A sad portrait of congenital syphilis in the State of Rio de Janeiro. Case report with Polymerase Chain Reaction (PCR) of scrapings from skin lesions and placenta fragment positive for Treponema pallidum

Introduction: Congenital syphilis is a serious public health problem that causes high rates of intrauterine morbidity and mortality, revealing flaws and weaknesses in the health system. Objective: to report a case of congenital syphilis in a university hospital in the Center-South Region of the State of Rio de Janeiro, Brazil. Case report: A pregnant woman, aged between 19 and 23 years old, carrying a Pregnant Woman's Handbook with a record of seven prenatal consultations and a note of the serological reaction for positive syphilis, but without any treatment, hospitalized at the University Hospital of Vassouras (RJ), in labor, gave birth to a newborn (NB) with a clinical picture and serological test of congenital syphilis. The NB required care in an intensive care unit and was discharged 28 days after birth. Scraping of skin lesions of the NB and placenta was performed for analysis by molecular biology (PCR in house) and genetic material of Treponema pallidum was detected. Conclusion: Congenital syphilis is a serious outcome of syphilis during pregnancy, consuming high financial resources and significant emotional distress for the mother, father, the whole family, as well as for the health teams. Our case report was the first that we are aware of in Brazil with a diagnosis by PCR for positive Treponema pallidum of skin scraping and placental fragment. It also showed poor quality prenatal care, a common factor in most cases of CS in our reality

Role of SOX9 and Hif-1α expression in placentas of patients with HELLP

Purpose: In this study, we investigated the immunohistochemical staining of SRY-box transcription factor 9 (SOX9) and Hif-1α expression in placentas of pregnant woman with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. Methods: Placentas of 20 normotensive and 20 women with HELLP syndrome were processed for routine histological tissue processing. The biochemical and clinical parameters of patients were recorded. Placentas were stained with hematoxylin-eosin and SOX9 and Hif-1α immunostaining. Results: Normotensive placentas showed normal histology of placenta, however placentas of HELLP syndrome showed intense thrombosis, thinning of the villi membrane and vascular dilatation. In placentas of normotensive patients, SOX9 reaction was immunohistochemically negative, however placentas of HELLP group showed SOX9 expression in decidual cells, and syncytial regions of floating villi and inflammatory cells. In placentas of normotensive patients, Hif-1α reaction was mainly negative in vessels and connective tissue cells. Placentas of HELLP group showed increased Hif-1α expression in decidual cell and especially inflammatory cells in the maternal region. Conclusions: Hif-1α and SOX9 proteins can be used as a marker to show severity of preeclampsia and regulation of cell proliferation and angiogenesis during placental development.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Histopathological, ultrastructural, and immunohistochemical examination of changes in the placenta as a result of severe preeclampsia

Purpose: To investigate the role of hypoxia-inducible transcription factor-1 alpha (HIF-1α) and angiogenetic factor endothelin-1 (ET-1) expression in regulating hypoxia and placental development by routine histopathological methods. Methods: Twenty preeclamptic and normal placentas were used. Placenta tissue pieces were examined histopathologically after routine paraffin follow-ups. HIF-1α and ET-1 proteins were examined immunohistochemically, and placental tissues were examined ultrastructurally. Results: Increase in syncytial proliferation, endothelial damage in vessels, and increase in collagen were observed in preeclamptic placentas. As a result of preeclampsia, an increase was observed in HIF-1α and ET-1 protein levels in the placenta. Dilatation of endoplasmic reticulum and loss of cristae in mitochondria were observed in trophoblast cells in preeclamptic placental sections. Conclusion: High regulation of oxygen resulting from preeclampsia has been shown to be a critical determinant of placentagenesis and plays an important role in placental differentiation, changes in maternal and fetal blood circulation, trophoblastic invasion, and syncytial node increase. It has been thought that preeclampsia affects secretion by disrupting the endoplasmic reticulum structure and induces mitochondrial damage, and that ET-1 may potentially help in the induction of stress pathways as a result of hypoxia in preeclampsia.

Influencia de la anastomosis de las arterias umbilicales (Hyrtl's) en la morfometría y eficiencia placentaria / Influence of the anastomosis of the umbilical arteries (Hyrtl's) on the morphometry and efficiency of the placenta

