Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

Corioamnionitis Histológica Asociada a Muerte Fetal / Histological Chorioamnionitis Associated with Fetal Death

INTRODUCCIÓN. Anualmente ocurren más de 2 millones de muertes fetales a nivel mundial, siendo fundamental el estudio anatomopatológico placentario para disminuir el número de muertes inexplicadas. OBJETIVO. Revisar la literatura existente acerca de corioamnionitis histológica, los criterios para establecer su diagnóstico, su presencia y posible asociación en estudios de causas de muerte fetal. METODOLOGÍA. Se realizaron búsquedas en bases de datos electrónicas para recopilar estudios de causas de muerte fetal que incluyeron corioamnionitis histológica. RESULTADOS. Se encontraron 13 estudios que evaluaron mortalidad fetal y que entre sus causas incluyeron corioamnionitis histológica. DESARROLLO. El estudio microscópico placentario en muertes fetales es esencial al investigar una muerte fetal. Las anomalías placentarias son la causa más común de muerte fetal, la corioamnionitis aguda es la lesión inflamatoria más frecuente. Se detallaron los criterios más relevantes para definir corioamnionitis aguda histológica pero aún no se establece un consenso. Estudios de causas de muerte fetal en años recientes han reportado corioamnionitis histológica entre 6,3% y 41,3% de casos. Las alteraciones inflamatorias del líquido amniótico son una causa importante de muerte fetal, siendo la corioamnionitis la más frecuente en este grupo. CONCLUSIÓN. En estudios para determinar las causas de muerte fetal se evidenció corioamnionitis aguda histológica en hasta el 41,3% de casos, por lo que podría estar asociada a dicho evento. Sin embargo, es necesario establecer un sistema de estadiaje de corioamnionitis histológica mediante un panel de expertos a nivel mundial.

INTRODUCTION. Annually more than 2 million fetal deaths occur worldwide, being fundamental the placental anatomopathological study to reduce the number of unexplained deaths. OBJECTIVE. To review the existing literature on histological chorioamnionitis, the criteria to establish its diagnosis, its presence and possible association in studies of causes of fetal death. METHODOLOGY. Electronic databases were searched to collect studies of causes of fetal death that included histologic chorioamnionitis. RESULTS. Thirteen studies were found that evaluated fetal mortality and that included histologic chorioamnionitis among their causes. DEVELOPMENT: Placental microscopic study in fetal deaths is essential when investigating a fetal death. Placental abnormalities are the most common cause of fetal death, acute chorioamnionitis being the most frequent inflammatory lesion. The most relevant criteria for defining histologic acute chorioamnionitis have been detailed but consensus has not yet been established. Studies of causes of fetal death in recent years have reported histologic chorioamnionitis in between 6,3% and 41,3% of cases. Inflammatory changes in the amniotic fluid are an important cause of fetal death, with chorioamnionitis being the most frequent in this group. CONCLUSIONS. In studies to determine the causes of fetal death, histological acute chorioamnionitis was evidenced in up to 41,3% of cases, so it could be associated with this event. However, it is necessary to establish a histological chorioamnionitis staging system by means of a worldwide panel of experts.

Initiation of human parturition: signaling from senescent fetal tissues via extracellular vesicle mediated paracrine mechanism

A better understanding of the underlying mechanisms by which signals from the fetus initiate human parturition is required. Our recent findings support the core hypothesis that oxidative stress (OS) and cellular senescence of the fetal membranes (amnion and chorion) trigger human parturition. Fetal membrane cell senescence at term is a natural physiological response to OS that occurs as a result of increased metabolic demands by the maturing fetus. Fetal membrane senescence is affected by the activation of the p38 mitogen activated kinase-mediated pathway. Similarly, various risk factors of preterm labor and premature rupture of the membranes also cause OS-induced senescence. Data suggest that fetal cell senescence causes inflammatory senescence-associated secretory phenotype (SASP) release. Besides SASP, high mobility group box 1 and cell-free fetal telomere fragments translocate from the nucleus to the cytosol in senescent cells, where they represent damage-associated molecular pattern markers (DAMPs). In fetal membranes, both SASPs and DAMPs augment fetal cell senescence and an associated ‘sterile’ inflammatory reaction. In senescent cells, DAMPs are encapsulated in extracellular vesicles, specifically exosomes, which are 30–150 nm particles, and propagated to distant sites. Exosomes traffic from the fetus to the maternal side and cause labor-associated inflammatory changes in maternal uterine tissues. Thus, fetal membrane senescence and the inflammation generated from this process functions as a paracrine signaling system during parturition. A better understanding of the premature activation of these signals can provide insights into the mechanisms by which fetal signals initiate preterm parturition.

