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Abstract Objective To compare the outcomes of emergency and planned peripartum hysterectomies. Methods The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. Results A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p=0.014), and higher postoperative hemoglobin levels (9.9±1.3 versus 8.3±1.3; p<0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. Conclusion Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.
Resumo Objetivo Comparar os resultados das histerectomias periparto de emergência e planejada. Métodos Este estudo transversal retrospectivo foi realizado em dois hospitais. Os resultados maternos e neonatais foram comparados de acordo com as histerectomias periparto de emergência e planejada. Resultados Um total de 34.020 partos foram avaliados retrospectivamente, e 66 casos de histerectomia periparto foram analisados. Destes, 31 eram casos de cirurgias planejadas, e 35, cirurgias de emergência. As pacientes que foram submetidas à histerectomia periparto planejada tiveram uma taxa menor de transfusão de sangue (83,9% versus 100%; p=0,014), e níveis mais elevados de hemoglobina pós-operatória (9,9±1,3 versus 8,3±1,3; p<0,001) em comparação com o grupo de histerectomia de emergência. O peso ao nascer foi menor, embora as pontuações na escala de aparência, frequência cardíaca, irritabilidade reflexa, tônus muscular, e respiração (appearance, pulse, grimace, activity, and respiration, Apgar, em inglês) fossem maiores no grupo da cirurgia planejada em comparação com os casos de emergência. Conclusão A histerectomia periparto planejada com uma equipe experiente resulta em menos necessidade de transfusão e melhora os resultados neonatais em relação à histerectomia periparto de emergência.
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Humanos , Feminino , Gravidez , Placentação , Emergências , HisterectomiaRESUMO
A pré-eclâmpsia (PE) caracteriza-se por um quadro clínico grave e multissistêmico em gestantes previamente normotensas e até o momento sem etiologia completamente esclarecida. Vários mecanismos fisiopatológicos têm sido implicados na patogênese e biomarcadores vêm sendo estudados para rastreamento de PE, porém ainda precisam ser validados para detecção precoce deste estado hipertensivo, o que complica a previsão e o tratamento da PE
Pre-eclampsia (PE) is a severe and multisystemic in previously normotensive pregnant women and, so far without fully clarified etiology. Several pathophysiological mechanisms have been implicated in the pathogenesis and biomarkers have been studied for PE screening, but they still need to be validated for early detection of this hypertensive state which complicates PE prediction and treatment.
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Resumen: ANTECEDENTES: La inmunología de la reproducción no es un área nueva: siempre ha estado relacionada con el aborto recurrente y con la falla repetida en la implantación, sobre todo en el contexto de una fertilización in vitro. Recientemente emergieron nuevos conceptos importantes que los ginecoobstetras deben considerar. OBJETIVO: Interrelacionar los conceptos básicos de inmunología, embriología y reproducción asistida para comprender mejor lo que la primera puede resolver y lo que no. METODOLOGÍA: Estudio retrospectivo efectuado con base en la búsqueda electrónica, llevada a cabo en febrero de 2020 en las bases de datos: PubMed y Google Scholar con los siguientes términos (MeSH): abortion, spontaneous/immunology; embryo implantation/immunology; HLA-c antigens/immunology; immune tolerance/immunology; immunity, maternally-acquired/immunology; uterus/immunology; killer cells, natural/immunology; placentation/immunology; receptors, kir/immunology; antigen presentation/genetics; antigen presentation/immunology; maternal-fetal exchange/genetics; maternal-fetal exchange/immunology. RESULTADOS: Se reunieron 289 artículos y se eliminaron 248 por no cumplir con los criterios de inclusión; solo se analizaron 41. Los artículos identificados sirvieron de base para actualizar la situación de la inmunología en el contexto de la medicina de la reproducción. Durante el proceso se revisaron otros artículos que sirvieran de soporte bibliográfico a los conceptos descritos en esta revisión. CONCLUSIONES: Debido al destacado interés en el estudio de la genética de los embriones, la medicina de la reproducción se enfocó más en ella y dejó de lado a la inmunología. Sin embargo, como la genética sigue sin poder explicar de manera adecuada las fallas en la implantación, la inmunología de la reproducción vuelve a cobrar impulso.
