RESUMO
Endometriosis is thought to result from implantation of endometrial tissue swept back into the pelvic cavity during menstruation, or from coelomic metaplasia of the peritoneum. Yet not all women with menstrual reflux develop endometriosis. The authors present and analyse the arguments in favour of immune system involvement in the physiopathology of this frequent disease. A knowledge of the antigens that have been recognized and of the operative mechanisms will probably make it possible to understand better the repercussions of endometriosis on fertility, to develop diagnostic methods less traumatic than those available at present and to modulate treatments and improve their effectiveness.
Assuntos
Endometriose/imunologia , Neoplasias Uterinas/imunologia , Formação de Anticorpos/imunologia , Linfócitos B/imunologia , Endometriose/etiologia , Endometriose/fisiopatologia , Feminino , Fertilidade , Humanos , Imunidade Celular/imunologia , Linfócitos T/imunologia , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/fisiopatologiaRESUMO
Several biological systems originating in the fetus and in the mother are involved in embryo implantation, maintenance of the pregnancy, protection of the fetus against outside influences and the start of labour (these are the immune system, endocrine system, and the endothelial system). In order to work efficiently there has to be some co-ordination. Cytokines which were first described by immunologists make it possible for information between the systems to be exchanged. The authors, referring to recent publications, show that there are several cytokines with specific receptors at the feto-placental interface. The place and the physiological role of these molecules in co-ordinating the links are discussed. These cytokines can be involved in many pathological situations.
Assuntos
Citocinas/imunologia , Gravidez/imunologia , Fatores Estimuladores de Colônias/imunologia , Feminino , Humanos , Interferons/imunologia , Interleucina-2/imunologia , Interleucina-6/imunologia , Troca Materno-Fetal/imunologia , Fatores de Crescimento Transformadores/imunologia , Fator de Necrose Tumoral alfa/imunologiaRESUMO
It used to be rare for multiple pregnancies to occur but we have seen a spectacular rise in them in France between 1970 and 1986. Triplet deliveries increased threefold. The authors analyse a personal series of 23 pregnancies (19 triplets, 3 quadruplets and 1 quintuplet pregnancy). Sixteen of these 23 were medically induced. The main complications that have been observed were: threatened premature delivery in 86%, high blood pressure in 34.7%, anaemia in 50%, and urinary tract infections in 30.4%, 6.8% of the babies had congenital malformations. Reviewing the literature has made it possible to discern the epidemiological factors causing multi-fetal pregnancies: family history, high female fertility, maternal age, ethnic factors, hormonal contraception etc... At present it is medically assisted reproduction that is the big supplier of multi-fetal pregnancies in developed countries. We have reviews of several maternal as well as fetal complications: the ovarian hyperstimulation syndrome, extra-uterine pregnancy, hypertension, anaemia, spontaneous abortion, prematurity, intra-uterine growth retardation and malformations.
Assuntos
Gravidez Múltipla/fisiologia , Adulto , Fatores Etários , Epidemiologia , Feminino , Fármacos para a Fertilidade/uso terapêutico , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Gravidez Múltipla/efeitos dos fármacosRESUMO
The authors report a case of twins conjoined at the umbilicus and diagnosed by ultrasound after 19 weeks of amenorrhoea in whom an assessment in utero was carried out using magnetic resonance imaging after the patient had been curarized. A review of the literature on this very difficult problem of conjoined twins has given us the possibility to assess the diagnostic measures as well as the prognosis of this pathology. In particular we point out the results that can be obtained using MRI in utero during the second and third trimesters of the pregnancy.
