Mother's Anxiety Face Primigravidal Delivery Ages 20-35 Years at Mandiri Midwife Practices Cengkal Sewu Village, Kayen District, Pati Regency

Anxiety before labor in pregnant women is a physiological matter, but in facing labor process in which there are a series of physical and psychological changes that starting with uterine contractions, dilatation of the birth canal, and spending baby and placenta which ended with first punding between mother and baby. Anxiety and depression are two types of interference that related each other. The objectives of this study is to explore mother’s anxiety facing labor primigravid 20-35 years old in BPM Sulityowati Cengkalsewu Village Sub Kayen Pati Regency. This study used a qualitative method with phenomenological approach. Technique of data collection with in depth interview and purposive sampling. The results of in-depth interview in participant obtained information mother’s anxiety resolve labor primigravid 20-35 years old about definition, causes, family support, factors of anxiet. and how to prevent and resolve anxiety. All mothers who are facing labor already know about the content of the anxiety in the face of first child labor. As well as how to prevent and resolve that anxiety.Mother’s anxiety facing labor primigravid 20-35 years old is good.

Augmented KCa2.3 Channel Feedback Regulation of Oxytocin Stimulated Uterine Strips from Nonpregnant Mice

Uterine contractions prior to 37 weeks gestation can result in preterm labor with significant risk to the infant. Current tocolytic therapies aimed at suppressing premature uterine contractions are largely ineffective and cause serious side effects. Calcium (Ca2+) dependent contractions of uterine smooth muscle are physiologically limited by the opening of membrane potassium (K+) channels. Exploiting such inherent negative feedback mechanisms may offer new strategies to delay labor and reduce risk. Positive modulation of small conductance Ca2+-activated K+ (KCa2.3) channels with cyclohexyl-[2-(3,5-dimethyl-pyrazol-1-yl)-6-methyl-pyrimidin-4-yl]-amine (CyPPA), effectively decreases uterine contractions. This study investigates whether the receptor agonist oxytocin might solicit KCa2.3 channel feedback that facilitates CyPPA suppression of uterine contractions. Using isometric force myography, we found that spontaneous phasic contractions of myometrial tissue from nonpregnant mice were suppressed by CyPPA and, in the presence of CyPPA, oxytocin failed to augment contractions. In tissues exposed to oxytocin, depletion of internal Ca2+ stores with cyclopiazonic acid (CPA) impaired CyPPA relaxation, whereas blockade of nonselective cation channels (NSCC) using gadolinium (Gd3+) had no significant effect. Immunofluorescence revealed close proximity of KCa2.3 channels and ER inositol trisphosphate receptors (IP3Rs) within myometrial smooth muscle cells. The findings suggest internal Ca2+ stores play a role in KCa2.3-dependent feedback control of uterine contraction and offer new insights for tocolytic therapies.

Detection of Preventable Fetal Distress During Labor From Scanned Cardiotocogram Tracings Using Deep Learning

Despite broad application during labor and delivery, there remains considerable debate about the value of electronic fetal monitoring (EFM). EFM includes the surveillance of fetal heart rate (FHR) patterns in conjunction with the mother's uterine contractions, providing a wealth of data about fetal behavior and the threat of diminished oxygenation and cerebral perfusion. Adverse outcomes universally associate a fetal injury with the failure to timely respond to FHR pattern information. Historically, the EFM data, stored digitally, are available only as rasterized pdf images for contemporary or historical discussion and examination. In reality, however, they are rarely reviewed systematically or purposefully. Using a unique archive of EFM collected over 50 years of practice in conjunction with adverse outcomes, we present a deep learning framework for training and detection of incipient or past fetal injury. We report 94% accuracy in identifying early, preventable fetal injury intrapartum. This framework is suited for automating an early warning and decision support system for maintaining fetal well-being during the stresses of labor. Ultimately, such a system could enable obstetrical care providers to timely respond during labor and prevent both urgent intervention and adverse outcomes. When adverse outcomes cannot be avoided, they can provide guidance to the early neuroprotective treatment of the newborn.

Preterm Labor and Treatment Efficacy-Safety

With medical sciences on the verge of advancement, preterm labor still remains a bothersome issue in modern obstetrics. A few therapeutic agents that suppress uterine contractile activity have gained success up to some extent. Tocolytics are medications used to suppress premature labor. These drugs can decrease the strength and frequency of uterine contractions and help in delay the onset of labor but are not able to prolong pregnancy to full-term. Presently, the choice of a best tocolytic drug remains debatable. This review discusses efficacy and safety of various useful agents which have been used so far. Further clinical trials are required to select an effective, and most importantly, safe therapy for the threatened preterm labor.

Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor

During labor, uterine contractions trigger the response of the autonomic nervous system (ANS) of the fetus, producing sawtooth-like decelerations in the fetal heart rate (FHR) series. Under chronic hypoxia, ANS is known to regulate FHR differently with respect to healthy fetuses. In this study, we hypothesized that such different ANS regulation might also lead to a change in the FHR deceleration morphology. The hypothesis was tested in an animal model comprising nine normoxic and five chronically hypoxic fetuses that underwent a protocol of umbilical cord occlusions (UCOs). Deceleration morphologies in the fetal inter-beat time interval (FRR) series were modeled using a trapezoid with four parameters, i.e., baseline b, deceleration depth a, UCO response time τu and recovery time τr. Comparing normoxic and hypoxic sheep, we found a clear difference for τu (24.8±9.4 vs. 39.8±9.7 s; p < 0.05), a (268.1±109.5 vs. 373.0±46.0 ms; p < 0.1) and Δτ = τu − τr (13.2±6.9 vs. 23.9±7.5 s; p < 0.05). Therefore, the animal model supported the hypothesis that hypoxic fetuses have a longer response time τu and larger asymmetry Δτ as a response to UCOs. Assessing these morphological parameters during labor is challenging due to non-stationarity, phase desynchronization and noise. For this reason, in the second part of the study, we quantified whether acceleration capacity (AC), deceleration capacity (DC), and deceleration reserve (DR), computed through Phase-Rectified Signal Averaging (PRSA, known to be robust to noise), were correlated with the morphological parameters. DC, AC and DR were correlated with τu, τr and Δτ for a wide range of the PRSA parameter T (Pearson's correlation ρ > 0.8, p < 0.05). In conclusion, deceleration morphologies have been found to differ between normoxic and hypoxic sheep fetuses during UCOs. The same difference can be assessed through PRSA based parameters, further motivating future investigations on the translational potential of this methodology on human data.

Maternal interleukin-6 and prostaglandin levels post-regiosacral counter-pressure as pain therapy due to uterine contractions

Pain is a physiological condition that is generally experienced by almost all mothers in labor or pain during menstruation (dysmenorrhea). Pain causes tachycardia in the mother, increased oxygen consumption, lactic (lactic) acid production, hyperventilation with a risk of respiratory alkalosis, and increased skeletal muscle tension. Regiosarcal Counter Pressure is an effective therapy to reduce pain due to uterine contractions. Based on research that has been done, Regiosarcal counter-pressure therapy can reduce pain levels and has also been shown to slightly reduce prostaglandin (PGE-2) levels in an insignificant amount. Changes in PGE-2 are suspected to have an impact on the stimulant hormone Interleukin-6 (IL-6). This study aims to determine the levels of IL-6 and prostaglandins in the first stage of labor. The research method used quasi-experimental, with inclusion criteria of first-stage labor, no pelvic abnormalities and other abnormalities that hindered the process of vaginal delivery, primiparas, singleton pregnancies, the location of the head did not receive painkillers. The results obtained 25 respondents with an average age of 23.72 (± 2.89) years, the average concentration of IL-6 before therapy was 185.159 (± 3.76) pg/ml and the mean after therapy was 180.782 (± 22.05) pg. /ml, the mean concentration of PGE2 before treatment was 223.521 (± 72.73) pg/ml and the mean after treatment was 179.873 (± 110.61) pg/ml. Administration of regiosacral counter-pressure therapy did not significantly reduce the levels of the hormone IL-6 and prostaglandins in women who experienced uterine contractions.

Blocking the BKCa channel induces NF-κB nuclear translocation by increasing nuclear calcium concentration

