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Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study

The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput...

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Autores principales: Malvasi, Antonio, Cicinelli, Ettore, Baldini, Giorgio Maria, Vimercati, Antonella, Beck, Renata, Dellino, Miriam, Damiani, Gianluca Raffaello, Cazzato, Gerardo, Cascardi, Eliano, Tinelli, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962106/
https://www.ncbi.nlm.nih.gov/pubmed/36835178
http://dx.doi.org/10.3390/ijms24043767
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author Malvasi, Antonio
Cicinelli, Ettore
Baldini, Giorgio Maria
Vimercati, Antonella
Beck, Renata
Dellino, Miriam
Damiani, Gianluca Raffaello
Cazzato, Gerardo
Cascardi, Eliano
Tinelli, Andrea
author_facet Malvasi, Antonio
Cicinelli, Ettore
Baldini, Giorgio Maria
Vimercati, Antonella
Beck, Renata
Dellino, Miriam
Damiani, Gianluca Raffaello
Cazzato, Gerardo
Cascardi, Eliano
Tinelli, Andrea
author_sort Malvasi, Antonio
collection PubMed
description The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the “dystocic pain”, that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS.
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spelling pubmed-99621062023-02-26 Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study Malvasi, Antonio Cicinelli, Ettore Baldini, Giorgio Maria Vimercati, Antonella Beck, Renata Dellino, Miriam Damiani, Gianluca Raffaello Cazzato, Gerardo Cascardi, Eliano Tinelli, Andrea Int J Mol Sci Article The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the “dystocic pain”, that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS. MDPI 2023-02-13 /pmc/articles/PMC9962106/ /pubmed/36835178 http://dx.doi.org/10.3390/ijms24043767 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Malvasi, Antonio
Cicinelli, Ettore
Baldini, Giorgio Maria
Vimercati, Antonella
Beck, Renata
Dellino, Miriam
Damiani, Gianluca Raffaello
Cazzato, Gerardo
Cascardi, Eliano
Tinelli, Andrea
Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title_full Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title_fullStr Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title_full_unstemmed Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title_short Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
title_sort prolonged dystocic labor in neuraxial analgesia and the role of enkephalin neurotransmitters: an experimental study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962106/
https://www.ncbi.nlm.nih.gov/pubmed/36835178
http://dx.doi.org/10.3390/ijms24043767
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