Assuntos
Imageamento por Ressonância Magnética , Gravidez Múltipla , Diagnóstico Pré-Natal , Gêmeos Unidos/patologia , Abdome/anormalidades , Adulto , Feminino , Humanos , Gravidez , Ultrassonografia , Umbigo/anormalidadesRESUMO
The authors analyse a series of 23 multiple pregnancies (19 triplet pregnancies, 3 quadruplets and 1 quintuplet). The first objective is to fight prematurity. Over and above all use of drugs as tocolytics (beta-mimetic drugs and progesterone) should routinely be advised and as soon as there is any threat of premature labour hospitalisation is needed. Twenty one of the 23 patients had prophylactic cerclage (Shirodkar's stitch). In 77% of the cases respiratory distress in the newborn was avoided by using cortico-therapy. Vaginal delivery can be carried out under certain conditions in triplet pregnancies. If certain precautions are taken there does not seem to be any immediate difference in the post delivery period of these children if they are born vaginally or by caesarean. Perinatal mortality is raised (at 5.6% for triplets and 58.3% for quadruplets). The psychological implications of these pregnancies are important. Problems appear as soon as the diagnosis is made and continue for years afterwards. On the social level, help given by the social services are usually inadequate. If the couples belong to the National Association for Mutual Aid of Parents of Children of Multiple Births, a system of mutual support is available. We recommend that these pregnancies should be looked after by several disciplines. These consist not only of obstetricians, paediatricians, anaesthetists, those who resuscitate together, but also psychologists, dietitians, social workers, community workers and physiotherapists.
Assuntos
Protocolos Clínicos , Gravidez Múltipla/fisiologia , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/prevenção & controle , Complicações do Trabalho de Parto/terapia , Equipe de Assistência ao Paciente , Gravidez , Gravidez Múltipla/psicologia , Apoio Social , Serviço SocialRESUMO
46 late interruptions of pregnancy (16 to 33 weeks of amenorrhea) were performed with the use of prostaglandins E1 ovules, of 1 mg, placed in the posterior vaginal cul-de-sac every 12 hours. It concerned 13 deaths in utero or extremely premature rupture of the membranes, 25 fetal indications (9 chromosomal abnormalities and 16 severe malformations), and 8 maternal indications. The efficacy was good either with ovules alone (84.7%) or associated with a balloon probe (5.3%). Expulsion is faster in the case of fetal deaths (average = 8 hours), than in therapeutic interruptions of pregnancy (average = 20 hours). The necessary doses did not exceed 3 mg of PgE1. There were very few side effects, essentially gastro-intestinal in nature and the course was simple. No obstetrical complication was noted. This method is therefore particularly effective with minimal side effects. Easy to use, it must be reserved for very precise indications.
Assuntos
Aborto Terapêutico/métodos , Prostaglandinas E/uso terapêutico , Adolescente , Adulto , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Prostaglandinas E/administração & dosagemRESUMO
In 1982 Weinstein described the Hellp-Syndrome in pre-eclampsia. Two personal case histories have led the authors to discuss the need to specify this syndrome. Apart from the classical elements of pre-eclampsia, which are: arterial hypertension, proteinuria and oedema, there are bowel symptoms in 86% of cases and on the biological level there is thrombocytopenia and a rise in the transaminases as well as a haemolytic anaemia. Some cases of rupture of the liver have been described. Treatment is that of pre-eclampsia. This involves treatment with cortisone and sometimes with heparin. Delivery of the fetus is, however, the only really effective treatment. The characteristic three elements of the Hellp-Syndrome seem to be linked to disseminated intravascular coagulation and have long been considered very serious factors in pre-eclampsia. On the other hand it does seem to be useful for the clinician to know about the Hellp-syndrome in order to estimate the seriousness of a case where there are vasculo-renal elements in the syndrome and in order to avoid diagnosis mistakes in cases where the symptoms are often deceptive.
Assuntos
Anemia Hemolítica/complicações , Coagulação Intravascular Disseminada/complicações , Fígado/enzimologia , Pré-Eclâmpsia/complicações , Trombocitopenia/complicações , Adulto , Feminino , Humanos , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/enzimologia , Gravidez , SíndromeRESUMO
We have seen a patient who became pregnant. She was suffering from cystic fibrosis diagnosed late in life at the age of 26 years. Her case has allowed the authors to make some observations on this association of pregnancy with cystic fibrosis which will become increasingly common. 5% of individuals are heterozygous for this condition. The prospect for these patients surviving gets better and better. Although their fertility seems to be lowered it is possible for them to become pregnant. They are caught in the web of almost constant episodes of broncho-pulmonary infection with lasting effects on their respiratory capacities in 50% of cases. About 83% of these patients will deliver prematurely because of the respiratory distress they suffer. It is difficult to predict the long-term effects of pregnancy on the survival of these patients since the mortality rate anyhow is about 10% per year. According to the literature pregnancy will cause a permanent deterioration in respiratory function in about 37% of cases. The history of this particular case should be able to give new hope to some women suffering from this condition. All the same, there are a large number of problems that still have to be dealt with.