = 0.003). An analysis of rectal dynamics showed that in the first trimester, the most common species were: L. johnsonii 19.4%, and L. plantarum 9.7%, in the second trimester: L. crispatus 9.7% and L. mucosae 6.5%, and in the third trimester: L. casei 9.7% and L. rhamnosus 9.7%. Individual dynamics of the Lactobacillus species composition showed variability, characterized by continuous, intermittent, or periodic colonization. The patients examined were mostly colonized by three Lactobacillus species in vagina (32.3%), whereas for the rectum, one Lactobacillus species during the whole pregnancy duration was common (32.3%). Conclusion This study showed that in the examined group of healthy, pregnant Polish women, the vaginal Lactobacillus flora, both qualitative and quantitative, was stable during the three subsequent trimesters. In contrast, the number of rectal Lactobacillus species dramatically decreased after the first trimester

Calcium Supplementation Dose and Vegetable Intake Determine Preeclampsia

Preeclampsia is one of the cause of high maternal mortality rates. Risk factors for preeclampsia include a lack of nutrients such as vitamin A, calcium, sodium and potassium. Calcium intake in pregnant women is not only obtained from calcium supplementation, but also obtained from consumed foods such as vegetables. to analyzed the relationship between calcium supplementation dose and vegetable intake with preeclampsia in third trimester of pregnant women. observational analytic used a prospective cohort design. A total of 65 third trimester pregnant women participated in the study in Bantul, Yogyakarta. The calcium supplementation dose was obtained through interview using a questionnaire, while vegetable intake was obtained through the food frequency and food recall 2x24 hours. 16 third trimester pregnant women experienced preeclampsia. The mean calcium dose consumed per day was 476.2 mg. The average intake of vegetables per day for pregnant women was 250.9 gr. Kaplan-Mier with the log rank method states that there was a significant difference between calcium supplementation dose (p=0.007) and preeclampsia. There was a significant difference between vegetable intake (p=0.007) and preeclampsia. there was a significant relationship between calcium supplementation dose and vegetable intake with preeclampsia in third trimester pregnant women

Adhesive and degradative properties of human placental cytotrophoblast cells in vitro.

Human fetal development depends on the embryo rapidly gaining access to the maternal circulation. The trophoblast cells that form the fetal portion of the human placenta have solved this problem by transiently exhibiting certain tumor-like properties. Thus, during early pregnancy fetal cytotrophoblast cells invade the uterus and its arterial network. This process peaks during the twelfth week of pregnancy and declines rapidly thereafter, suggesting that the highly specialized, invasive behavior of the cytotrophoblast cells is closely regulated. Since little is known about the actual mechanisms involved, we developed an isolation procedure for cytotrophoblasts from placentas of different gestational ages to study their adhesive and invasive properties in vitro. Cytotrophoblasts isolated from first, second, and third trimester human placentas were plated on the basement membrane-like extracellular matrix produced by the PF HR9 teratocarcinoma cell line. Cells from all trimesters expressed the calcium-dependent cell adhesion molecule cell-CAM 120/80 (E-cadherin) which, in the placenta, is specific for cytotrophoblasts. However, only the first trimester cytotrophoblast cells degraded the matrices on which they were cultured, leaving large gaps in the basement membrane substrates and releasing low molecular mass 3H-labeled matrix components into the medium. No similar degradative activity was observed when second or third trimester cytotrophoblast cells, first trimester human placental fibroblasts, or the human choriocarcinoma cell lines BeWo and JAR were cultured on radiolabeled matrices. To begin to understand the biochemical basis of this degradative behavior, the substrate gel technique was used to analyze the cell-associated and secreted proteinase activities expressed by early, mid, and late gestation cytotrophoblasts. Several gelatin-degrading proteinases were uniquely expressed by early gestation, invasive cytotrophoblasts, and all these activities could be abolished by inhibitors of metalloproteinases. By early second trimester, the time when cytotrophoblast invasion rapidly diminishes in vivo, the proteinase pattern of the cytotrophoblasts was identical to that of term, noninvasive cells. These results are the first evidence suggesting that specialized, temporally regulated metalloproteinases are involved in trophoblast invasion of the uterus. Since the cytotrophoblasts from first trimester and later gestation placentas maintain for several days the temporally regulated degradative behavior displayed in vivo, the short-term cytotrophoblast outgrowth culture system described here should be useful in studying some of the early events in human place

