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RESEARCH QUESTION: What differences exist in the phenotypes of pre-eclampsia, perinatal outcomes and neonatal echocardiography between pregnancies conceived naturally and through IVF? DESIGN: Six hundred and ten women diagnosed with pre-eclampsia between January 2002 and December 2022 were included in this study. This research was conducted within the IVF and Maternal-Fetal Medicine Department of Kaohsiung Chang Gung Memorial Hospital, Taiwan. Participants were divided into two groups: those who achieved pregnancy through IVF, and those who conceived naturally. The phenotypes of pre-eclampsia and perinatal outcomes were assessed using a propensity-matched sample (nâ¯=â¯218), along with neonatal echocardiography. RESULTS: After conducting propensity score matching, the natural conception group had a higher prevalence of early-onset pre-eclampsia (53.9% versus 37.7%, Pâ¯=â¯0.04) and exhibited more severe features of pre-eclampsia (89.1% versus 69.8%, Pâ¯=â¯0.01) compared with the IVF group. Regarding perinatal outcomes, neonates in the IVF group had higher placental weights compared with the natural conception group (580 versus 480 g, Pâ¯=â¯0.031). The prevalence of abnormal findings on neonatal echocardiography was similar between the groups. Multivariate analysis showed that greater gestational age at delivery reduced the likelihood of abnormal findings on echocardiography [adjusted risk ratio (aRR) 0.950, Pâ¯=â¯0.001], while pregestational diabetes mellitus increased the likelihood of abnormal findings (aRR 1.451, Pâ¯=â¯0.044). Septal defects were the most common type of defect, occurring in 16.1% of infants. CONCLUSION: The impact of IVF conception on the severity of pre-eclampsia is not as expected. Neonatal echocardiography revealed a higher prevalence of abnormalities in offspring of women with pre-eclampsia compared with the general population. However, these issues were not linked to the method of conception, suggesting the existence of undisclosed factors that could influence the clinical features and perinatal outcomes of pre-eclampsia.
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Ecocardiografía , Fertilización In Vitro , Preeclampsia , Resultado del Embarazo , Humanos , Femenino , Embarazo , Preeclampsia/epidemiología , Adulto , Recién Nacido , Resultado del Embarazo/epidemiología , Fenotipo , Taiwán/epidemiología , FertilizaciónRESUMEN
BACKGROUND: Ritodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma. CASE PRESENTATION: A 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation, with an undiagnosed placental chorioangioma, underwent tocolysis due to preterm uterine contractions. Her clinical condition deteriorated, attributed to mirror syndrome and adverse events induced by ritodrine. An emergency cesarean section was performed at 27 1/7 weeks of gestation, delivering an infant with generalized subcutaneous edema. A placental tumor measuring 8.5 cm was discovered during the operation, and pathology confirmed chorioangioma. Gradual improvement in her symptoms and laboratory data was observed during the postpartum period. Identifying mirror syndrome and ritodrine-induced side effects poses challenges. Therefore, this case is educational and warrants discussion. CONCLUSION: Our case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload.
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Hemangioma , Trabajo de Parto Prematuro , Ritodrina , Recién Nacido , Embarazo , Femenino , Humanos , Adulto , Ritodrina/efectos adversos , Hidropesía Fetal/inducido químicamente , Cesárea/efectos adversos , Placenta , Trabajo de Parto Prematuro/tratamiento farmacológico , Hemangioma/complicaciones , Hemangioma/tratamiento farmacológico , SíndromeRESUMEN
We hypothesized and investigated whether prenatal exposure to preeclampsia (PE) would simultaneously affect perinatal cardiovascular features and angiotensin system expressions. This prospective study was composed of mother-neonate dyads with (n = 49) and without maternal preeclampsia (n = 48) in a single tertiary medical center. The neonates exposed to PE had significantly larger relative sizes for the left and right coronary arteries and a higher cord plasma level of aminopeptidase-N, which positively correlated with the maternal diastolic blood pressures and determined the relative sizes of the left and right coronary arteries, whereas the encoding aminopeptidase-N (ANPEP) mRNA level in the PE cord blood leukocytes was significantly decreased, positively correlated with the neonatal systolic blood pressures (SBPs), and negatively correlated with the cord plasma-induced endothelial vascular cell adhesion molecule-1 mRNA levels. The PE cord plasma significantly induced higher endothelial mRNA levels of angiotensin II type 1 receptor (AT1R) and AT4R, whereas in the umbilical arteries, the protein expressions of AT2R and AT4R were significantly decreased in the PE group. The endothelial AT1R mRNA level positively determined the maternal SBPs, and the AT4R mRNA level positively determined the neonatal chamber size and cardiac output. In conclusion, PE may influence perinatal angiotensin system and cardiovascular manifestations of neonates across placentae. Intriguing correlations between these two warrant further mechanistic investigation.