Proper Level of Knowledge on Anatomy for Learning Embryology: Based in the Survey Analysis on the Newly Introduced Teaching Method (Group Presentation of Anatomy) to the Embryology Class / 체질인류학회지

Embryology is essential for the undergraduate students of medical college to understand the process and mechanisms related to both normal and abnormal development. In almost all medical colleges, anatomy class precedes embryology or at least begin simultaneously with embryology even when the anatomy related subjects including embryology are operated as integrated process during the course of basic medical science curriculum. However in the medical college of Dankook University, embryology begins in premedical course and also precedes anatomy and other anatomy related subjects. This pattern of curriculum might have its own merit and there shouldn't be any problem or difficulty in learning general embryology contents such as fertilization process, early weeks of development, congenital malformations, and fetal membranes. However, the situation is somewhat different in learning system based embryology which is focused on the development of each human system during the embryonic period. As an attempt of prerequisite learning of anatomical knowledge before beginning each chapter of system based embryology, group presentation method was newly introduced to the embryology class. In this study, a survey analysis was performed in both presentation and non-presentation group. Common survey questionnaire for both presentation and non-presentation group was composed of previous experiences on embryology related subjects, necessities of knowledge on anatomy in learner's aspect, and free comments on embryology class at large. For the presentation group, preferred methods and contents for the prerequisite learning of anatomy, relevances in the level of difficulty and length of presentation class, and preferred level of prerequisite learning of anatomy were added to survey questionnaire. In the results, necessities of knowledge on anatomy in learner's aspect between presentation and non-presentation group was different with statistical significance. In non-presentation group, it was revealed that the students themselves hardly recognize the necessities of prerequisite learning because originally they had no experience on anatomy class. Therefore, the results revealed that the precedent effort of lecturer to supply diverse chances in prerequisite learning of anatomy is a high priority especially when embryology precedes anatomy or other anatomy related subjects.

Molecular detection and genotypic characterization of toxoplasma gondii in paraffin-embedded fetoplacental tissues of women with recurrent spontaneous abortion

Background: Congenital toxoplasmosis is an important cause of spontaneous abortion worldwide. However, there is limited information on detection and genotypic characterization of Toxoplasma gondii [T. gondii] in women with recurrent spontaneous abortion [RSA]. The aim of this study is the molecular detection and genotypic characterization of T. gondii in formalin-fixed, paraffin-embedded fetoplacental tissues [FFPTs] of women with RSA that have referred to the Avicenna Research Institute in Tehran, Iran

Materials and Methods: This experimental research was undertaken on 210 FFPTs of women with RSA. The information of the patients was collected from the archives of Avicenna Research Institute in Tehran, Iran. After DNA extraction, the presence of T. gondii was examined by nested polymerase chain reaction targeting the GRA6 gene. Genotyping was performed on positive samples using polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] that targeted the GRA6 and SAG3 genes. Sequencing was conducted on two GRA6 positive samples

Results: T. gondii DNA was detected in 3.8% [8/210] of the samples. Genotyping showed that all positive samples belonged to type III of the T. gondii genotype. Sequencing two genomic DNAs of the GRA6 gene revealed 99% similarity with each other and 99-100% similarity with T. gondii sequences deposited in GenBank. There were six patients with histories of more than three abortions; one patient had a healthy girl and another patient had two previous abortions. Abortions occurred in the first trimester of pregnancy in seven patients and in the second trimester of pregnancy in one patient

Conclusion: The results of this study have indicated that genotype III is the predominant type of T. gondii in women with RSA in Tehran, Iran. Also, our findings suggest that toxoplasmosis may play a role in the pathogenesis of RSA. However, further studies are needed to elucidate a clear relationship between T. gondii infection and RSA

