RESUMO
OBJECTIVE: To study whether the occurrence and type of placental lesions vary according to the time of onset of COVID-19 in pregnant women. DESIGN: Case-control study. SETTING: Departments of Gynaecology-Obstetrics and Pathology, Strasbourg University Hospital, France. POPULATION: Cases were 49 placentas of women with COVID-19. Controls were 50 placentas from women who had a past history of molar pregnancy. COVID-19 placentas were categorised based on whether birth occurred at more or less than 14 days post-infection. METHODS: Comparison between case and controls. MAIN OUTCOME MEASURES: Maternal and neonatal outcomes were recorded. Macroscopic and microscopic examination of the placentas was performed. RESULTS: The rate of vascular complications was higher in the COVID groups than in the controls (8 [16.3%] versus 1 [2%], p = 0.02). Signs of fetal (22[44.9%] versus 13 [26%], p = 0.05) and maternal (44 [89.8%] versus 36 [72.0%], p = 0.02) vascular malperfusion and signs of inflammation (11 [22.4%] versus 3 [6.0%], p = 0.019) were significantly more common in the COVID-19 groups than in the control group. Fetal malperfusion lesions (9 [39.1%] versus 13 [50.0%], p = 0.45) and placental inflammation (4 [17.4%] versus 7 [26.9%], p = 0.42) rates were not significantly different between the two COVID-19 groups. Chronic villitis was significantly more common when the delivery occurred >14 days after infection than in the group that delivered <14 days after infection (7 [26.9%] versus 1 [4.4%], p = 0.05). CONCLUSIONS: Our study suggests that SARS-COV-2 induces placental lesions that evolve after disease recovery, especially with the development of inflammatory lesions, such as chronic villitis.
Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Neoplasias Uterinas , Recém-Nascido , Gravidez , Feminino , Humanos , Placenta/irrigação sanguínea , Estudos de Casos e Controles , SARS-CoV-2 , Inflamação/patologia , Parto , Neoplasias Uterinas/patologia , Complicações Infecciosas na Gravidez/epidemiologiaRESUMO
The autonomic nervous system plays a leading role in the control of fetal homeostasis. Fetal heart rate variability (HRV) analysis is a reflection of its activity. We developed a new index (the Fetal Stress Index, FSI) reflecting parasympathetic tone. The objective of this study was to evaluate this index as a predictor of fetal acid-base status. This was an experimental study on chronically instrumented fetal lambs (n = 11, surgery at 128 +/- 2 days gestational age, term = 145 days). The model was based on 75% occlusion of the umbilical cord for a maximum of 120 minutes or until an arterial pH ≤ 7.20 was reached. Hemodynamic, gasometric and FSI parameters were recorded throughout the experimentation. We studied the FSI during the 10 minutes prior to pH samplings and compared values for pH>7.20 and pH≤ 7.20. In order to analyze the FSI evolution during the 10 minutes periods, we analyzed the minimum, maximum and mean values of the FSI (respectively FSImin, FSImax and FSImean) over the periods. 11 experimentations were performed. During occlusion, the heart rate dropped with an increase in blood pressure (respectively 160(155-182) vs 106(101-120) bpm and 42(41-45) vs 58(55-62) mmHg after occlusion). The FSImin was 38.6 (35.2-43.3) in the group pH>7.20 and was higher in the group pH less than 7.20 (46.5 (43.3-52.0), p = 0.012). The correlation of FSImin was significant for arterial pH (coefficient of -0.671; p = 0.004) and for base excess (coefficient of -0.632; p = 0.009). The correlations were not significant for the other parameters. In conclusion, our new index seems well correlated with the fetal acid-base status. Other studies must be carried out in a situation close to the physiology of labor by sequential occlusion of the cord.
