Barusiban, an effective long-term treatment of oxytocin-induced preterm labor in nonhuman primates

Preterm labor (PTL) affects up to 25% of human pregnancies in developing countries, but there are few therapeutic options. Based on the key role of oxytocin (OXT) in labor and parturition, OXT antagonists are a potentially useful class of drugs for PTL. Barusiban is a new selective, potent, and long-acting OXT receptor antagonist. In this study barusiban was given by continuous i.v. infusion to monkeys during the last 3 wk of pregnancy; the monkeys were also given daily doses of OXT to induce uterine contractions and simulate PTL. Barusiban effectively suppressed OXT-induced PTL-like contractions and prevented early delivery. In contrast, fenoterol (a beta2-adrenoceptor [beta2-AR] agonist used as a comparative control) did not inhibit uterine contractions in this model. Barusiban was particularly effective in maintaining low intrauterine pressure (IUP) near the end of pregnancy, which is when IUP in both OXT controls and fenoterol-treated females increased substantially. Although barusiban delayed the onset of labor, it did not prevent normal delivery. These data demonstrate the safety and efficacy of barusiban in reducing uterine contractility in response to repeated OXT challenge, and suggest that barusiban may be therapeutically effective in long-term treatment of PTL.     

Effect of dose and day of treatment on uterine response to oxytocin in mares

To determine the effect of dose and day of oxytocin treatment on intrauterine pressure, 6 normal mares were treated with 10 or 25 IU oxytocin 2 days before ovulation, on the day of ovulation and 2 days after ovulation. Intrauterine pressure (IUP) was measured using micro-tip-catheters (one placed intrauterine, a second and third serving as reference sensors in the vagina and external to the mare) and transmitted by telemetry for 30 min to establish a baseline before saline was administered, iv, and for an additional 30 min after saline administration. Oxytocin was then given, iv, and IUP was recorded for 60 min. No change in IUP was observed after saline injection. The administration of both 10 (n=16) and 25 (n=10) IU oxytocin induced a response (P<0.01). The intensity of response depended on the day of administration (P<0.01) and the dose of oxytocin (P<0.001). The variation of response was significantly greater after 10 IU oxytocin (CV 15.78%) compared with 25 IU oxytocin (CV 6.42%). The uterine response was greatest on Day 2 prior to ovulation and lowest on Day 2 after ovulation. The response was negatively correlated to increasing plasma progesterone (10 IU oxytocin: r = -0.435, 25 IU oxytocin: r = -0.265). There was no correlation between the uterine response and plasma estradiol-17beta concentration (P<0.01). In conclusion the results of this study show that oxytocin administration to mares before ovulation provides a greater response than after ovulation. A decline in the intensity of response after ovulation can be compensated for with a higher dose of oxytocin. Furthermore, the use of the multiple catheter technique is an effective method for assessing changes in uterine pressure.     

Relation between fetal arterial PO2 and oxytocin-induced uterine contractions in pregnant sheep

The relation between oxytocin-induced type A uterine contractions and fetal arterial PO2, measured continuously with an intravascular oxygen electrode, was studied in nine chronically catheterized sheep during late pregnancy. Oxytocin provoked dose-related increases in intrauterine pressure (IUP) and decreases in fetal PaO2. There was a significant positive relationship between changes in IUP and the maximum decrease in fetal PaO2 (average r = 0.696, df = 92; P less than 0.001). We conclude that changes in uterine activity contribute to transient fetal hypoxemia, and that administration of exogenous oxytocin provides an experimental paradigm to examine the consequences of this relationship.     

Continuous Fetal Heart Rate Monitoring and Tocodynamometry in Routine Obstetrical Care,Fetal Stress and Non-Stress Testing,and Labor Induction in the Chimpanzee (Pan troglodytes)

The use of continuous fetal heart rate (FHR) and uterine pressure monitoring in the chimpanzee (Pan troglodytes) by external Doppler transducer and tocodynamometer is described in 1) the routine obstetrical assessment of fetal well-being, 2) oxytocin challenge (stress) testing (OCT) and non-stress testing (NST) for the diagnosis of in utero fetal distress, and 3) induction of labor by intravenous oxytocin infusion, by surgical rupture of the chorio-amniotic membranes (amniotomy), or by a combination of these techniques, as an alternative to Caesarean section for clinical, managemental, or experimental purposes. FHR traces were analyzed during a total of 57 term pregnancies for three basic characteristics: baseline rate, variability, and periodic pattern. Results indicated that continuous FHR monitoring in the chimpanzee can provide a valuable tool for fetal assessment and management of labor in any attempt to reduce the unacceptably high annual incidence of perinatal and neonatal infant mortality reported in the U.S.     

