Regulatory T Cells Show Dynamic Behavior During Late Pregnancy, Delivery, and the Postpartum Period.

Regulatory T cells (Tregs) are critical immunomodulators during early pregnancy by preventing maternal T-cell activation against fetal cells. However, how populations of maternal Tregs vary during and after pregnancy in humans is still unclear. Therefore, we investigated Treg subsets in the peripheral blood of pregnant women from late pregnancy through the postpartum period. To accomplish this, the following circulating Treg subsets were analyzed in 43 healthy pregnant women and 35 nonpregnant women by flow cytometry during the third trimester, on the day of delivery, and postpartum: CD4DimCD25Hi, CD4+CD25HiFoxp3+, and CD4+CD25HiCD127-/dim. Additionally, the expression levels of the transcription factor Foxp3 in CD4DimCD25Hi Treg were analyzed. We have found that CD4DimCD25Hi Treg subset significantly decreased in the pregnant women on the day of delivery relative to the third trimester ( P < .05), and that all Treg subsets significantly increased postpartum compared to the third trimester and the day of delivery ( P < .05). Moreover, the Foxp3 expression ratios within the CD4DimCD25Hi Treg subset decreased during pregnancy and until delivery compared to those measured in the nonpregnant women and significantly increased postpartum compared to the third trimester and the day of delivery ( P < .05). Thus, despite their established role in offering immunoprotection to the fetus in early pregnancy, the number of circulating Tregs also varies from late pregnancy to the postpartum period. Our results offer an explanation for the possible effects of pregnancy on the clinical outcomes of some autoimmune diseases during the postpartum period.

Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization.

Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months). Under local anesthesia, both uterine arteries were embolized. In 160 patients, partial embolization was intentionally performed to preserve fertility, which may be decreased after conventional UFE. In partial UFE, only the small arterial vessels to the fibroids were embolized, leaving the large vessels of the fibroids patent. The Kaplan-Meier method and Cox regression were used for the statistical analysis. Results During follow-up, 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns. It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively. Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy. Complication rates in patients treated with partial UFE (14.6%) were not greater than rates in patients treated with conventional UFE (23.1%, P = .04). Conclusion Conventional and partial UFE may be safe and effective outpatient procedures for women with uterine fibroids who want to conceive. © RSNA, 2017.

[Translation, adaptation and psychometric evaluation of the instrument Activity Record (ACTRE)]. / Tradução, adaptação e avaliação psicométrica do questionário Activity Record (ACTRE).

OBJECTIVE: To perform the cultural adaptation of the instrument Activity Record (ACTRE) and evaluate its psychometric qualities. METHOD: Six steps were followed:1) translation of the original instrument, 2) back-translation, 3) formal equivalence assessment, 4) evaluation by an expert in Portuguese language, 5) final critique by experts in the field and 6 ) applying the questionnaire to 53 pregnant women, aged between 18 and 39 years, at two different moments with an interval time of two hours aimed to evaluate the reliability level of temporal stability (test-retest) using the the Intraclass Correlation. RESULTS: The results of the Intraclass Correlation at the level of test / retest reliability ranged between 0.88 and 1.00. The Cronbach's alpha, calculated for all the questions in the activities most often mentioned, was 0.77, we obtained a further significant correlations between the various issues together in this set of activities. CONCLUSION: The Portuguese version of the ACTRE was easily understood by all pregnant women and revealed a high reliability.

Impact of Labor on Peripheral Blood Maternal T-Cell Subsets and on Regulatory T and B Cells.

PURPOSE: Labor is thought to positively influence immune system development in the offspring, but studies investigating the impact of different modes of delivery on maternal immune system cells are scarce. Therefore, the aim of this study was to investigate the effect of labor on maternal peripheral blood T-cell subsets and on the recently described regulatory T and B cells. METHODS: Cross-sectional study comparing the absolute counts and percentages of peripheral blood T-cell subsets (maturation and activation profiles) and regulatory T and B cells between healthy pregnant women who delivered their newborns via elective cesarean (no labor; n = 14) and those who had a spontaneous vaginal delivery (after labor; n = 18). The cells were characterized using flow cytometry. RESULTS: We found that compared to the women who had elective cesareans, those who had spontaneous vaginal deliveries had significantly ( P < .05) lower absolute counts of B cells (median [cells/µL]: 146 [interquartile range, IQR = 49] vs 192 [IQR = 65]) and natural killer-like T (NKT-like) cells (median [cells/µL]: 154 [IQR = 125] vs 224 [IQR = 117]) in the peripheral blood. No further significant differences, particularly in regulatory T and B cells, were identified between the study groups. CONCLUSION: Labor does not seem to have a major impact on maternal peripheral blood T-cell subsets or regulatory T and B cells.

