They showed that the levels of SP were higher in the LUS of patients scheduled for repeated CS, while the levels of VIP were reduced in the LUS. On this important topic, Malvasi et al., investigated the presence of substance P (SP) and vasoactive intestinal polypeptide (VIP) and their fibers in the LUS of patients submitted to CS. This is true not only for the enkephalinergic fibers, but also the oxytocin ones, highly present in the cervico-isthmic zone, influencing the reproductive system and sexual disorders after surgical cervical procedures. 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.įurthermore, as above mentioned, the cervix is one of the regions of the uterus which harbors the vast majority and greatest variety of neuro fibers, especially in a pregnant uterus. 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 LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. 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. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). 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. 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 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).
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