Nuclear factor kappa B (NF-κB) transcriptionally regulates several genes involved in initiating uterine contractions. A key factor controlling NF-κB activity is its translocation to the nucleus. In myometrial smooth muscle cells (MSMCs), this translocation can be stimulated by the inflammatory molecule lipopolysaccharide (LPS) or by blocking the potassium calcium-activated channel subfamily M alpha 1 (KCNMA1 or BKCa) with paxilline (PAX). Here, we sought to determine the mechanism by which blocking BKCa causes NF-κB-p65 translocation to the nucleus in MSMCs. We show that LPS- and PAX-induced NF-κB-p65 translocation are similar in that neither depend on several mitogen-activated protein kinase pathways, but both require increased intracellular calcium (Ca2+). However, the nuclear transport inhibitor wheat germ agglutinin prevented NF-κB-p65 nuclear translocation in response to LPS but not in response to PAX. Blocking BKCa located on the plasma membrane resulted in a transient NF-κB-p65 nuclear translocation that was not sufficient to induce expression of its transcriptional target, suggesting a role for intracellular BKCa. We report that BKCa also localizes to the nucleus and that blocking nuclear BKCa results in an increase in nuclear Ca2+ in MSMCs. Together, these data suggest that BKCa localized on the nuclear membrane plays a key role in regulating nuclear Ca2+ and NF-κB-p65 nuclear translocation in MSMCs.

Genetic Variants of Progesterone Receptor in Etiology of Preterm Delivery

Background: Preterm delivery (PTD) accounts for around 11% of pregnancies worldwide. Unfortunately, no diagnostic indicator, specific mechanism or genetic predisposition has yet been identified. One of the hypotheses suggest local or functional progesterone decrease as a potential reason for preterm uterine contractions leading to preterm delivery. It is believed that any change in progesterone receptor DNA may be crucial for higher risk of preterm delivery due to abnormal response to prostaglandins, normally inhibited by properly built progesterone. The aim of this study was to determine whether there is an association between progesterone gene polymorphisms (PROGINS and +331G/A) and preterm birth. Methods and Results: A total of 230 women were enrolled, including 115 cases of preterm deliveries (between 22 and 36 weeks of gestation) and 115 healthy mothers of full-term infants. Genomic DNA was isolated from the blood sample. Polymerase chain reaction (PCR) amplification was carried out in a final volume of 25µl. Genotyping was assayed by PCR. Statistical analysis of the results was conducted with p<0.05 accepted as statistically significant. For both PROGINS (Alu ins/del) and +331G/A (rs10895068) polymorphisms were equally frequent in case and control group. The prevalence of PGR alleles in both groups was also comparable.Conclusion: The results of our study showed no association between progesterone gene polymorphisms (PROGINS and +331G/A) and risk of preterm delivery. Identifying mechanisms to prolong the length of gestation, particularly in women at risk for preterm delivery, will improve both maternal and fetal outcomes.

Stimulasi Puting Susu terhadap Lama Pengeluaran Plasenta

Bleeding is still the second highest cause of AKI in Gorontalo Province. Bleeding in the mother after delivery can be caused by retained placenta, which is a condition where the placenta has not been born 30 minutes after the fetus is born. Nipple stimulation carried out immediately after the baby is born can influence the hypothalamus to release the hormone oxytocin which will strengthen uterine contractions thereby shortening the time for placental separation.Objective: To analyze the effect of nipple stimulation on the duration of expulsion of the placenta.This research method uses Pre Experiment Design research with Static Group Comparison. The k population used was 30 mothers who gave birth normally, consisting of 15 respondents in the nipple stimulation intervention group and 15 respondents in the control group. Independent variable; nipple stimulation and the dependent variable of the duration of expulsion of the placenta.Results: The average length of time for expulsion of the placenta in the nipple stimulation intervention group was 7.07 minutes and the control group mother was 11.13 minutes. The results of statistical tests with Independent t-test = 0.004 < 0.05.The conclusion is that there is an effect of nipple stimulation on the duration of expulsion of the placenta.

A Rare Case of Pregnancy Complicated by Bladder Exstrophy and Uterine Prolapse

Uterine prolapse and bladder exstrophy (BE) during pregnancy is a rare condition. The aim of this study was to present a rare case of pregnancy complicated by both bladder exstrophy and uterine prolapse. A 39-year-old pregnant woman (gravida 2, para 1) presented to the maternity department at 39 weeks of gestation with labor pain. Physical examination showed regular uterine contractions; the cervix was completely out of the vaginal opening with dilatation of 3 cm and effacement of 30%. She had a history of multiple surgeries for correction of bladder exstrophy and also suffered from uterine prolapse. In active labor, abnormal fetal heart rate tracing happened, so an emergent cesarean section was planned, and a healthy neonate with the normal Apgar score was born. At regular follow-up until four months after delivery, there was no sign or symptom of uterine proplase. Multidisciplinary management of patients with BE and uterine prolapse may result in optimal perinatal outcomes. Uterine prolapse may disappear after delivery, even in the complicated case of bladder exstrophy.