Prenatal Exposure to Drugs and Allergic Diseases in Offspring

Recent studies reported increased risks for the development of allergic diseases in children after prenatal exposure to drugs. The mechanisms by which drug exposure may actually cause allergic diseases are not known. It has been suggested that these drugs promote transplacental allergen transfer to the fetus, resulting in the preservation of allergens. If transferred to the fetus, these allergens could induce a Th2-dominant immune response and allergic sensitization of the fetus. The development of the fetal immune system is influenced by the allergic state of the mother. Maternal IgE can cross fetal membranes, and a Th2-dominant phenotype in the mother can promote an allergy-prone phenotype in the fetus. The fetal immune system starts early in development but mainly matures in later trimesters. Maternal use of antibiotics during pregnancy may prove to be a risk factor for persistent wheezing and allergy development in early infancy. Paracetamol exposure during pregnancy was associated with allergic rhinitis, its use until 6 months of age was associated with allergic sensitization and a history of asthma in girls. Exposure to proton pump inhibitors (PPIs) and Histamine 2-antagonists (H2As) has been associated with an increased risk for the development of atopic dermatitis, asthma, allergic rhinitis, and especially with the development of multiple allergic diseases. Our reviews showed it is necessary to prescribe such drugs under the consultation of an expert physician and to try and reduce exposure as much as possible to prevent offspring allergies in the case of mothers with a history of allergic diseases.

Chorioamnionitis: Is a major player in the development of bronchopulmonary dysplasia? / 소아과

Chorioamnionitis is an inflammation in the fetal membranes or placenta. When chorioamnionitis develops, fetal lungs are exposed to inflammatory cytokines and mediators via amniotic fluid. Because inflammation plays a pivotal role in the development of bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, fetal lung inflammation induced by chorioamnionitis has been considered to be one of the major pathogenetic factors for BPD. Although there have been a number of studies that demonstrated the relationship between chorioamnionitis and BPD, there are still controversies on this issue. The controversies on the relationship between chorioamnionitis and BPD arise from not-unified definitions of chorioamnionitis and BPD, different study populations, and the proportion of contribution between inflammation and infectious microorganisms. The publication bias also contributes to the controversies. Clinical trials targeting chorioamnionitis or microorganisms that cause chorioamnionitis will answer on the actual relationship between chorioamnionitis and BPD and provide a novel prophylactic strategy against BPD based on that relationship.

Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

To compare the management outcome of induction of labor with expectant management in patients with term pre labor mpture of membranes [PROM]. Randomized controlled trial. This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25[th] July 2010 to 25[th] January 2012. A total of 384 patients were selected for this study, which were divided into two groups by lottery methoid. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma, The mean duration between PROM to onset of active labor in group A was significantly less [8.4 +/- 2.3 hours] as compared to group B in which it was [9.6 +/- 2.1 hours] [p = 0.000]. The mean duration between PROM to delivery in group A was significantly less in group A [17.4 +/- 20] versus group B [22.2 +/- 2.0 hours] [p = 0.0000]. The spontaneous vaginal delivery [SVD] rate was considerably higher [p=0.056] in group A in which 161 [83.8%] patients delivered by SVD and 31 [16.1%] patients by LSCS. In group B, 146 [76.0%] patients delivered by SVD and 46 [23.9%] patients by LSCS. In group A, 8 [4.1%] patients developed chorioamnionitis and 13 [6.7%] patients in group B [p = 0.262]. In group A there were 178 [92.7%] neonates with APGAR score of > 5 at 1 minute in contrast to 173 [90.1%] in group B with [p = 0.363]. Similarly in group A at 5 minutes, there were 178 [92.7%] neonates with APGAR score of >7 and 173 [90.1%] in group B [p = 0.460]. There were 9 [4.6%] cases of neonatal sepsis in group A, in comparison with 12 [6.2%] patients in group B [p = 0.501]. The mean duration of labor in induced patients was less as compared to patients with expectant management

Prevalência de Streptococcus agalactiae em gestantes da Grande Porto Alegre, RS: relato de caso / Prevalence of Streptococcus agalactiae in pregnant women of Porto Alegre, RS: case report

O Streptococcus agalactiae é um coco Gram-positivo, beta-hemolítico que faz parte da microbiota de membranas mucosas, colonizando, principalmente, o trato intestinal e o genitourinário. A identificação no trato anogenital das gestantes é de importância para asaúde da mulher e do feto, visto que esse microrganismo pode causar infecções neonatais graves, septicemia, pneumonia e meningite neonatal, assim como causar infecção no organismo materno e comprometer a evolução da gestação. Cento e quarenta e quatrogestantes foram submetidas à coleta de secreção vaginal e perianal para cultura em meio Stuart. A amostra da secreção vaginal foi inoculada em agar sangue e a amostra da secreção anal em meio azida, as quais foram incubadas a 37°C, por 24 horas, seguindo-se o teste de CAMP. Foi possível verificar a alta frequência de colonização por S.agalactiae, neste estudo (40%), principalmente em pacientes entre a 34ª e a 37ª semanas de gestação (64%), o que ressalta a importância da inclusão da cultura de secreção vaginal e perianal para pesquisa desse microrganismo nos exames pré-natais...

