title: Women with high BMI: should they be managed differently due to antagonising action of leptin in labour?
abstract: Leptin - a protein hormone is synthesised in the adipose tissue in humans. Its level therefore should be directly proportional to the amount of adipose tissue in the body. There is evidence that leptin may be responsible for various complications in obese and morbidly obese women in labour by its effect on the myometrium causing uterine smooth muscle relaxation (causes less Ca(2+) flux in myometrium). By doing this, we believe it opposes oxytocin effect on the myometrium which in fact promotes uterine smooth muscle contractions (causes more Ca(2+) flux in myometrium). The opposing action of these two hormone may contribute to the dysfunctional labour process, prolonged first stage of labour, increase in operative vaginal delivery in second stage of labour and increase in caesarean section rate both in first and second stage of labour in obese women. Also, there is increased incidence of postdated pregnancy, induction of labour and atonic postpartum haemorrhage in obese and morbidly obese women. Does this mean labour should be managed differently in women with high BMI?
authors.affiliation: Department of Obstetrics and Gynaecology, Queens Hospital, London RM7 0AG, UK. wrekhaw@gmail.com
authors.forename: Rekha
authors.initials: R
authors.lastname: Wuntakal
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kaler
authors.forename: Tony
authors.initials: T
authors.lastname: Hollingworth
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D020738:Leptin / Q000378:metabolism*; D008954:Models, Biological; D009130:Muscle, Smooth / Q000502:physiology; D009765:Obesity / Q000150:complications* / Q000378:metabolism*; D007744:Obstetric Labor Complications / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism*; D010121:Oxytocin / Q000378:metabolism* / Q000494:pharmacology; D011247:Pregnancy; D014590:Uterine Contraction / Q000187:drug effects / Q000502:physiology
chemical_list: D020738:Leptin; D010121:Oxytocin