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I probiotici sono tutti realmente “pro-biotici”? Linee guida nazionali ed internazionali.
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New peptides, hormones and parturition
No full textThis brief review emphasizes the importance of three novel discovered factors produced by fetal membranes, placenta and/or by the fetus itself in regulating uterine contractility. We have shown that, as reported for other hormones and substances, nitric oxide and endothelin may influence myometrial activity in an autocrine/paracrine manner interacting with other well-known agents such as prostaglandins, oxytocin and hormones. We also demonstrated that different isoforms of nitric oxide synthase (NOS) may play different roles throughout gestation and during labor. We have suggested that another peptide produced by trophoblast cells, adrenomedullin, may affect, directly or indirectly, myometrial contractility during pregnancy, although much remains to be learned about the mechanisms controlling adrenomedullin expression by the feto-placental tissues cells during pregnancy. Continued research is necessary to better define the complex interactions that result in parturition, both at term and preterm, and to allow a more rational approach to management of the premature labor, exploring new possible pharmacological solutions
Effect of epidural analgesia on labor times and mode of delivery: a prospective study.
No full textPurpose: To assess changes in labor times and delivery outcome in low-risk women requesting pain relief and undergoing epidural analgesia, according to the epidural analgesia schemes. Materials and Methods: Prospective observational study of 499 low-risk women with epidural analgesia. Speed of dilatation (SD) (centimeters of dilatation / hours), speed of lowering of the fetal head through maternal pelvis (SL) (centimeters in lowering / hours), time of active phase of labor (TA), cesarean section (CS), vacuum application (VA) were dependent variables in multivariable linear and logistic regressions. Results: Dilution of ropivacain, fentanyl amount, and volume of the first dose of epidural analgesia did not seem to affect labor times. Epidural analgesia with schemes used in this study favored both the dilatation and the fetal head lowering through maternal pelvis. Every five minutes from the first dose of epidural to the last top-up, SD decreased by about 13% (p = 0.002), SL decreased by about 14% (p < 0.001), and TA increased by about 40% (p < 0.001). Additionally, every five minutes from the first dose of epidural to the last top-up, the odds of an operative vaginal birth (vacuum) increased by 0.7% (p < 0.001). Increasing of number of top-ups independently caused a reduction in odds of undergoing CS (odds ratio 0.434; C.I. 95% 0.219 - 0.859, p = 0.017), without influencing labor times. Conclusion. Epidural analgesia in patients requesting pain relief favors normal course of labor if it is not discontinued or delayed
Alpha Lipoic Acid (ALA) effects on subchorionic hematoma. Preliminary clinical results
Full text linkOBJECTIVE: The clinic use of alpha Lipoic Acid (ALA) is linked to its capability to exert antioxidant effects and, more interestingly, to counteract the pathologic changes of complex networks of cytokines, chemokines and growth factors, restoring their physiological state. The aim of this randomized controlled clinical trial was to test the contribution of oral supplementation of ALA to the standard treatment with Progesterone vaginal suppositories, in healing subchorionic hematomas in patients with threatened miscarriage. Controls were administered only Progesterone suppositories.
PATIENTS AND METHODS: Nineteen pregnant women in the first trimester of gestation, with threatened miscarriage and ultrasound evidence of subchorionic hematoma, were included in the trial and randomly divided in two groups: controls, treated with 400 mg Progesterone (200 mg 2 times per day), given by vaginal suppositories, and case study treated with the same Progesterone dosage, plus ALA, given orally at the dose of 600 mg (300 mg 2 times per day, DAV®, Lo.Li. Pharma srl, Italy). Sixteen patients completed the trial. Treatment was performed until complete resolution of the clinical picture.
RESULTS: In both groups, the subjects improved significantly but, in general, a better and faster evolution in the major signs of threatened miscarriage was observed in the subjects treated with ALA and Progesterone. In these patients, the speed of resorption of subchorionic hematoma was significantly (p ≤ 0.05) superior compared to controls. The ALA and Progesterone group showed a faster decrease or disappearance of all symptoms than that observed in the control group, however the difference was not significant.
CONCLUSIONS: These preliminary results suggest that ALA supplementation significantly contributes to speed up the process of restoration of physiological conditions in threatened miscarriage and ameliorates the medical conditions of both the mothers and the foetus, probably modulating the networks of cytokines, growth factors and other molecules
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