1,720,973 research outputs found
Coagulation activation, fibrinolysis and inhibitors in neonates
No full textEnhanced coagulation activation with reduced antithrombin III (ATIII) activity was seen in healthy neonates. Although systemic tissue plasminogen activator (t-PA) and urokinase-like plasminogen activator (u-PA) levels showed no significant differences from normal adults, enhanced fibrinolysis was indicated by elevated D-dimer and low plasminogen levels in the neonates in this study. Enhanced fibrinolysis observed was countered by elevated plasminogen activator inhibitor-I (PAI-1) levels, a trend similar to that observed in the amniotic fluid during labour. The elevated PAI-1 level seen in neonates may have a beneficial effect in preventing haemorrhage in the neonatal period. The haemostatic and fibrinolytic mechanisms studied in normal pregnancy neonates were similar to neonates born to gestational diabetes mellitus (GDM) mothers. Further studies need to include neonates with poor outcome and low Apgar score to assess their haemostatic status
Can formal education and training improve the outcome of instrumental delivery?
No full textObjective(s): The primary objective was to examine the effect of formal education and training on instrumental delivery with respect to its success rate and associated neonatal and maternal morbidity. The secondary objective was to determine factors that could influence the success rate of instrumental delivery. Study design: Prospective case-control study with historical controls set in a teaching hospital in Sheffield. The prospective group included all women who had instrumental deliveries between 1 November 1999 and 29 February 2000. The control group included all women who delivered between 1 February 1997 and 1 February 1998. An educational package involving formal postgraduate training and self-directed learning were introduced in the time period between the prospective and the control groups. Medical notes were reviewed in the historical controls. For both the control and prospective groups, the following patient characteristics were recorded: maternal age, parity, whether or not onset of labour was induced, use of oxytocin in the second stage of labour, delay in the second stage, operator grade, vaginal findings at delivery and the use of epidural analgesia. Results: The overall failure rate was not different in the prospective group (16%) compared with the control group (18.5%). However, the introduction of an educational package was associated with significant decrease in maternal morbidity associated with cervical, severe labial and high vaginal tears (Odds Ratio (OR) 0.29, CI 0.09–0.97) and neonatal morbidity associated with admission to SCBU (OR 0.72, CI 0.02–0.60), severe neonatal scalp injury (OR 0.14, CI 0.02–0.98) and facial injuries (OR 0.02, CI 0.01–0.04). The factors identified to affect the success of instrumental deliveries were: OP and OT positions of the baby at delivery (OR 0.28, CI 0.17–0.44) and inexperienced operators (OR 0.11, CI 0.02–0.58). Conclusion: In this study, formal education and training of medical staff did not influence the success rate of instrumental delivery but was associated with improved safety for both mother and baby.<br/
The use of adhesion prevention agents in obstetrics and gynaecology
No full textThis new scientific impact paper discusses adhesions, which are fibrinous bands between and within organs that develop after aberrant healing, usually as a consequence of inflammation after surgery or infection. Adhesions bear a significant economic burden on the NHS, but occurrence has been reduced by laparoscopic and microscopic surgery techniques.The evidence into the use of anti-adhesive agents in obstetrics and gynaecology is evaluated, concluding that further evidence which incorporates the current health economy is required
Interventions for treating chronic pelvic pain in women
No full textBackground: Chronic pelvic pain is common in women in the reproductive and older age groups and causes disability and distress. Often investigation by laparoscopy reveals no obvious cause for the pain. As the pathophysiology of chronic pelvic pain is not well understood its treatment is often unsatisfactory and limited to symptom relief. Currently the main approaches to treatment include counselling or psychotherapy, attempts to provide reassurance by using laparoscopy to exclude serious pathology, progestogen therapy such as medroxyprogesterone acetate, and surgery to interrupt nerve pathways.Objectives: We aimed to identify and review treatments for chronic pelvic pain in women. The review included studies of patients with a diagnosis of pelvic congestion syndrome or adhesions but excluded those with pain known to be caused by i) endometriosis, ii) primary dysmenorrhoea (period pain), iii) pain due to active chronic pelvic inflammatory disease, or iv) irritable bowel syndrome.Search strategy: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials (searched 20th January 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005), and reference lists of articles.Selection criteria: Randomised controlled trials (RCTs) with women who had chronic pelvic pain. The review authors were prepared to consider studies of any intervention including