Pulsatility of the umbilical cord in full-term natural childbirths / Pulsatilidad del cable umbilical en nacimientos a plazo normal / Pulsatilidade do cordão umbilical em partos normais a termo

ABSTRACT Objective Measure umbilical cord pulsatility time and evaluate correlation/association with maternal and neonatal characteristics. Method Cross-sectional study, with 76 binomials, carried out in 2017, in a maternity hospital in Alagoas. Analysis with Pearson or Spearman correlation test and Mann-Whitney or Kruskal-Wallis test. Results Sixty-two parturients and their newborns participated of the research. The women had a gestational age ≥ 37 weeks, natural cephalic birth, without distortions. The newborns had average weight of 3326.29g, mostly male. The umbilical cord pulsatility time was 285.48s. There is a correlation between umbilical cord pulsatility time and placental delivery time (p<0.001). Other correlations/associations were not significant. Conclusion It suggested using a correlation between pulsatility time and placental delivery time in clinical decision making for good practices in childbirth assistance.

RESUMEN Objetivo Medir tiempo de pulsatilidad del cordón umbilical y evaluar la correlación/asociación con las características maternas y neonatales. Método Estudio transversal, con 76 pares, realizado en 2017, en maternidad en Alagoas. Análisis con la prueba de correlación de Pearson o Spearman y la prueba de Mann-Whitney o Kruskal-Wallis. Resultados Sesenta y dos mujeres en trabajo de parto y sus recién nacidos participaron. Las mujeres tenían edad gestacional ≥ 37 semanas, parto cefálico normal, sin distorsiones. Los recién nacidos tenían peso promedio de 3326.29g, la mayoría de ellos varones. Tiempo de pulsatilidad del cordón umbilical fue de 285.48s. Había correlación entre el tiempo de pulsatilidad del cordón umbilical y el momento del parto placentario (p<0,001). Otras correlaciones/asociaciones no fueron significativas. Conclusión Sugiere una correlación entre el tiempo de pulsatilidad y el tiempo de parto placentario para las buenas prácticas en la atención del parto.

RESUMO Objetivo Mensurar tempo de pulsatilidade do cordão umbilical e avaliar correlação/associação com característica maternas e neonatais. Método Estudo transversal, com 76 binômios, realizado no ano de 2017, em maternidade de Alagoas. Análise com teste de correlação de Pearson ou Spearman e teste de Mann-Whitney ou Kruskal-Wallis. Resultados Sessenta e duas parturientes e seus recém-nascidos participaram da pesquisa. As mulheres tinham idade gestacional ≥ 37 semanas, parto normal cefálico, sem distorcias. Os recém-nascidos tinham peso médio de 3326,29g, maioria do sexo masculino. O tempo de pulsatilidade do cordão umbilical foi 285,48s. Há correlação entre tempo de pulsatilidade do cordão umbilical e tempo de dequitação da placenta (p<0,001). Demais correlações/associações não foram significativas. Conclusão Sugere-se o uso correlação entre tempo de pulsatilidade e tempo de dequitação da placenta na tomada de decisão clínica para boas práticas na assistência ao parto.

Concentrations of Polybrominated Diphenyl Ethers in Maternal Blood, Placental Size, and Risk for Fetal Growth Restriction: A Nested Case-control Study / 生物医学与环境科学（英文）

Objective@#To explore the effects of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on placental size and birth outcomes.@*Methods@#Based on the perspective Wenzhou Birth Cohort, this nested case-control study included 101 fetal growth restriction (FGR) and 101 healthy newborns. Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry. The basic information of mother-newborn pairs was collected from questionnaires, whereas the placental size and birth outcomes of newborns were obtained from hospital records.@*Results@#A total of 19 brominated diphenyle ether (BDE) congeners were detected in maternal serum samples. Higher concentrations of BDE-207, -208, -209, and ∑ @*Conclusion@#A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes. Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.

