The Experts below are selected from a list of 9 Experts worldwide ranked by ideXlab platform

Sakthi Priya A - One of the best experts on this subject based on the ideXlab platform.

  • A Comparitive study on prevention of PPH by Routine AMSTL Vs AMSTL with AMR's Manuevre
    2017
    Co-Authors: Sakthi Priya A
    Abstract:

    OBJECTIVE: Amr's manoeuvre when used with AMSTL is more effective in prevention of PPH than routine AMSTL alone. DESIGN: Prospective comparative study. SETTING: Government Rajaji Hospital Madurai, Department of Obstetrics and gynaecology from period between January 2016 to July 2016. POPULATION: 500 patients eligible for vaginal delivery were divided into 2 groups: STUDY GROUP: 250 patients Amr's manoeuvre, by stretching the cervix for 90 seconds with ovum forceps, done with AMSTL CONTROL GROUP: 250 patients with routine AMSTL alone. METHODS: The study done between January 2016 to July 2016 in Department of Obstetrics and Gynaecology. All patients were subjected to history taking, general examination, routine laboratory evaluation, ultrasound evaluation. Inclusion criteria were Age more than 18yrs, patients eligible for normal labour Exclusion criteria were Antepartum haemorrhage in this pregnancy, Placenta previa, Gestational hypertension, Multiple pregnancy, Diabetes, Severe anemia with hb 4kg baby, History of post partum haemorrhage, Pre-existing maternal haemorrhagic conditions like factor 8 or 9 deficiency or von willebrand disease. Amr's manoeuvre works by Ferguson Reflex. MAIN OUTCOME MEASURES: Age, BMI and parity of the patients noted. Mode of delivery and whether the delivery was spontaneous, induced or accelerated was noted. Predelivery and postdelivery evaluation of hemoglobin measurement were performed. Postpartum blood loss measured. Episiotomy, perineal tears, uterine tone status recorded. RESULTS: The mean age in study group was 23.5 and control group was 23.6. overall 52.5% were primigravida. 61% belong to normal BMI. 59.8% had spontaneous labour. 91% had labour natural. Maximum number of patients had blood loss in the range of 200 — 400 ml. study group 58.8% in control group 59.2%. severe PPH ie > 1000m1 did not occur in both groups. Rate of PPH defined as > 500m1 was 3.2% in study group and 3.6% in control group the difference of which is statistically not significant. Mean blood loss in study group is 263.22m1 and in control group is 285.76m1 which is significant. 8 patients had PPH in study group and 9 patients had PPH in control group. In PPH range mean blood loss in cases is 615m1 and in controls is 713.3m1 which is also statistically significant. The mean predelivery Hb in study group was 10.44g and in control group was 10.47g. postdelivery fall in Hb was significant in control group but not in study group. CONCLUSIONS: Amr's maneuver done along with routine AMSTL is an effective method in prevention of postpartum haemorrhage. It reduces the amount of blood loss even when there is a tendency for PPH to occur. It just requires an extra pair of ovum holding forceps in the delivery kit and training the available man power. So this method is very much suitable in low resource settings were refrigeration of uterotonics is difficult or man power to administer intramuscular or intravenous injections is difficult to avail

Giorgio Sansone - One of the best experts on this subject based on the ideXlab platform.

  • neural pathways mediating vaginal function the vagus nerves and spinal cord oxytocin
    Scandinavian Journal of Psychology, 2003
    Co-Authors: Barry R Komisaruk, Giorgio Sansone
    Abstract:

    The initial observations, made in our laboratory with Knut Larsson, of the ability of vaginocervical stimulation (VCS) to block withdrawal responses to foot pinch in rats has led to findings of multiple behavioral, autonomic, and neuroendocrine effects of this potent stimulus in rats and also in women. It has led to an understanding of: (1) the neuroanatomical and neurochemical basis of a novel and potent pain-blocking mechanism; (2) likely neuroanatomical pathways mediating both the Ferguson Reflex and a specific autonomic response - the pupil-dilating effect of VCS; (3) a role for oxytocin as a putative central nervous system neurotransmitter that stimulates autonomic sympathetic preganglionic neurons within the spinal cord; and (4) a novel pathway that can convey sensory activity from the cervix, adequate to induce orgasm, via the vagus nerves. This latter pathway bypasses the spinal cord and projects directly to the medulla oblongata, and thus can convey genital afferent activity despite complete spinal cord injury at any level.