Abstract: BACKGROUND: Reproductive immunology is not a new area in reproductive medicine, it has always been related to recurrent miscarriage and repeated implantation failure, especially in the context of IVF. Recently, new concepts have emerged that are important for OBGYN specialists to keep in mind. OBJECTIVE: Interrelating the basic concepts of immunology, embryology and assisted reproduction to better understand what the former can and cannot solve. METHODOLOGY: Retrospective study based on the electronic search, carried out in February 2020, in the databases: PubMed and Google Scholar with the following terms (MeSH) The following MeSH terms were used: Abortion, Spontaneous/immunology; Embryo Implantation/immunology; HLA-C Antigens/immunology; Immune Tolerance/immunology; Immunity, Maternally-Acquired/immunology; Uterus/immunology; Killer Cells, Natural/immunology; Placentation/immunology; Receptors, KIR/immunology; Antigen Presentation/genetics; Antigen Presentation/immunology; Maternal-Fetal Exchange/genetics; Maternal-Fetal Exchange/immunology. RESULTS: 289 articles were collected, and 248 articles were deleted because they did not meet the inclusion criteria; only 41 were analyzed. The articles identified served as a basis for updating the status of immunology in the context of reproductive medicine. During the process, other articles were reviewed to serve as bibliographic support for the concepts described in this review. CONCLUSIONS: Due to the outstanding interest in the study of embryo genetics, reproductive medicine focused more on it and left immunology aside. However, since genetics still cannot adequately explain implantation failures, reproductive immunology is gaining momentum again.
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Resumen OBJETIVO: Reportar la evidencia quirúrgica, disponible en la bibliografía actual, acerca de la conducta médica que debe seguirse en pacientes con placenta anormalmente adherida en embarazos mayores de 20 semanas, según la pérdida hemática que se correlaciona con la morbilidad y mortalidad materna. METODOLOGÍA: Revisión sistemática de la bibliografía asentada en PubMed, Google Scholar, Uptodate y SciELO de artículos publicados en inglés y español, entre 2002 y 2019, con las palabras clave Mesh (Medical Subject Headings): placenta acreta; placenta previa; uterine repair; caesarean hysterectomy; placenta percreta; uterine conservation; uterine compression suture; hemorragia obstétrica; placentación anómala; placenta anormalmente adherida. Criterios de inclusión: artículos de casos y controles, y series de casos que incluyeron pacientes con diagnóstico de placenta anormalmente adherida, con apartados de la técnica quirúrgica utilizada y descripción de su desenlace. RESULTADOS: Se encontraron 40 artículos y se seleccionaron 34 que describían casos con diagnóstico de placenta anormalmente adherida y descripción de la técnica quirúrgica aplicada para disminuir la morbilidad y mortalidad materna. Se compararon las distintas técnicas quirúrgicas; se encontraron 9 artículos con técnicas quirúrgicas distintas para el control de la hemorragia obstétrica, en 2 de ellos no hubo reporte de la pérdida hemática, útil para esta revisión. CONCLUSIONES: Se demuestra que la técnica vascular integral avanzada (VIVA) y de Bautista son las que mejor se relacionan con disminución de la morbilidad y mortalidad materna. La búsqueda de técnicas quirúrgicas y estrategias para abatir la muerte materna, por placenta anormalmente adherida y la aplicación y comprensión de lo aquí expuesto, puede contribuir a disminuir la incidencia de desenlaces fatales.