La anastomosis de Hyrtl's (AH), vaso único con amplia variabilidad anatómica, comunica las arterias umbilicales cerca de la inserción del cordón umbilical en las placentas humanas. El objetivo del presente trabajo fue determinar si existe relación entre las características morfométricas de la placenta y la presencia de anastomosis y analizar si esta tiene influencia en la eficiencia placentaria. Estudio descriptivo. Se analizaron 60 placentas provenientes de madres que aceptaron participar en la investigación, embarazo único, a término (entre 37,0 y 41,6 semanas), con edades entre 18 y 37 años, con al menos cuatro visitas a control prenatal, sin comorbilidades. Las características placentarias de peso, diámetros y grosor se tomaron en fresco. Una vez fijadas con formaldehido al 10 %, mediante disección se ubicó, clasificó y fotografió la anastomosis. El peso de la placenta fue 494,4 ± 87,1 gramos, el grosor central correspondió a 1,7 ± 0,4 cm, DM 19,9 ± 2,0 cm y Dm 18,4 ± 1,7 cm. La inserción de cordón predominante fue excéntrica (65 %) y la forma discoidea u ovalada (60 %). En 51 placentas se ubicó la presencia de anastomosis (85 %). En el grupo de placentas con presencia AH se encontró un peso placentario más bajo al compararlo con el grupo que no presentó AH, el resto de las características morfométricas de la placenta, incluido el tipo de inserción de cordón umbilical no presentaron relación con la anastomosis. La eficiencia placentaria expresada con la relación entre peso neonato/peso placenta presentó diferencias significativas en el grupo con presencia de anastomosis, con mayores valores comparados con el grupo sin anastomosis. La presencia de AH contribuye positivamente a la eficiencia placentaria. Sin embargo, el incremento del peso placentario puede ser un efecto compensador de la placenta y no siempre indica una mayor eficiencia funcional del órgano.

SUMMARY: Hyrtl's anastomosis (HA), a single vessel, with wide anatomical variability, communicates the umbilical arteries, near the insertion of the umbilical cord in human placentas. The objective of this study was to determine if there is a relationship between the morphometric characteristics of the placenta and the presence of the anastomosis and to analyze if this influences the placental efficiency. Descriptive study. We analyzed 60 placentas from mothers who agreed to participate in the study, single pregnancy, term (between 37.0 and 41.6 weeks), aged between 18 and 37 years with at least four visits to prenatal control, without comorbidities. The placental characteristics of weight, diameters and thickness were taken fresh. Once fixed with 10 % formaldehyde, the anastomosis was located, classified, and photographed by dissection. The weight of the placenta was 494.4 ± 87.1 g, the central thickness corresponded to 1.7 ± 0.4 cm, the MD 19.9 ± 2.0 cm and Dm 18.4 ± 1.7 cm: The predominant cord insertion was eccentric, with 65 % and the discoid or oval shape with 60 %. In 51 placentas the presence of anastomosis was found (85 %). In the group of placentas with AH presence, a lower placental weight was found when compared to the group that did not present AH, the rest of the morphometric characteristics of the placenta, including the type of umbilical cord insertion, were not related to the anastomosis. Placental efficiency expressed as the neonatal weight/placental weight ratio showed significant differences in the group with presence of anastomosis, with higher values compared to the group without anastomosis. The presence of HA contributes positively to placental efficiency. However, the increase in placental weight may be a compensatory effect of the placenta and does not always indicate a greater functional efficiency of the organ.

Revisión bibliográfica: ecografía intraparto / Review: intrapartum ultrasound

The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.

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.

Revisión sistemática de la exactitud diagnóstica de la gota gruesa en comparación con la reacción en cadena de la polimerasa para malaria asociada al embarazo, 2010-2022 / Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022

RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

Doppler Ultrasound of the Umbilical Artery: Clinical Application / Ultrassonografia Doppler da artéria umbilical: Aplicação clínica

Abstract Objective To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. Methods Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. Results The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. Conclusion Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.

Resumo Objetivo Compilar informação relevante proveniente da literatura atual sobre a ultrassonografia Doppler das artérias umbilicais (AUs) na prática clínica, considerações e limitações técnicas e perspectivas futuras. Métodos A pesquisa bibliográfica foi realizada nos bancos de dados PubMed e Medline e restringiu-se a artigos escritos na língua inglesa. Recorreu-se também à bibliografia dos artigos selecionados, quando necessário, para obter informação relevante. Resultados A utilização desta técnica como método de vigilância de rotina está apenas recomendada emgravidezes de alto risco comdisfunção placentar.Metanálises de estudos randomizados mostraram que o seguimento obstétrico baseado nos achados do Doppler da artéria umbilical pode melhorar a mortalidade e a morbilidade perinatal. É consensual que os valores dos índices Doppler da AU decrescem com o avanço da idade gestacional. No entanto, há ainda muita incerteza quanto aos valores de referência. Conclusão As informações obtidas através da AU Doppler US são a base para muitas decisões clínicas importantes. Trabalhos de investigação nesta área são essenciais para tentar colmatar atuais limitações da técnica.