Assuntos
Acidose/fisiopatologia , Doenças Fetais/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Animais , OvinosRESUMO
OBJECTIVE: Assess the impact of routine injection of 5 units of oxytocin as soon as the anterior shoulder is delivered on the incidence of postpartum haemorrhage (PPH) in a context of daily practice. MATERIALS AND METHODS: Single-centre before-and-after study evaluating the effect of a change in the protocol for PPH prevention as applied in our obstetrical unit. During the first period, oxytocin (5 units) was to be injected only in case of PPH risk factors. During the second period, the injection was systematic. RESULTS: In the "before" study period, there were 1953 patients vaginal deliveries and 843 (43%) oxytocin injections, with a protocol compliance of 85%. In the "after" study period, 2018 women had vaginal deliveries and 1911 (95%) had an oxytocin injection (protocol compliance: 95%). The whole study period was associated with a reduced risk of moderate haemorrhage (13.4% vs. 9.2%, P<0.001), but no significant reduced risk of severe haemorrhage was observed (2.1% vs. 2.0%, P=0.79). After logistic regression, the study period remained associated with a significant reduction in the risk of moderate PPH (OR=0.72 [0.58-0.89]). CONCLUSION: Routine injection of 5 units of oxytocin makes it possible to reduce the risk of moderate PPH, but it does not affect the risk of severe PPH.
Assuntos
Parto Obstétrico/efeitos adversos , Ocitocina/administração & dosagem , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Adulto , Quimioprevenção/métodos , Quimioprevenção/normas , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Injeções , Terceira Fase do Trabalho de Parto , Hemorragia Pós-Parto/epidemiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Adulto JovemRESUMO
For many years, there is a debate on gestational diabetes screening, including what screening test and thresholds to use. The purpose of this literature review is to determine whether gestational diabetes screening in France meets the 10 definition criteria of the WHO. The DG is a public health problem, with a natural history partially known and detectable at an early stage. Currently, there is no data showing that there is a benefit to treat patient screens by the new criteria. The one-step approach-screening test can only detect fetal complications and not maternal complications. It seems to be acceptable for the population of pregnant women. The diagnostic test and treatment also seem to be acceptable to us. To this day, its reproducibility is uncertain. Screening leads to an increase in obstetric interventions. Several studies found that screening for gestational diabetes is cost-effective but in a different context of care than in France.
Assuntos
Diabetes Gestacional/diagnóstico , Programas de Rastreamento , Diagnóstico Pré-Natal , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Diagnóstico Precoce , Feminino , França/epidemiologia , Humanos , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Gravidez , Diagnóstico Pré-Natal/normas , Diagnóstico Pré-Natal/estatística & dados numéricos , Valores de Referência , Reprodutibilidade dos TestesRESUMO
Postpartum haemorrhage (PPH) is a major cause of maternal mortality, accounting for one-quarter of all maternal deaths worldwide. Uterotonics after birth are the only intervention that has been shown to be effective for PPH prevention. Tranexamic acid (TXA), an antifibrinolytic agent, has therefore been investigated as a potentially useful complement to this for both prevention and treatment because its hypothesized mechanism of action in PPH supplements that of uterotonics and because it has been proved to reduce blood loss in elective surgery, bleeding in trauma patients, and menstrual blood loss. This review covers evidence from randomized controlled trials (RCTs) for PPH prevention after caesarean (n=10) and vaginal (n=2) deliveries and for PPH treatment after vaginal delivery (n=1). It discusses its efficacy and side effects overall and in relation to the various doses studied for both indications. TXA appears to be a promising drug for the prevention and treatment of PPH after both vaginal and caesarean delivery. Nevertheless, the current level of evidence supporting its efficacy is insufficient, as are the data about its benefit:harm ratio. Large, adequately powered multicentre RCTs are required before its widespread use for preventing and treating PPH can be recommended.
Assuntos
Antifibrinolíticos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Cesárea , Feminino , Feto/efeitos dos fármacos , Humanos , Hemorragia Pós-Parto/tratamento farmacológico , Gravidez , Ácido Tranexâmico/efeitos adversosRESUMO
BACKGROUND: To evaluate the impact of the new IADPSG thresholds on gestational diabetes mellitus (GDM) prevalence. METHODS: Universal screening for GDM was performed in 200 consecutive patients at 24 to 28 weeks with 75 g oral glucose tolerance test. RESULTS: The prevalence of GDM was 14.0%. We observed that among the 28 patients with GDM, 16 (57.1%) had only one abnormal value, 10 (35.7%) two abnormal values and only two (7.2%) had three abnormal values. For the 16 patients with one abnormal value, 13 of them (81.2%) have an abnormal fasting plasma glucose (FPG). Patients with GDM had an increased body mass index (29.6 kg/m(2) vs 25.1 kg/m(2), P<0.001) and more important rates of familial history of type II diabetes (46.4% vs 21.5%, P<0.005) and history of GDM in a previous pregnancy (21.4% vs 2.9%, P<0.002) compared to non-GDM patients. Birth weight was increased in offspring of mothers with GDM (3451.3g vs 3387.4 g, P<0.05). CONCLUSION: Our study found an increased rate of GDM with the new IADPSG criteria compared to previous published data. Higher rates of GDM represent a challenge for the organization of perinatal teams involved in GDM care.