HUBUNGAN KADAR HEMOGLOBIN IBI HAMIL TRIMESTER III DENGAN LAMA PERSALINAN DI RB ANNISA KOTA SEMARANG

Kematian ibu di Indonesia yaitu 390 per 100000 kelahiran hidup merupakan tertinggi di ASEAN menurut SDKI 1994. Penyebab langsung kematian ibu antara lain perdarahan (28%), eklampsia (24 %), infeksi(11%), partus lama (5%), abortus (5%) dan lain-lain (11%). Penyebab tidak langsungnya antara lain anemia, kurang energi kronis (KEK) dan keadaan 4 terlalu (terlalu muda/tua, sering dan banyak). Penelitian ini bertujuan untuk mengetahui hubungan kadar Hb ibu trimester III dengan lama persalinan di RB Annisa Kota Semarang. Jenis penelitian ini adalah explanatory research dengan metode survei analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh ibu hamil trimester III yang memeriksakan kemalilan dan bersalin di RB Annisa Kota Semarang sebanyak 52 orang ibu hamil. Pengambilan sampel dilakukan secara purposive. Pengol;ahan dan amalisa data dilakukan dengan menggunakan komputer SPSS 10.0 diuji dengan uji Chi-Square untuk keseluruhan responden kemudian dibagi atas primipara dan multipara dan masing-masing diuji lagi dengan korelasi Pearson Product Momen. Hasil penelitian ini menunjukkan bahwa sebagian besar responden adalah primipara (65,4%), kadar Hb normal (78,8%), lama persalinan normal (84,6%). Rata-rata kadar Hb 11,594 gram %, rata-rata lama persalinan responden 242,27 menit. Standar deviasi kadar Hb 0,909. Standar deviasi lama persalinan 133,11. Hasil uji statistik dengan Chi-Square pada keseluruhan responden menunjukkan probabilitas 0,218 artinya tidak ada hubungan antara kadar hb ibu hamil trimester III dengan lama persalinan di RB Annisa Kota Semarang. Pda primipara setelah diuji dengan korelasi Pearson Product Momen menunujukkan bahwa tidak ada hubungan antara kadar hb ibu hamil trimester III dengan lama persalinan di RB Annisa Kota Semarang (p=0,080; r=-0,304). Demikian juga pada multipara tidak ada hubungan antara kadar hb ibu hamil trimester III dengan lama persalinan di RB Annisa Kota Semarang (p=0,394; r=0,214). Disarankan bagi peneliti lain agar penelitian selanjutnya dapar meneliti variabel-variabel lain yang belum diteliti yang mungkin berhubungan dan mempengaruhi lama persalinan dengan jumlah sampel yang lebih besar. Kata Kunci: Kadar Hb, hamil, lama persalinan RELATION OF PREGNANT WOMAN HEMOGLOBIN RATE (HB) TRIMESTER III WITH LONG DURATION LABOUR IN RB ANNISA SEMARANG Mother mortality in Indonesia that is 390 per 100000 birth of life represent highest in ASEAN according to SDKI 1994. Direct cause of mother mortality for example bleeding (28%), eklampsia (24 %), infektion(11%), prolonged labour(5%), abortus (5%) others (11%). Indirect cause of mother mortality for example anemia, lack chronic energy (KEK) and situation 4 too (too young/old, often and many). This research aim to know thr relation of pregnan moman Hb rate thhird trimester with long duration labour in RB Annisa Semarang. This research type is explanatory research with analitic survey method with approach of cross sectional. Population in this research is entire pregnant woman third trimester checking pregnancy and labour in RB Annisa Semarang counted 52 pregnant woman in month of April until Mei 2005. Intake of sample done by purposive. Processing and data analysis done by using SPSS computer 10.0 tested with Chi-Square test to the overall of reponder then divided to the multipara and primipara and each tested again with Pearson Product Moment correlation. Result of this research indicate that most responder is primipara (65,4%), normal Hb rate (78,8%), normal long duration labour (84,6%). Rate Hb mean 11,594 gram %, responder duration labour mean 242,27 menutes. Deviasi Hb rate standard 0,909. Deviasi standard duration labour 133,11. Result of statistical test with Chi-Square at overall of responder show its 1,218 probability mean there is no relation between pregnant women hb rate of third trimester with long duration labour in RB Annisa Semarang. At primipara after tested with Pearson Product Moment correlation indicate that there is no relation between pregnant women hb rate of third trimester with long duration labour in RB Annisa Semarang (p=0,080; r=-0,304). And so do at multipara there is no relation between pregnant women hb rate of third trimester with long duration labour in RB Annisa Town Semarang (p=0,394; r=0,214). Suggested to other researcher so that furthermore research can check other variable like styles of eat some food in pregnant women which not yet been checed which possible correlate and influence long duration labour with amount of larger ones sampel. Keyword: Rate Hb, Pregnant, Long duration labou