Utilização da Placenta Humana na Cicatrização de Úlceras nos Pés de Pessoas com Diabetes: Revisão Integrativa / Use of the Human Placenta in the Healing of Foot Ulcers in People With Diabetes: Integrative Review / Uso De la Placenta Humana en la Cicatrización de las Úlceras del Pie en Personas con Diabetes: Revisión Integradora

Objetivo:Identificar na literatura as contribuições da utilização da placenta humana na cicatrização de úlceras nos pés de pessoas com diabetes. Método: Estudo de revisão integrativa realizado por meio da busca de artigos na Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, National Library of Medicine (PubMed), Web of Science e Scopus, com a utilização das estratégias de busca: Placenta AND "Pé diabético" e Placenta AND "Diabetic foot". Resultados: A busca inicial resultou em 148 artigos. Após aplicação dos critérios de inclusão e exclusão, obteve-se amostra final de 12 artigos. Observou-se que a placenta tem potencial de promover a melhora do tecido de granulação e a circulação periférica, maior repitelização, redução na área da ferida, com uso majoritário de aloenxerto de membranas placentária e amniótica criopreservadas. Conclusão: A placenta humana é um material biológico rico em nutrientes que apresentou potencial para contribuir com o reparo tecidual de úlceras nos pés de pessoas com diabetes em menor período de tempo.

Objective:To identify in the literature the contributions of the use of the human placenta in the healing of foot ulcers in people with diabetes. Method: An integrative review study carried out by searching articles in Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, National Library of Medicine (PubMed), Web of Science and Scopus, using the search strategies: Placenta AND "Diabetic foot" and Placenta AND "Diabetic Foot". Results: The initial search resulted in 148 articles. After applying the inclusion and exclusion criteria, a final sample of 12 articles was obtained. It was observed that the placenta has the potential to promote the improvement of granulation tissue and peripheral circulation, greater epithelialization, and reduction in the wound area, with the majority use of cryopreserved placental and amniotic membrane allograft. Conclusion: The human placenta is a nutrient-rich biological material that has the potential to contribute to the tissue repair of foot ulcers in people with diabetes in a shorter period of time.

Objetivo:Identificar en la literatura las contribuciones del uso de la placenta humana en la cicatrización de las úlceras del pie en personas con diabetes. Método: Estudio de revisión integradora, realizado mediante búsqueda de artículos en LILACS, SCIELO, CINAHL, Cochrane Library, PubMed, Web of Science y Scopus, utilizando las estrategias de búsqueda: Placenta AND "Diabetic foot" y Placenta AND "Diabetic Foot". Resultados: La búsqueda inicial resultó en 148 artículos. Tras aplicar los criterios de inclusión y exclusión, se obtuvo una muestra final de 12 artículos. Se observó que la placenta tiene el potencial de promover la mejoría del tejido de granulación y circulación periférica, mayor reepitelización, reducción del área de la herida, con uso mayoritario de aloinjerto de placenta y membrana amniótica criopreservados. Conclusión: La placenta humana es un material biológico rico en nutrientes que tiene el potencial de contribuir a la reparación tisular de las úlceras del pie en personas con diabetes en un período de tiempo más corto.

Perfil da metilação do DNA do binômio mãe-filho no contexto da obesidade materna, adiposidade fetal e neonatal / DNA methylation profile of the mother-child binomial in maternal obesity, fetal and neonatal adiposity

