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Coordinated elevation of membrane type 1-matrix metalloproteinase and matrix metalloproteinase-2 expression in rat uterus during postpartum involution
Kengo Manase, Toshiaki Endo, Mitunobu Chida, Kunihiko Nagasawa, Hiroyuki Honnma, Kiyohiro Yamazaki, Yoshimitu Kitajima, Taeko Goto, Mika Kanaya, Takuhiro Hayashi, Toshihiro Mitaka, Tsuyoshi Saito
Reproductive Biology and Endocrinology , 2006, DOI: 10.1186/1477-7827-4-32
Abstract: We performed gelatin zymography, northern blot analysis and immunohistochemistry to compare the expression levels of MT1-MMP, MMP-2, matrix metalloproteinase-9 (MMP-9) and the tissue inhibitors of MMPs-1 and 2 (TIMP-1 and TIMP-2) in the rat uterus 18 h, 36 h and 5 days after parturition with their expression levels during pregnancy (day 20).We found that both MT1-MMP and MMP-2 localized mainly in the cytoplasm of uterine interstitial cells. The expression levels of MT1-MMP and MMP-2 mRNAs and the catalytic activities of the expressed proteins significantly increased 18 h and 36 h after parturition, but at postpartum day 5, their mRNA expression levels and catalytic activities decreased markedly. The expression levels of MMP-9 increased 18 h and 36 h after parturition as determined by gelatin zymography including the expression levels of TIMP-1 and TIMP-2.These expression patterns indicate that MT1-MMP, MMP-2, MMP-9, TIMP-1 and TIMP-2 may play key roles in uterine postpartum involution and subsequent functional regenerative processes.During pregnancy, the uterus enlarges, which in rats is mainly caused by an increase in the amount of collagen and hypertrophy of the uterine smooth muscle cells. After parturition, the uterus undergoes involution during which it returns to its prepregnancy state. Matrix metalloproteinases (MMPs) are a group of structurally related endopeptidases that catalyze the degradation of various macromolecular components of the extracellular matrix and basement membrane [1,2], and induce various forms of tissue remodeling, including wound healing [3,4], trophoblast invasion [5,6], organ morphogenesis [7,8], and uterine [9-11], mammary gland [12,13], and prostate gland [14,15] involution. We previously reported that an increase in the expression levels of both membrane type 1-MMP (MT1-MMP) and MMP-2 plays a key role in tissue remodeling during corpus luteum structural involution both in rats and humans [16-18].To obtain additional information on t
The Association between Traditional Chinese Dietary and Herbal Therapies and Uterine Involution in Postpartum Women
Ming Ho,Tsai-Chung Li,Shan-Yu Su
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1155/2011/918291
Abstract: Background. Traditional Chinese postpartum care is believed to help in the recovery of women after delivery. Objective. This study investigated the association of elements in dietary and herbal therapy with uterine involution. Methods. Indices of uterine involution were measured ultrasonographically in 127 postpartum women between 4-6 weeks after delivery. A self-reported retrospective questionnaire was used to query women about their frequencies of taking herbal medicines and consuming special diets during the first month after delivery. Correlation coefficients were calculated to identify the associations, then the regression models were used to identify the predictors. Result. Among the herbal medicines and diet, consumption of Eucommia ulmoides (E. ulmoides) negatively correlated with the AP diameter of the uterus and the cavity. E. ulmoides was also the only predictor of maximum AP diameter of the uterus, AP diameter of the uterus 5 cm from the fundus, and the maximum AP diameter of the cavity. Moreover, consumption of Sheng-hau-tang was significantly correlated with anteverted uterus and was a predictor of anteverted uterus. Conclusion. E. ulmoides and Sheng-hau-tang positively correlated with the degree of uterine involution after delivery, implying that both therapies might possess the pharmacological efficacy of uterine contraction in postpartum women.