Characterization of B cells in healthy pregnant women from late pregnancy to post-partum: a prospective observational study.

BACKGROUND: B cells play a role in pregnancy due to their humoral and regulatory activities. To our knowledge, different maturational stages (from transitional to memory) of circulating B cell subsets have not yet been characterized (cell quantification and phenotype identification) in healthy pregnant women. Thus, the objective of our study was to characterize these subsets (as well as regulatory B cells) from late pregnancy to post-partum and to compare them with the circulating B cells of non-pregnant women. METHODS: In all of the enrolled women, flow cytometry was used to characterize the circulating B cell subsets according to the expression of IgD and CD38 (Bm1-Bm5 classification system). Regulatory B cells were characterized based on the expression of surface antigens (CD24, CD27, and CD38) and the production of IL-10 after lipopolysaccharide stimulation. RESULTS: Compared to the absolute counts of B cells in the non-pregnant women (n = 35), those in the pregnant women (n = 43) were significantly lower (p < 0.05) during the 3rd trimester of pregnancy and on delivery day (immediately after delivery). The percentages of these cells on delivery day and at post-partum were significantly lower than those in the non-pregnant women. In general, the absolute counts and percentages of the majority of the B cell subsets were significantly lower in the 3rd trimester of pregnancy and on delivery day than in the non-pregnant women. However, these counts and percentages did not differ significantly between the post-partum and the non-pregnant women. The most notable exceptions to the above were the percentages of naïve B cells (which were significantly higher in the 3rd trimester and on delivery day than in the non-pregnant women) and of CD24(hi)CD38(hi) regulatory B cells (which were significantly higher in the post-partum than in the non-pregnant women). CONCLUSION: According to our study, the peripheral B cell compartment undergoes quantitative changes during normal late pregnancy and post-partum. Such findings may allow us to better understand immunomodulation during human pregnancy and provide evidence that could aid in the development of new strategies to diagnose and treat pregnancy-associated disturbances. Our findings could also be useful for studies of the mechanisms of maternal responses to vaccination and infection.

[Vertebral metrics: application of a new mechanical instrument to evaluate the spinal column]. / Métrica vertebral: a aplicação de uma nova tecnologia na análise da coluna vertebral.

OBJECTIVE: To present the results of the first application of the new technology - Vertebral Metrics - the analysis of the 3D position of the vertex of each spinous process in pregnant women. MATERIAL AND METHODS: The Vertebral Metrics was applied to women without associated pathology in four stages of pregnancy (12, 20, 32, 37 weeks gestation). We applied univariate linear models. RESULTS: We found that the differences that occur during pregnancy are more significant at the position y (anteroposterior). It was found also that there is a positive correlation between the biomechanical position of the vertex of each of the vertebrae with the homologous position of rest. DISCUSSION/CONCLUSION: Through Vertebral Metrics innovative results could be obtained in analyzing biomechanics of the spine. A device that has different applications can be easily adopted in areas such as orthopedics, neurosurgery, pediatrics and rehabilitation. It should also be noted that this instrument is not exhausted in the sample of this research because it can be further applied to the general population.

Objectivo: Apresentar os resultados da primeira aplicação da nova tecnologia ­ Métrica Vertebral ­ na análise da posição 3D do vértice de cada uma das apófises espinhosas, em mulheres grávidas.Material e Métodos: O Métrica Vertebral foi aplicado a mulheres, sem patologia associada, em quatro momentos da gravidez (12, 20, 32, 37 semanas de gestação). Aplicaram-se modelos lineares univariados.Resultados: Observou-se que as diferenças que ocorrem ao longo da gravidez são mais significativas ao nível da posição y (anteroposterior). Verificou-se, igualmente, que existe uma correlação biomecânica positiva entre a posição do vértice de cada uma das vértebras com a posição homóloga das restantes.Discussão/Conclusão: Através do Métrica Vertebral foi possível obter resultados inovadores na análise biomecânica da colunavertebral. É um dispositivo que tem diferentes aplicações podendo ser facilmente adoptado em áreas como ortopedia, neurocirurgia, pediatria e reabilitação. É de realçar ainda que este instrumento não se esgota na amostra da presente investigação pois pode ser futuramente aplicada à população em geral.