Introdução: Um mecanismo epigenético pelo qual os efeitos adversos do ambiente intra-uterino são transferidos aos descendentes é a metilação do DNA. Objetivo: Avaliar a relação entre obesidade materna, ganho de peso gestacional (GPG) e alteração da metilação do DNA sobre o desenvolvimento fetal e neonatal. Metodologia: Subpopulação de gestantes do estudo epidemiológico prospectivo "Coorte Araraquara" foram acompanhadas durante os três trimestres da gestação, parto e no pós-parto. Para avaliar o impacto do GPG na metilação do DNA e desenvolvimento fetal e neonatal, as gestantes foram alocadas em 2 grupos: ganho de peso gestacional adequado (n=45) e ganho de peso gestacional excessivo (n=30). Para avaliar o impacto da obesidade materna na metilação do DNA e desenvolvimento fetal e neonatal, as gestantes foram alocadas em 2 grupos: A. IMC pré-gestacional adequado (n=25) e B. IMC pré-gestacional sobrepeso/obesidade (n=39 gestantes). A biometria e composição corporal fetal foram avaliadas por ultrassom Siemens ACUSON X300TM (Siemens®, Mountain View, CA, USA) e a composição corporal do neonato por pletismografia, com o PEA POD (Cosmed®, Concord, CA, USA). A dieta materna ao final da gestação foi investigada por recordatórios de 24 horas e analisada no software Nutrition Data System for Research (NDSR, Minnesota, USA). O DNA dos sangues materno e cordão umbilical, da vilosidade e decídua placentárias foram extraídos utilizando proteinase K pelo método santing-out. As regiões hipo e hipermetiladas foram analisados pela técnica de Digestão Enzimática Sensível à Metilação associada à PCR quantitativa (qPCR) e a expressão gênica por qPCR. Para análise da influência do GPG o DNA do sangue materno de gestantes com GPG adequado (N=8) versus com GPG excessivo (N=8), foi hibridizado na plataforma Illumina com o Human Methylation 850K Bead Chip (Illumina, CA, USA). Para análise estatística aplicou-se o Teste t, Qui-quadrado (X2), ANOVA de medidas repetidas e modelos de regressão linear múltiplo e o nível de significância adotado foi de p≤0,05. Resultados: O excessivo ganho de peso gestacional (EGPG) alterou os triglicerídeos (TGs) e colesterol total (CT) maternos, o diâmetro occipito-frontal (DOF) do feto, a circunferência da cabeça, perímetro torácico, peso e a massa gorda neonatais. A análise de metilação global do DNA materno identificou 46 posições diferencialmente metiladas e 11 regiões diferencialmente metiladas (DMRs). Nove fenótipos humanos foram enriquecidos para essas 11 DMRs localizadas em 13 genes (EMILIN1, HOXA5, CPT1B, CLDN9, ZFP57, BRCA1, POU5F1, ANKRD33, HLA-B, RANBP17, ZMYND11, DIP2C, TMEM232), destacando-se os termos resistência à insulina e hiperglicemia. O DNAm materno foi associado com parâmetros de composição corporal, como: tecido total da coxa e do braço fetais e gordura subcutânea da coxa e do braço fetais, bem como ao percentual de massa gorda e massa gorda neonatais. A metilação do DNA materno também foi associada com os TGs e a insulina de jejum maternos, com circunferência abdominal e circunferência da cabeça fetais (CC) e CC neonatal. As DMRs estudadas foram enriquecidas em 142 processos biológicos, 21 funções moleculares e 17 componentes celulares. Três módulos gênicos diferencialmente metilados foram identificados. Por outro lado, o IMC pré-gestacional sopreso/obesidade alterou os percentis do diâmetro biparietal (DBF), o DOF, a CC, a espessura da gordura subcutânea do abdômen (ETSA), tecido total do braço, massa muscular do braço e gordura subcutânea do braço fetais e a CC do neonato. O gene H19DMR foi significativamente menos metilado no sangue materno do grupo com sobrepeso/obesidade em comparação ao grupo com IMC pré-gestacional adequado, para o sangue do cordão umbilical e tecidos placentários, não houve diferença de metilação entre os grupos, bem como não houve diferença de expressão gênica dos genes H19 e IGF2 nos tecidos placentários entre os grupos. Houve associações entre metilação de H19DMR no sangue do cordão umbilical com os percentis do DBP, com a ETSA e a CC neonatais; na decídua com o DOF, a CC e comprimento fetais; no vilo com o DOF, a CC e a ETSA fetais e com a CC neonatal. A expressão do gene H19 na decídua também foi associada ao DBP e ao percentil do comprimento do fêmur fetais; no vilo com o DOF e gordura subcutânea do braço fetais. A expressão do gene IGF2 na decídua foi associada com o DBP fetal e no vilo com o DOF fetal. Conclusão: A metilação do DNA foi alterada pelo ganho de peso gestacional e obesidade maternos e se associou com a adiposidade e crescimento fetais. O excessivo GPG alterou o metiloma materno e está envolvido com um fenótipo de risco para o desenvolvimento de doenças crônicas e metabólicas, a exemplo da diabetes.