Assuntos
Diabetes Gestacional/epidemiologia , Programas de Rastreamento/métodos , Adulto , Glicemia/análise , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/genética , Diabetes Gestacional/diagnóstico , Jejum , Feminino , França , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , RecidivaRESUMO
OBJECTIVES: Prenatal screening was set up to identify patients at high-risk of chromosome 21 trisomy based on maternal serum markers measurement. However, the risk of trisomy 21 should not be the only result considered by obstetricians. In fact, abnormal marker values can be associated with other fetal diseases and used to improve maternal and fetal follow-up. Our objective was therefore to study other predictive values of maternal serum markers. MEANS AND METHODS: A search through publications was conducted using the PubMed® or Cochrane® databases. RESULT: In case of high PAPP-A there is no link with any complications. Second trimester high hCG or first trimester low hCG are associated with an increased vascular risk. High α-fetoprotein level is a marker of neural tube defects or abdominal wall defect. Persistence of high α-fetoprotein with normal echography can suggest other rare fetal diseases. Low maternal serum markers suggests 18 trisomy. Oestriol reflects the fetal hypothalamo-hypophyseal axis and can be used as a diagnosis tool. CONCLUSION: Serum markers could be interesting tools for the identification of high-risk pregnancy and the prevention of neonatal complications. They also appear as a potential help to diagnose certain congenital malformations.
Assuntos
Biomarcadores/sangue , Síndrome de Down/diagnóstico , Diagnóstico Pré-Natal/normas , Gonadotropina Coriônica Humana Subunidade beta/sangue , Síndrome de Down/sangue , Estriol/sangue , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Proteína Plasmática A Associada à Gravidez/análise , Valores de Referência , alfa-Fetoproteínas/análiseRESUMO
OBJECTIVES: To evaluate the educational interest of a workshop on diagnosis and repair of obstetric anal sphincter injuries (OASIS). To evaluate the theoretical and anatomical knowledge of OASIS repair by French residents in obstetrics and gynecology. MATERIALS AND METHODS: The workshop was composed of slides, video of repair and training using cadaveric sow's anal sphincters. All subjects were tested with a questionnaire before and after the course. RESULTS: Thirty residents participated. Classification of OASIS was known by 13.3% of the residents before the training versus 93.3% after the workshop (P<0.001). Initially, only 6.7% correctly classified operative procedures of OASIS versus 86.7% after the workshop (P<0.001). Per pre-test, 90% of residents did not know how to identify the internal anal sphincter (IAS) versus 3% at post-test (P<0.001). Seventy percent of trainees correctly identified the external anal sphincter (EAS) at the beginning of training. Before the course, no resident knew the repair of the IAS and only one third knew the technical repair of the EAS. After the workshop, the theoretical knowledge of EAS and IAS repair were acquired by all (P<0.001). CONCLUSION: Structured hands-on training improves significantly the knowledge of OASIS diagnosis and repair.