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Preeclampsia , Humanos , Femenino , Embarazo , Preeclampsia/metabolismo , Preeclampsia/genética , Adulto , Recién Nacido , Sangre Fetal/metabolismo , Presión Sanguínea , Estudios Prospectivos , Receptor de Angiotensina Tipo 1/genética , Receptor de Angiotensina Tipo 1/metabolismo , Sistema Cardiovascular/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismoRESUMEN
Placenta accreta spectrum (PAS) accounts for 7% of maternal mortality and is associated with intraoperative and postoperative morbidity caused by massive blood loss, infection, and adjacent organ damage. The aims of this study were to identify the protein biomarkers of PAS and to further explore their pathogenetic roles in PAS. For this purpose, we collected five placentas from pregnant subjects with PAS complications and another five placentas from normal pregnancy (NP) cases. Then, we enriched protein samples by specifically isolating the trophoblast villous, deeply invading into the uterine muscle layer in the PAS patients. Next, fluorescence-based two-dimensional difference gel electrophoresis (2D-DIGE) and MALDI-TOF/MS were used to identify the proteins differentially abundant between PAS and NP placenta tissues. As a result, nineteen spots were determined as differentially abundant proteins, ten and nine of which were more abundant in PAS and NP placenta tissues, respectively. Then, specific validation with western blot assay and immunohisto/cytochemistry (IHC) assay confirmed that heat shock 70 kDa protein 4 (HSPA4) and chorionic somatomammotropin hormone (CSH) were PAS protein biomarkers. Further tube formation assays demonstrated that HSPA4 promoted the in vitro angiogenesis ability of vessel endothelial cells, which is consistent with the in vivo scenario of PAS complications. In this study, we not only identified PAS protein biomarkers but also connected the promoted angiogenesis with placenta invasion, investigating the pathogenetic mechanism of PAS.
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Proteínas del Choque Térmico HSP110 , Placenta Accreta , Biomarcadores , Cesárea , Células Endoteliales/patología , Femenino , Proteínas del Choque Térmico HSP110/metabolismo , Humanos , Placenta/patología , Placenta Accreta/patología , Placenta Accreta/cirugía , EmbarazoRESUMEN
OBJECTIVES: To investigate the cardiovascular features and endothelium in neonates born to mothers with preeclampsia. STUDY DESIGN: In this combined observational cohort and case-control study, neonates born to mothers with normotension and mothers with preeclampsia were recruited at a neonatal intensive care unit of a tertiary medical center. Cardiovascular measurements by echocardiography and the clinical measures upon admission were analyzed. Vascular cell adhesion molecule-1 expression in umbilical arteries and in in vitro endothelial cell stimulation with plasma were examined. Continuous data were compared using nonparametric analysis, and their relationships were analyzed using linear regression. Binary logistic regression was performed in the model of adjustment of birth body weight and for multivariate analysis. RESULTS: In the cohort, almost all cardiovascular segments positively correlated to birth weight. Notably, neonates (n = 65) of mothers with preeclampsia had significantly larger coronary arteries at birth than neonates of mothers with normotension (n = 404) (median size of left main coronary artery 1.36 mm versus 1.08 mm, p <0.001; median size of right coronary artery, RCA 1.25 mm versus 1.0 mm, p <0.001). The size of the right coronary artery positively correlated to the maternal antepartum diastolic blood pressure (r = 0.298, P = .018) and was associated with in-hospital death (P < .001). Meanwhile, endothelial vascular cell adhesion molecule-1 expression was significantly increased in the umbilical arteries of the preeclamptic group and following preeclamptic cord-plasma stimulation. The latter also correlated with their relative coronary sizes. CONCLUSIONS: Neonates of mothers with preeclampsia had distinctive coronary dilatation at birth. Coronary size might be useful as a severity index of neonatal endothelial inflammation as a result of maternal preeclampsia.