Introduction: An epigenetic mechanism by which the adverse effects of the intrauterine environment are transferred to offspring is DNA methylation. Objective: Evaluate the relationship between maternal obesity, gestational weight gain and DNA methylation alteration on fetal and neonatal development. Methodology: Subpopulation of pregnant women from the prospective epidemiological study "Cohorte Araraquara" were followed during the three trimesters of pregnancy, delivery and postpartum and were allocated into 2 groups: A. adequate weight (N=25) and B. overweight/obesity (N=39 pregnant women). Fetal biometry and adiposity were evaluated by ultrasound and the neonate's body composition by plethysmography, with the PEA POD (Cosmed®, Concord, CA, USA). Maternal diet in the end of pregnancy was investigated using 24-hour recalls and analyzed using the Nutrition Data System for Research software (NDSR, Minnesota, USA). DNA maternal and umbilical cord blood, and placental villus and decidua were extracted using proteinase K by the santing-out method. The hypo and hypermethylated regions were analyzed by the Methylation Sensitive Enzymatic Digestion technique associated with quantitative PCR (qPCR) and gene expression by qPCR. To analyze the influence of gestational weight gain (GWG), maternal blood DNA from pregnant women with adequate AGWG (N=8) versus excessive EGWG (N=8) was hybridized on the Human Methylation 850K Bead Chip (Illumina, CA). For statistical analysis, the t test, chi-square (X2) test, repeated measures ANOVA and multiple linear regression models were applied, and the significance level adopted was p≤0.05. Results: The pre-gestational weight, pre-gestational BMI and BMI during pregnancy were higher in group B. In this same group, higher values of fasting insulin, us-CRP and lipid consumption were found in relation to group A. subcutaneous abdominal fat thickness (SCFT) and subcutaneous fat of the fetal arm was also higher in group B compared to group A. Regarding the body composition of neonates, the amount of fat mass was higher in group B. The H19DMR gene was less methylated in maternal blood from group B. No statistical difference was found in the values of IGF2 and H19 gene expression between the groups. There were associations between methylation of the H19DMR gene in umbilical cord blood with fetal biparietal diameter (BPD) and SCFT and neonatal head circumference (HC); in the decidua with occipito frontal diameter (OFD), fetal length and HC; in the villi with DOF, HC and SCFT and neonatal HC. Excessive gestational weight gain altered 46 CpG sites, 11 differentially methylated regions (DMRs) located in 13 genes, namely: EMILIN1, HOXA5, CPT1B, CLDN9, ZFP57, BRCA1, POU5F1, ANKRD33, HLA-B, RANBP17, ZMYND11, DIP2C, TMEM232. These DMRs were enriched in 142 biological processes, 21 molecular functions, 17 cellular components and 9 human phenotypes. In addition, 3 differentially methylated gene modules were identified to the phenotype of interest. Conclusion: DNA methylation was altered by maternal nutritional status and was associated with fetal adiposity and growth. Excessive GPG altered maternal methylome and was associated with the phenotype of metabolic diseases such as diabetes mellitus.

PCR em tempo real no diagnóstico da toxoplasmose congênita / Real-time PCR in the diagnosis of congenital toxoplasmosis

O diagnóstico da toxoplasmose congênita apresenta limitações sendo, portanto, necessárias novas opções de exames. A análise do líquido aminiótico pela PCR em tempo real já se mostrou eficaz para confirmação da infecção fetal. No entanto, o seu desempenho em outras amostras biológicas ainda não está claro. O objetivo deste estudo é avaliar a PCR em tempo real no sangue da mãe e do recém-nascido assim como no líquido amniótico e placenta, no diagnóstico da toxoplasmose congênita. Esse é um estudo descritivo de gestantes com toxoplasmose acompanhadas no Rio de Janeiro, Brasil. Foi realizada PCR em tempo real em amostras de sangue materno, líquido amniótico, placenta e sangue dos recém-nascidos e o exame histopatológico das placentas. Também foram coletados dados clínicos e laboratoriais dos recém-nascidos. Foram acompanhadas 116 gestantes e analisadas 298 amostras. Uma (0,9%) gestante apresentou PCR positiva no sangue, três (3,5%) no líquido amniótico, uma (2,3%) na placenta e nenhum recém-nascido apresentou PCR positiva no sangue. O estudo histopatológico foi sugestivo de infecção por toxoplasmose em 24 (49%) placentas. Seis (5,2%) recém-nascidos foram diagnosticados com toxoplasmose congênita e apenas os casos com PCR positiva no líquido amniótico tinham associação do resultado da PCR com o diagnóstico de infecção congênita. Tanto as amostras de sangue materno quanto as de sangue dos recém-nascidos e placenta, não demonstraram ser promissoras no diagnóstico da toxoplasmose congênita. Novos estudos são necessários para avaliar o real papel do diagnóstico molecular em outros materiais biológicos que não o líquido amniótico.

The diagnosis of congenital toxoplasmosis has limitations so new options are needed. Real-time PCR analysis of amniotic fluid has proven effective for confirming fetal infection. However, its performance in other biological samples still needs to be determined. This study aims to evaluate the real-time PCR role in the blood of the mother and newborn as well as in the amniotic fluid and placenta, in congenital toxoplasmosis diagnosis. It is a descriptive study of pregnant women with toxoplasmosis followed in Rio de Janeiro, Brazil. Real-time PCR was performed on maternal blood, amniotic fluid, placenta, and newborn blood samples. In addition, a histopathological examination of the placentas was performed and data from the babies were collected. One hundred and sixteen pregnant women were followed and 298 samples were analyzed. One (0.9%) pregnant woman had positive PCR in the blood, three (3.5%) in the amniotic fluid, one (2.3%) in the placenta, and any newborn had positive PCR in the blood. The histopathological study suggested toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis and only the cases with positive PCR in amniotic fluid associated with the diagnosis of congenital infection. Neither maternal nor newborn blood and placenta samples have not shown promise in diagnosing congenital toxoplasmosis. Further studies are needed to evaluate the fundamental role of molecular diagnostics in others biological materials than amniotic fluid.