Repair of an oroantral communication by a human amniotic membrane: a novel technique

The amniotic membrane is the innermost layer of fetal membrane and is attached to the chorion in the placenta. This membrane has been used for nearly a century in varied fields such as ophthalmology, reconstructive surgery, and burn treatment. In this case report, we used a human amniotic membrane to repair an iatrogenic oroantral communication that occurred during the extraction of the patient's right upper second molar. A splint was given after the perforation was covered with human amniotic membrane and healing was clinically evaluated at various intervals. The outcome of the study revealed that the human amniotic membrane was an efficient graft material for repairing the defect caused by an iatrogenic oroantral communication following tooth extraction.

Transient folate deprivation in combination with small-molecule compounds facilitates the generation of somatic cell-derived pluripotent stem cells in mice / 华中科技大学学报（医学）（英德文版）

Induced pluripotent stem cells (iPSCs) can be propagated indefinitely, while maintaining the capacity to differentiate into all cell types in the body except for the extra-embryonic tissues. This iPSC technology not only represents a new way to use individual-specific stem cells for regenerative medicine but also constitutes a novel method to obtain large numbers of disease-specific cells for biomedical research. However, the low efficiency of reprogramming and genomic integration of oncogenes and viral vectors limit the potential application of iPSCs. Chemical-induced reprogramming offers a novel approach to generating iPSCs. In this study, a new combination of small-molecule compounds (SMs) (sodium butyrate, A-83-01, CHIR99021, Y-27632) under conditions of transient folate deprivation was used to generate iPSC. It was found that transient folate deprivation combined with SMs was sufficient to permit reprogramming from mouse embryonic fibroblasts (MEFs) in the presence of transcription factors, Oct4 and Klf4, within 25 days, replacing Sox2 and c-Myc, and accelerated the generation of mouse iPSCs. The resulting cell lines resembled mouse embryonic stem (ES) cells with respect to proliferation rate, morphology, pluripotency-associated markers and gene expressions. Deprivation of folic acid, combined with treating MEFs with SMs, can improve the inducing efficiency of iPSCs and reduce their carcinogenicity and the use of exogenous reprogramming factors.

Factores de riesgo en la corioamnionitis / Chorioamnionitis risk factors

Se realizó un estudio de casos y controles de 96 gestantes (48 en cada grupo) que parieron en el Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba, en el bienio 2008-2009, para determinar algunos factores clinicoepidemiológicos que incidieron en la aparición de corioamnionitis. En la investigación fueron incluidas todas las embarazadas con 28 semanas de gestación y más. Para validar los resultados se utilizaron la prueba no paramétrica de Ji al cuadrado, el método porcentual y las proporciones. En la casuística, los factores determinantes de la ocurrencia del proceso infeccioso, fueron: malnutrición materna por defecto (en 26,8 por ciento), politactos (más de 3 en 15,5 por ciento), infecciones genitales asociadas al embarazo (en 74,2 por ciento), tiempo de rotura de membranas e inicio del trabajo de parto después de 24 horas (en 22,7 por ciento).

A case-control study of 96 pregnant women (48 in each group) who delivered at Tamara Bunke Bider Teaching Gynecobstetric Hospital from Santiago de Cuba was carried out during the biennium 2008-2009, in order to determine some clinical-epidemiological factors that influence in the chorioamnionitis onset. All pregnant women with 28 gestation weeks or more were included in the research. Non-parametric chi-square test, percentage method, and proportions were used to validate the results. Determinant factors of the occurrence of the infectious process in the case material were as follows: maternal malnutrition by default (in 26,8 percent), multiple vaginal examination (more than 3 in 15,5 percent), pregnancy-associated genital infections (in 74,2 percent), and membrane rupture time and labor initiation after 24 hours (in 22,7 percent).

