scholarly journals Anandamide Exerts a Differential Effect on Human Placenta Before and After the Onset of Labor

2021 ◽  
Vol 12 ◽  
Author(s):  
Paula Accialini ◽  
Cyntia Abán ◽  
Tomás Etcheverry ◽  
Mercedes Negri Malbrán ◽  
Gustavo Leguizamón ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Endocannabinoid System ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Before And After ◽  
Elective Cesarean ◽  
Main Components ◽  
Relevant Finding

The onset of labor involves the action of multiple factors and recent reports have postulated the endocannabinoid system as a new regulator of this process. Our objective was to study the role of anandamide, one of the main endocannabinoids, on the regulation of placental molecules that contribute to the onset of labor at term. Placental samples were obtained from patients with laboring vaginal deliveries and from non-laboring elective cesarean sections. Vaginal delivery placentas produced higher prostaglandins levels than cesarean section samples. Besides, no differences were observed in NOS basal activity between groups. Incubation of vaginal delivery placentas with anandamide increased prostaglandins concentration and decreased NOS activity. Antagonism of type-1cannabinoid receptor (CB1) did not alter the effect observed on NOS activity. Conversely, incubation of cesarean section placentas with anandamide reduced prostaglandins levels and enhanced NOS activity, the latter involving the participation of CB1. Furthermore, we observed a differential expression of the main components of the endocannabinoid system between placental samples, being the change in CB1 localization the most relevant finding. Our results suggest that anandamide acts as a modulator of the signals that regulate labor, exerting differential actions depending on CB1 localization in laboring or non-laboring term placentas.

Timing and Safety of Postpartum Enoxparin.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4110-4110
Author(s):  
Rachel A. Freedman ◽  
Jeffrey Zwicker ◽  
Kenneth Alan Bauer
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Postpartum Period ◽  
Retrospective Cohort ◽  
Low Molecular Weight Heparin ◽  
Control Group ◽  
Low Molecular Weight ◽  
Cesarean Sections ◽  
Vaginal Deliveries

Abstract The appropriate time to restart anticoagulation in the postpartum period is not known. Both the American College of Obstetrics and Gynecology as well as American College of Chest Physicians (ACCP) have issued guidelines regarding the use of anticoagulants during pregnancy but neither have generated recommendations regarding the timing of the first dose of low-molecular-weight heparin (LMWH) in the postpartum period. The incidence of postpartum hemorrhage was assessed in a retrospective cohort study of 95 women treated with enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin versus a control group of women undergoing vaginal delivery (3.6% versus 1.4%, P=0.72) or cesarean section (5.1% versus 3.4%, P=0.98). There were no severe postpartum hemorrhages following the re-initiation of enoxaparin postpartum. In 75% of vaginal deliveries and 49% of cesarean sections, enoxaparin was restarted within 24 hours. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 hours following cesarean section. We conclude that severe postpartum hemorrhage is an infrequent complication following the administration of enoxaparin postpartum. In support of current clinical practice, enoxaparin can be safely administered 0 to 24 hours following vaginal delivery and 12 to 36 hours following cesarean section.

scholarly journals The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lucas D. Ekstrom ◽  
Viktor H. Ahlqvist ◽  
Margareta Persson ◽  
Cecilia Magnusson ◽  
Daniel Berglind
Keyword(s):  
Cesarean Section ◽  
Cardiorespiratory Fitness ◽  
Cycle Ergometer ◽  
Elective Cesarean Section ◽  
Cesarean Sections ◽  
Cycle Ergometer Test ◽  
Elective Cesarean ◽  
Birth Characteristics ◽  
Ergometer Test

Abstract Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.

scholarly journals Global Changes of 5-mC/5h-mC Ratio and Methylation of Adiponectin and Leptin Gene in Placenta Depending on Mode of Delivery

2021 ◽  
Vol 22 (6) ◽  
pp. 3195
Author(s):  
Aneta Słabuszewska-Jóźwiak ◽  
Marcelina Malinowska ◽  
Anna Kloska ◽  
Joanna Jakóbkiewicz-Banecka ◽  
Mariusz Gujski ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Elective Cesarean Section ◽  
Global Changes ◽  
Delivery Mode ◽  
Cesarean Sections ◽  
Global Methylation ◽  
Vaginal Deliveries ◽  
Elective Cesarean