Abstract OBJECTIVE: Report the surgical evidence available in the current literature about the medical behavior to be followed in patients with abnormally attached placenta in pregnancies older than 20 weeks, according to blood loss that correlates with maternal morbidity and mortality. METHODOLOGY: Systematic review of the literature available on PubMed, Scholar.google.com, Uptodate, SciELO, of articles published in English and Spanish, from 2002 to the present (August 2019), with the following keywords Mesh (Medical Subject Headings ): placenta acreta; previous placenta; uterine repair; Caesarean Hysterectomy; placenta percreta; uterine conservation; uterine compression suture; obstetric hemorrhage; anomalous placentation; abnormally attached placenta. Inclusion criteria: articles of control cases and case series that included pregnant patients with abnormally adhered placental diagnosis and sections of the surgical technique used, the outcome of which is described in the manuscript. RESULTS: 40 articles were found but only 34 studies were described that described cases with abnormally adhered placental diagnosis and description of the surgical technique used to achieve a decrease in maternal morbidity and mortality, so the different surgical techniques were compared, 9 articles were found with techniques different surgical procedures for the control of obstetric hemorrhage, in 2 of them there was no report of blood loss, useful for this review. CONCLUSIONS: It is shown that the advanced integral vascular technique (VIVA) and that of Bautista are the ones that are best related to a decrease in maternal morbidity and mortality. The search for surgical techniques and strategies to reduce maternal death, due to an abnormally attached placenta and the application and understanding of what is stated here, can contribute to reducing the incidence of fatal outcomes.
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Background: Peripartum hysterectomy is a life-saving obstetric procedure that is performed at the time of a caesarean section or postpartum following either vaginal delivery or caesarean section. The purpose of the present study was to determine the incidence, risk factors ,indications ,maternal and neonatal morbidity, mortality and complications of emergency peripartum hysterectomy performed at a tertiary teaching hospital in South India and to compare the results with other reports in literature.Methods: During the period of study between January 2015-December 2016, there were 50 cases of emergency peripartum hysterectomy at Tirunelveli medical college hospital, Tirunelveli, Tamil Nadu, South India. Medical, pathology and operation theatre records were analyzed retrospectively. Details of maternal age, parity, booking status, underlying risk factors, past obstetric history, gestational age at delivery ,mode of delivery ,indications for emergency peripartum hysterectomy, type of operation, intraoperative and post-operative complications, blood components transfusion ,maternal and neonatal outcomes were noted and analyzed.Results: During the 2-year study period there were 50 emergency peripartum hysterectomy out of 14,363 deliveries, a rate of 1 per 294 deliveries (3.4/1000 deliveries). 80% of hysterectomies were performed after caesarean delivery and 20% after vaginal delivery. The two major indications were abnormal placentation (40%) and uterine atony (28%). There were 6 maternal deaths among patients who underwent emergency peripartum hysterectomy during the period of study.Conclusions: Improved antenatal care, correction of anaemia, identification of risk factors for peripartum hysterectomy, timely referral, expedite management, timely decision, availability and liberal use of blood components and appropriate management of post-operative complications by experienced clinical team are the main stay for saving maternal lives. With increasing rate of caesarean section there is rise in the incidence of abnormal placentation.
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Successful pregnancy and delivery of a healthy offspring largely rely on a well-developed placenta. Defects in placental development may lead to various pregnancy complications. However, placenta has been one of the least understood organs. The mechanism of its development and function, as well as the molecular association between placental disorders and pregnancy complications remain unclear, thus become the least known area in the exploration of pregnancy and life. Along with the advances in modern techniques, the understanding of the placenta has been deepened from tissue structure to cellular and molecular level, and gradually toward the omics and systematic biology. In recent years, a number of groundbreaking achievements have been made in the field of placental development, which were summarized in this article. Some relevant international funding programs and future prospects in this area were also discussed.
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Successful pregnancy and delivery of a healthy offspring largely rely on a well-developed placenta. Defects in placental development may lead to various pregnancy complications. However, placenta has been one of the least understood organs. The mechanism of its development and function, as well as the molecular association between placental disorders and pregnancy complications remain unclear, thus become the least known area in the exploration of pregnancy and life. Along with the advances in modern techniques, the understanding of the placenta has been deepened from tissue structure to cellular and molecular level, and gradually toward the omics and systematic biology. In recent years, a number of groundbreaking achievements have been made in the field of placental development, which were summarized in this article. Some relevant international funding programs and future prospects in this area were also discussed.
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Esta revisión describe a los genes involucrados en los procesos inmunes y angiogénicos necesarios para la formación de la placenta, y cómo alteraciones en el fino equilibrio en el que están puede predisponer a la preeclampsia.
This review describes the genes involved in the immune and angiogenic processes that lead to normal placenta development and vascularity. Any change in this fragile equilibrium may predispose to preeclampsia.
