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1.
Prenat Diagn ; 42(11): 1438-1447, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36050925

RESUMO

OBJECTIVE: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. METHODS: Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age. RESULTS: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31). Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. CONCLUSIONS: In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups.


Assuntos
Transfusão Feto-Fetal , Terapia a Laser , Peso ao Nascer , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Retardo do Crescimento Fetal/cirurgia , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/epidemiologia , Transfusão Feto-Fetal/cirurgia , Idade Gestacional , Humanos , Recém-Nascido , Terapia a Laser/efeitos adversos , Gravidez , Gravidez de Gêmeos , Estudos Retrospectivos , Gêmeos Monozigóticos
2.
J Am Coll Cardiol ; 79(1): 52-62, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34991789

RESUMO

BACKGROUND: Preeclampsia (PE) is an independent risk factor for adverse maternal cardiovascular outcomes. The role of maternal cardiac function in the pathophysiology of PE remains unclear. OBJECTIVES: This study sought to describe differences in cardiac function at midgestation between women who develop PE and those with uncomplicated pregnancy and to establish whether routine cardiac assessment at midgestation can improve performance of screening for PE achieved by established biomarkers. METHODS: Mean arterial pressure was measured, medical history was obtained, and left ventricular (LV) systolic and diastolic functions were assessed using standard echocardiography and speckle tracking imaging. Uterine artery pulsatility index and serum placental growth factor and soluble fms-like tyrosine kinase-1 were measured. RESULTS: In 4,795 pregnancies, 126 (2.6%) developed PE. Following multivariable analysis, peripheral vascular resistance was significantly higher and LV global longitudinal systolic strain, ejection fraction, cardiac output, and left atrial area were mildly lower in women who developed PE compared to those who did not. There was a weak association between maternal cardiovascular indices and biomarkers of placental perfusion and function. Cardiac indices did not improve the performance of screening for PE on top of maternal risk factors, mean arterial pressure, and biomarkers of placental perfusion and function. CONCLUSION: Women who develop PE have an increase in peripheral vascular resistance and a mild reduction in LV functional cardiac indices long before PE development. However, cardiac indices do not improve the performance of screening for PE; thus, their routine clinical use is not advocated.


Assuntos
Pré-Eclâmpsia/fisiopatologia , Resistência Vascular/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Débito Cardíaco/fisiologia , Ecocardiografia Doppler , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Análise Multivariada , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/epidemiologia , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Volume Sistólico/fisiologia , Sístole/fisiologia , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue
3.
Rheumatology (Oxford) ; 58(11): 2000-2008, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31079145

RESUMO

OBJECTIVES: In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies. METHODS: This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity. RESULTS: The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies. CONCLUSION: In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD.


Assuntos
Autoanticorpos/sangue , Doença Mista do Tecido Conjuntivo/imunologia , Complicações na Gravidez/imunologia , Ribonucleoproteína Nuclear Pequena U1/imunologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/imunologia , Adulto , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/imunologia , Feminino , Retardo do Crescimento Fetal/imunologia , Bloqueio Cardíaco/congênito , Bloqueio Cardíaco/imunologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/imunologia , Recém-Nascido , Nascido Vivo/epidemiologia , Lúpus Eritematoso Sistêmico/congênito , Lúpus Eritematoso Sistêmico/imunologia , Doença Mista do Tecido Conjuntivo/complicações , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Estudos Retrospectivos , Natimorto/epidemiologia
4.
J Matern Fetal Neonatal Med ; 25(8): 1228-32, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22082154

RESUMO

OBJECTIVE: The 12q24.12 locus has been reported to be involved in the control of many traits and also in severe diseases such as cardiovascular disease, hypertension and some immune-related disease. To our knowledge, no study has been published so far investigating the role of this locus in the pathogenesis of preeclampsia (PE). METHODS: We genotyped four single nucleotide polymorphisms (SNPs) in 12q24.12 locus in 198 preeclamptic, 224 chronic hypertensive and 265 normotensive women from Italy, to test the contribution polymorphisms/haplotypes on the onset of preeclampsia and their association with chronic hypertension. RESULTS: No association was observed for any single SNP, while a common haplotype CGTG (21% in normotensive women) revealed a possible protective effect (OR 0.64, 95% CI 0.42-0.97) against preeclampsia. CONCLUSIONS: Our data suggest that a common haplotype within 12q24.12 locus may be associated with a protective effect against preeclampsia. This observation may be linked with the potential role of this region in the control of microcirculation. To the best of our knowledge, our study is the first one that links the 12q24.12 locus with this life-threatening perinatal complication of unknown etiology. Further physiological and functional studies are needed to clarify the molecular mechanisms and pathways of preeclampsia.


Assuntos
Cromossomos Humanos Par 12 , Loci Gênicos/fisiologia , Pré-Eclâmpsia/genética , Adulto , Idade de Início , Estudos de Casos e Controles , Cromossomos Humanos Par 12/genética , Cromossomos Humanos Par 12/fisiologia , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Itália/epidemiologia , Idade Materna , Polimorfismo de Nucleotídeo Único/fisiologia , Pré-Eclâmpsia/epidemiologia , Gravidez
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