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Enfermedad de la Arteria Coronaria/etiología , Vasos Coronarios/fisiopatología , Endotelio Vascular/fisiopatología , Inflamación/diagnóstico , Preeclampsia/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Dilatación Patológica/diagnóstico , Dilatación Patológica/etiología , Dilatación Patológica/fisiopatología , Endotelio Vascular/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Recién Nacido , Inflamación/fisiopatología , Masculino , Embarazo , Estudios RetrospectivosRESUMEN
RESEARCH QUESTION: Preimplantation genetic testing for aneuploidies has increasingly been employed for embryo selection, resulting in a recent surge in mosaic embryos. According to the cytogenetic results, which types of mosaic embryo survive early pregnancy, progress to the second trimester and finally result in a live birth? DESIGN: This study evaluated 30,587 pregnant women undergoing amniocentesis from January 2004 to March 2020 at the cytogenic centre of Kaohsiung Chang Gung Memorial Hospital. Samples from amniocentesis were cultured using the in-situ method. The types and distribution of level III chromosomal mosaicism (two or more cells with the same abnormality in two or more colonies and both culture dishes, clinically referred to as 'true mosaicism') were retrospectively reviewed. RESULTS: Among the 30,587 women, 78 cases (0.26%) of level III chromosomal mosaicism were identified. The types of chromosomal mosaicism were classified as sex chromosome mosaicism (SCM), autosomal chromosome mosaicism (ACM) and marker chromosome mosaicism (MCM), with SCM, ACM and MCM accounting for 58.97%, 32.05% and 8.97% of cases, respectively. The most common mosaic cell lines were monosomy X and trisomy 21. The most common mosaic cell line progressing to live birth was monosomy X. CONCLUSIONS: Mosaic monosomy X and trisomy 21 are the most common cell lines of true mosaicism determined by amniocentesis. Monosomy X mosaicism is the most common cell line in live births. For women considering the transfer of these types of mosaic embryo in a circumstance where euploid embryos are unavailable, clinicians should provide careful prenatal counselling, detailed ultrasonography and amniocentesis.
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Síndrome de Down , Mosaicismo/estadística & datos numéricos , Diagnóstico Preimplantación/estadística & datos numéricos , Síndrome de Turner , Amniocentesis/estadística & datos numéricos , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
Increased maternal inflammatory response has been noted in women with pregnancies complicated by preterm birth and small-for-gestational age infants. However, the association between gestational exposure to air pollutants, maternal inflammatory response, and fetal growth remains unclear. In this study, we aimed to investigate the association between exposure to air pollutants during pregnancy and the concentration of inflammatory indicators in maternal and fetal circulations, as well as fetal growth. We recruited 108 healthy pregnant women living in northern (n = 55) and southern (n = 53) areas of Taiwan and prospectively collected information of exposure to outdoor air pollutants throughout gestation. Maternal blood from each trimester and umbilical cord blood after delivery were collected and analyzed for inflammatory indicators including high sensitivity C-reactive protein (hs-CRP), interleukin-1ß (IL-1ß), and tumor necrosis factor (TNF)-α. Our results showed that exposure to particulate matter less than or equal to 10 µm (PM10) and ozone (O3) during the first trimester had a direct effect on reduction of birth weight, but the direct effect of PM10 mediated by hs-CRP and the direct effect of O3 mediated by TNF-α on fetal birth weight were not significant. Exposure to PM10 and PM2.5 during the second and third trimesters also directly affected birth weight. Furthermore, exposure to sulfur dioxide (SO2) caused changes in the concentrations of TNF-α in maternal blood during the second trimester, which subsequently resulted in reduced fetal weight. Together, these results indicate that exposure to air pollutants may cause both direct and indirect effects on the reduction of fetal weight.
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Contaminantes Atmosféricos , Contaminación del Aire , Nacimiento Prematuro , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/análisis , Contaminación del Aire/estadística & datos numéricos , Peso al Nacer , Femenino , Humanos , Lactante , Recién Nacido , Exposición Materna/estadística & datos numéricos , Material Particulado/análisis , Material Particulado/toxicidad , Embarazo , TaiwánRESUMEN
PURPOSE: To study the association between paternal age and schizophrenia in offspring. METHODS: This report describes a nationwide population-based cohort study from 1997 to 2013. Data from Taiwan's National Health Insurance Research Database were utilized to answer the research question. A total of 17,649 offspring with schizophrenia were selected from 11 million offspring in the general population. Additionally, we established the offspring without schizophrenia as the comparison group by matching the study cohort by age, gender in a 1:4 ratio (n = 70,596). RESULTS: The median age at first presentation with schizophrenia was 20 years (interquartile range (IQR), 17 to 24). Comparison of the schizophrenia and non-schizophrenia groups indicated that father's age at birth (30.0 (IQR), 27 to 33 vs. 29.0 (IQR), 26 to 32 years), mother's age at birth (26.0 (IQR), 24 to 29 vs. 26.0 (IQR), 23 to 29 years), paternal schizophrenia (2.6% vs. 0.6%), and maternal schizophrenia (4.4% vs. 0.7%) were all significantly greater in the schizophrenia group. In addition, each 5-year increase in father's age increased the odds of being diagnosed with schizophrenia (model 1: aOR = 1.22; 95% CI 1.20, 1.24; model 2: aOR = 1.20; 95% CI 1.18, 1.23). Subgroup analysis showed that each 5-year increase in father's age increased the odds of being diagnosed with schizophrenia in male and female offspring, as well as in offspring of mothers and fathers with or without schizophrenia (aOR = 1.20 to 2.20, all p values < 0.01). CONCLUSION: This study indicated that advanced paternal age increased the risk of schizophrenia in offspring. Offspring born to fathers older by 5-year increments were at heightened risk of schizophrenia.
