RESUMO
OBJECTIVE: The purpose of this study was to characterize placental expression of the prostaglandin synthase enzymes cyclooxygenase (COX) -1 and -2 and prostaglandin dehydrogenase (PGDH, a degrading enzyme). STUDY DESIGN: Forty-one women between 20 and 37 weeks' gestation and 39 matched term controls with either spontaneous labor or premature rupture of membranes were enrolled in a prospective case-control study. The relative amounts of placental RNAs at delivery were determined using real-time polymerase chain reaction (PCR). RESULTS: Placental COX-1 RNA decreased with advancing gestational age at delivery (R(2) = 0.13, P = .001), and increased by 43% when chorioamnionitis was present (P = .006). Among patients presenting at term, oxytocin use was associated with 30% lower expression of COX-1 (P = .01). COX-2 and PGDH were not associated with these variables. CONCLUSION: Placental COX-1 RNA at delivery decreases with advancing gestational age and with oxytocin use at term. Thus, expression of placental COX-1 is not constitutive. Placental expression of COX-2 and PGDH do not correlate with gestational age, chorioamnionitis, or oxytocin use.
Assuntos
Ruptura Prematura de Membranas Fetais/metabolismo , Hidroxiprostaglandina Desidrogenases/metabolismo , Trabalho de Parto Prematuro/metabolismo , Placenta/enzimologia , Prostaglandina-Endoperóxido Sintases/metabolismo , Estudos de Casos e Controles , Ciclo-Oxigenase 1 , Primers do DNA , Feminino , Regulação Enzimológica da Expressão Gênica , Idade Gestacional , Humanos , Hidroxiprostaglandina Desidrogenases/genética , Proteínas de Membrana , Reação em Cadeia da Polimerase , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Prostaglandina-Endoperóxido Sintases/genética , RNA/análiseRESUMO
OBJECTIVE: This study was undertaken to assess contemporary outcomes in pregnancies managed expectantly after extremely preterm premature (< or =24 weeks) premature rupture of the membranes (EPPROM). STUDY DESIGN: We queried antepartum and ultrasound databases for patients with EPPROM. Data on pregnancy outcome and short-term neonatal outcomes were collected. RESULTS: Forty-six patients with EPPROM were studied. Patients were hospitalized at 24 weeks' gestation and given antibiotics and antenatal steroids. Median gestational age at PPROM was 22.0 weeks (range 16.9-24 weeks); 43 (93%) elected expectant management, 2 of whom later had an intrauterine fetal death. Median latency period to delivery was 13 days (range 0-96 days), with mean gestational age at delivery of 25.8+/-3.4 weeks. Overall survival was 47% (27 of 57 infants), after a median hospital stay of 71 days (range 17-209 days). Ten (37%) of the survivors have serious sequelae. CONCLUSION: Although significant pregnancy prolongation after previable PPROM occurs in many cases, neonatal outcomes remain poor.