Maternal plasma noradrenaline levels at 29 weeks and gestational age at birth.

OBJECTIVE: To investigate the relationship between maternal plasma noradrenaline levels at a mean gestational age of 29 weeks and gestational age and weight at birth. DESIGN: Original research. SAMPLE: Seventy-four pregnant women with a mean gestational age of 29 weeks. METHODS: Psychological anxiety levels (Spielberger State and Trait questionnaire) and plasma stress hormone levels (noradrenaline and adrenaline) were measured in pregnant women at a mean gestational age of 29 weeks. Statistical analysis was applied to investigate links between these variables and gestational age and weight at birth. OUTCOME MEASURES: Self-rating anxiety, State and Trait Spielberger questionnaire, maternal noradrenaline and adrenaline levels, gestational age and weight at birth. RESULTS: There was a significant inverse relationship between maternal noradrenaline levels and the infant gestational age at birth (r = 0.09, p = 0.05). There was no relationship between maternal noradrenaline levels and weight at birth. CONCLUSIONS: There was a significant inverse relationship between maternal noradrenaline levels and gestational age at birth, suggesting the possibility of underlying mechanisms linking maternal noradrenaline and timing of delivery.

Factor V Leiden and prothrombin G20210A in Portuguese women with recurrent miscarriage: is it worthwhile to investigate?

OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.

Comparative evaluation of the tridimensional spine position measured with a new instrument (Vertebral Metrics) and an optoelectronic system of stereophotogrammetry.

We designed and built a non-invasive instrument, called Vertebral Metrics, to measure the x, y, and z positions of each spinous process of the spine on a standing position. In the present study, we perform a comparative evaluation of Vertebral Metrics, by comparing the results obtained from this instrument with those from a validated optoelectronic system of stereophotogrammetry, with 10 infrared cameras. The sample was composed of 11 women aged between 14 and 39 years. After marking the various points on the spinal column, from the first cervical vertebra to the first sacral vertebra, they were measured first with the new instrument (Vertebral Metrics) and then by means of the optoelectronics system. Afterwards, the results were subjected to a thorough comparison. The statistical comparison of the results was performed using an ANOVA model with three factors (Instrument, Subject, and Vertebra) for the intervertebral distance.

Primary antiphospholipid syndrome: pregnancy outcome in a portuguese population.

INTRODUCTION: Women with antiphospholipid syndrome (APS) may suffer from recurrent miscarriage, fetal death, fetal growth restriction (FGR), pre-eclampsia, placental abruption, premature delivery and thrombosis. Treatment with aspirin and low molecular weight heparin (LMWH) combined with close maternal-fetal surveillance can change these outcomes. OBJECTIVE: To assess maternal and perinatal outcome in a cohort of Portuguese women with primary APS. PATIENTS AND METHODS: A retrospective analysis of 51 women with primary APS followed in our institution (January 1994 to December 2007). Forty one (80.4%) had past pregnancy morbidity and 35.3% (n=18) suffered previous thrombotic events. In their past they had a total of 116 pregnancies of which only 13.79 % resulted in live births. Forty four patients had positive anticardiolipin antibodies and 33 lupus anticoagulant. All women received treatment with low dose aspirin and LMWH. RESULTS: There were a total of 67 gestations (66 single and one multiple). The live birth rate was 85.1% (57/67) with 10 pregnancy failures: seven in the first and second trimesters, one late fetal death and two medical terminations of pregnancy (one APS related). Mean (+/- SD) birth weight was 2837 +/- 812 g and mean gestational age 37 +/- 3.3 weeks. There were nine cases of FGR and 13 hypertensive complications (4 HELLP syndromes). 54.4% of the patients delivered by caesarean section. CONCLUSIONS: In our cohort, early treatment with aspirin and LMWH combined with close maternal--fetal surveillance was associated with a very high chance of a live newborn.

[Sclerotherapy of female varicocele]. / Escleroterapia do varicocelo feminino.

The female varicocile is associated to the pelvic congestion syndrome that is described. Five patients 31 to 52 years old are presented. Four of them have continuous pelvic pain and the fifth had huge vaginal and vulvar varices. Flebography of the left ovarian vein showed retrograde flux of the dilated vein. Sclerotherapy with Aethoxysklerol 3% was performed. There was an immediate relief of symptoms. During the follow up period between 9 and 12 months the five patients were asymptomatic. There are publications of embolization of the ovarian vein, however the present cases are the first ones in which the selective Sclerotherapy was the only treatment used with good results.