Oxytocin Massage Can Expedite the Time of Colostrum Discharge in the Post Section Caesarian  [PDF]
Rika Resmana, Dian Nur Hadianti
Open Journal of Nursing (OJN) , 2019, DOI: 10.4236/ojn.2019.97057
Abstract: The production of breast milk is physiologically influenced by prolactin hormone and breast milk is influenced by oxytocin hormone. Oxytocin massage can increase the oxytocin hormone. The increase in the oxytocin hormone can expedite the time of colostrum. The use of drugs in the post section cesarean (SC) will inhibit the formation of breast milk production. Oxytocin massage is one of the efforts to expedite the release of colostrum. Purpose: To analyze the implementation of oxytocin massage in accelerating the release of colostrum in post-SC and the effect of oxytocin massage, breast care and the frequency of breastfeeding simultaneously to accelerate the release of colostrum. Method: The design used quasi-experiment. The population were post-SC with a sample of 60 people (30 post-SC were treated with oxytocin massage and 30 post-SC were not treated). Both groups were interviewed and observed in breast care, the frequency of breastfeeding and the time of first colostrum discharge. Result: Analysis used independent T-test and double linear regression test with α = 0.05. The results showed significantly that expedite time of colostrum in the post SC group with oxytocin massage occurred 23.04 hours faster than the controlled group who were not treated with oxytocin massage and post SC who were given oxytocin massage accompanied by breastfeeding their babies as often as possible to be faster 2.6 hours when the colostrum was released with α value < 0.05. Conclusion: Massage oxytocin speeds up the release of colostrum in the post SC.
Oxytocin in Pregnancy and the Postpartum: Relations to Labor and Its Management  [PDF]
Marie Prevost,Phyllis Zelkowitz,Togas Tulandi,Barbara Hayton,Nancy Feeley,C. Sue Carter,Lawrence Joseph,Hossein Pournajafi-Nazarloo,Erin Yong Ping,Haim Abenhaim,Ian Gold
Frontiers in Public Health , 2014, DOI: 10.3389/fpubh.2014.00001
Abstract: 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.
Comparison of Oxytocin and Misoprostol in Reduction of Postpartum Hemorrhage
Talaat Dabaghi Ghaleh,Fatemeh Lalooha,Faride Movahed,Simindokht Moradi,Omid Mashrabi
Research Journal of Biological Sciences , 2012, DOI: 10.3923/rjbsci.2011.652.655
Abstract: Postpartum hemorrhage ranks among the leading causes of maternal morbidity and mortality, both in developed and developing countries. Intravenous Oxytocin is using now to reduce of postpartum hemorrhage. With this trial, researchers sought to determine the effectiveness of oral Misoprostol as an Uterotonic drug in comparison with intravenous Oxytocin in patients with a low risk of postpartum hemorrhage undergoing delivery. To compare the effect of 400 μg of oral Misoprostol with 10 IU of intravenous Oxytocin in preventing postpartum hemorrhage. In a randomized controlled trial conducted in Kosar hospital, 300 pregnant women with inclusion criteria received either 400 μg of oral Misoprostol or 10 IU of intravenous Oxytocin after delivery of the anterior shoulder or within 1 min of delivery. Hemoglobin and hematocrit of maternal was checked during admission and 24 h after delivery and compared together. There was no difference between two groups in hematocrit drop in 3.33±3.44 and 2.81±1.26% of the participants in the Oxytocin and Misoprostol group (p = 0.325). The rate of use of additional oxytocin was higher in the Oxytocin group (34.8 vs. 20.5%, p = 0.013). Shivering was higher in misoprostol group (12.3 vs. 2.9%, p = 0.005). Fever occurred only in 2 cases of Misoprostol group (p = 0.236). The routine use of 400 μg of oral misoprostol was no less effective than 10 IU of intravenous oxytocin in reducing blood loss after delivery as assessed by change in postpartum hematocrit and hemoglobin.