Relationship between timing of ovariectomy and maintenance of pregnancy in the guinea-pig

The effect of ovariectomy (OVX) and OVX + progesterone (P) treatment on the regulatory profile and uterine function of the guinea-pig are described. Before day 23 of gestation in the intact pregnant guinea-pig, the placental contribution to P-content is small in comparison with the increasing ovarian contribution. After day 30, the ovarian P-content starts to decrease and the placental P-content exceeds the ovarian contribution, indicating the “luteo-placental shift” (LPS) in P-biosynthesis. Thus, when 14 guinea-pigs were ovariectomized around day 21 of gestation all started aborting within 53 hours of OVX. A gradual increase in intrauterine pressure (IUP), a decrease in P-levels in heart and uterine vein plasma and in the uterine and placental tissues and an increase in the levels of PGF in uterine vein plasma and uterine tissue were observed in these animals. However, if the OVX was delayed until after day 30 of gestation, to examine the biological consequences of advanced LPS in P-biosynthesis, there was no increase in IUP and the animals did not abort in the next 5 days. Furthermore, P-therapy following OVX in the day 21 pregnant guinea-pigs prevented the increase in IUP and the animals did not abort. These observations establish for the guinea-pig a correlation between the success in pregnancy maintenance and the degree of the LPS in P-biosynthesis. These studies therefore emphasize the indispensable role of progesterone in pregnancy maintenance.     

持续镇痛分娩对产妇分娩结局和新生儿评分的影响

目的:研究持续镇痛分娩对产妇分娩结局和新生儿评分的影响。方法:选择2018年7月～2019年7月中国医科大学航空总医院(本院)采取硬膜外分娩镇痛的101例产妇,将其随机分为两组。当产生确切的镇痛效果,进入第二产程后,观察组的51例产妇采用0.4μg/m L舒芬太尼以及0.08%罗哌卡因进行持续镇痛分娩;对照组的50例产妇则在宫口开全后,使用生理盐水替代泵内的局麻药物,直到分娩结束。比较两组产妇催产素的使用率,宫口扩张度和第一、第二产程按压硬膜外自控镇痛泵的次数,分娩方式,新生儿的体质量,脐动脉血pH值,出生后1 min和5 min Apgar评分,产妇修复会阴部时的视觉模拟评分(visual analogue scale, VAS)评分及产妇对于第二产程镇痛的满意度评分。结果:两组产妇催产素的使用率、宫口扩张度和第一、第二产程按压硬膜外自控镇痛泵的次数、分娩方式(剖宫产率、器械助产率、自然分娩率)、第一产程镇痛时间、第一以及第二产程时间相比均无显著差异(P0.05);两组新生儿的体质量,脐动脉血pH值,出生后1 min和5 min Apgar评分小于8分的新生儿所占的比例相比没有明显的差异(P0.05);观察组产妇修复会阴部时的VAS评分明显低于对照组(P0.05),产妇对于第二产程镇痛的满意度评分明显高于对照组(P0.05)。结论:持续镇痛分娩对产妇分娩结局和新生儿评分无明显的影响,但可显著提高产妇对第二产程镇痛和修复会阴部时镇痛的满意度。     

Effect of empty uterine space on birth intervals and fetal and placental development in pigs