Ultrastructure of bovine placenta during all gestational period / Ultraestrutura de placenta bovina durante todo o período gestacional

Placentas from pregnant cows with different gestation periods were used. Placental fragments of all groups were processed and evaluated by transmission electron microscopy. After fragment analysis, bovine placenta was observed to be epitheliochorial type in early pregnancy, becoming progressively sinepiteliocorial at the beginning of the second trimester. There are no ultrastructural evidences of inflammation in the region of caruncles throughout gestation, despite the invasion of caruncle proper lamina by trophoblast cells. However, throughout pregnancy and especially at the end, there were evident signs of cell degeneration in both trophoblast and the uterine epithelium. The active trophoblast cells intensely phagocytize cellular debris. There are complex interdigitations between the surface of the trophoblast and the uterine epithelium, which is related to the increase of the exchange surface between mother and fetus. At the end of pregnancy, interdigitations disappear, favoring the detachment and expulsion of the placenta after birth.(AU)

Foram utilizadas placentas de vacas abatidas em frigorífico com diversos tempos gestacionais. Fragmentos de placentomo de todos os grupos foram processados e avaliados em microscopia eletrônica de transmissão. Após análise dos fragmentos, observou-se que a placenta bovina é do tipo epiteliocorial no início da gestação, tornando-se sinepiteliocorial progressivamente a partir do início do segundo mês de gestação. Não existem evidências ultraestruturais de inflamação na região das carúnculas durante toda a gestação, apesar da invasão da lâmina própria caruncular por células trofoblásticas. No entanto, durante toda a gestação e em especial ao seu final, foram observados sinais evidentes de degeneração celular, tanto do trofoblasto como do epitélio uterino. As células trofoblásticas ativas fagocitam intensamente os debris celulares originados dessas degenerações. Existem complexas interdigitações entre a superfície do trofoblasto e do epitélio uterino, o que estaria relacionado com o aumento da superfície de troca entre mãe e feto. Ao final da gestação, praticamente desaparecem essas interdigitações, favorecendo o descolamento e a expulsão da placenta após o parto.(AU)

Imunofenotipagem dos linfócitos positivos para indoleamina 2, 3 dioxigenase (IDO) em cultura de células de placenta bovina / Phenotyping of the indoleamine 2, 3 dioxygenase (IDO) positive lymphocytes in bovine placental cell culture

A gestação é um estado fisiológico que exige adaptações imunológicas para que transcorra normalmente. Nesse período a mãe e o feto apresentam uma relação imunológica, ou seja, a interface materno fetal. A enzima indoleamina 2,3 dioxigenase (IDO) desempenha um papel importante na tolerância materno fetal, por ser responsável pela metabolização do triptofano, impedindo por diversas vias a proliferação principalmente de linfócitos TCD8. Diversos tipos celulares estão presentes na interface materno fetal e vários deles podem expressar a IDO. Os leucócitos com perfil Th1 produzem uma citocina conhecida: o interferon γ que estimula a expressão da IDO em vários tipos celulares. Os linfócitos são divididos em subpopulações de acordo com sua função e fenótipo. Seus tipos incluem linfócitos T, linfócitos B e as células natural killer (NK). Hormônios também atuam nesse processo a progesterona que exerce função determinante sobre a resposta imunológica materna podendo alterar o prognóstico gestacional e o estrógeno essencial para a tolerância materno fetal e manutenção da prenhez. Dessa maneira este trabalho tem por objetivo principal identificar os linfócitos presentes na placenta bovina em cultivo que expressam IDO (linfócitos T, linfócitos B e células NK), frente a estimulação por progesterona, estrógeno e interferon γ nas diversas fases gestacionais utilizando a citometria de fluxo. Segundo os resultados no período de 67,5 a 77, 5 dias com a adição de interferon γ a expressão da enzima IDO aumentou discretamente nos linfócitos TCD3, TCD4, e diferente dos linfócitos T CD8 apresentaram uma elevada expressão da enzima (4,48 ± 2,12 - 8,65± 4,91)....