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As desordens hipertensivas na gestação, em especial a pré-eclâmpsia (PE), são consideradas, nos países em desenvolvimento, a maior causa de morbimortalidade tanto materna quanto perinatal. Com objetivo de alcançar maior entendimento da fisiopatologia da PE e de evitar as manifestações clínicas desta doença e suas consequências, foram realizadas pesquisas relacionadas à suplementação de substâncias que atuariam na fisiopatologia, em especial examinando o uso do ácido acetilsalicílico (AAS). O uso de AAS em baixas doses em gestantes com alto risco de desenvolver PE quando iniciado na 16ª semana de gestação, ou mesmo antes, pode ser considerado importante avanço devido aos resultados observados em estudos relatando boa eficácia e redução do risco de morte perinatal, de restrição de crescimento intrauterino e de nascimento pré-termo.(AU)
Hypertensive disorders in pregnancy, particularly preeclampsia (PE), are considered a major cause of maternal and perinatal morbidity and mortality in developing countries. With the objetive of improving the knowledge about the pathophysiology of PE, and to avoid the clinical manifestations and consequences of this disease, several studies related with the supplementation of acetylsalicylic acid (AAS) on the PE pathophysiology have been performed. The use of low doses of AAS starting at or before week 16 can be considered an important advance in reducing the risk of perinatal death, intrauterine growth restriction and preterm birth.(AU)
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Humanos , Feminino , Gravidez , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/prevenção & controle , Aspirina/uso terapêutico , Gravidez de Alto Risco/efeitos dos fármacos , Placentação/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Metanálise como Assunto , Eficácia , Trabalho de Parto Prematuro/prevenção & controleRESUMO
A utilização da transgenia com a proteína fluorescente verde (GFP) como marcador de células de origem fetal nas placentas de clones bovinos servirá de modelo inédito para estudo morfofisiológico e imunológico da interação materno-fetal, visto que possibilitará o seu mapeamento, diferenciando as células fetais das maternas. Tal modelo terá aplicação direta, principalmente porque estes são animais que apresentam problemas em relação ao seu desenvolvimento. Com o auxílio deste modelo, pretende-se verificar o transporte de substâncias entre a mãe e o feto via endocitose, pela imunolocalização das proteínas chamadas de caveolinas. Para tanto foram utilizados 06 bovinos clonados e 30 bovinos de inseminação artificial (IA) com idade até 90 dias de gestação, os quais tiveram seu desenvolvimento interrompido mediante abate humanitário das receptoras e ovariosalpingohisterectomia, com posterior recuperação do útero gestante. Foram coletados os placentônios e o cório. Uma parte das amostras foi recortada e fixada, por imersão, em solução de parafolmaldeído a 4% ou formoldeído a 10% em tampão fosfato de sódio (PBS) a 0,1M pH 7.4, solução de Zamboni (4% de paraformoldeído, 15% de ácido pícrico, em tampão fosfato de sódio a 0,1M pH 7.4), metacarn (60% de metanol, 30% de clorofórmio, e 10% de ácido acético glacial), para verificação da morfologia e realização de imuno-histoquímica para as proteínas caveolinas -1 e -2 (CAV -1 e CAV-2)...
The transgenic application of green fluorescent protein (GFP) as fetal cell marker on cattle cloned placenta could provide an exclusive model for studying the morphologic and immunologic maternal-fetal interactions, providing information about its mapping, distinguishing the fetal from maternal cells. This model will have direct application, mainly because these animals present problems during its development. With this model's support, we intend to verify the substances transport between mother and fetus during endocytosis, through the immunolocalization of protein named caveolae. For these, we used 06 cloned bovine and 30 cattle samples of artificial insemination (AI) with 90 days of pregnancy, which had been their development interrupted by humanitarian slaughter of the recipient and recovery of the pregnant uterus. We collected the placentome and the chorion. A part of the samples was cut and fixed, by immersion, on a solution containing 4% of parafomaldehyde or 10% of formaldehyde on a sodium phosphate buffer (PBS), at 0,1M pH 7.4, Zamboni solution (4% of paraformaldehyde, 15% of picric acid, on sodium phosphate buffer 0,1M pH 7.4), metacarn (60% of metanol, 30% of chloroform, and 10% glacial acetic acid), for morphologic and immunohistochemistry verification for caveolinas proteins -1 and -2 (CAV -1 and CAV- 2). The caveolins -1 were found in fetal and maternal villi, but its strongest staining was observed in the endometrial stroma. The caveolins -2 had positive staining in trophoblast and chorioallantoic membrane, and specifically in giant trophoblastic binucleated cell. Therefore the results were compared between cloned cattle and from AI or natural mating, for assisting on detection of the reason of many placental alterations, embryonic losses, spontaneous abortion, post-natal mortality and large offspring syndrome on laboratory-manipulated animals. The result suggests that the proteins caveolins -1 and -2 (CAV-1 and CAV-2)...