Equine abortion associated with placentitis caused by Pasteurella pneumotropica / Aborto equino associado a placentite por Pasteurella pneumotropica

Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.(AU)

Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.(AU)

Equine abortion associated with placentitis caused by Pasteurella pneumotropica / Aborto equino associado a placentite por Pasteurella pneumotropica

Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.

Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.

Comparative analysis of trophoblasts and angiogenesis in human placental compartments / Análisis comparativo de trofoblastos y angiogénesis en compartimentos placentarios humanos

SUMMARY: Trophoblasts perform different functions depending on their location. This study aimed to obtain structural clues about the functions of villous and extravillous trophoblasts by using light and electron microscopy. Term placenta samples were obtained from 10 healthy pregnant women following cesarean sections. Frozen sections were stained with hematoxylin-eosin, semi- thin sections were stained with toluidine blue and examined with a light microscope, while thin sections were contrasted using uranyl acetate-lead citrate and evaluated under an electron microscope. Fine structural features of villous trophoblasts overlapped some villous stromal cells. In addition to the usual appearance of mature capillaries in villous stroma, we demonstrated and reported maturational stages of angiogenetic sprouts in term placenta. Extravillous trophoblasts were classified according to their location: fibrinoid, chorion, trophoblastic, column, maternal vascular endothelium, or decidua. All of these trophoblasts shared some ultrastructural features but also were distinct from each other. In decidua, it was noted that the endothelial lining of some vessels was invaded by a few endovascular trophoblasts with irregular microvilli. These cells shared some ultrastructural properties with both villous trophoblasts and stromal cells. Examination showed that angiogenesis was still present in term placentas and that trophoblasts, endothelial and stromal cells have very similar properties ultrastructurally, suggesting they represent transformational forms.

RESUMEN: Los trofoblastos dependiendo de su ubicación realizan diferentes funciones. Este estudio tuvo como objetivo obtener pistas estructurales sobre las funciones de los trofoblastos vellosos y extravellosos mediante el uso de microscopía óptica y electrónica. Se obtuvieron muestras de placenta a término de 10 mujeres embarazadas sanas después de cesáreas. Las secciones congeladas se tiñeron con hematoxilina-eosina, las secciones semidelgadas se tiñeron con azul de toluidina y se examinaron con un microscopio óptico, mientras que las secciones delgadas se contrastaron con acetato de uranilo-citrato de plomo y se evaluaron con un microscopio electrónico. Las finas características estructurales de los trofoblastos vellosos se superponen a algunas células estromales vellosas. Además de la apariencia habitual de capilares maduros en el estroma velloso, demostramos e informamos etapas de maduración de brotes angiogenéticos en la placenta a término. Los trofoblastos extravellosos se clasificaron según su localización: fibrinoide, corion, trofoblástico, columna, endotelio vascular materno o decidua. Todos estos trofoblastos compartían algunas características ultraestructurales, pero también eran distintos entre sí. En decidua se observó que el revestimiento endotelial de algunos vasos estaba invadido por unos pocos trofoblastos endovasculares con microvellosidades irregulares. Estas células compartían algunas propiedades ultraestructurales tanto con los trofoblastos vellosos como con las células del estroma. El examen mostró que la angiogénesis todavía estaba presente en las placentas a término y que los trofoblastos, las células endoteliales y estromales tienen propiedades ultraestructurales muy similares, lo que sugiere que representan formas de transformación.

Investigation of FAS and IL-6 expression in placentas with HELLP syndrome / Investigación de la expresión de FAS e IL-6 en placentas con síndrome de HELLP

SUMMARY: The aim of our study was to investigate the effect of inflammation in the placenta on the pro-apoptotic development after severe preeclampsia. Placenta tissue samples of 15 HELLP syndrome and 15 healthy 35-38th week-pregnant women were involved in the study. Tissue samples were taken only from the maternal side of the placenta and fixed in 10 % formaldehyde, then blocked in paraffin wax and 4-6 mm-thick sections were cut and stained with Harris Hematoxylene-Eosin. Antigen retrieval was performed for sections, incubated with FAS antibody and anti-IL-6 antibody. After the application of streptavidin peroxidase followed by AEC chromogen solution, sections were counterstained with Harris hematoxylin. Significant thickening of the fibrinoid layer, degeneration and apoptotic change in decidua cells, marked increase in the hyalinized area, degenerative changes in the syncytial regions of the chorionic villus and an increase in syncytial nodes and bridges and IL- expression were observed as positive. FAS expression was positive in the pycnotic nuclei of decidual cells in the maternal region and in the syncytial regions. It was observed that the proapoptotic process increased as a result of severe preeclampsia. It was concluded that the control of cytokine activity and reduction of pro-apoptotic signal during the inflammation process will slow down the development of HELLP syndrome.