Pregnancy is a physiological state that requires immune adaptation in order to be successfully carried on. During this period, mother and fetus establish an immune tolerance status at the maternal fetal interface. Indoleamine 2,3-dioxygenase (IDO) plays an important role in maternal-fetal tolerance by metabolizing tryptophan, impairs by several pathways, mainly T CD8 cells proliferation. Several cell types are present in the maternal fetal interface and several of them can express IDO. Leucocytes with Th1 produce a cytokine known as interferon γ that stimulates the expression of IDO in several cell types. Lymphocytes are divided into sub-populations according to their function and phenotype: T lymphocytes, B lymphocytes and natural killer cells (NK). Hormones also involved in this process where progesterone exerts decisive role on maternal immune response that may change gestational outcome and estrogen is essential for fetal maternal tolerance and maintenance of pregnancy. Therefore, the main objective of this study was to identify lymphocytes in the bovine placental cell culture that are sensitive to progesterone, estrogen and interferon γ, IDO expression in various gestational stages using flow cytometry. According to the results in the gestational period from 67.5 to 77.5 days with the addition of interferon γ expression IDO was slightly increased in TCD3 lymphocytes, CD4, and differently from the other T cells CD8 displayed an higher expression of the enzyme (4.48±2.12 to 8.65±4.91)...

The Jamaican fetus: overview of various studies / El feto jamaicano: panorama de varios estudios

OBJECTIVE: To describe a series of studies conducted which investigated maternal nutrition and its effect on birth outcome. METHODS: Seven hundred and twelve women attending their first antenatal clinic visit at the University Hospital of the West Indies were invited to join a prospective study. The women were followed throughout their pregnancies and seen at 14, 17, 20, 25, 30 and 35 weeks gestation. At these visits, the mother's weight, height and triceps skinfold thickness were measured. Abdominal ultrasound was performed to determine placental and fetal growth. Birth and placental weight, head, chest, mid-upper arm and abdominal circumference, crown-rump and crown-heel length were measured. After delivery, mothers and their children were recruited into a longitudinal study of postnatal growth in which blood pressure was measured annually initially and then half yearly from age one year. RESULTS: The interrelationship of first trimester maternal weight, subsequent weight gain in pregnancy, placental weight in early pregnancy and fetal growth were reported. Placental volume was shown to be an earlier predictor of infant size, and placental volume and intrauterine life on birthweight and blood pressure in childhood showed a relationship to blood pressure at two to three years old. The ultrasound derived fetal growth curves for a Jamaican population was created. CONCLUSION: Maternal nutritional status has an important effect on fetal size and birthweight and fetal size has an effect on blood pressure in childhood, suggesting that the initiating events in programming of blood pressure occur early in pregnancy.

OBJETIVO: Describir una serie de estudios encaminados a investigar la nutrición materna y su efecto en el resultado del embarazo. MÉTODOS: Setecientos doce mujeres que asistían a su primera visita de la clínica prenatal en el Hospital Universitario de West Indies, fueron invitados a sumarse a un estudio prospectivo. Se realizó un seguimiento de las mujeres a lo largo de sus embarazos, con visitas en las semanas 14, 17, 20, 25, 30 y 35 de gestación. En estas visitas, se midió el peso, la altura y el grosor del pliegue cutáneo del tríceps. Se les realizó un ultrasonido abdominal con el fin de determinar el crecimiento placentario y fetal. Se midieron el peso al nacer y el peso de la placenta, la cabeza, el pecho, circunferencia del abdomen y la parte media superior del brazo, las longitudes céfalo-caudal y coronilla-talón. Después del parto, las madres y sus niños fueron reclutados para un estudio longitudinal de crecimiento postnatal en el que la presión sanguínea se mide anualmente, inicialmente y luego a mitad de año desde el primer año de edad. RESULTADOS: Se reportó la interrelación del peso materno en el primer semestre, el subsiguiente aumento de peso en el embarazo, el peso de la placenta al inicio del embarazo, y el crecimiento fetal. El volumen de la placenta resultó ser un predictor temprano del tamaño del infante, y el volumen de la placenta y la vida intrauterina en el peso al nacer, y la presión sanguínea en la infancia mostró una relación con la presión sanguínea a los dos hasta los tres años de edad. CONCLUSIÓN: El estado de la nutrición materna tiene un efecto importante en el tamaño del feto y el peso al nacer, y el tamaño del feto tiene un efecto sobre la presión sanguínea en la infancia, lo cual sugiere que los procesos que inician la programación de la presión sanguínea ocurren en una etapa temprana del embarazo.