Safety and Efficacy of Misoprostol versus Oxytocin for the Prevention of Postpartum Hemorrhage  [PDF]
Minoo Rajaei,Samieh Karimi,Zohreh Shahboodaghi,Hamidreza Mahboobi,Tahereh Khorgoei,Farzam Rajaei
Journal of Pregnancy , 2014, DOI: 10.1155/2014/713879
Abstract: Postpartum hemorrhage (PPH) is the commonest cause of maternal death worldwide. Studies suggest that the use of misoprostol may be beneficial in clinical settings where oxytocin is unavailable. The aim of this study was to compare the safety and efficacy of oxytocin and misoprostol when used in the prevention of PPH. In a double-blind randomized controlled trial, 400 pregnant women who had a vaginal delivery were assigned into two groups: to receive either 20 IU of oxytocin in 1000?mL Ringer’s solution and two placebo tablets or 400?mcg oral misoprostol (as two tablets) and 2?mL normal saline in 1000?mL Ringer’s solution. The quantity of blood loss was higher in the oxytocin group in comparison to the misoprostol group. There was no significant difference in the decrease in hematocrit and hemoglobin between the two groups. Although there was no significant difference in the need for transfusions between the two groups, the patients in the oxytocin group had greater need for additional oxytocin. Results from this study indicate that it may be considered as an alternative for oxytocin in low resource clinical settings. This study is registered with ClinicalTrials.gov NCT01863706. 1. Background Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after caesarean section (CS) or normal vaginal delivery (NVD). It may be defined as ≥500?mL hemorrhage after vaginal or ≥1000?mL hemorrhage after CS delivery [1–3]. PPH is one of the most common obstetric maternal complications and is among the three most common etiologies of maternal death worldwide [4]. Its incidence is increasing and it affects 1–5% of all deliveries [5, 6]. Atony is the main cause of PPH and is responsible for about 80% of PPHs [7]. Therefore, uterotonic agents are administered. Oxytocin infusion, single dose of methylergometrine, and then carboprost tromethamine are used in 15-to-20-minute intervals in atony. Misoprostol, which is a prostaglandin E1 analog, is an inexpensive drug and can be absorbed by the following routes of administration: vaginal, rectal, or oral (sublingual or buccal absorption) [8, 9]. Gastrointestinal symptoms (nausea, vomiting, and diarrhea) and fever are the most common adverse effects of misoprostol, which often are mild and self-limited [10–12]. Several studies have shown that misoprostol is more effective than oxytocin and methylergometrine in the treatment of PPH [13, 14]. Although misoprostol can be used as first-line therapy in the treatment of PPH where oxytocin is not available [15], other studies have not confirmed that
Relationships Between Measurements of Vaginal Electrical Impedance, Uterine Involution and Hormonal Profiles in Postpartum Dairy Cows
S. Bowers,S. Gandy,K. Graves,A. Moore,S. Willard
Journal of Animal and Veterinary Advances , 2012,
Abstract: The objective of this study was to determine whether relative changes in vaginal electrical impedance (VEI) readings would correlate to characteristics associated with involution of the uterus and hormone profiles postpartum in the dairy cow. In experiment I, the use of VEI measurements for monitoring follicular development and ovulation were verified. Jersey cows (n = 16) were administered prostaglandin F2a (PG) and sampled at 12 h intervals for 7 d post-PG. At each sampling period, VEI measurements were recorded, ultrasonography was performed to obtain follicular measurements, and serum samples collected for the determination of progesterone (P4) and estradiol (E2) using RIA. Serum concentrations of P4 decreased and E2 increased post-PG, while VEI decreased prior to ovulation; which is consistent with previous studies. In experiment II, Jersey cows (n = 18) were sampled twice weekly from d 1 to 60 postpartum (PP). On these days, VEI measurements were recorded, follicular sizes and cross-sectional area of the left and right uterine horns captured using ultrasonography, uterine tone scores assigned by palpation and serum samples collected for P4 and E2 determinations. Uterine horn diameter differences were negatively correlated with uterine tone scores and VEI measurements (i.e., as uterine horn diameter differences decreased, uterine tone and VEI measurements increased). Uterine tone scores were also positively correlated with VEI measurements. The relationship of VEI to early PP uterine involution was further confirmed in Holstein cows (n = 25), with increases in VEI readings occurring from week 2 to week 4 PP. In summary, VEI measurements patterned periovulatory hormonal profiles for cycling Jersey cows, and were significantly correlated with changes in uterine size, uterine tone, resumption of estrous cycles and/or day PP in Jersey and Holstein cows post-calving. These data suggest that VEI may be used as an objective tool for quantifying the association of uterine involution with the resumption of reproductive cyclicity (as determined by P4 and E2 profiles) in the PP dairy cow.