A substantial loss of embryos occurs between Days 30 and 40 of pregnancy in the pig under crowded intrauterine conditions, but it is not clear whether this loss affects the growth of adjacent conceptuses. Birth intervals are known to increase with decreasing litter size, but the factors responsible are unknown. Two possibilities are that increased birth weight associated with reduced litter size and the empty uterine space and resulting constricted uterine regions that occur in pigs with small litters may impair piglet delivery. To address these, pregnant gilts were laparotomized on Day 35 of pregnancy and one or two fetuses were manually crushed through the uterine wall on the ovarian or cervical end of each uterine horn to create an empty uterine space behind or in front of the litter of piglets, respectively, in relation to the route of delivery from the uterus. A subset of gilts was slaughtered at 105 days of gestation to confirm that the empty uterine spaces were successfully created and to determine their effects on placental and fetal weights of adjacent conceptuses. At slaughter, the lengths of all externally visible empty constricted regions of the uterus were measured. The uterine horns were opened and the lengths of each placenta were measured from the umbilicus toward the ovary and toward the cervix to assess whether placentas developed symmetrically, and then each fetus and placenta was weighed. Fetal crushing successfully created constricted empty uterine regions on the ovarian and cervical ends of the uterine horns. Ovarian-side placental lengths were greater than cervical-side for conceptuses adjacent to fetuses crushed on the ovarian end of the horn. Cervical-side placental lengths were greater than ovarian-side for conceptuses adjacent to fetuses crushed on the cervical end. Both placental and fetal weights were greater (10% and 6%, respectively, P<0.05) for conceptuses adjacent to crushed fetuses compared to nonadjacent conceptuses. Remaining gilts were farrowed to determine the effect of litter size, average birth weights, and treatment on birth intervals of piglets, which were monitored using 24-h video surveillance. The negative association between number of piglets born alive and average birth interval was confirmed and was not explained by litter size-induced reduction in litter average birth weights. Birth intervals and stillbirth rate did not differ between cervically- and ovarian-treated gilts. These results indicate that conceptus loss on Day 35 of gestation can benefit the growth of adjacent placentas and fetuses, but the benefit is small. Increased average birth weight and the presence of empty uterine space that occurs when litter size is reduced does not fully explain the effect of litter size on birth intervals.     

The ovarian and cervical regions of the rat uterus display a different contractile response to serotonin and prostaglandin F2alpha. I. The estrous cycle

In pharmacological studies using isolated tissues, the sensitivity to different agonists may vary depending on the anatomical region. The aim of the present study was to evaluate the in vitro contractile response to serotonin, prostaglandin F2alpha, and oxytocin of the ovarian and the cervical uterine segments isolated from rats in the four different stages of the rat estrous cycle. Non-cumulative curves were recorded for both, the ovarian and the cervical uterine segments. The cervical portion displayed a higher contractile response to serotonin and a lower response to PGF2alpha than the ovarian portion. Oxytocin induced similar responses in both uterine segments. The uterine ovarian segment displayed a similar sensitivity to serotonin in all the estrous cycle stages, whereas in the cervical segment, influenced by estrogens in diestrus and proestrus, an increase in contractility was observed. According to these findings, serotonin might participate in the spermatozoa transport toward the oviduct. The higher response of the ovarian portion to prostaglandin F2alpha is in line with its role during labor and delivery.     

Differences in the effects of vasopressin and oxytocin on rabbit myometrial activity and a possible mediation of prostaglandins

Uterine responses to vasopressin and oxytocin were monitored in non-pregnant and 3- or 6-8-day-pregnant rabbits by recording the intrauterine pressure. Oxytocin stimulated uterine activity in all groups, but the effect of vasopressin was stimulatory in non-pregnant animals, inhibitory in those 3 days post coitum and weakly stimulatory in those later in pregnancy. Inhibition of prostaglandin (PG) synthesis, by the administration of indomethacin, reduced the spontaneous uterine activity as well as the responses to oxytocin and vasopressin in the non-pregnant rabbits, but had little effect in the pregnant animals. During infusion of PGF-2alpha, PGE-1 or PGE-2 in 6-8-day-pregnant rabbits, the stimulatory response to vasopressin, although slight before the infusion, was inhibited whereas the stimulatory response to oxytocin remained virtually unchanged. The results suggest that vasopressin and oxytocin under certain hormonal conditions, are able to activated the uterine contractions by mechanisms in which the involvement of PG is not obligatory.     

