Asociación de nivel bajo de PAPP-A en primer trimestre con resultados obstétricos adversos / Association of low PAPP-A level in the first trimester with adverse obstetric outcomes

ANTECEDENTES: La PAPP-A es una proteína utilizada en obstetricia de forma rutinaria para el cribado de aneuploidías de primer trimestre. En los últimos años se está conociendo más acerca de su papel en la función placentaria. Diversos estudios están mostrando una asociación entre un nivel bajo de PAPP-A y distintos eventos obstétricos. OBJETIVO: Establecer una asociación entre PAPP-A baja y eventos obstétricos adversos. MÉTODO: Estudio retrospectivo de casos y controles anidado en una cohorte. Se han recogido las gestaciones únicas con PAPP-A inferior a percentil 5 en primer trimestre durante 2 años. Se ha recogido de la misma cohorte un grupo control, en proporción 2:1. Se compara mediante análisis estadístico la incidencia de eventos obstétricos adversos de cada grupo. RESULTADOS: Se incluyó un total de 285 pacientes en el grupo de casos y 570 pacientes en el grupo control. Se observó un aumento significativo en el grupo de casos de la incidencia de prematuridad, restricción del crecimiento, hipertensión gestacional y diabetes gestacional. Se ha correlacionado la PAPP-A baja con varios eventos obstétricos adversos, incluyendo prematuridad (OR 4,27), diabetes gestacional (OR 2,40), restricción del crecimiento (OR 2,36) e hipertensión gestacional (OR 2,22). No se observó relación con el resto de eventos obstétricos adversos. CONCLUSIÓN: Un nivel de PAPP-A bajo se asocia con aumentos significativos de prematuridad, diabetes gestacional, restricción del crecimiento e hipertensión gestacional.

BACKGROUND: PAPP-A is a placental protein used in obstetrics as a first trimester marker in aneuploidy screening. In the last few years we are knowing more about its placental function. Some studies are showing a association between low PAPP-A and obstetrical adverse events. AIM: Establish an association between low PAPP-A an obstetrical adverse events. METHOD: This is a retrospective nested case-control study. We identified each singleton pregnancy with a normal phenotype and a low PAPP-A (under percentile 5) in the last 2 years, and match it with a control group of the same population in a 2:1 proportion. It was compared the incidence of each obstetrical adverse outcomes with statistical analysis. RESULTS: We found 285 patients in the case group and match it with 570 patients from control group. It was observed a significative increase in the incidence of prematurity, intrauterine growth restriction, gestational hypertension and gestational diabetes. A low PAPP-A level was correlated with some obstetrical adverse events, like prematurity (OR 4.27), gestational diabetes (OR 2.40), intrauterine growth restriction (OR 2.36) and gestational hypertension (OR 2.22). We observe no correlation with the rest of outcomes. CONCLUSIONS: A low PAPP-A level is related with significative increases of prematurity, gestational diabetes, intrauterine growth restriction and gestational hypertension.

Relação entre a contagem de eritroblastos no sangue do cordão umbilical e os resultados obstétricos e neonatais em fetos pequenos para a idade gestacional e com Doppler de artéria umbilical normal / Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal dopplervelocimetry of umbilical artery

OBJETIVO: Avaliar resultados obstétricos e neonatais em gestantes com fetos pequenos para a idade gestacional após 35 semanas segundo a contagem de eritroblastos (EB) no sangue de cordão umbilical.MÉTODOS: A contagem de EB por 100 leucócitos no sangue do cordão umbilical foi obtida de 61 gestantes com fetos pequenos para a idade gestacional e Doppler umbilical normal. Estas foram divididas em 2 grupos: EB≥10 (grupo estudo, n=18) e EB<10 (grupo controle, n=43). Resultados obstétricos e neonatais foram comparados entre os grupos. Para a análise estatística, foram utilizados teste do χ2e t de Student, com nível de significância adotado de 5%.RESULTADOS: A média±desvio padrão de EB por 100 leucócitos foi de 25,0±13,5 para o grupo estudo e de 3,9±2,2 para o grupo controle. Os grupos EB≥10 e EB<10 não diferiram estatisticamente em relação à idade materna (24,0 versus 26,0 anos), primiparidade (55,8 versus 50%), comorbidades (39,5 versus 55,6%) e idade gestacional no parto (37,4 versus 37,0 semanas). O grupo EB≥10 apresentou maior taxa de cesárea (83,3 versus 48,8%, p=0,02), sofrimento fetal (60 versus 0%, p<0,001) e pH<7,20 (42,9 versus11,8%, p<0,001). O peso de nascimento e o percentil de peso para a idade gestacional foram significativamente menores no grupo EB≥10 (2.013 versus 2.309 g; p<0,001 e 3,8 versus 5,1; p=0,004; respectivamente). Não houve nenhum caso de Apgar de 5º minuto abaixo de 7.CONCLUSÃO: A contagem de EB acima de 10 por 100 leucócitos no sangue do cordão umbilical foi capaz de identificar maior risco de parto cesárea, sofrimento fetal e acidose de nascimento em fetos pequenos para a idade gestacional com dopplervelocimetria de artéria umbilical normal.