It was suggested that the epigenetic alterations of the placenta are associated with obesity, as well as the delivery mode. This study aimed to assess the effect of maternal outcome and delivery procedure on global placental DNA methylation status, as well as selected 5’-Cytosine-phosphate-Guanine-3’ (CpG) sites in ADIPOQ and LEP genes. Global DNA methylation profile in the placenta was assessed using the 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) ratio evaluated with the ELISA, followed by target gene methylation patterns at selected gene regions which were determined using methylation-specific qPCR in 70 placentas from healthy, pregnant women with single pregnancy. We found no statistically significant differences in 5-mC/5-hmC ratio between intrapartum cesarean sections (CS) and vaginal deliveries (p = 0.214), as well as between elective cesarean sections and vaginal deliveries (p = 0.221). In intrapartum cesarean sections, the ADIPOQ demethylation index was significantly higher (the average: 1.75) compared to elective cesarean section (the average: 1.23, p = 0.010) and vaginal deliveries (the average: 1.23, p = 0.011). The LEP demethylation index did not significantly differ among elective CS, intrapartum CS, and vaginal delivery groups. The demethylation index of ADIPOQ correlated negatively with LEP in the placenta in the vaginal delivery group (r = −0.456, p = 0.017), but not with the global methylation. The methylation of a singular locus might be different depending on the mode of delivery and uterine contractions. Further studies should be conducted with locus-specific analysis of the whole genome to detect the methylation index of specific genes involved in metabolism.

scholarly journals Comparison of Malondialdehyde Level in the Cord Blood of Newborn Infants of vaginal and cesarean deliveries

2019 ◽  
Vol 10 (3) ◽  
pp. 2487-2494
Author(s):  
Eman Khammas ALSaadi ◽  
Batol Faisal Taher ◽  
Mohammed Abid Darweesh ◽  
Mohammed Abul Al-Monther
Keyword(s):  
Oxidative Stress ◽  
Cesarean Section ◽  
Cord Blood ◽  
Vaginal Delivery ◽  
Oxidative Stress Marker ◽  
Elective Cesarean Section ◽  
Stress Injury ◽  
Vaginal Deliveries ◽  
Two Samples ◽  
Elective Cesarean

The oxidative stress injury that has been linked to poor perinatal outcome and birth asphyxia may be found even with normal pregnancy, and it is severity in a newborn may be related to modes of delivery for which our study aimed to identify. Furthermore, this study was aimed to study the effect of both related- maternal, and related neonatal characteristics on baby’s oxidative stress marker level (Malondialdehyde). Fifty newborn children were selected in both labor ward and operating theatre of Al-Sadder Teaching Hospital, Misan, Iraq. They were divided into two groups. The first group comprised 28 newborns, who were born by a vaginal delivery; the second group consisted of 22 newborns who delivered by elective cesarean section. The laboratory measurement of levels of an important antioxidant factor [malondialdehyde (MDA)] in baby’s cord blood has been extracted and used as an indicator of stress. We compared the two samples of different malondialdehyde levels in relation to variables as the delivery type, some maternal, fetal and neonatal characteristics. The results of this study revealed that MDA level was higher among neonates delivered through Elective Cesareans Section than those delivered through Vaginal Delivery with significant statistical value (p>0.0001). The previous delivery mood has a statistically significant value of (p>0.02) among mothers who had no previous deliveries.  While there were no significant statistical values regarding maternal characteristics as (ages, parity, residency, antenatal care, history of previous abortion, and body mass index) as well as fetal and neonatal characteristics as (sex, birth weight, fetal presentation, and Apgar score) and high MDA level. The current study was concluded that babies delivered by Elective Cesarean Section had been exposed to more oxidative stress compared to the normal Vaginal Deliveries especially for the Primigravidas.

Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kimitoshi Imai MD
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Breech Presentation ◽  
Vaginal Birth ◽  
Low Risk ◽  
Retrospective Observational Study ◽  
Vacuum Extraction ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Multiparous Women

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

scholarly journals Delivery of Twin Gestation (≥ 32.0 Weeks): The Vaginal Route as a Practicable and Safe Alternative to Cesarean Section

2020 ◽  
Vol 80 (10) ◽  
pp. 1033-1040
Author(s):  
Anne Dathan-Stumpf ◽  
Katharina Winkel ◽  
Holger Stepan
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Neonatal Outcome ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
Delivery Mode ◽  
Safe Alternative ◽  
Vaginal Deliveries ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Objective The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. Material and Methods A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. Results The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Conclusion Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.

scholarly journals Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies

2020 ◽  
Author(s):  
Sabine Enengl ◽  
Peter Oppelt ◽  
Simon-Hermann Enzelsberger ◽  
Philip Sebastian Trautner ◽  
Omar Shebl ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Time Interval ◽  
Apgar Scores ◽  
Outcome Parameters ◽  
Retrospective Data Analysis ◽  
Vaginal Deliveries ◽  
Mode Of Birth ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Purpose Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery. Methods This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted. Results A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05). Conclusion Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

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