RESUMEN: El objetivo de nuestro estudio fue investigar el efecto de la inflamación en la placenta sobre el desarrollo proapoptótico después de la preeclampsia severa. Se recogieron muestras de tejido de placenta de 15 mujeres con síndrome de HELLP y 15 mujeres sanas con un embarazo de 35 a 38 semanas. Se tomaron muestras de tejido solo del lado materno de la placenta y se fijaron en formaldehído al 10 %, luego se bloquearon en parafina y se cortaron secciones de 4-6 mm de espesor y se tiñeron con hematoxilena-eosina de Harris. La recuperación del antígeno se realizó para secciones, incubadas con anticuerpo FAS y anticuerpo anti-IL-6. Después de la aplicación de estreptavidina peroxidasa seguida de solución de cromógeno AEC, las secciones se contrastaron con hematoxilina de Harris. Se observó como positivo un engrosamiento significativo de la capa fibrinoide, degeneración y cambio apoptótico en las células de la decidua, aumento marcado en el área hialinizada, cambios degenerativos en las regiones sincitiales de la vellosidad coriónica y un aumento en los nódulos y puentes sincitiales y la expresión de IL-6. La expresión de FAS fue positiva en los núcleos picnóticos de las células deciduales en la región materna y en las regiones sincitiales. Se observó que el proceso proapoptótico se incrementó como consecuencia de la preeclampsia severa. Se concluyó que el control de la actividad de las citocinas y la reducción de la señal proapoptótica durante el proceso de inflamación ralentizarán el desarrollo del síndrome de HELLP.

Participação dos neutrófilos durante a implantação embrionária no desenvolvimento da placenta em camundongos / Participation of neutrophils during embryonic implantation in the placental development in mice

A implantação do embrião na parede uterina é um processo complexo que consiste na interação do blastocisto com as células epiteliais do útero, e depende de diferentes tipos celulares do microambiente uterino. Embora a literatura mostre a participação de neutrófilos neste processo, os dados ainda são incipientes para proposição da função exata destas células nos períodos iniciais da gestação. Dados do nosso grupo de pesquisa mostraram que neutrófilos pró-angiogênicos induzem a tolerância gestacional, e que a depleção de neutrófilos durante as fases iniciais da gestação prejudica a implantação do blastocisto e a progressão da gestação. Com base nestes resultados, o presente estudo visou investigar se a depleção de neutrófilos na fase pré-receptiva da janela de implantação do blastocisto altera a morfologia placentária. Para tanto, foi utilizado o modelo de gestação alogênica, onde camundongos fêmeas C57BL/6, após cruzamento com machos Balb/C foram tratadas com anticorpo anti-Ly6G ou isotipo no dia 1,5 da gestação (24 horas após a detecção do plug vaginal) em dose suficiente para manter a depleção de neutrófilos circulantes por 48 horas (200µg/ 500µL; i.p). No final da gestação (dia 18,5), o sangue periférico foi coletado e, em seguida, os animais foram submetidos a laparotomia para retirada da placenta, a qual foi submetida à análise histológica. As análises dos leucócitos circulantes evidenciaram a efetividade do tratamento para depleção de neutrófilos periféricos. A análise histológica mostrou alterações significativas na morfologia da placenta nos animais tratados com anti-Ly6G. Foram detectadas a redução da zona juncional, de células trofoblásticas e de fatores angiogênicos, como fator de crescimento do endotélio vascular (VEGF), e das moléculas de adesão intracelular-1 (ICAM-1) e de plaqueta e endotélio (PECAM-1). Esses dados evidenciam a importância dos neutrófilos nos primeiros dias de gestação para o desenvolvimento da placenta

Blastocyst implantation is a complex process, consisting of the interaction between blastocyst and uterine epithelial cells. Also, it is well known that the implantation site resembles an inflammatory response, with a profusion of recruited immune cells into the endometrial stroma and lumen from the blood. The role of macrophages, natural killers, and dendritic cells have been extensively studied, however, the participation of neutrophils in this process remains unclear. Data from our research group showed that pro-angiogenic neutrophils induced gestation tolerance, also peripheral neutrophils depletion at the time of active placental development led to smaller embryo sizes and abnormal placentation in mice. In this context, the present study aimed to investigate whether pharmacological depletion of neutrophils in mice in the blastocyst implantation phase alters placental morphology. Therefore, C7/BL/6 female mice, after mating with Balb/C males, were treated with an anti-Ly6G antibody or isotype on day 1 of gestation (after detection of the vaginal plug) at a dose sufficient to maintain the depletion of circulating neutrophils for 48 hours (200 µg/500µL; i.p). At the end of the gestational day (day 18), peripheral blood was collected, and then the animals were submitted to laparotomy for the placenta removal and subsequent histological analysis. The analysis of circulating leukocytes from neutrophils depleted mice showed a reduction of peripheral neutrophils up to 48 hours after antibody injection. The histological analysis showed significant alterations in the placenta morphology of the animals treated with anti-Ly6G. The morphometric analyses showed a reduction in the size of neutrophils depleted placenta due to diminished junctional zone and reduction of trophoblast cells. Also, it was observed a reduction of vascular endothelial growth factors (VEGF), reduction of adhesion molecules intracell-1 (ICAM-1), and platelets and endothelium (PECAM-1) positive cells in the junctional zone. In conclusion, these data show the importance of neutrophils on the first days of pregnancy for the development of the placenta

Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period / Dispneia e COVID-19: uma revisão de diagnósticos confundidores no período pós-parto

Abstract The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.