Assuntos
Canal Anal/lesões , Canal Anal/cirurgia , Avaliação Educacional , Internato e Residência , Complicações do Trabalho de Parto/cirurgia , Procedimentos Cirúrgicos Obstétricos/educação , Canal Anal/patologia , Competência Clínica , Feminino , Ginecologia/educação , Humanos , Procedimentos Cirúrgicos Obstétricos/métodos , Obstetrícia/educação , Gravidez , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVES: Assessment of pregnancy outcomes after bariatric surgery and analysis of follow-up particularities of such pregnancies. PATIENTS AND METHODS: A retrospective study of 63 post-bariatric surgery pregnancies compared to 259 pregnancies of obese un-operated patients. Pregnancy outcomes, neonatal datas, delay influence between surgery and pregnancy beginning, bariatric surgery type and gastric banding (GB) loosening consequences were analysed. RESULTS: In the surgical brand were developed less gestational diabetes (DG) (P=0,05), deliveries were more often normal (P=0,004) and births shown less macrosomias and small for gestational age newborns (P=0,04). Neonatal state was improved among operated patients: less Apgar scores less than 7 at 1 minute (P=0,05) and less cord blood pH less than 7,2 (P=0,03). They gained more weight during the pregnancy (P=0,0003) and only 53% had a nutritional management and assessment. Patients with GB loosening gained more weight (P=0,0003). Lastly, there were no difference due to the different bariatric surgery techniques or nutritional follow-up in the pregnancy course and neonatal state. DISCUSSION AND CONCLUSION: Bariatric surgery improves obstetric and neonatal prognosis. Improvements have to be developed in the multidisciplinary follow-up in order to avoid nutritional deficiencies or important weight gain pregnancy in case of GB.
Assuntos
Cirurgia Bariátrica , Obesidade/cirurgia , Complicações na Gravidez , Resultado da Gravidez , Índice de Apgar , Peso ao Nascer , Parto Obstétrico , Diabetes Gestacional/epidemiologia , Feminino , Sangue Fetal/química , Macrossomia Fetal/epidemiologia , Gastroplastia , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Obesidade/complicações , Gravidez , Estudos RetrospectivosRESUMO
Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. A small number of cases during pregnancy have been described in literature. We report one HPS case in a pregnant patient at 21 week's gestation with systemic lupus erythematosus. We discuss diagnostic difficulties, obstetrical complications and therapeutic options.
Assuntos
Linfo-Histiocitose Hemofagocítica/terapia , Complicações Hematológicas na Gravidez/terapia , Corticosteroides/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Citocinas/sangue , Feminino , Febre/etiologia , Humanos , Hipóxia/etiologia , Lúpus Eritematoso Sistêmico/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Fagocitose , Hemorragia Pós-Parto/terapia , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Trombocitopenia/complicaçõesAssuntos
Programas de Rastreamento/métodos , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/isolamento & purificação , Antibioticoprofilaxia/economia , Feminino , Doenças Fetais/economia , Doenças Fetais/prevenção & controle , Humanos , Programas de Rastreamento/economia , Gravidez , Complicações Infecciosas na Gravidez/economia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Estreptocócicas/economia , Infecções Estreptocócicas/prevenção & controleRESUMO
OBJECTIVE: To evaluate the management and outcome of pregnancy in women with essential thrombocytemia. PATIENTS AND METHODS: We conducted a retrospective study including all the pregnant women with essential thrombocytemia followed between January 2000 and January 2008 in a University Hospital (hôpital Jeanne-de-Flandre, Lille, France). We report our experience of 18 pregnancies in 13 women. The management and the complications of these pregnancies were reported. RESULTS: All the patients were treated with low dose aspirin during the pregnancy. We observed one intrauterine death, one premature delivery at 29 weeks of gestation and six maternal haemorrhages at delivery (33%). DISCUSSION AND CONCLUSION: It is essential to treat these patients with low dose aspirin as soon as the pregnancy begins. Aspirin will be continued in postpartum with anticoagulant treatment. This management appears to improve the obstetric outcome and decrease the thrombotic complications usually described. A national register seems to be necessary to evaluate the complications occurring during pregnancy and the optimum follow-up.
Assuntos
Aspirina/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombocitemia Essencial/tratamento farmacológico , Adulto , Feminino , Hospitais Universitários , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto JovemAssuntos
Anormalidades Congênitas/terapia , Procedimentos Clínicos/ética , Ética Médica , Doenças do Prematuro/terapia , Cuidados Paliativos/ética , Anormalidades Congênitas/diagnóstico , Comportamento Cooperativo , Procedimentos Clínicos/legislação & jurisprudência , Eutanásia Ativa/ética , Eutanásia Ativa/legislação & jurisprudência , Feminino , França , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Doenças do Prematuro/diagnóstico , Comunicação Interdisciplinar , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/legislação & jurisprudência , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Cuidados Paliativos/legislação & jurisprudência , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/legislação & jurisprudência , Gravidez , Diagnóstico Pré-Natal/ética , Ordens quanto à Conduta (Ética Médica)/ética , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudênciaRESUMO
Rapidly involuting congenital haemangioma (RICH) is a rare vascular tumour whose antenatal diagnosis is difficult. During ultrasound examination at 32nd weeks' gestation, a voluminous heterogeneous cephalic lesion was discovered that could be a haemangioma or a teratoma. A caesarean delivery was performed. The tumour was removed directly after birth. The pathology examination concluded on a RICH. Antenatal, prepartum and postnatal management are not consensual and must consider the lesion size.