Análise crítica dos métodos não-farmacológicos de indução do trabalho de parto / Critical analysis of non-pharmacological methods for induction of labor

A indução do trabalho de parto tem se tornado prática corrente na Obstetrícia moderna. Vários métodos têm sido propostos, e dentre eles os não-farmacológicos merecem destaque. Estes métodos podem ser classificados como naturais e artificiais. Os estudos realizados para avaliar os diversos métodos naturais, como homeopatia, acupuntura, óleo de rícino, enema, banho quente de imersão, relações sexuais e estimulação mamária para indução do trabalho de parto, são heterogêneos e ainda não existe evidência suficiente de que possam ser utilizados na prática clínica. Dentre os métodos artificiais, o descolamento das membranas encontra-se associado à indução efetiva do parto, porém, o procedimento é doloroso e pode ser desconfortável para as mulheres. A capacidade máxima de dilatação da laminária ocorre entre 12 e 24 horas, entretanto tem sido pouco utilizada devido ao surgimento de métodos mais efetivos. A sonda de Foley constitui um procedimento efetivo que pode ser usado na presença de contraindicações para os métodos farmacológicos, especialmente em gestantes com cesárea anterior, porém persistem preocupações quanto ao risco de infecção materna e fetal. Por outro lado, a ruptura artificial das membranas e os métodos mecânicos ainda não podem ser recomendados, porque as evidências sobre sua efetividade e segurança são insuficientes, mesmo quando associados à administração intravenosa de ocitocina.

Induction of labor has been currently a routine practice in Obstetrics. Several methods have been proposed and among them the non-pharmacological methods deserve consideration. These methods are classified as natural and artificial ones. Studies conducted to evaluate natural methods, such as homeopathy, acupuncture, ricin oil, enema, hot water immersion, sexual intercourse and nipple stimulation for labor induction, are heterogeneous and there is no enough evidence yet to support their use in clinical practice. Among artificial methods, membrane sweeping is associated with success on labor induction but can be a painful procedure, which is considered uncomfortable by several women. The maximum dilation of laminaria occurs between 12 and 24 hours, but this method has been less used because other methods are more effective. Foley catheter is a safe and effective procedure that can be used in the presence of contraindications for pharmacological methods, especially in pregnant women with previous cesarean section. Notwithstanding, there are still concerns about the risk of maternal/fetal infection. On the other hand, artificial rupture of membranes (amniotomy) cannot be recommended so far because evidences about its effectiveness and safety are insufficient, even when associated with intravenous administration of oxytocin.

Effect of Hyoscine-N-Butyl bromide [buscopan] in accelerating first stage of labor

To determine the effect of Hyoscine-N-Butyl Bromide [Busocpan] in accelerating first stage of labor and its relationship to the presence or absence of fetal membrane. The study was carried out between 1st May, 2007 and 3rd October, 2007 at Jidhafs Maternity Hospital in the Kingdomof Bahrain. A quasi-experimental prospective randomized control study was conducted on 92 primigravidas with single cephalic pregnancies who underwent spontaneous labor and who were not subjected for augmentation with any drug in active phase of labor. Sixty four patients were subjected to 40 mg intra-muscular injection of Busocpan and 28 acted as control. The rate of cervical dilatation was compared in both groups. The duration of fist stage of labor was 3.6 +/- 3.0 hours [mean +/- Standard deviation] for the Busocpan group and 4.7 +/- 2.9 hours [mean +/- SD.] for the control group. On comparing the mean of the duration of first stage of labor amongst different subgroups, it was found that the difference was only statistically significant in Buscopan group with absent membranes as compared to Busocpan group with intact membranes. Hyoscine-N-Butylbromide [Buscopan] was not effective in shortening the first stage of labor for primigravidas in comparison to control. However, Busocpan proved to be highly effective in shortening first stage of labor among patients with absent fetal membranes as compared to those who received Busocpan when their fetal membranes were present

Histological and Immunohistochemical Findings of the Intermediate Trophoblasts in Normal Full Term and Pre-eclamptic Placentas