Resumo O puerpério é um período complexo que se inicia com a dequitação placentária e dura por 6 semanas, no qual a readaptação do organismo materno e a redistribuição do volume sanguíneo ocorrem, além de ser também um cenário propício para eventos pró-trombóticos. No contexto da pandemia de SARS-CoV-2, vírus responsável pela COVID-19, a atenção da comunidade científica e dos profissionais da saúde está voltada a elucidar os aspectos da doença, como a etiologia, a transmissão, o diagnóstico e o tratamento. Considerando o ciclo gravídico-puerperal, é oportuna a revisão de condições clínicas que ocorrem durante este período e que apresentam a dispneia como sintoma, a fimde evitar que ela seja automaticamente associada à COVID-19 sem investigações aprofundadas, o que pode levar à negligência do diagnóstico de outras condições importantes e que podem ser, por vezes, fatais.

Determination of the relationship among cell proliferation, metabolic activity and stage of pregnancy by AgNORs as markers in bovine placenta / Determinación de la relación entre la proliferación celular, la actividad metabólica y la etapa de preñez por los AgNOR como marcadores en la placenta bovina

SUMMARY: Nucleolus Organizer Regions (NORs) are defined as nucleolar components containing argyrophilic proteins selectively stained by silver methods (AgNORs). Several investigations have shown the AgNOR quantity and area represent a valuable parameter of cell kinetics, since they reflect the level of activity and cellular proliferation. This article addresses an evaluation of the functional activity and relation between days of pregnancy and proliferative capacity of trophoblastic mononucleate and binucleate cells from bovine placentomes. Both the number and size of AgNORs were determined in different phases of gestation by silver nitrate staining in conventional histological slides. The results showed a significant increase (from 1 to 12 AgNORs) in the number of AgNORS per trophoblastic mononucleate cell in the 3rd trimester, with predominance of 4-6 AgNORs/cell. In the 1st and 2nd trimesters, the number ranged between 1 and 9 AgNORs/cell, with predominance of 1-3 AgNORs. No significant differences were observed between the 2nd and 3rd trimesters, but in the first, in binucleate cells (19-27 and 10-18 AgNORs/cell, respectively) - this number was higher than the one registered in trophoblastic mononucleate cells in the same period. Thus, AgNORs can be used as markers of the proliferative placental cell cycle and established a relation between number of AgNORs and days of gestation. This relation can be used for diagnoses and prognoses of several placental pathologies, including pregnancy losses from manipulated embryos.

RESUMEN: Las Regiones Organizadoras de Nucléolos (NOR) se definen como componentes nucleolares que contienen proteínas argirofílicas teñidas selectivamente por métodos de plata (AgNOR). Varias investigaciones han demostrado que la cantidad y el área de AgNOR representan un parámetro importante de la cinética celular, ya que reflejan el nivel de actividad y proliferación celular. Este trabajo analiza la actividad funcional y la relación entre los días de preñez y la capacidad proliferativa de las células trofoblásticas mononucleadas y binucleadas de placentomas bovinos. Tanto el número como el tamaño de los AgNOR se determinaron en diferentes fases de la gestación mediante tinción con nitrato de plata en portaobjetos histológicos convencionales. Los resultados mostraron un aumento significativo (de 1 a 12 AgNOR) en el número de AgNORS por célula mononucleada trofoblástica en el tercer trimestre, con predominio de 4-6 AgNOR / célula. En el primer y segundo trimestre, el número osciló entre 1 y 9 AgNOR / célula, con predominio de 1-3 AgNOR. No se observaron diferencias significativas entre el 2do y 3er trimester; en el primer trimestre, en células binucleadas (19-27 y 10-18 AgNORs / célula, respectivamente) - este número fue superior a la cantidad registrada en células mononucleadas trofoblásticas en el mismo período. Por tanto, los AgNOR se pueden utilizar como marcadores del ciclo celular placentario proliferativo y se establece una relación entre el número de AgNOR y los días de gestación. Esta relación puede ser útil en el diagnóstico y pronóstico de varias patologías placentarias, incluidas las pérdidas de preñeces de embriones manipulados.