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Edad Paterna , Esquizofrenia/genética , Adolescente , Adulto , Estudios de Cohortes , Padre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Madres , Factores de Riesgo , Esquizofrenia/epidemiología , Esquizofrenia/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Pregnant women have high serum concentrations of sex steroid hormones, which are major regulators of paracrine and autocrine responses for many maternal and placental functions. The main purpose of this study was to compare patients with preeclampsia and patients with uncomplicated pregnancies in terms of serum steroid hormones (estradiol [E2], progesterone [P4], dehydroepiandrosterone sulfate [DHEAS], and testosterone [T]) throughout pregnancy and the levels of cord blood and placental steroid receptors during the third trimester. METHODS: Quantitative real-time reverse transcription PCR, western blotting, and immunohistochemistry were used to determine the levels of steroid hormones in the serum and cord blood and the placental levels of estrogen receptor-α (ERα), ERß, androgen receptor (AR), and progesterone receptor (PR). RESULTS: There were 45 women in the uncomplicated pregnancy group and 30 women in the preeclampsia group. Serum levels of T were greater and serum levels of E2 were reduced in the preeclampsia group, but the two groups had similar levels of P4 and DHEAS during the third trimester. Cord blood had a decreased level of DHEAS in the preeclampsia group, but the two groups had similar levels of P4, E2, and T. The two groups had similar placental mRNA levels of ERα, ERß, AR, and PR, but the preeclampsia group had a higher level of ERß protein and a lower level of ERα protein. Immunohistochemistry indicated that the preeclampsia group had a greater level of ERß in the nucleus and cytoplasm of syncytiotrophoblasts and stromal cells. CONCLUSIONS: Women with preeclampsia had lower levels of steroid hormones, estrogen, and ERα but higher levels of T and ERß. These molecules may have roles in the pathogenesis of preeclampsia.
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Sangre Fetal/metabolismo , Hormonas Esteroides Gonadales/metabolismo , Placenta/metabolismo , Preeclampsia/metabolismo , Receptores de Esteroides/metabolismo , Adulto , Biomarcadores/sangre , Biomarcadores/metabolismo , Sulfato de Deshidroepiandrosterona/metabolismo , Estradiol/sangre , Estradiol/metabolismo , Femenino , Hormonas Esteroides Gonadales/sangre , Humanos , Persona de Mediana Edad , Preeclampsia/sangre , Preeclampsia/diagnóstico , Embarazo , Progesterona/sangre , Progesterona/metabolismo , Estudios Prospectivos , Receptores de Esteroides/sangre , Testosterona/sangre , Testosterona/metabolismo , Adulto JovenRESUMEN
Pre-eclampsia is one of the main causes of perinatal mortality and morbidity. Many biomarkers for diagnosing pre-eclampsia have been found but most have low accuracy. Therefore, a potential marker that can detect pre-eclampsia with high accuracy is required. Infection has been reported as a cause of pre-eclampsia. In recent years, protein microarray chips have been recognized as a strong and robust tool for profiling antibodies for infection diagnoses. The purpose of the present study was to profile antibodies in the human plasma of healthy and pre-eclamptic pregnancies to identify suitable biomarkers. In this study, an Escherichia coli chip was probed with samples from 29 individuals (16 pre-eclamptic women and 13 healthy pregnant women) to profile plasma antibodies. Bioinformatics tools were used to analyze the results, discover conserved motifs, compare against the entire human proteome, and perform protein functional analysis. An antibody classifier was identified using k-top scoring pairs and additional samples for a blinded test were collected. The findings indicated that compared with the healthy women, the pre-eclamptic women exhibited 108 and 130 differentially immunogenic proteins against human immunoglobulins G and M, respectively. In addition, pre-eclamptic women developed more immunoglobulin G but less immunoglobulin M against bacterial surface proteins compared with healthy women. The k-top scoring pairs identified five pairs of immunogenic proteins as classifiers with a high accuracy of 90% in the blind test. [AG] [ISV] GV [AE] L [LF] and [IV] [IV] RI [AG] [AD] E were the consensus motifs observed in immunogenic proteins in the immunoglobulin G and immunoglobulin M of pre-eclamptic women, respectively, whereas GA [AG] [AL] L [LF] and [SRY] [IQML] [ILV] [ILV] [ACG] GI [GH] [AEF] [AK] [ATY] [RG] N [IV] were observed in the immunoglobulins G and immunoglobulin M of healthy women, respectively.