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Animais , Feminino , Gravidez , Lactente , Bovinos , Animais Geneticamente Modificados/embriologia , Cavéolas/ultraestrutura , Caveolinas/genética , Clonagem de Organismos/veterinária , Apoptose , Crescimento Celular , Endocitose , Imunofluorescência/veterinária , Metabolismo dos Lipídeos , Pinocitose , Vilosidades Coriônicas/fisiologiaRESUMO
Los embarazos gemelares implican mayor riesgo de complicaciones materno-fetales que los embarazos únicos, particularmente en los monocoriales. El objetivo del trabajo fue describir las características clínicas y los desenlaces materno-fetales, por tipo de placenta (monocorial o bicorial), de los embarazos gemelares atendidos en el Hospital Universitario de Santander (HUS), institución de tercer nivel de complejidad localizada en Bucaramanga (Colombia). Materiales y métodos: estudio descriptivo de cohorte, se incluyeron las pacientes que terminaron un embarazo gemelar entre 2007 y 2011 en el HUS, hospital general de referencia de la región centro-oriental del país. Muestreo consecutivo. Se evaluó la edad gestacional en la primera consulta al hospital, los hallazgos clínicos en la evaluación inicial, la terminación del parto y los resultados perinatales. Se hace análisis descriptivo por tipo de corionicidad. Resultados: se incluyeron un total de 248 gestantes con embarazo gemelar en el periodo de estudio. La mediana de la edad gestacional en la primera atención en el hospital en fue de 34 semanas. Al ingreso, 127 (51,2 %) pacientes se diagnosticaron con embarazo monocorial, pero solo en dos terceras partes coincidió el diagnóstico prenatal de corionicidad con el del posparto. Se diagnosticó RCIU con más frecuencia en embarazos monocoriales que en bicoriales (22,3 vs. 7,5 %), y el doppler se encontró alterado con mayor frecuencia en fetos de embarazo monocorial (7,8 vs. 1,1 %). Los neonatos > 24 semanas de edad gestacional de embarazo monocorial pesaron, en promedio, 109 g (IC 95 %: 34-184) menos que los bicoriales. Conclusiones: los resultados de este estudio sugieren un problema de salud pública en este grupo de pacientes, con inicio tardío de control prenatal, de remisión tardía a centros especializados y capacidad insuficiente para definir corionicidad. Se requiere plantear estrategias de atención que incluyan considerar los embarazos gemelares como alto riesgo y garantizar la atención oportuna y adecuada, orientada por una guía de cuidado diferencial para este grupo de gestantes...