Trocas materno-fetais dos eletrólitos / Fetomaternal exchange of electrolytes

A descrição do transporte placentário envolve informações sobre mecanismos, propriedades e regulação genética das substâncias moleculares. Nas trocas materno-fetais faz-se necessário atravessar uma camada de células do sinciotrofoblasto (microvilosidades e camada basal da membrana plasmática)bem como o tecido conectivo e o endotélio capilar fetal. Assim, a troca sanguínea entre as duas circulações materna e fetal por meio do espaço interviloso e dos capilares vilosos ocorre através da barreira placentária. Os tipos de transporte de substâncias através da placenta são variáveis. Diversos mecanismos de transporte do sódio têm sido demonstrados, embora o transporte ativo de K+ ainda não esteja bem esclarecido no ser humano. O transporte placentário de cálcio, magnésio e fósforo acontece por transporte ativo, o qual aumenta no último trimestre de gestação, e coincide com o aumento da mineralização do esqueleto fetal. Desta forma, o entendimento das relações entre as diversas substâncias do organismo e o transporte através da placenta se faz necessário para melhor compreender a nutrição fetal e a patogênese de algumas doenças intra-útero.

Apical Maxi-chloride channel from human placenta: 12 years after the first electrophysiological recordings

The Maxi-chloride channel was the first ion channel described by electrophysiological methods in placenta. Because it is difficult to access a complex epithelium such as the placenta for electrophysiological procedures, the studies of ion channels from placental membranes have been performed only very recently. It was only in 1993 that a direct demonstration of a high-conductance chloride channel in apical membranes of intact trophoblastic epithelium was mentioned, and two years later, the description of this channel was reported from purified placental apical membranes reconstituted into artificial lipid membranes suitable for patch-clamp recordings. This brief review comments on the work done with regard to the electrophysiological characterization and regulation of the large-conductance or "Maxi" chloride channel and its contribution to the development of a cellular model for syncytiotrophoblast ion transport.

[Sexual dimorphism of the alkalaine phosphatase activity in placenta]

Some aspects of the anatomical and physiological sexual dimorphism in mammals have been studied. In order to study the placental sexual diomorphism, the enzymatic activie of alkaline phosphatase [ALP] in embryo and its placenta was investigated. In the present study a group of 75 adult female white mice [australian strain] in the same age were used. The animals were divided in to control and experimental groups. All female mice were mated with males of the same strain and age [one mae /three female] and were kept in controlled conditions. the experimental group 1 animals were studied in days 10 to 14 and group 2 in days 15 to 19 of pregnancy. From the day 10 to 19 of gestation, every day 6 pregnant mice were sacrified and two embryos from each part of the uterus were extruded to assay enzymatic activity of ALP in embryo and placenta. from day 15 to 19 sex determination of embryos was established. the resultes indicated that the rate and developmental pattern of ALP activity in placenta revealed a significant difference in male and female [p

[ association of different maternal hemoglobin levels with placental weight, birth weight and placental ratio]

Large placental weight and a high placental to birth weight ratio are both known predictors of higher adult blood pressure related to low maternal hemoglobin and a fall in mean cell volume. So we decided to study the association of maternal hemoglobin levels with placental weight, birth weight, and placental ratio. This prospective study was performed on 500 pregnant women who were hospitalized in Amir- Almomenin Hospital in Semnan, Iran, for delivery from September 2001 to September 2002. Maternal hemoglobin concentration was measured at first trimester during prenatal care and before delivery using Coulter counter method. Birth and placental weights were measured at delivery. The patients with systemic disease, history of smoking, poly or oligohydramnious, placental abnormality, twin or multiple pregnancies, high blood pressure and fetal congenital anomaly were excluded from the study. Stepwise regression analysis was used to determine this association and p value<0.05 was significant. Krusskal Wallis and anova analysis showed that the lowest range of birth weight was associated with hemoglobin concentration of < 10 gr/dl in pregnancy. [p=0. 1] and maternal age of less than 25 years old [p=0.007]. The maximum of placental weight was in pregnant women with parity of 3 to 4 [p=0.005]. The maximum of placental ratio [placental weight / birth weight] was with hemoglobin concentration of 9-9.9 gr/'dl onthird trimester. [p=0.001] Using multiple regression analysis, we detected a positive correlation between birth weight and late maternal hemoglobin levels [p=0.0179], between placental weight and parity [p=0.0008] and a negative association of placental ratio with maternal hemoglobin concentration in first trimester [p=0.0034]