Assuntos
Vértebras Cervicais , Hemangioma/diagnóstico , Hemangioma/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Cesárea , Diagnóstico Diferencial , Feminino , Idade Gestacional , Hemangioma/congênito , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Neoplasias da Coluna Vertebral/congênito , Resultado do Tratamento , Ultrassonografia Pré-NatalRESUMO
Ectopic prolactin secretion remains exceptional and originates mainly from malignant tumors. We report the case of a 47-year-old woman who presented amenorrhea leading to unravel important hyperprolactinaemia (269 ng/mL) with no hypothalamo-pituitary mass on magnetic resonance imaging (MRI). Pelvic imaging revealed the presence of a large pelvic mass that originated from the mesocolon. After complete surgical extraction, histological examination was in favour of a "perivascular epithelioid cell tumor" (PEComa). Prolactin levels normalized after surgical extraction and remained normal after a 3-year follow-up, totally free of tumour recurrence and/or metastasis. This suggests that hyperprolactinaemia was most likely related to the PEComa, despite negative reactions with antiprolactin antibodies at immunohistochemistry. Alternatively to a direct prolactin secretion by the tumor, one could hypothesize that the tumour secreted a prolactin stimulating factor or a dopamine antagonist that could not be identified. In conclusion, in face of an important hyperprolactinaemia without any hypothalamic-pituitary mass, it remains important to search for an ectopic prolactin production, such as a PEComa.
Assuntos
Células Epitelioides/patologia , Hiperprolactinemia/patologia , Prolactinoma/patologia , Neoplasias de Tecidos Moles/patologia , Amenorreia/etiologia , Feminino , Humanos , Neoplasias Hipotalâmicas/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prolactina/biossíntese , Prolactina/fisiologiaRESUMO
Early premature rapture of the membranes (PROM) during pregnancy is associated with a high risk of perinatal morbidity and mortality. Early PROM impairs lung structures and function through 3 mechanisms : 1) oligo-hydramnios ; 2) fetal inflammatory syndrome ; and 3) prematurity. Thus, the related causes of respiratory failure at birth after PROM are: hyaline membrane disease, persistent pulmonary hypertension induced by impaired endothelial function and/or lung hypoplasia, materno-fetal infection, and bronchopulmonary dysplasia resulting at least in part from the fetal inflammatory syndrome. Severity of the respiratory morbidity is largely unpredictable. Even if gestational age at PROM is considered as a prognostic factor, survival without morbidity exist after PROM as early as 18 weeks GA. Better knowledge of the pathophysiology improved the outcome of the preterm infants born after early PROM. Optimal management of the respiratory failure including minimizing barotrauma is required to prevent from bronchopulmonary dysplasia.