Twin pregnancies, especially monochorionic placentations, are associated with a higher rate of maternal and foetal complications when compared to singleton pregnancies. The objective of this work was to describe the clinical characteristics and the maternal and foetal outcomes according to the type of placentation (monochorial or dichorial) of twin pregnancies delivered at Hospital Universitario de Santander (HUS), a level III institution located in Bucaramanga, Colombia. Materials and methods: Descriptive cohort study. The cohort consisted of patients delivered of a twin pregnancy between 2007 and 2011 at the HUS, a general referral hospital for the central-eastern region of the country. The assessment included gestational age at the time of initial presentation to the hospital, clinical findings during the initial assessment, delivery completion, and perinatal results. Descriptive analysis by chorionicity type. Results: A total of 248 women with a twin pregnancy during the study period were included. The mean gestational age on the first visit to the hospital was 34 weeks. On admission, 127 patients (51.2%) were diagnosed with a monochorionic pregnancy, but only in two thirds of the cases was the prenatal chorionicity diagnosis consistent with the post-partum finding. IUGR was diagnosed more frequently in monochorionic than in dichorionic pregnancies (22.3% v. 7.5%) and abnormal Doppler findings were more frequent in monochorionic foetuses (7.8% v. 1.1%). Neonates > 24 of gestational age in monochorionic pregnancies weigh in average 109 gr (IC 95%: 34-184) less than dichorionic twins. Conclusions: The results of this study suggest a public health problem in this group of patients who come late for their prenatal visits and are late referrals to specialized centres, when there is already a limited ability to determine chorionicity. There is a need to develop care strategies in which twin pregnancies are included as a high-risk condition, and to ensure timely and adequate care provision in accordance with differential care guidelines for this group of pregnant women...
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Adulto , Feminino , Gravidez , Transfusão Feto-Fetal , Trabalho de Parto Prematuro , Placentação , Gravidez de Alto Risco , Gravidez de GêmeosRESUMO
Foi avaliada a existência de correlação entre diferentes anexos fetais de mocós e determinada a relação entre peso do feto e peso da placenta, a relação entre o peso do feto e comprimento do cordão umbilical e a relação entre o peso do feto e comprimento do feto. Foram utilizados anexos fetais e fetos de três, cinco e seis fêmeas, respectivamente, no terço inicial, médio e final de gestação, obtidas no Centro de Multiplicação de Animais Silvestres (CEMAS-UFERSA). Os dados foram expressos em média ± desvio-padrão, bem como valores mínimos e máximos, avaliados pelo programa estatístico GraphPad Prism Versão 6.0. Após a análise dos pressupostos paramétricos, os dados foram submetidos aos Testes de Kruskal-Wallis e Mann-Whitney, e regressão linear. A relação entre peso do feto e peso da placenta demonstrou expressão y = 33,73 + 16,38x com cálculo do coeficiente de correlação entre o peso do feto e o peso da placenta elevado e positivo, evidenciando dependência entre as variáveis (R2 = 0,7251). A relação entre o peso do feto e comprimento do cordão umbilical demonstrou expressão y = 35,64 + 25,64x e a análise de correlação entre as variáveis, positiva (R2 = 0,7201) indicando elevada dependência entre as variáveis. Quanto à relação entre o peso do feto e comprimento do feto, identificou-se uma relação do tipo y = a + bx, cuja expressão definida foi y = 1,26 + 0,41x, com análise de correlação das variáveis apresentando elevada correlação considerando-se o valor de R2 = 0,7890. As variáveis analisadas demonstram uma influência direta no desenvolvimento embrionário e fetal em mocós confirmando a correlação destes com o tamanho do feto.
We evaluated the correlation between different fetal membranes of rock cavies and determined the relationship between fetal weight and placental weight, the relationship between fetal weight and length of the umbilical cord and the relationship between fetal weight and length of the fetus. The fetuses and fetal membranes of three, five and six females respectively in the first third, middle and late gestation were used, obtained from Multiplication Center for Wild Animals of the Federal University Rural of Semiarid (CEMAS-UFERSA). The data were expressed as mean ± standard deviation, minimum and maximum values, evaluated by the statistical program GraphPad Prism version 6.0. After analysis of parametric assumptions, the data were subjected to Kruskal-Wallis test and Mann-Whitneys test and linear regression. The relationship between fetal weight and placental weight showed the expression y = 33.73 + 16.38x with an estimate of the coefficient of correlation between fetal weight and placental weight high and positive, showing dependence between variables (R2 = 0.7251). The relationship between fetal weight and length of the umbilical cord showed expression y = 35.64 + 25.64x and the correlation analysis between variables, positive (R2 = 0.7201) indicating high dependence between variables. Regarding the relationship between fetal weight and length of the fetus, we identified a relationship of the type y = a + bx, whose expression was defined y = 1.26 + 0.41x, with correlation analysis of the variables showing high correlation considering the value of R2 = 0.7890. The variables analyzed demonstrate a direct influence on embryonic andfetal development in rock cavies confirming the correlation of these with the size of the fetus.