Differential Expression of Placenta Growth Factors and Their Receptors In the Normal and Pregnancy-Induced Hypertensive Human Placentas

Placental development requires extensive angiogenesis and the invasion of the maternal decidua by the trophoblasts. Adequate and organized interaction of vascular endothelial growth factors (VEGF), placenta growth factors (PlGF), and their receptors are essential for a normal development and function of the placenta. In this study, we evaluated the expressions of PlGFs and their receptors, mRNAs by Northern blotting, in situ hybridization and RT-PCR in the normal and pregnancy-induced hypertensive (PIH) placentas. The expression level of PlGF-2 mRNA was lower in the PIH placentas compared to control as assessed by Northern blotting and in situ hybridization. PlGF mRNA was mainly localized to the vasculosyncytial membrane of placental villi and villous stroma. The expression of PlGF receptor-1 (PlGFR-1) was significantly increased in the PIH placentas compared to the normal ones. These results suggest that the alteration of PlGF-2 and PlGFR-1 mRNA expressions in the placenta are related to the pathogenesis of PIH.

Placental ratio and fetal growth pattern.

INTRODUCTION: Placental hypertrophy and reduced fetal growth have been postulated to be an adaptation to maintain placental function in pregnant women with complications such as malnutrition. If this is true, a pregnancy with impaired fetal growth, resulting in a small for gestational age (SGA) infant, should have an increased placental weight to birthweight ratio (placental ratio) compared to those with appropriate for gestational age (AGA) or large for gestational age (LGA) infants. OBJECTIVES: To determine the relationship between placental ratio and fetal growth pattern. MATERIAL AND METHOD: Labour and delivery data of 1000 deliveries in the Department of Obstetrics & Gynecology, Siriraj Hospital from January 2001 to June 2001 were retrospectively studied to compare the placental ratios among pregnancies with SGA, appropriate for gestational age (AGA) and large for gestational age (LGA) infants. RESULTS: From 96 SGA, 804 AGA and 100 LGA cases, a higher placental ratio was found in the SGA group compared to AGA (0.2074 and 0.1985 respectively, p = 0.013). However, actual placental hypertrophy was not found as demonstrated by a lower placental weight in SGA compared with AGA pregnancies of the same birthweight range. There was no significant difference in placental ratio between the LGA and AGA group, the ratios being 0.2020 and 0.1985 respectively (p = 0.260). Although a positive correlation between placental weight and birthweight was observed in the AGA and LGA groups, it was not demonstrated in the SGA infants. This might influence the placental ratio in the SGA group. CONCLUSION: SGA pregnancies are associated with an increased placental ratio which appears not to be due to placental hypertrophy. As reduced birthweight has been shown to be correlated to diseases in adult life, whether this association between SGA and an increased placental ratio will have an implication in future obstetric care and prediction of diseases in adult life remains to be elucidated.

Aspectos fisiologicos da permeabilidade placentaria e riscos fetais pela exposicao materna / Phisiologic aspects of placental permeability and fetal risks caused by maternal exposition

Este artigo faz uma revisao da estrutura placentaria, seus mecanismos fisiologicos de transporte, e o reflexo sobre o feto da passagem de algumas substancias capazes de determinar alteracoes no seu bem estar e desenvolvimento.