Rice, Gregory E. - One of the best experts on this subject based on the ideXlab platform.

  • Late pregnancy and parturition in the sheep
    'Elsevier BV', 1996
    Co-Authors: Mclaren, Wendy J., Young I. Ross, Rice, Gregory E.
    Abstract:

    Parturition in the sheep is preceded by activation of the fetal hypothalamic-pituitary-adrenal (HPA) axis. Late in the last third of gestation the hypothalmic peptides corticotrophin releasing hormone (CRH) and arginine vasopressin (AVP) act to stimulate the release of adrenocorticotrophic hormone (ACTH) from the fetal pituitary gland. The pre-parturient ACTH surge increases the secretion rate of cortisol from the fetal adrenal gland. Cortisol provides the trigger for labor onset by the induction of changes in placental steroid output. An increase in P450 17α-hydroxylase expression causes a decrease in maternal progesterone concentrations and a concomitant increase in placental estrogen output. The rise in the estrogen/progesterone ratio enhances the sensitivity of the myometrium to stimulatory agonists such as prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), and oxytocin. Furthermore, the change in the steroid milieu increases the secretion rate of PGF2α from uterine tissues, including the maternal placenta, endometrium, and fetal membranes. Birth is a complex sequence of endocrine events culminating in coordinated expulsive mechanisms. Vaginal distension in the second stage of labor causes oxytocin release from the maternal posterior pituitary gland (the “Ferguson” Reflex). The exact role of oxytocin in the initiation of labor, however, is controversial. Despite high uterine oxytocin receptor concentrations in late pregnancy, oxytocin concentrations in maternal and fetal plasma are not increased until labor onset. Oxytocin acts to enhance PGF2α release in late pregnancy. PGF2α production by the endometrium and maternal cotyledon stimulates synchronous and forceful contractions of the uterus. PGE2 production by the fetal trophoblast activates the fetal HPA axis. Furthermore, PGE2 is a major contributor to cervical effacement and softening. Prematurity and postmaturity represent great hazards to the neonate. If the fetus is to survive outside the uterus without being compromised, fetal organ systems, including the respiratory, thermoregulatory, and gastrointestinal systems, must be adequately developed. It seems appropriate then that maturation of body functions essential for postnatal survival are activated by the same mechanism that triggers labor onset. Fetal glucocorticoids promote development and differentiation of fetal organ systems. Cortisol stimulates surfactant synthesis by the type II cells of the fetal lung, allowing epinephrine to release the surfactant. In addition, cortisol stimulates production of liver glycogen in the last 15 days of pregnancy. Glycogen reserves contribute to the maintenance of fetal body temperature in the first few days following birth. Cortisol also plays a role in controlling fetal erythropoiesis. In the sheep, maturation of the HPA axis is essential for labor onset. Many other stimulatory factors, however, augment the myometrial contractile activity characteristic of labor. Parturition is not the result of a single signal. Rather, it is the result of a progressive maturation of multiple pathways that may culminate to coordinate and synchronize fetal maturation, myometrial contractile activity, and preparation of the birth canal

Barry R Komisaruk - One of the best experts on this subject based on the ideXlab platform.