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Animais , Ratos , Feto , Placentação , RoedoresRESUMO
FUNDAMENTO: A fisiopatologia da Pré-Eclampsia (PE) é caracterizada por deficiência no processo de placentação, disfunção endotelial sistêmica e hiperfluxo do Sistema Nervoso Central (SNC). Do ponto de vista clínico, seria interessante determinar a ocorrência desses fenômenos antes do aparecimento das manifestações clínicas da doença, levantando a possibilidade de novos métodos de predição da PE. OBJETIVO: Comparar o processo de placentação, a função endotelial e o hiperfluxo do SNC em gestantes de alto risco para desenvolvimento de PE que posteriormente desenvolveram ou não a síndrome. MÉTODOS: Um total de 74 gestantes foi submetido ao exame de Dilatação Fluxo-Mediada (DFM) da artéria braquial, dopplerfluxometria de artérias uterinas e oftálmica para avaliação da função endotelial, processo de placentação e hiperfluxo central, respectivamente. Os exames foram realizados entre 24 e 28 semanas de gestação e as pacientes foram acompanhadas até o puerpério para coleta de dados. RESULTADOS: Quinze pacientes tiveram a gestação complicada pela PE e 59 se mantiveram normotensas até o puerpério. Pacientes que subsequentemente desenvolveram PE apresentaram entre 24 e 28 semanas de gestação, maiores valores no índice de pulsatilidade das artérias uterinas e menores valores de DFM (p < 0,001 e p = 0,001, respectivamente). Entretanto, não houve diferença nos valores obtidos no índice de resistência da artéria oftálmica (p = 0,08). CONCLUSÃO: Os dados obtidos sugerem que a deficiência no processo de placentação e a disfunção endotelial precedem cronologicamente as manifestações clínicas da PE, o que não ocorre com o hiperfluxo do SNC.
BACKGROUND: The physiopathology of Preeclampsia (PE) is characterized by a deficiency in the process of placentation, systemic endothelial dysfunction and Central Nervous System (CNS) hyperflow. From a clinical point of view, it would be interesting to determine the occurrence of these phenomena before the onset of clinical manifestations of the disease, raising the possibility of new methods for predicting PE. OBJECTIVE:Compare the process of placentation, endothelial function and CNS hyperflow in pregnant women at high risk for the development of PE who subsequently developed or not the syndrome. METHODS: A total of 74 pregnant women underwent the Flow-Mediated Dilation (FMD) of the brachial artery, Doppler study of uterine and ophthalmic arteries for the assessment of endothelial function, process of placentation and central hyperflow, respectively. The examinations were performed between 24 and 28 weeks of gestation and were followed until the postpartum period for data collection. RESULTS: Fifteen patients had PE and 59 remained normotensive until the puerperium. Patients who subsequently developed PE had between 24 and 28 weeks of gestation, higher pulsatility index of uterine arteries and lower values of FMD (p < 0.001 and p = 0.001, respectively). However, there was no difference in the values obtained in the resistive index in the ophthalmic artery (p = 0.08). CONCLUSION: The data obtained suggest that the deficiency in the process of placentation and endothelial dysfunction chronologically precede the clinical manifestations of PE, which does not occur with CNS hyperflow.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Endotélio Vascular/fisiopatologia , Pré-Eclâmpsia/fisiopatologia , Útero/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Sistema Nervoso Central/irrigação sanguínea , Sistema Nervoso Central/fisiopatologia , Idade Gestacional , Placenta/irrigação sanguínea , Placenta/fisiopatologia , Placentação/fisiologia , Fatores de Risco , Estatísticas não Paramétricas , Artéria Uterina/fisiopatologia , Útero/irrigação sanguíneaRESUMO
OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Assuntos
Humanos , Hemoglobinas , Hemorragia , Coreia (Geográfico) , Prontuários Médicos , Placenta , Placentação , Hemorragia Pós-Parto , Período Pós-PartoRESUMO