PURPOSE: To analyze the obstetrical and neonatal outcomes of pregnancies with small for gestation age fetuses after 35 weeks based on umbilical cord nucleated red blood cells count (NRBC).METHODS: NRBC per 100 white blood cells were analyzed in 61 pregnancies with small for gestation age fetuses and normal Doppler findings for the umbilical artery. The pregnancies were assigned to 2 groups: NRBC≥10 (study group, n=18) and NRBC<10 (control group, n=43). Obstetrical and neonatal outcomes were compared between these groups. The χ2 test or Student's t-test was applied for statistical analysis. The level of significance was set at 5%.RESULTS: The mean±standard deviation for NRBC per 100 white blood cells was 25.0±13.5 for the study group and 3.9±2.2 for the control group. The NRBC≥10 group and NRBC<10 group were not significantly different in relation to maternal age (24.0 versus 26.0), primiparity (55.8 versus 50%), comorbidities (39.5 versus55.6%) and gestational age at birth (37.4 versus 37.0 weeks). The NRBC≥10 group showed higher rate of caesarean delivery (83.3 versus 48.8%, p=0.02), fetal distress (60 versus 0%, p<0.001) and pH<7.20 (42.9 versus11.8%, p<0.001). The birth weight and percentile of birth weight for gestational age were significantly lower on NRBC≥10 group (2,013 versus 2,309 g; p<0.001 and 3.8 versus 5.1; p=0.004; respectively). There was no case described of 5th minute Apgar score below 7.CONCLUSION: An NRBC higher than 10 per 100 white blood cells in umbilical cord was able to identify higher risk for caesarean delivery, fetal distress and acidosis on birth in small for gestational age fetuses with normal Doppler findings.

Application of serum alpha-L-fucosidase in monitoring the function of placenta / 国际检验医学杂志

Objective To investigate the application of maternal serum α-L-fucosidase to the placental function monitoring. Methods Comparative analysis of the changes of serum α-L-fucosidase between 120 patients with advanced placental dysfunction, pregnant women with different stages of gestation and 80 healthy non-pregnant woman was performed,and the correlation of the se-rum α-L-fucosidase of 120 cases with advanced placental dysfunction with UE3 and HPL was analyzed.Results The level of serumα-L-fucosidase of patients with placental dysfunction was lower than that of normal pregnant women,and the difference was statisti-cally significant (P <0.05 ).The serum α-L-fucosidase was correlated with UE3 and HPL which were the indicators of placental function monitoring (r=0.534 and 0.587,P <0.05).Conclusion Serum α-L-fucosidase can serve as the conventional biochemical indicator for monitoring placental function.

Fatores associados ao falso diagnóstico pré-natal da restrição de crescimento fetal / Factors associated with false diagnosis of fetal growth restriction

OBJETIVO: Descrever os fatores relacionados ao falso diagnóstico de restrição de crescimento fetal (RCF). MÉTODOS: Foram incluídas 48 gestantes encaminhadas ao nosso serviço com suspeita de RCF, não confirmada após o nascimento. Estas foram comparadas ao grupo de gestantes com RCF confirmada e foram descritas características relacionadas a esses falso-positivos. Os dados foram analisados utilizando-se o programa Statplus para Mac(r), versão 5.8. Os resultados obtidos no estudo foram divididos em variáveis categóricas e contínuas para análise. Para comparação entre proporções, foi aplicado o teste do χ2 ou o teste exato de Fisher. O nível de significância foi estabelecido em p<0,05 para todos os testes. RESULTADOS: As gestantes com falso diagnóstico de restrição de crescimento fetal apresentavam as seguintes características: chegaram ao serviço em idade gestacional mais precoce (média de 32,8 semanas); entre 2 e 6 exames de ultrassonografia antes da matrícula no hospital terciário (média 3,8); foram submetidas à ultrasonografia até a 12ª semana em apenas 25% dos casos; tinham medida da altura uterina normal em 66,7% dos casos; foram submetidas a pelo menos 1 ultrassonografia com percentil normal em 52,1% dos casos; tinham a última ultrassonografia (média de 36 semanas) com percentil médio de 18; foram submetidas em média a 5 exames de ultrassonografia e 4,6 exames de vitalidade após ingressarem no serviço. CONCLUSÃO: O falso diagnóstico da RCF envolve custos hospitalares altos e demanda maior de especialistas. Deve-se valorizar a medida da altura uterina, por meio de exame físico cuidadoso e confirmar esse diagnóstico com a ultrassonografia nas últimas semanas de gestação, antes que a conduta ...