BACKGROUND: Recent studies have suggested that implantation site intermediate trophoblasts (ISITs) and chorionic type intermediate trophoblasts (CTITs) show different immunohistochemical findings, and that each type has specific location in placentas. However, we observed that both subtypes are intimately admixed in many areas of the placentas and both types are proliferated around the infarcts. METHODS: In order to examine the site specificity in their distribution and the changes of intermediate trophoblasts (ITs), if any, in the pre-eclamptic placentas, quantitative analyses of ISITs and CTITs using p63, CD146, placental alkaline phosphatase, human placental lactogen, and alpha-inhibin were performed in normal and pre-eclamptic placentas containing infarcts. RESULTS: In the fetal membranes of both normal and pre-eclamptic placentas, CTITs and ISITs were equally identified, forming distinct layers. ISITs were predominant in the intervillous septum and basal plate, while CTITs were predominant in the subchorionic area. At the margin of infarcts in pre-eclamptic placentas, both subtypes were increased in number, forming distinct layers. CONCLUSIONS: The subtypes of ITs do not have site specificity in placentas. Increased number of ITs and zonal distribution around infarcts suggest that CTITs and ISITs have differentiation associated relationship, and the differentiation might be related to the microenvironment of placenta, such as intraplacental oxygen concentration.

Management of Cervical Incompetence with Bulging Fetal Membranes : Emergency Cerclage Versus Bed Rest / 대한주산의학회잡지

PURPOSE: To compare clinical outcomes after management with bed rest versus cerclage for treatment of amniotic sac bulging in the second trimester. METHODS: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27weeks of gestation, were treated with bed rest or emergency cerclage. We analyzed the pregnancy outcome retrospectively. 25 women underwent an emergency cerclege and 35 women underwent the bed rest. RESULTS: Gestational age at time of diagnosis was 22.40 weeks in the emergency cerclage and 22.39 weeks in the bed rest group. Mean interval from diagnosis until delivery was 8.65 weeks in the emergency cerclage group and 1.18 weeks in the bed rest group (p<0.001). Mean gestational age at delivery was 31 weeks in emergency cerclage group and 23.74 weeks in the bed rest group (p<0.001). Preterm delivery before 26 weeks and 34 weeks of gestation were significantly lower in the emergency cerclage group (p<0.001). Perinatal mortality was 17.4% in the emergency cerclage group and 48.6% in bed rest group (P=0.026). CONCLUSION: Emergency cerclage reduced preterm delivery before 26 and 34 weeks and improved perinatal outcome compared with bed rest treatment.

Evolução morfométrica dos anexos embrionários e fetais bovinos obtidos por monta natural, com 10 a 70 dias da gestação / Biometrics evolution of the embryonic and fetal annexes in cows obtained by natural mating, at 10 to 70 days of gestation

O período inicial da gestação de bovinos é caracterizado por grandes perdas embrionárias. Considerando a importância deste fator no âmbito da reprodução animal foram estudados os anexos embrionários e fetais bovinos fecundados por monta natural de 15-70 dias de gestação, com o objetivo de estabelecer parâmetros morfométricos da placenta na fase inicial da gestação. Com uso de um paquímetro foram realizadas mensurações do comprimento (crânio caudal), largura (latero lateral) e altura (dorso ventral) das membranas corioalantóide e amniótica. O início da formação dos cotilédones foi observado e quantificado, assim como, o peso placentário. O peso médio do saco gestacional aumentou com o evoluir da idade gestacional, entretanto, o crescimento foi acelerado a partir de 20-30 dias de gestação. O comprimento crânio caudal e dorso ventral da membrana corioalantóide e do âmnio apresentaram crescimento lento e gradual com o evoluir dos períodos gestacionais analisados. Com 30-40 dias de gestação, os primeiro cotilédones já eram visualizados e contatos com facilidade na superfície coriônica. Os períodos de crescimento coincidiram com os maiores índices de perdas gestacionais em bovinos. Os parâmetros aqui analisados poderão servir para futuras investigações dos anexos embrionários de organismos manipulados em laboratório.

The main goal of this morphometrical study was to characterize the development of the extra-embryonic membranes of 15 to 70-day-old bovine embryos obtained by natural mating. With a millimeter paquimeter the cranio-caudal, latero-lateral and dorso-ventral measurements of chorion and amnion were determined. The development of the cotyledons and weight of the gestational sac were observed and quantified. The weight of the gestational sac increased during gestation; however, the growth was faster then 20 to 30 days. The cranial-caudal and dorsal-ventral length of the choriallantois and the amnion developed slowly and gradually with progress of the gestational period, and the cranio-caudal length decreased after 50 to 60 days of gestation, increasing in the next period. After 30 to 40 days of gestation, the first cotyledons were visualized and counted easily in the chorionic surface. The growth periods were the same of the main gestational losses in cattle. The parameters analyzed could be useful for investigations of extra-embryonic membranes in organisms manipulated in the laboratory.