  • neural pathways mediating vaginal function the vagus nerves and spinal cord oxytocin
    Scandinavian Journal of Psychology, 2003
    Co-Authors: Barry R Komisaruk, Giorgio Sansone
    Abstract:

    The initial observations, made in our laboratory with Knut Larsson, of the ability of vaginocervical stimulation (VCS) to block withdrawal responses to foot pinch in rats has led to findings of multiple behavioral, autonomic, and neuroendocrine effects of this potent stimulus in rats and also in women. It has led to an understanding of: (1) the neuroanatomical and neurochemical basis of a novel and potent pain-blocking mechanism; (2) likely neuroanatomical pathways mediating both the Ferguson Reflex and a specific autonomic response - the pupil-dilating effect of VCS; (3) a role for oxytocin as a putative central nervous system neurotransmitter that stimulates autonomic sympathetic preganglionic neurons within the spinal cord; and (4) a novel pathway that can convey sensory activity from the cervix, adequate to induce orgasm, via the vagus nerves. This latter pathway bypasses the spinal cord and projects directly to the medulla oblongata, and thus can convey genital afferent activity despite complete spinal cord injury at any level.

Mclaren, Wendy J. - One of the best experts on this subject based on the ideXlab platform.

  • Late pregnancy and parturition in the sheep
    'Elsevier BV', 1996
    Co-Authors: Mclaren, Wendy J., Young I. Ross, Rice, Gregory E.
    Abstract:

    Parturition in the sheep is preceded by activation of the fetal hypothalamic-pituitary-adrenal (HPA) axis. Late in the last third of gestation the hypothalmic peptides corticotrophin releasing hormone (CRH) and arginine vasopressin (AVP) act to stimulate the release of adrenocorticotrophic hormone (ACTH) from the fetal pituitary gland. The pre-parturient ACTH surge increases the secretion rate of cortisol from the fetal adrenal gland. Cortisol provides the trigger for labor onset by the induction of changes in placental steroid output. An increase in P450 17α-hydroxylase expression causes a decrease in maternal progesterone concentrations and a concomitant increase in placental estrogen output. The rise in the estrogen/progesterone ratio enhances the sensitivity of the myometrium to stimulatory agonists such as prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), and oxytocin. Furthermore, the change in the steroid milieu increases the secretion rate of PGF2α from uterine tissues, including the maternal placenta, endometrium, and fetal membranes. Birth is a complex sequence of endocrine events culminating in coordinated expulsive mechanisms. Vaginal distension in the second stage of labor causes oxytocin release from the maternal posterior pituitary gland (the “Ferguson” Reflex). The exact role of oxytocin in the initiation of labor, however, is controversial. Despite high uterine oxytocin receptor concentrations in late pregnancy, oxytocin concentrations in maternal and fetal plasma are not increased until labor onset. Oxytocin acts to enhance PGF2α release in late pregnancy. PGF2α production by the endometrium and maternal cotyledon stimulates synchronous and forceful contractions of the uterus. PGE2 production by the fetal trophoblast activates the fetal HPA axis. Furthermore, PGE2 is a major contributor to cervical effacement and softening. Prematurity and postmaturity represent great hazards to the neonate. If the fetus is to survive outside the uterus without being compromised, fetal organ systems, including the respiratory, thermoregulatory, and gastrointestinal systems, must be adequately developed. It seems appropriate then that maturation of body functions essential for postnatal survival are activated by the same mechanism that triggers labor onset. Fetal glucocorticoids promote development and differentiation of fetal organ systems. Cortisol stimulates surfactant synthesis by the type II cells of the fetal lung, allowing epinephrine to release the surfactant. In addition, cortisol stimulates production of liver glycogen in the last 15 days of pregnancy. Glycogen reserves contribute to the maintenance of fetal body temperature in the first few days following birth. Cortisol also plays a role in controlling fetal erythropoiesis. In the sheep, maturation of the HPA axis is essential for labor onset. Many other stimulatory factors, however, augment the myometrial contractile activity characteristic of labor. Parturition is not the result of a single signal. Rather, it is the result of a progressive maturation of multiple pathways that may culminate to coordinate and synchronize fetal maturation, myometrial contractile activity, and preparation of the birth canal