lifestyle, physical, medical, surgical and psychological treatments. Outcome measures were pain rating scales, quality of life measures, economic analyses and adverse events.Data collection and analysis: For each included trial, information was collected including the method of randomisation, allocation concealment and blinding. Data were extracted independently by the two review authors using forms designed according to the Cochrane guidelines.Main results: Nineteen studies were identified of which fourteen were of satisfactory methodological quality. Five studies were excluded. Progestogen (medroxyprogesterone acetate) was associated with a reduction of pain during treatment while goserelin gave a longer duration of benefit. Counseling supported by ultrasound scanning was associated with reduced pain and improvement in mood. A multidisciplinary approach was beneficial for some outcome measures. Benefit was not demonstrated for adhesiolysis (apart from where adhesions were severe), uterine nerve ablation, sertraline or photographic reinforcement after laparoscopy. Writing therapy and static magnetic field therapy showed some evidence of short-term benefit.Authors' conclusions: The range of proven effective interventions for chronic pelvic pain remains limited and recommendations are based largely on single studies. Given the prevalence and healthcare costs associated with chronic pelvic pain in women, randomised controlled trials of other medical, surgical and psychological interventions are urgently required.Chronic pelvic pain is common in women in the reproductive and older age groups and it causes disability and distress that result in significant costs to health services. The pathogenesis of chronic pelvic pain is poorly understood. Often investigation by laparoscopy reveals no obvious cause for the pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, and central sensitisation of the nervous system. A vascular hypothesis proposes that pain arises from dilated pelvic veins in which blood flow is markedly reduced. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. Currently the main approaches to treatment include counseling or psychotherapy, attempts to provide reassurance using laparoscopy to exclude serious pathology, progestogen therapy such as with medroxyprogesterone acetate and surgery to interrupt nerve pathways
To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section
No full textMany gynaecologists do not currently close the peritoneum after caesarean section (CS). Recently, several studies examining adhesion formation after repeat CS appear to favour closure of the peritoneum after caesarean section. We performed a systematic review of the current available evidence with regard to the long-term outcome, mainly in terms of adhesion formation after closure versus non-closure of peritoneum during CS. We undertook a literature search between January 1995 and February 2008 using MEDLINE, Pubmed, EMBASE, Cochrane central controlled trials register and Cochrane pregnancy and childbirth group trials register. We also had searched all the references cited in the relevant studies. Both English and non-English language papers were included. Prospective studies which compared peritoneal closure versus non-closure during CS in terms of adhesion formation were included. Studies were included if they had a primary objective to examine adhesion formation in a repeat caesarean section, had a clear study design, had an adhesion scoring system, excluded patients who had adhesions in the primary caesarean section or interim surgeries after the primary caesarean section, and had no usage of anti-adhesion agents in the primary caesarean section. Retrospective studies which were performed by case-notes review alone, were excluded. Eleven studies were identified via our search strategy. Five were retrospective and six were prospective. Out of the eleven studies, three satisfied the inclusion criteria and were included (n = 249); two studies were follow-ups of RCTs and one was not randomised. Out of 249 women included in the analysis, 110 had peritoneal closure during CS whereas the other 139 did not have peritoneal closure. Meta-analysis was performed using the two randomised studies plus (i) the unadjusted estimate from the non-randomised study and (ii) the reported adjusted estimate, adjusted for baseline differences in the groups. Non-closure of the peritoneum during CS resulted in a significantly increased likelihood of adhesion formation in both meta-analyses—OR (95% CI): (i) 2.60 (1.48–4.56) and (ii) 4.23 (2.06–8.69). This systematic review has demonstrated that according to current data in the literature, there is some evidence to suggest that non-closure of the peritoneum after caesarean section is associated with more adhesion formation compared to closur
Peritoneal healing and adhesion formation/reformation
No full textIntra-abdominal adhesion formation and reformation after surgery is a cause of significant morbidity, resulting in infertility and pain. The understanding of the pathogenesis of adhesion formation and reformation especially at the cellular and molecular level can help to further develop more effective treatments for the prevention of adhesion formation and reformation. Following an injury to the peritoneum, fibrinolytic activity over the peritoneal surface decreases, leading to changes in the expression and synthesis of various cellular mediators and in the remodelling of the connective tissue. The cellular response to peritoneal injury and adhesion formation and reformation are reviewed. Analysis of the available literature data on the cellular mediators in the peritoneal fluid showed variation in results from different investigators. The potential sources of variability and error are examined. It is still unclear if there is significant individual variation in the peritoneal response to injury
IL-1, IL-6 and TNF-? concentrations in the peritoneal fluid of women with pelvic adhesions
No full textBackground: pelvic adhesions are a significant cause of morbidity and are associated with infertility and pain. The three pro-inflammatory cytokines interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-alpha are involved in adhesion formation/reformation. Methods: the concentration of these three cytokines was examined in the peritoneal fluid of women undergoing laparoscopy, in order to examine the factors affecting their concentrations, with specific reference to the presence or absence of adhesions. Results: we found that the concentration of TNF-alpha in the peritoneal fluid was significantly correlated to the menstrual cycle day (P < 0.01), with increasing concentration as the menstrual cycle progressed from the follicular to the luteal phase. In contrast, IL-1 and IL-6 levels did not show any variation throughout the menstrual cycle. Increased TNF-alpha was found in patients with pelvic adhesions compared with those with normal pelvis; the concentration of TNF-alpha was highest in mild compared with severe adhesions. In contrast, IL-1 concentration was higher in the presence of severe adhesions. IL-6 levels were significantly correlated with the grade of endometriosis (P < 0.05), but there were no significant correlations of either TNF-alpha or IL-1 concentrations with the various grades of endometriosis. Conclusions: the exact role of TNF-alpha and IL-1 in adhesion formation is still unknown, but the results from this study suggest that their concentration in the peritoneal fluid is associated with the degree of adhesions present.<br/
Expression of neuronal markers in the endometrium of women with and those without endometriosis
No full textSTUDY QUESTION How do the expression patterns of neuronal markers differ in the endometrium of women with and without endometriosis?SUMMARY ANSWER The neuronal markers, PGP9.5, NGFp75 and VR1, are expressed in the endometrium at levels that do not differ between women with and without endometriosis.WHAT IS KNOWN ALREADY Aberrant neuronal growth within the uterus may contribute to abnormal fertility and uterine dysfunction. However, controversy still exists as to whether aberrant innervation in the endometrium is associated with gynaecological pathology such as endometriosis. This may reflect the use of subjective methods such as histology to assess the innervation of the endometrium. We, therefore, employed a quantitative method, western blotting, to study markers of endometrial innervation in the presence and absence of endometriosis.STUDY DESIGN, SIZE, DURATION This study included 45 women undergoing laparoscopic examination for the diagnosis of endometriosis. Endometrial samples were analysed by western blot for the expression of neuronal and neurotrophic markers, PGP9.5, VR1 and NGFp75.PARTICIPANTS/MATERIALS, SETTINGS, METHODS Endometrial pipelle biopsies were obtained from patients with (n = 20, study group) and without (n = 25, control group) endometriosis. Tissue was analysed by immunohistochemistry and western blot analysis for the expression of pan-neuronal marker, PGP9.5, sensory nociceptive marker, TPVR1, and low-affinity neurotrophic growth factor receptor, NGFRp75.MAIN RESULTS AND THE ROLE OF CHANCE PGP9.5, NGFp75 and VR1 were expressed in the endometrium of women, independent of the presence of endometriosis. Furthermore, the expression level of PGP9.5, VR1 and NGFp75 did not alter between the two cohorts of women.LIMITATIONS, REASONS FOR CAUTION Studies of this nature are subject to the heterogeneous nature of patient population and tissue samples despite attempts to standardize these parameters. Hence, further studies using similar methodology will be required to confirm our results.WIDER IMPLICATIONS OF THE FINDINGS Our results highlight that sensory neuronal markers are present in women with and without endometriosis. Future work will assess what the targets of the endometrial nerves are and investigate their function, their impact on endometrial biology and, in particular, whether aberrant neuronal function, rather than the mere presence of neuronal function, could be the root cause of subfertility and/or pain affecting many endometriosis sufferers. Our results do not, however, confirm the previous paradigm of increased innervation in the endometrium of women with endometriosis, nor the use of nerve cell detection from pipelle biopsies to diagnose endometriosis.STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Infertility Research Trust (IRT) and the University of Malaya. There are no competing interests
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