Expressão local do fator de necrose tumoral alfa na ruptura prematura de membranas / Local expression of tumor necrosis factor-alpha on premature rupture of membranes

OBJETIVO: comparar a expressão do fator de necrose tumoral alfa (TNF-α) em membranas ovulares com ruptura prematura (RPM) e com ruptura oportuna das mesmas; verificar a associação entre a expressão do TNF-α em membranas ovulares e o grau de corioamnionite das mesmas e correlacionar a expressão do TNF-α e o tempo de ruptura das membranas. MÉTODOS: foram analisadas as membranas ovulares de 31 parturientes com RPM, com idade gestacional acima de 34 semanas, e de 14 parturientes com ruptura oportuna das membranas, com idade gestacional igual ou maior de 37 semanas. A detecção da corioamnionite foi feita por meio de estudo histopatológico. A avaliação da expressão do TNF-α foi feita por meio de técnica imunoistoquímica, na qual foi empregado o método streptavidina-biotina-peroxidase (LSAB). RESULTADOS: o tempo médio de ruptura foi de 16,6 horas. A frequência da expressão de TNF-α, nos Grupos Controle e Estudo, não mostrou diferença significante (χ2=6,6; p=0,08). No Grupo Estudo, houve correlação entre o grau de corioamnionite e a intensidade da expressão de TNF-α (coeficiente de Spearman (Rs)=0,4; p=0,02). CONCLUSÕES: não houve diferença significante entre as expressões do TNF-α em membranas ovulares com ruptura prematura e com ruptura oportuna das mesmas; no Grupo Estudo, constatou-se associação significante entre a expressão do TNF-α e o grau de corioamnionite e não houve associação entre o tempo de ruptura e a intensidade da expressão do TNF-α.

PURPOSE: to compare the expression of tumor necrosis factor-alpha (TNF-α) in ovular membranes with premature rupture (MPR) and with opportune rupture; to verify the association between the expression of the TNF-α in ovular membranes and the degree of chorioamnionitis, correlating the expression of the TNF-α and the membranes' time of rupture. METHODS: ovular membranes from 31 parturients with MPR, with gestational ages over 34 weeks, and from parturients with opportune membranes' rupture, with gestational ages equal or over 37 weeks. Chorioamnionitis detection has been done by histopathological analysis. The evaluation of the TNF-α expression has been done by immune-histochemical technique, using the labile streptavidin-biotin-peroxidase (LSAB) method. RESULTS: the average rupture time was 16.6 hours. The ratio of the TNF-α expression in the Control and Study Groups did not show a significant difference (χ2=6.6; p=0.08). In the Study Group, there was no correlation between the degree of chorioamnionitis and the intensity of TNF-α expression (Spearman's coefficient (Rs)=0.4; p=0.02). CONCLUSIONS: there was no significant difference between the TNF-α expression in ovular membranes with premature or opportune rupture; in the Study Group, there was significant association between TNF-α expression and the degree of chorioamnionitis, and there was no association between rupture time and the intensity of TNF-α expression.

Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia

Objective. To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. Design. A cross-sectional study. Setting. Labour Ward; Muhimbili National Hospital; Dar es Salaam; Tanzania. Methods. The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measu- red. Data on socio-demographic characteristics; iron supplementation; malaria prophylaxis; blood transfusion during current pregnancy; and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb =11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - Hb 7.0 - 8.9 g/dl; and severe - Hb 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (37 weeks); Apgar score; stillbirth; early neonatal death; low birth weight (LBW) (2 500 g) and very low birth weight (VLBW) (1 500 g). Results. A total of 1 174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14 - 46 years) and median parity was 2 (range 0 - 17). The prevalence of anaemia and severe anaemia was 68and 5.8; respectively. The risk of preterm delivery increased significantly with the severity of anaemia; with odds ratios of 1.4; 1.4 and 4.1 respectively for mild; moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7; 3.8 and 1.5; and 1.9 and 4.2 respectively. Conclusion. The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia