Elevated maternal lipids in early pregnancy are not associated with risk of intrapartum caesarean in overweight and obese nulliparous women

Fyfe, Elaine; Rivers, Karen; Thompson, John M. D.; Thiyagarajan, Kamala Pl; Groom, Katie; Dekker, Gustaaf A.; McCowan, Lesley

doi:10.1186/1471-2393-13-143

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…These findings of poor contractility and risk of CS have been confirmed by other studies (e.g. Cedergren, 2009;Fyfe et al 2013), but reduced in vitro contractility was not found by other studies (Higgins et al 2010), perhaps reflecting experimental differences, such as stretch, and the difficulty, even in larger studies, of controlling for confounding factors around obesity.…”

Section: Effect Of Maternal Body Mass Index (Bmi) and Cholesteolsupporting

confidence: 81%

Myometrial physiology – time to translate?

Arrowsmith

Kendrick

Hanley

et al. 2014

Experimental Physiology

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To provide an overview of the current understanding of myometrial contractility and give examples of where this has or is close to being applied clinically. r What advances does it highlight?Examples of where myometrial science has been translated into clinical practice/patient benefit are discussed, as well as including suggestions of how it can be advanced.In this short review, we discuss how recent insights into myometrial physiology may be taken forward and translated into much-needed novel therapies for problems associated with labour. We consider excitation-contraction coupling in the myometrium and how this relates to our understanding of the changes that occur to produce myometrial contractions and successful labour. We then discuss how this information has already been used in the development of drugs to either stimulate or relax the myometrium, to address the needs of women with either slow (dystocic) labours or threatened preterm labours, respectively. We next present the data showing how basic physiological findings pertaining to hypoxia and lactate production have been taken and translated into a tool for predicting and thus better managing difficult labours. We then highlight examples of where physiological research has started to provide mechanistic insight into clinical problems associated with labour and parturition (obesity, diabetes, advanced maternal age, postdate and twin pregnancies) and suggest how these findings could be translated into new therapies for difficult labours.

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Section: Effect Of Maternal Body Mass Index (Bmi) and Cholesteolsupporting

confidence: 81%

Myometrial physiology – time to translate?

Arrowsmith

Kendrick

Hanley

et al. 2014

Experimental Physiology

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show abstract

“…Translating these in vitro studies into clinically relevant results, however, is challenging due to the many factors that contribute to a successful vaginal delivery. Fyfe et al 19 reported that increased maternal total cholesterol measured at 14 to 16 weeks was not associated with an increased risk for first-stage CD for failure to progress.…”

Section: Labor Progressionmentioning

confidence: 98%

Intrapartum Management of the Obese Gravida

Carpenter¹

2016

Clinical Obstetrics &Amp; Gynecology

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Obese women are at increased risk for multiple labor abnormalities, including postdates pregnancy, failed induction of labor, prolonged labor, cesarean delivery, and postpartum hemorrhage (PPH). Prolonged labor among obese women is confined to the first stage of labor. In the setting of reassuring fetal and maternal status, increased time to progress in the first stage of labor should be allowed. Uterine atony occurs more frequently in obese women and vigilance in the prevention of PPH is critical. There is a lack of high-quality data to guide the management of induction, labor, and PPH prevention among obese women.

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“…Mice with dysfunctional hepatic cholesterol clearance exhibited reduced oxytocin responses and abnormal labor without pup expulsion [ 122 ]. In humans, elevated maternal cholesterol at 14–16 weeks gestation is not a risk factor for first stage labor dystocia leading to cesarean section [ 123 ]. We found no studies that evaluated labor progress or outcomes by maternal cholesterol or maternal triglyceride levels near the time of birth.…”

Section: Review Of Evidence: Biologic Mechanisms Of Labor Dysfunctionmentioning

confidence: 99%

Parturition dysfunction in obesity: time to target the pathobiology

Carlson

Hernandez

Hurt

2015

Reprod Biol Endocrinol

101

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Over a third of women of childbearing age in the United States are obese, and during pregnancy they are at increased risk for delayed labor onset and slow labor progress that often results in unplanned cesarean delivery. The biology behind this dysfunctional parturition is not well understood. Studies of obesity-induced changes in parturition physiology may facilitate approaches to optimize labor in obese women. In this review, we summarize known and proposed biologic effects of obesity on labor preparation, contraction/synchronization, and endurance, drawing on both clinical observation and experimental data. We present evidence from human and animal studies of interactions between obesity and parturition signaling in all elements of the birth process, including: delayed cervical ripening, prostaglandin insensitivity, amniotic membrane strengthening, decreased myometrial oxytocin receptor expression, decreased myocyte action potential initiation and contractility, decreased myocyte gap junction formation, and impaired myocyte neutralization of reactive oxygen species. We found convincing clinical data on the effect of obesity on labor initiation and successful delivery, but few studies on the underlying pathobiology. We suggest research opportunities and therapeutic interventions based on plausible biologic mechanisms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0129-6) contains supplementary material, which is available to authorized users.

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Elevated maternal lipids in early pregnancy are not associated with risk of intrapartum caesarean in overweight and obese nulliparous women

Cited by 13 publications

References 25 publications

Myometrial physiology – time to translate?

Myometrial physiology – time to translate?

Intrapartum Management of the Obese Gravida

Parturition dysfunction in obesity: time to target the pathobiology

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