Uterine motility in the cow during the estrous cycle. III. Effects of oxytocin, xylazine, and adrenoceptor blockers

Intrauterine pressure (IUP) was recorded in nonlactating dairy cows using an intraluminal catheter with two micropressure transducers located 15 cm apart at the distal end. There was a significant increase (P < 0.05) in IUP following administration of xylazine and oxytocin at all four stages of the estrous cycle. The most significant increase in IUP occurred during proestrus for both drugs. The effect of pretreatment with adrenoceptor-blocking agents on IUP changes induced by xylazine and oxytoxin was evaluated. Alpha-1 adrenoceptor blockade (prazosin) had no effect on IUP following xylazine treatment. However, alpha-2 adrenoceptor blockade (yohimbine) resulted in a reduction (P < 0.05) in IUP compared to controls. Neither prazosin or yohimbine affected oxytocin-induced IUP.     

县乡两级医院自控硬膜外分娩镇痛对产程及分娩结局的影响

目的观察县乡两级医院产妇行自控硬膜外分娩镇痛对产程及分娩结局的影响,评价县乡两级医院产妇行自控硬膜外分娩镇痛的安全性与可行性。方法选择足月单胎头位妊娠并经阴道试产的初产妇200例,均无硬膜外镇痛禁忌证,根据分娩镇痛要求,将其纳入镇痛组(P组,100例)及对照组(C组,100例)。记录两组第一、二产程及总产程时间,分娩方式,产后出血及催产素使用率,新生儿娩出后1、5min Apgar评分,分娩镇痛的不良反应等。结果 P组较C组的第二产程和总产程显著延长,催产素使用率P组明显高于C组;两组第一产程中转剖宫产率,器械助产率,羊水胎粪污染率,新生儿娩出后1、5min Apgar评分,分娩镇痛的不良反应均无统计学差异。结论硬膜外分娩镇痛可使第二产程及总产程延长、催产素使用率增加,但不增加急诊剖宫产率和经阴道器械助产率,明显降低了社会因素手术率,对分娩结局无不良影响,用于县乡两级医院产妇是安全可行的。     

Detection of immunoreactive human placental oxytocin and its contractile effect on the uterine muscle

Freshly obtained human placentas from various periods of gestation were quantitatively analysed for their immunoreactive oxytocin (OT) content and its biological activity was examined in a Magnus apparatus by utilizing rat uterus. The mean values for placental immunoreactive OT per gram tissue increased from the first to the second trimester, maintaining its high level to term. The total content of placental OT also increased continually from the beginning of pregnancy to term. Blood levels of estrogen stimulated neurophysin (ESN) and OT were concomitantly enhanced through gestation. Placental extract and synthetic OT showed similar peaks in the elution pattern of ion-exchange chromatography through a carboxymethyl cellulose column. Synthetic OT and placental extract induced marked uterine contraction in diestrous rats. However placental extract previously incubated with OT antiserum failed to induce this effect. Though detection of immunoreactive OT by immunoassay alone does not provide definite identification of pituitary and placental OT, the present study suggests that placental immunoreactive OT could have a contracting effect on the uterine muscle.     

Long chain polyunsaturated Fatty acids alter oxytocin signaling and receptor density in cultured pregnant human myometrial smooth muscle cells

Epidemiological studies and interventional clinical trials indicate that consumption of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) such as docosahexaenoic acid (DHA) lengthen gestational duration. Although the mechanisms are not well understood, prostaglandins (PG) of the 2-series are known to play a role in the initiation and progress of labor. In animal studies, modest DHA provision has been shown to reduce placental and uterine PGE(2) and PGF(2α), matrix metalloproteinase (MMP)-2 and MMP-9 expression, and placental collagenase activity. However, modulation of PG biosynthesis may not account for all the effects of LC n-3 PUFAs in labor. We investigated one potential PG-independent mechanism of LC PUFA action using cultured pregnant human myometrial smooth muscle cells. Our goal was to characterize the effect of LC PUFA treatment on oxytocin signaling, a potent uterotonic hormone involved in labor. The addition of 10 μM-100 μM DHA or arachidonic acid (AA) to the culture media for 48 h resulted in dose dependent enrichment of these fatty acids in membrane lipid. DHA and AA significantly inhibited phosphatidylinositol turnover and [Ca(2+)](i) mobilization with oxytocin stimulation compared to bovine serum albumin control and equimolar oleic acid. DHA and AA significantly reduced oxytocin receptor membrane concentration without altering binding affinity or rate of receptor internalization. These findings demonstrate a role for LC n-3 PUFAs in regulation of oxytocin signaling and provide new insight into additional mechanisms pertaining to reports of dietary fish and fish oil consumption prolonging gestation.     