Assuntos
Displasia Broncopulmonar/etiologia , Ruptura Prematura de Membranas Fetais/fisiopatologia , Hipertensão Pulmonar/etiologia , Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Displasia Broncopulmonar/prevenção & controle , Feminino , Doenças Fetais/etiologia , Ruptura Prematura de Membranas Fetais/terapia , Idade Gestacional , Humanos , Doença da Membrana Hialina/etiologia , Doença da Membrana Hialina/terapia , Hipertensão Pulmonar/terapia , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oligo-Hidrâmnio/fisiopatologia , Síndrome da Persistência do Padrão de Circulação Fetal/terapia , Gravidez , Prognóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/etiologiaRESUMO
BACKGROUND: Nociceptive stimulation induces pulmonary vasoconstriction in fetuses and newborns. The mechanism of this response is not fully understood. As the systemic hemodynamic response to pain is mainly mediated by sympathetic stimulation, we hypothesized that pain-induced pulmonary vasoconstriction results from the activation of catecholaminergic receptors. To test this hypothesis, we studied the pulmonary vascular response to nociceptive stimuli in fetal lambs before and after alpha-adrenoceptor blockade. METHODS: Surgery was performed in fetal lambs. Catheters were placed into the ascending aorta, superior vena cava, and main pulmonary artery. An ultrasonic flow transducer was placed around the left pulmonary artery, and subcutaneous catheters were placed in the limb. The hemodynamic responses to (1) subcutaneous injection of formalin (which is used as nociceptive stimulus in experimental studies), (2) prazosin (specific alpha(1)-adrenoceptor antagonist), and (3) formalin during prazosin infusion were evaluated. Plasma cortisol and catecholamine concentrations were measured. RESULTS: Pulmonary vascular resistance (PVR) increased by 50% (P < 0.01) after the formalin test. PVR did not change after the formalin test during prazosin infusion or during prazosin infusion alone. Catecholamine and cortisol levels did not change during any of the protocols. DISCUSSION: Our results indicate that the fetal pulmonary vasoconstrictive response to pain involves alpha(1)-adrenoceptors activation. As plasma catecholamine concentrations did not change after the formalin test, we speculate that the pulmonary vascular response to nociceptive stimuli could be triggered by a local release of catecholamine induced by sympathetic stimulation.
Assuntos
Doenças Fetais/fisiopatologia , Pulmão/irrigação sanguínea , Dor/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Vasoconstrição , Antagonistas Adrenérgicos alfa/farmacologia , Animais , Pressão Sanguínea , Catecolaminas/sangue , Modelos Animais de Doenças , Doenças Fetais/sangue , Doenças Fetais/induzido quimicamente , Feto/cirurgia , Formaldeído , Idade Gestacional , Frequência Cardíaca Fetal , Hidrocortisona/sangue , Pulmão/efeitos dos fármacos , Pulmão/embriologia , Dor/sangue , Dor/induzido quimicamente , Dor/embriologia , Prazosina/farmacologia , Circulação Pulmonar , Receptores Adrenérgicos alfa 1/efeitos dos fármacos , Ovinos , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/embriologia , Fatores de Tempo , Resistência Vascular , Vasoconstrição/efeitos dos fármacosRESUMO
Intra-uterine arteriovenous malformations are a possible etiology of persistent metrorrhagia especially in the event of a history of miscarriages, cornuale pregnancy, molar pregnancy or gravidic trophoblastic diseases. We report 4 cases of patients having an intra-uterine arteriovenous malformation. The diagnosis of such lesions calls upon first intention Doppler echography. This diagnosis is confirmed thereafter by angiography. The first intention treatment is embolization which can save time if carried out at the same time as the angiography. This treatment is rapid and final, enabling the patients to have other pregnancies later on. An echographic follow-up, according to a schedule which remains to be defined, is necessary in order to check the good involution of this type of vascular malformation.
Assuntos
Malformações Arteriovenosas/diagnóstico , Útero/irrigação sanguínea , Aborto Espontâneo/etiologia , Adolescente , Adulto , Angiografia , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/terapia , Embolização Terapêutica , Feminino , Humanos , Mola Hidatiforme/etiologia , Metrorragia/etiologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Gravidez Ectópica/etiologia , Ultrassonografia DopplerRESUMO
OBJECTIVES: To evaluate the efficacy and safety of a surgical treatment for stress urinary incontinence by implantation of a silicone-coated polyester tape (Lift). MATERIALS AND METHODS: This retrospective study included 72 female patients having had a suburethral silicone-coated polyester tape inserted as treatment for stress urinary incontinence, combined or not with pelvic surgery. We recorded the patient's characteristics, the surgical procedure, the short and long-term results and complications. RESULTS: Seventy-two patients were operated, 60 of whom were fully evaluated. The average follow-up was 17 months. On 48 patients (80%) the treatment was successful, 3 (5%) were improved, and 9 (15%) were regarded as a failure. Dysuria occurred in six (10%) patients, five were de novo, and one was persistent. Ten patients (16.6%) presented de novo urge incontinence. The main complication was a higher rate of severe infections, accompanied by defective healing (4, i.e. 6.7%). CONCLUSION: The procedure using a silicone-coated polyester tape seems to be efficient, but insufficiently secure. This higher rejection rate leads us to prefer other synthetic materials proved to be better tolerated.