O papel da dopplervelocimetria no diagnostico da funcao placentaria / The diagnosis of placental function by dopplervelocimetry

A placenta e responsavel pela nutricao e oxigenacao adequada do feto durante a vida intra-uterina. A funcao placentaria pode ser avaliada pela dopplervelocimetria das circulacoes utero-placentaria, feto-placentaria e fetal. Nas gestacoes de alto risco para insuficiencia placentaria, a avaliacao dopplervelocimetrica e de fundamental importancia, principalmente, na orientacao da conduta obstetrica

Influências das condiçöes maternas nos níveis sangüíneos da HCG e HPL no primeiro trimestre da gestaçäo / The influence of the maternal environment in the peripherical blood levels of GCH and LPH during first trimester of pregnancy

Com a finalidade de avaliar a influência do meio ambiente materno nos níveis sangüíneos dos hormônios gonadotrófico (HCG) e lactogêncio plancentário (HPL) no início da gestaçäo, foram estudadas 326 gestantes de primeiro trimestre. O HCG e o HPL foram dosados e padronizados para o dia 70 da gestaçäo para permitir a comparaçäo dos resultados. O meio ambiente materno foi avaliado através das dosagens de hemoglobina (Hb), hematócrito (Ht), volume corpuscular médio (VCM), contagem de glóbulos vermelhos (CGV), ferro (Fe), ferritina (Fer), capacidade total de ligaçäo do ferro (TIBC) e índice de massa corpórea (IMC). Concluiu-se que existe uma correlaçäo inversa estatisticamente significativa entre o IMC, Hb e Ht e os níveis sangüíneos maternos do HCG

Placenta humana. I - Descriçäo de um modelo experimental para estudo da circulaçäo fetoplacentária / Human placenta. I - An experimental model for placental circulation

Faz-se breve discussäo sobre modelos experimentais para estudo da placenta humana. Descreve-se um modelo desenvolvido cujas características permitem reproduzir aspectos fisiológicos, farmacológicos e bioquímicos da circulaçäo fetoplacentária humana

Morbimortalidad perinatal asociada a senescencia placentaria / Perinatal morbimortalidad associated with placental senescence

Con el objetivo de determinar la asociación entre la senescencia placentaria (placenta grado III, según Grannum) y la morbimortalidad perinatal, llevamos a cabo un estudio prospectivo que incluyó a un total de 370 pacientes divididas en dos grupos: pacientes con placenta senescente (182 casos) y pacientes con placenta no senescente (plancentas grado 0, I o II, según Grannum)(188 casos), (grupo testigo). Las pacientes con senescencia placentaria tuvieron una mayor frecuencia de oligoamnios (37 vs 24 por ciento del grupo control), pruebas de reserva fetal no reactivas (35 casos vs 17 del grupo testigo y terminación del embarazo mediante cesárea (82 vs 41 por ciento del grupo testigo) (P<0.05). Los recién nacidos no presentaron diferencias respecto a su peso, calificación de Apgar al nacimiento, pero sí hubo una mayor presencia de líquido amniótico meconial (13 vs 8 por ciento) del grupo testigo, P < 0.05) y un mayor número de ingresos a la Unidad de Terapia Neonatal (17 casos vs cinco casos del grupo testigo) (P<0.05), en los hijos de madres con placenta senescente. Se concluye que la senescencia placentaria se asocia con una mayor frecuencia de morbimortalidad perinatal y que al detectar este hallazgo ultrasonográfico es recomendable realizar pruebas cardiotocográficas, biofísicas y hemodinámicas, para evaluar integralmente el bienestar fetal y determinar la mejor vía de nacimiento del producto y el momento oportuno para la interrupción del embarazo

Transfer of IgG subclasses across placenta in term and preterm newborns

In order to study placental transfer of IgG subclasses, paired blood samples were collected from mothers and umbilical cord of preterm (N = 69) and full-term (N = 68) newborns. The full-term group was further divided into 3 subgroups: appropriate for gestational age (AGA, N = 43), large for gestational age (LGA, N = 13) and small for gestational age (SGA, N = 12), according to birth weight. IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were measured by the single radial immunodiffusion technique using monoclonal antibodies. IgG1 and IgG3 newborn subclass concentrations (10.17 and 0.57 g/l, respectively) increased with increasing gestational age and reached maternal levels (IgG1 = 8.86; IgG3 = 0.67 g/l) during the 37th week of pregnancy. Low levels of these subclasses were found in premature newborns. IgG2 from newborns were always lower than maternal levels (P<0.05). LGA and SGA newborns had equivalent levels of IgG1 and IgG2 compared with AGA. SGA newborns had higher levels of IgG3 and lower levels of IgG4 than LGA and AGA newborns.