Biphasic effect of a prostacyclin methyl ester analog on uterine contractility in the chronically catheterized pregnant rhesus monkey in late gestation

We determined the in vivo effects of a prostacyclin methyl ester analog (PGI2) administration on myometrial activity in twelve chronically- catheterized pregnant rhesus monkeys during the last third of pregnancy under three different states of myometrial contractility: postsurgical contractions, spontaneous contractures and oxytocin induced contractions. Prostacyclin (200 micrograms) was administered to four monkeys 2-3 h after surgery, to eight monkeys having only contractures, and to four monkeys having oxytocin induced contractions. Vehicle administration was performed in six animals having contractures and to four having oxytocin induced contractions. In all three experimental paradigms PGI2 administration elicited a biphasic response in uterine contractility. An initial increase in the 5 min average intrauterine pressure (IUP) value from 2.3 +/- 1.29 to 5.8 +/- 2.29; 3.6 +/- 2.38 to 7.6 +/- 3.59; and 2.3 +/- 0.65 to 8.6 +/- 0.72 (SD); was observed in the post-surgical, spontaneous contracture and oxytocin induced contraction groups respectively (mmHg, P less than 0.05). This increase was followed by a fall in the 5 min average IUP from 2.3 +/- 1.29 to 0.6 +/- 0.49; 3.6 +/- 2.38 to 1.3 +/- 0.86; and 2.3 +/- 0.65 to 0.1 +/- 0.11 in the post-surgical, spontaneous contracture and oxytocin induced contraction groups respectively (mmHg, P less than 0.05). A fall in mean arterial blood pressure from 89 +/- 9.0 to 55 +/- 10.9 (mmHg, P less than 0.05) and a compensatory tachycardia from 108 +/- 18.2 to 164 +/- 56.2 (beats.min-1, P less than 0.05) was observed by 10 min after PGI2 administration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of time at which oxytocin is administered during labor on uterine activity and perinatal death in pigs

Oxytocin is extensively used to induce or augment uterine contractions, especially to facilitate the third stage of labor in humans. Administration of oxytocin to parturient sows reduces duration of labor whereas mortality of the offspring may remain unchanged. This study aimed to evaluate whether time of administration of oxytocin during parturition may alter the uterine response and fetal outcomes. Two hundred parturient sows were randomly assigned to intramuscularly receive either saline solution (control group) or oxytocin 0.083 IU/kg immediately after the delivery of the 1st, 4th or 8th piglet (groups O-1, 0-4 and 0-8, respectively). Uterine effects and fetal outcomes were registered in all groups. The duration of labor was 20-40 min shorter (P < 0.0001) and time interval between babies was reduced by 3-5 min (P < 0.0001) in the three groups receiving oxytocin. The duration and intensity of contractions, meconium-stained piglets and intrapartum deaths decreased as time at which oxytocin administered during labor was increased. In group 0-8, we observed approximately 70% less meconium-stained piglets and intrapartum deaths than in the control group. In conclusion, oxytocin administered at early phases of parturition to sows may increase duration and intensity of uterine contractions as well as adverse fetal outcomes.     

Spinal effects of oxytocin on uterine motility in anesthetized rats

The rat uterus receives an innervation from the lumbosacral and thoracolumbar segments of the spinal cord. These segments receive descending oxytocinergic projections from the paraventricular nucleus of the hypothalamus. We tested the hypothesis that oxytocin regulates uterine motility through a spinal site of action. Oxytocin was administered in anesthetized female rats either intrathecally at the lumbosacral or thoracolumbar spinal cord levels or intravenously. Uterine activity was revealed by measuring changes of intrauterine pressure using an indwelling balloon placed in one caudal uterine horn. The uterus displayed a spontaneous activity characterized by intrauterine pressure rises, the frequency, amplitude, and duration of which were dependent on the stage of the estrous cycle. Oxytocin delivered at the lumbosacral level affected the frequency (during proestrus, estrus, and diestrus) and amplitude (during proestrus and estrus) of uterine activity. During estrus, oxytocin delivered at the thoracolumbar level affected the frequency, amplitude, and duration of the intrauterine pressure rises. Intravenous oxytocin not only affected intrauterine pressure rises (namely amplitude during proestrus and estrus and frequency and duration during estrus) but also increased the basal tone during estrus. The effects of lumbosacral oxytocin were partly mimicked by the oxytocin agonist [Thr(4),Gly(7)]-oxytocin blocked by the oxytocin receptor antagonist atosiban and by hexamethonium. Arginine vasopressin delivered at the lumbosacral level had no effect. These results support our hypothesis that oxytocin released by descending paraventriculo-spinal pathways and acting on spinal oxytocin receptors modulates the activity of the uterus. This regulation is cycle dependent.     

Demonstration that progesterone 'blocks' uterine activity in the ewe in vivo by a direct action on the myometrium

Intrauterine pressure was monitored in vivo in oestrogen-treated ovariectomized ewes before, during and after treatment with progesterone (50 mg s.c./day for 3 days). Progesterone reversibly reduced the frequency and amplitude of myometrial activity and abolished uterine reactivity to oxytocin (i.v.) and PGF-2alpha (intrauterine infusion). The rate of rise of intrauterine pressure during active pressure cycles was significantly reduced. These results confirm that the action of progesterone on the ovine myometrium is comparable to the classic progesterone 'block'. The intrauterine infusion of PGF-2alpha (10 microgram/min), which elicited a marked mechanical response in the control animals, failed to stimulate the progesterone-'blocked' uterus, suggesting that the inhibition produced by progesterone is due to a direct action of the hormone on the uterine muscle and not to an indirect mechanism operating through endometrial prostaglandin output.     

Uterine motility in the cow during the estrous cycle. I. Spontaneous activity

This study describes a method for measuring intrauterine pressure (IUP) changes and uterine motility in cows. Spontaneous uterine motility was recorded during the estrous cycle in stanchioned, nonlactating dairy cows using a pair of miniature pressure transducers mounted 15 cm apart at the distal end of a dacron catheter placed in one uterine horn via the cervix. Clinical examination of ovarian status and determination of the peripheral plasma levels of estradiol-17beta and progesterone were used to determine the stages of the cycle. The pressure sensors recorded variations in muscular resting tension (tone) and the occurrence, spatial distribution, and force of the uterine contractions. Both tone and uterine activity varied significantly during the cycle. They were minimal during diestrus, increased during proestrus, reached maximal values at estrus, and then decreased. The highest synchronized motor activity with presence of peristaltic-antiperistaltic movements occurred during estrus. The prevailing direction of the uterine contractions during late estrus (immediate preovulatory period) was cervico-tubal.     

Uterine activity, sperm transport, and the role of boar stimuli around insemination in sows

This paper describes changes in spontaneous myometrial activity around estrus, factors that affect myometrial activity, and the possible role of uterine contractions in the process of (artificial) insemination, sperm transport and fertilization. Myometrial activity in the sow increases during estrus. The activity is myogenic in origin, but several factors have been shown to affect myometrial activity. Natural mating stimulates uterine contractions through several mechanisms. The presence of a boar, rather than the act of mating, induces central oxytocin release in the sow and thus increases uterine activity. Estrogens in the ejaculate of a boar can trigger prostaglandin release by the endometrium and thus increase uterine activity. Tactile stimulation of the genital tract (cervix) or tactile stimulation of the back and flanks of the sow during artificial insemination does not cause a release of oxytocin. There is hardly any evidence for the effects of these latter stimuli on uterine activity, and if they are present at all, the effects are very small. Evidence for the effects of synthetic boar odor on oxytocin release and/or uterine activity is inconsistent. The mere presence of a boar during insemination, in contrast, clearly stimulates uterine activity through the release of oxytocin. Hormonal stimulation (intrauterine) of uterine activity with estrogens, prostaglandins, or oxytocins before, during or after insemination generally improves fertilization rate, especially in situations with reduced fertility. Therefore, uterine contractions are believed to play an important role in the transport of sperm cells to the oviducts after insemination. Whether uterine contractions are absolutely necessary for sperm transport through the uterine horns, however, is not clear. Intensive stimulation of uterine contractions using hormones can also reduce the fertilization rate, probably by increasing the reflux of sperm cells during insemination. In this respect, the presence of a boar during AI seems more adequate, as only sows with a low level of uterine activity show an increase in uterine activity in response to this stimulus.