How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan

Background: Limited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities. Methods and findings: A system dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse and switch antenatal care services in four provider sectors: public, private, traditional and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different subgroups by geographical locations and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences on if, when and where to seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within trimester 2, but for rural women within trimester 1. Antenatal care access delayed to trimester 3 had no protective impact on neonatal mortality. Conclusions: System dynamics modelling enables capturing the complexity of health-seeking behaviours and impact on outcomes, informing intervention design, implementation of targeted policies and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts and strong social network influences

The prevalence of Restless Legs Syndrome/Willis-ekbom disease (RLS/WED) in the third trimester of pregnancy:a systematic review

BACKGROUND: RLS is known as one of the most common movement disorders during pregnancy, which is most aggravated in the third trimester of pregnancy and can affect up to one-third of pregnant women. This study intends to determine the total prevalence of RLS in the third trimester of pregnancy through a systematic review.METHODS: The present study was conducted via meta-analysis method up to 2019. The papers related to the subject of interest were obtained through searching in SID, MagIran, IranDoc, Scopus, Embase, Web of Science (ISI), PubMed, Science Direct, and Google Scholar databases. Heterogeneity of the studies was examined via I2 index, and the data were analyzed in Comprehensive meta-analysis software.RESULTS: In investigating 10 papers capturing 2431 subjects within the age range of 25-39 years, the total prevalence of RLS in the third trimester of pregnancy based on meta-analysis was obtained as 22.9% (95% CI: 14.7-33.8%). Further, as the sample size increased, the RLS prevalence diminished, while with increase in years, this prevalence increased, where this difference was statistically significant (P &lt; 0.05).CONCLUSION: Prevalence of RLS in the third trimester of pregnancy is high, healthcare policymakers should organize educational classes to improve the life dimensions among this group of pregnant women.</p

Maternity

Women in the pregnancy would change the self concept to become a parent it is necessary supported especially by husband, because of discomfort during pregnancy can affect fetal growth and development. The success of wife in face of change and discomfort is very dependent of the role and support given by husband. From interviews at the initial survey conducted on 10 pregnant women in the LPTP Mother and Children Health Service Centre Bapelkes Godean Sleman Yogyakarta, there are 3 people say pregnant women are not supporting her husband during her pregnancy

Association of Special Supplemental Nutrition Program for Women, Infants, and Children With Preterm Birth and Infant Mortality.

Importance:Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially. Objective:To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits. Design, Setting, and Participants:This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019. Exposures:Receipt of WIC benefits during pregnancy. Main Outcomes and Measures:The first outcome was gestational age at birth: extremely preterm (&lt;28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life. Results:Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P &lt; .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86). Conclusions and Relevance:This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality

Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis

OBJECTIVE: To determine the impact of cervical excision for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes. DESIGN: Systematic review and meta-analysis of cohort studies. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA: Studies assessing fertility and early pregnancy outcomes in women with a history of treatment for cervical intraepithelial neoplasia versus untreated women. We classified the included studies according to treatment type and fertility or early pregnancy endpoint. ANALYSIS: Pooled relative risks and 95% confidence intervals using a random effect model, and interstudy heterogeneity with I(2) statistics. RESULTS: 15 studies fulfilled the inclusion criteria and were included. The meta-analysis did not provide any evidence that treatment for cervical intraepithelial neoplasia adversely affected the chances of conception. The overall pregnancy rate was higher for treated women than for untreated women (four studies; 43% v 38%, pooled relative risk 1.29, 95% confidence interval 1.02 to 1.64), although the heterogeneity between studies was high (P<0.0001). Pregnancy rates did not differ between women with an intention to conceive (two studies; 88% v 95%, 0.93, 0.80 to 1.08) and the number requiring more than 12 months to conceive (three studies, 15% v 9%, 1.45, 0.89 to 2.37). Although the rates for total miscarriages (10 studies; 4.6% v 2.8%, 1.04, 0.90 to 1.21) and miscarriage in the first trimester (four studies; 9.8% v 8.4%, 1.16, 0.80 to 1.69) was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester. The rate was higher for treated women than for untreated women (eight studies; 1.6% v 0.4%, 16,558 women; 2.60, 1.45 to 4.67). The number of ectopic pregnancies (1.6% v 0.8%; 1.89, 1.50 to 2.39) and terminations (12.2% v 7.4%; 1.71, 1.31 to 2.22) was also higher for treated women. CONCLUSION: There is no evidence suggesting that treatment for cervical intraepithelial neoplasia adversely affects fertility, although treatment was associated with a significantly increased risk of miscarriages in the second trimester. Research should explore mechanisms that may explain this increase in risk and stratify the impact that treatment may have on fertility and early pregnancy outcomes by the size of excision and treatment method used