Objetivos: Avaliar a influencia do estresse sobre os pesos maternos, placentários e fetais, as alterações histológicas placentárias e a expressão gênica dos fatores angiogênicos em ratas prenhes. Métodos: De setembro de 2007 a julho de 2008, foi realizado um estudo experimental do tipo casocontrole, em que 6 ratas prenhes foram submetidas a estímulos estressantes crônicos e agudos enquanto que 6 animais constituíram o grupo controle. No 20º dia de prenhez, todas as ratas foram sacrificadas. Os seguintes dados foram analisados e comparados entre os grupos: a. pesos maternos, placentários e fetais; b. alterações histológicas placentárias; e, c. expressão gênica dos fatores angiogênicos (VEGF-A e PlGF), dos seus receptores (VEGFR-1 e VEGFR-2) e do fator induzido por hipoxia (HIF-1). Resultados: Os pesos maternos, placentários e fetais foram significativamente menores no grupo de ratas prenhes-estressadas em relação ao controle. Histologicamente foram encontradas a presença de núcleos picnóticos no grupo prenhe-estressado. Observou-se expressão gênica significativamente maior de VEGF-A no grupo rata prenhe-estressada assim como redução significante da expressão gênica de PlGF, VEGFR-1, VEGFR-2, quando comparadas ao controle. Não houve alterações entre os grupos para o gene HIF-1. Conclusões: No modelo animal de estresse estudado, observou-se alterações significativas no peso placentário e da expressão gênica dos fatores angiogênicos placentários em ratas submetidas ao estresse.
Objectives: to evaluate the influence of the stress on the maternal, placental and fetal weights, on the histological findings and on the genetic expression of the angiogenic factors in pregnant rats. Methods: From September 2007 to Julie 2008, an experimental case-control study was conduced in which 6 pregnant rats were submitted to chronic and acute stress while six other were considered as controls. In the 20th day of gestation, all animals were sacrified. The following data were evaluated and compared between both groups: a. maternal, placental and fetal weights; b. histological findings; and c. genetic expression of angiogenic factors (VEGF-A and PIGF), receptors (VEGFR-1 and VEGFR-2) and hypoxic-induced factor (HIF- 1). Results: Maternal, placental and fetal weights were statistically smaller in the stressed animals comparing to controls. Histological analysis revealed picnotic nuclei in the placentas of stressed rats. A statistically significant increase in the genetic expression of VEGF-A as well as a reduction of the expression of the PlGF, VEGFR-1, VEGFR-2 were observed in the placentas of the stressed group in comparison to controls. There was no difference of expression of the gene HIF-1 between both groups. Conclusions: In the present animal model of stress, significant alterations in the placental weights, histology and genetic expression of the angiogenic factors among pregnant rats under stress.
Assuntos
Animais , Ratos , Modelos Animais , Placentação , Estresse FisiológicoRESUMO
OBJECTIVE: To investigate the clinical characteristics and associated risk factors for emergency peripartum hysterectomy classified by the amounts of blood loss. MATERIAL AND METHODS: We reviewed the medical records of 159 cases of peripartum hysterectomy among 46,666 deliveries, from Jan. 1995 to Dec. 2005 at the Dept. of Ob. & Gy. of Graduate School of Medicine, Gachon University of Medicine and Science. We divided the 159 cases into three groups based on the amounts of blood loss, which were group A as less than 2,000 mL of blood loss, group B as 2,000 to 4,000 mL of blood loss, and group C as more than 4,000 mL. The incidence, the type of delivery, the amounts of transfusion, the operative indication and the complications of peripartum hysterectomy were evaluated. RESULTS: The incidence of peripartum hysterectomy was 0.34% (159/46,666) and 0.47% in cases of cesarean section and 0.19% in vaginal delivery, respectively. There was no meaningful correlation between maternal age, parity, gestational age, hospital stay and amount of blood loss. The increments of blood loss correlated to the frequency of peripartum hysterectomy after cesarean section (p<0.05). The most common operative indication in group A was uterine atony (47.19%), and those in group B and C were adherent placentation (48.08%, 50.00%). Intraoperative and postoperative complications according to excessive bleeding were increased, and DIC, pulmonary infection, urethral and bladder injury were observed more frequently in group C than in group A. CONCLUSION: The emergency peripartum hysterectomy was related to adherent placentation and was accompanied with increased blood loss.