oxytocin and Dilatation--Pathologic

Cardiac diseases are the second cause of non-obstetrical death during pregnancy in France. Bicuspid aortic valve is the most frequent congenital cardiac disease but its characteristics are little known. We report two consecutive cases of pregnant patients with aortic bicuspidy, one with a severe aortic stenosis and one with a severe dilatation of the ascending aorta. We describe the anaesthetic management of delivery for these two cases and summarize the current recommendations for management of this condition during pregnancy.

Topics: Adult; Analgesia, Obstetrical; Anesthesia, Epidural; Anesthesia, Obstetrical; Aorta; Aortic Diseases; Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Cesarean Section; Delivery, Obstetric; Dilatation, Pathologic; Echocardiography; Female; Heart Valve Diseases; Hemodynamics; Humans; Oxytocics; Oxytocin; Preanesthetic Medication; Pregnancy; Pregnancy Complications, Cardiovascular

This study provides the first clear evidence of a close correlation between the biochemical composition of the cervix and the clinical course of delivery in terms of cervical dilatation. Cervical biopsy specimens were obtained from three groups of patients: Group A, ten women with favorable cervix and spontaneous labor; group B, 12 women with unfavorable cervix given 0.5 mg prostaglandin E2 in gel intracervically for cervical priming and induction of labor; and group C, five women with unfavorable cervix and spontaneous labor. Cervical dilatation time was significantly longer (18 hours) for women in group C compared with women in group A (6.7 hours) and in group B (5.0 hours; P less than .001). The total amount of cervical collagen was significantly higher in women in group C at 8.58 micrograms/mg compared with 6.7 micrograms/mg in women in group A and 5.47 micrograms/mg in prostaglandin E2-treated women in group B. The amount of nonextractable collagen also was significantly higher in women in group C, 23.6% compared with 11.3% in group A, and 12.4% in group B (P less than .01). The collagenolytic activity was significantly increased in cervical biopsy specimens from prostaglandin E2 gel-treated patients--520 U/100 mg wet weight compared with 380 U/100 mg wet weight in untreated patients in group A (P less than .05). From these results it is concluded that cervical collagen is an important regulator of cervical function in late pregnancy and term labor; that prostaglandin E2 is involved in cervical priming, initiation, and progress of term labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cervix Uteri; Collagen; Dilatation, Pathologic; Dinoprostone; Female; Humans; Hydroxyproline; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins E; Time Factors