Is Postpartum Uterine Involution Impacted by Instrumental or Operative Procedures? Ultrasound Study  [PDF]
Virginija Paliulyte, Grazina Stanislava Drasutiene, Diana Ramasauskaite, Daiva Bartkeviciene, Jolita Zakareviciene, Juozas Kurmanavicius
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.813131
Abstract: Objectives: Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after operated deliveries. This prospective observational study pays attention to the uterine involution period after the instrumental or operative delivery and compares the results with those observed in uncomplicated labour. Methods: Over two postpartum months 66 women after normal (48) and complicated (18) labour were examined for repeated uterine parameters. The analysis was performed using SPSS version 21. Results: There was no statistically significant difference between the median uterine size parameters or the uterine artery indices after the normal delivery and instrumental/operative uterine manipulations during the involution period, except for a faster declining trend observed in anteroposterior diameter within the first month after normal labour. The diastolic notch was more frequent in early puerperium after complicated labor, but less frequent later. The diastolic notch did not appear in all the postpartum women even two months after labour. There was evidence of more frequent gas detected in the pathological rather than in the physiological group. Conclusion: Postpartum uterine involution is not impacted by instrumental or operative procedures. After complicated labour gas appearance is more common, but it does not necessarily indicate the presence of endometritis or retained placental tissues.
Sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage
Beigi A,Tabarestani H,Moini A,Zarrinkoub F
Tehran University Medical Journal , 2009,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Postpartum hemorrhage is a major cause of maternal mortality and morbidity. It has been identified that active management of third stage of labor is an effective way in preventing postpartum hemorrhage. This randomized controlled trial was conducted to compare sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage in nulliparous women."n"nMethods: In this randomized controlled trial conducted in Arash hospital from 2006 to 2009, Five hundred forty two nulliparous pregnant women were enrolled. They were randomized to receive either 400 microgram sublingual misoprostol or 20 IU oxytocin intravenously, immediately after the birth of newborn. "n"nResults: Post partum Hemorrhage was significantly lower in women who received sublingual misoprostol (p<0.0001). Patients who received misoprostol had shorter length of third stage of labor (6.45 minute in misoprostol Vs 6.9 minute in oxytocin group, p=0.003). Comparison of hemoglobin levels in two groups before and after delivery showed that there is a significant lesser hemoglobin drop in misoprostol group p=0.046. Side effects were more common in misoprostol group (p<0.0001). However, they were not serious; shivering (35.66%) in misoprostol group and headache (9.63%) in oxytocin group were the most common adverse effects."n"nConclusions: Sublingual misoprostol is more effective than intravenous oxytocin in preventing postpartum hemorrhage and is recommended for prevention of postpartum hemorrhage.
Pulmonary Delivery of an Ultra-Fine Oxytocin Dry Powder Formulation: Potential for Treatment of Postpartum Haemorrhage in Developing Countries  [PDF]
Richard J. Prankerd, Tri-Hung Nguyen, Jibriil P. Ibrahim, Robert J. Bischof, Gemma C. Nassta, Livesey D. Olerile, Adrian S. Russell, Felix Meiser, Helena C. Parkington, Harold A. Coleman, David A. V. Morton, Michelle P. McIntosh
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082965
Abstract: Oxytocin is recommended by the World Health Organisation as the most effective uterotonic for the prevention and treatment of postpartum haemorrhage. The requirement for parenteral administration by trained healthcare providers and the need for the drug solution to be maintained under cold-chain storage limit the use of oxytocin in the developing world. In this study, a spray-dried ultrafine formulation of oxytocin was developed with an optimal particle size diameter (1-5 μm) to facilitate aerosolised delivery via the lungs. A powder formulation of oxytocin, using mannitol, glycine and leucine as carriers, was prepared with a volume-based median particle diameter of 1.9 μm. Oxytocin content in the formulation was assayed using high-performance liquid chromatography-mass spectroscopy and was found to be unchanged after spray-drying. Ex vivo contractility studies utilising human and ovine uterine tissue indicated no difference in the bioactivity of oxytocin before and after spray-drying. Uterine electromyographic (EMG) activity in postpartum ewes following pulmonary (in vivo) administration of oxytocin closely mimicked that observed immediately postpartum (0-12 h following normal vaginal delivery of the lamb). In comparison to the intramuscular injection, pulmonary administration of an oxytocin dry powder formulation to postpartum ewes resulted in generally similar EMG responses, however a more rapid onset of uterine EMG activity was observed following pulmonary administration (129 ± 18 s) than intramuscular injection (275 ± 22 s). This is the first study to demonstrate the potential for oxytocin to elicit uterine activity after systemic absorption as an aerosolised powder from the lungs. Aerosolised oxytocin has the potential to provide a stable and easy to administer delivery system for effective prevention and treatment of postpartum haemorrhage in resource-poor settings in the developing world.
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