PURPOSE: The aim of this study was to analize and describe some characteristics related to a false diagnosis of intrauterine growth restriction (IUGR). METHODS: We retrospectively included 48 pregnant women referred to our service with a suspected diagnosis of IUGR that was not confirmed after birth and we compared them to another group with confirmed IUGR. We then analyzed the characteristics of the false-positive results. The results of the study were divided into continuous and categorical variables for analysis. The χ2test or Fisher exact test was applied to compare proportions. The level of significance was set at p<0.05 for all tests. RESULTS: In our sample, pregnant women with a false diagnosis of IUGR had the following characteristics: they were referred earlier (mean gestational age of 32.8 weeks); were submitted to 2 to 6 ultrasound examinations before been registered in our service; in 25% of cases ultrasound examination was performed before 12 weeks; in 66.7% of cases the symphysis-fundal height measurement was normal; in 52.1% of cases they had at least 1 sonographic exam above the 10th percentile; on average, the last ultrasound examination (performed on average at 36 weeks) was above the 18th percentile; the women were submitted to a mean number of 5 ultrasound examinations and to a mean number of 4.6 vitality exams. CONCLUSION: The false diagnosis of IUGR involves high hospital costs and higher demand for specialists. The symphysis-fundal height measurement must be valued, and the diagnosis of IUGR must be confirmed with ultrasonography in the last weeks of pregnancy before any obstetric management is taken. .

An experimental study on permeability of basic fibroblast growth factor through placental barrier in rats / 第二军医大学学报

Objective: To investigate if bFGF can penetrate placental barrier. Methods: Sixteen day pregnant Wistar rats were selected. bFGF labeled with 125 I was injected peritoneally into the rats. The radioactivity of bFGF in different organs were determined in 30 min. Results: (1) 125 I bFGF was detected in the brain, heart, liver,lung and spleen. (2)With the same dose of 125 I bFGF, the concentration of it in the brain was at lowest level of all other organs.(3) In the range of safe dose, the permeability of bFGF through placental barrier was increased obviously. Conclusion: bFGF may penetrate placental barrier into rat's brain, which makes possible for the therapeutic intervention of bFGF in feotus. [

Factors affecting the transfer of ropivacalne across the single cotyledon of term human placenta / 中华麻醉学杂志

Objective To study the transfer of ropivacaine across the single cotyledon of the term human placenta and the effects of maternal hypoproteinemia and fetal acidemia on the transfer. Methods Eighteen placentas were obtained from healthy full term parturients within 5 min after vaginal or cesarean section delivery. The dual perfused human placental model was made. The placentas were randomly divided into three groups of 6 placentas : (A) control group in which 100% fresh frozen plasma was used in both maternal and fetal circulation with pH maintained at 7.4 on both sides; (B) fetal academia group in which 100% fresh frozen plasma was used in both circulations but fetal pH was reduced to 7.0; (C) maternal hypoproteinemia group in which 50% fresh frozen plasma used in maternal circulation and 100% fresh frozen plasma in fetal circulation, pH was maintained at 7.4 on both sides. Samples were taken from the perfusate in the reservoir at 15, 30, 60, 90, 120 min after ropivacaine (2?g?ml-1) and antipyrine (10 ?g?ml-1 ) were added in maternal circulation for determination of concentrations of ropivacaine, antipyrine, glucose and lactate. Glucose consumption rate, lactate generation rate and relative and absolute transfer ratio of ropivacaine were calculated. Results Absolute transfer ratio of ropivacaine was gradually increasing with perfusion time, reaching 8.7?1.0% (A) , 10.5 ?1.6% (B) and 11.8?1.1% respectively at 120 min. Relative transfer ratio of ropivacaine was relatively constant during 120 min perfusion and was significantly higher at each time point in group B and C than in group A ( P

Fetal cardiac function in fetal cardiac bypass / 中华胸心血管外科杂志

Objective To study the effects of fetal lamb cardiac bypass on the fetal cardiac function.Methods Eight ewes at gestation of 120 to 140 days have nine fetus which were randomly divided into control group (n = 4) and fetal bypass group (n = 5). Control group underwent sham procedure that fetal stemotomy was performed.Bypass group underwent fetal cardiac bypass with cen- trifugal pump and placenta for 30 minutes.Fetal mean blood pressure,heart rate and bleed gas data were recorded before bypass,30 minutes during bypass,1 hour after cessation of bypass,2 hour after cessation of bypass.Tei index of two ventricles and pulse index of umbilical arteries were recorded with ultrasonography.Plasma troponin I was assayed.Ultrastructure of fetal myocardium was recorded,Results Fetal mean blood pressure and heart rate of two groups have no changes during the experiment time.The umbilical pulse index of bypass group elevated significantly compared with control group (P

THE RELATION BETWEEN SERUM COPPER VALUE AND PLACENTAL FUNCTION IN PREGNANT WOMEN / 西安交通大学学报(医学版)

we examined the serum copper level in 125 pregnant women (83) normal pregnant women of 28～40 weeks of pregnancy; 12 patients with se-vere edema-proteinurine-hyperterision syndromeduring 37～40 weeks of pregnancy; 30 patientswith prolonged pregnancy) and compared it withurine E/C value and Apgar score in order to deter-mine the reliability of serum copper value in diag-nosing placental insufficiency. The results con-firmed that the serum copper value was increasingwith the growth of weeks of pregnancy, but it wasdecreasing after the fortieth week of pregnancy.Comparison of the serum copper value with theurine E/C value showed that when the E/C or = 10. And when the Apgar score7. These results indicatethat the serum copper value can serve as an indexof placental function in the third trimester of preg-nancy.