Leanne Bricker

Poor uterine contractility in obese women.

Objective  The aim of the study was to elucidate the reason for the high rate of caesarean section in obese women. We examined the following hypotheses: (1) obese women have a high incidence of complications related to poor uterine contractility—caesarean section for dysfunctional labour and postpartum haemorrhage. 2) The myometrium from obese women has less ability to contract in vitro.

Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness.

Objective To review systematically and critically evidence to derive estimates of costs and cost effectiveness of routine ultrasound screening for fetal abnormalities.

A comparison of the contractile properties of myometrium from singleton and twin pregnancies.

Objective Over half of twin pregnancies in US and UK deliver prematurely but the reasons for this are unclear. The contractility of myometrium from twin pregnancies has not been directly investigated. The objective of this research was to determine if there are differences in the contractile activity and response to oxytocin, between myometrium from singleton and twin pregnancies, across a range of gestational ages. Furthermore, we wished to determine if contractile activity correlates with increasing level of stretch, using neonatal birth weights as a marker of uterine stretch. Methods This was an in vitro, laboratory based study of myometrial contractility in women pregnant with one or two babies, using biopsies obtained from non-labouring women undergoing Caesarean section. Spontaneous, oxytocin-stimulated and depolarization induced contractile activity was compared. Results Direct measurements of myometrial contractility under controlled conditions show that the frequency of contractions and responses to oxytocin are significantly increased in twins compared to singletons. The duration of contraction however was significantly reduced. We find that contractile activity correlates with increasing levels of stretch, using neonatal birth weights as a surrogate for uterine stretch, with response to oxytocin being significantly positively correlated with birth weight. Conclusions We have found significant differences in contractile properties between myometrium from singleton and twin pregnancies and that increasing uterine stretch can alter the contractile properties of myometrium. We discuss the implication of these findings to preterm delivery and future studies.

Titrated low-dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trial

Objective  To evaluate the clinical effectiveness and safety of titrated low‐dose misoprostol for induction of labour (IOL) in the presence of prelabour rupture of membranes (PROM).

Differing In Vitro Potencies of Tocolytics and Progesterone in Myometrium From Singleton and Twin Pregnancies

We compared the relaxant effect of 2 known tocolytics; indomethacin and atosiban and progesterone, on pregnant human myometrial spontaneous and oxytocin-induced contractions from singleton and twin pregnancies. All agents exerted a concentration-dependent relaxant effect on myometrial contractions. There was no significant difference in the concentration–response curves between singletons and twins for progesterone or indomethacin on spontaneous contractions or atosiban on oxytocin-induced contraction. Under oxytocin however, the concentration–response curves for indomethacin and progesterone were significantly shifted to the right for both amplitude of contraction (P < .01) and activity integral (P < .01). When compared to singleton myometrium however, the concentration–response curves were significantly shifted to the right in the twin myometrium group (P < .05 progesterone and P < .001 indomethacin). We conclude that a greater concentration of progesterone and indomethacin is required to inhibit oxytocin-induced myometrial contractions in twins compared to singletons in vitro. The differences noted in the tissue pharmacologies may have implications for the successful prevention or inhibition of preterm labor in twin pregnancy.

Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study

To assess short‐ and long‐term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial.

OP08.06: AMIPROM: a pilot RCT on serial transabdominal amnioinfusion versus expectant management in very early PROM

matched controls. Additionally, the second purpose was to determine the relationship between the placental pathologies and uterine artery (UtA) Doppler findings. Methods: 172 patients with singleton pregnancies between 24 and 35 weeks who presented with signs of preterm labor and 169 healthy pregnant women with correlative properties who admitted for routine pregnancy visits were recruited for the study. UtA blood flows were evaluated with Doppler ultrasonography during uterine inertia for both patients having preterm labor signs and for the control group. Each patient followed until the birth and delivery in 48 hours/7 days/14 days were recorded. The placental pathologies were interpreted (Redline 2007) and the relationship between the Doppler findings and placental pathologies were investigated. Results: Placental pathologies were found to be higher in the study group compared to their controls (P = 0.002). According to placental pathology patterns; the study group had significantly higher subclinical chorioamnionitis (P = 0.014), maternal vascular maldevelopment (P = 0.000) and maternal vascular loss of integrity (P = 0.021) than the control group. In the study group, the patients’ who delivered in 48 hours/7 days/14 days, presence of abnormal placental pathologies were also found to be higher (P = 0.001/P = 0.000/P = 0.000) than the patients who did not deliver. The study group with abnormal placental pathologies had substantially higher UtA PI (0.98 ± 0.39) than the patients without placental pathologies (0.74 ± 0.21) (P = 0.001). Conclusions: An underlying abnormal placental pathology was found to be higher in patients showing preterm labor symptoms and in the patients particularly who deliver in early time periods. With this study, it’s shown for the first time that the placental lesions prosecuted for preterm delivery were associated with antenatal UtA blood flows.