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Anticuerpos/sangre , Antígenos/metabolismo , Proteínas de Escherichia coli/metabolismo , Escherichia coli/metabolismo , Preeclampsia/sangre , Preeclampsia/inmunología , Proteoma/metabolismo , Proteómica/métodos , Adulto , Secuencias de Aminoácidos , Secuencia de Aminoácidos , Proteínas de Escherichia coli/química , Femenino , Humanos , Preeclampsia/diagnóstico , Embarazo , Análisis por Matrices de Proteínas , Unión ProteicaRESUMEN
BACKGROUND: Maternal obesity is an emerging problem in the modern world. Growing evidence suggests that intrauterine high-fat (HF) exposure may predispose progeny to subsequent metabolic challenges. Progeny born to mothers who ate an HF diet also tends to eat an HF diet when growing and aggravate metabolic issues. Thus, the generational transmission of obesity is cyclical. Developing a strategy to prevent the occurrence of metabolic syndrome related to prenatal and/or postnatal HF diet is important. In this study, the reprogramming effects of maternal resveratrol treatment for the progeny with maternal HF/postnatal HF diets were investigated. METHODS: Sprague-Dawley dams were fed either a control or a high-fat/high sucrose diet (HFHS) from mating to lactation. After weaning, the progeny was fed chow or an HF diet. Four experimental groups were yielded: CC (maternal/postnatal control diet), HC (maternal HF/postnatal control diet), CH (maternal control/postnatal HFHS diet), and HH (maternal/postnatal HFHS diet). A fifth group (HRH) received a maternal HFHS diet plus maternal resveratrol treatment and a postnatal chow diet to study the effects of maternal resveratrol therapy. RESULTS: Maternal resveratrol treatment lessened the weight and adiposity of progeny that were programmed by combined prenatal and postnatal HFHS diets. Maternal resveratrol therapy ameliorated the decreased abundance of the sirtuin 1 (SIRT1) enzyme in retroperitoneal tissue and the altered leptin/soluble leptin receptor ratio of progeny. Maternal resveratrol therapy also decreased lipogenesis and increased lipolysis for progeny. CONCLUSIONS: Maternal resveratrol intervention can prevent adiposity programmed by maternal and postnatal HFHS diets by inducing lipid metabolic modulation. This study offers a novel reprogramming role for the effect of maternal resveratrol supplements against obesity.
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Adiposidad/efectos de los fármacos , Resveratrol/farmacología , Análisis de Varianza , Animales , Western Blotting , Peso Corporal/efectos de los fármacos , Dieta Alta en Grasa/efectos adversos , Ingestión de Alimentos/efectos de los fármacos , Femenino , Lactancia/efectos de los fármacos , Metabolismo de los Lípidos/efectos de los fármacos , Lipogénesis/efectos de los fármacos , Lipólisis/efectos de los fármacos , Masculino , Obesidad/metabolismo , Ratas , Ratas Sprague-Dawley , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sirtuina 1/metabolismoRESUMEN
AIM: Cervical pregnancy (CP) and cesarean scar pregnancy (CSP), defined as low-lying-implantation ectopic pregnancy (LLIEP), are rare conditions of aberrant implantation around the lowest portion of the uterus. This study aimed to illustrate the serum ß-human chorionic gonadotropin (ß-hCG) profile of LLIEP and to explore its implications with the clinical characteristics. METHODS: Women with LLIEP during the first trimester were retrospectively evaluated at a tertiary referral center from August 1999 to July 2016. Demographic and clinical data were recorded, including maternal age, gestational age (GA), serum ß-hCG level, maximal diameter of the gestational mass/sac (MDM/MDS) by ultrasonography and CSP implantation types. The serum ß-hCG level was measured on the day of ultrasound imaging. The significance of pretreatment the serum ß-hCG level and its correlations with the clinical characteristics were analyzed. RESULTS: A total of 88 LLIEP with 64 CSP and 24 CP was included. The mean GA at the time of diagnosis was 7 weeks (range, 5-12 weeks). The ß-hCG concentrations rapidly increased from GA 5 to 9 weeks and fluctuated thereafter. The ß-hCG levels correlated positively with GA and ultrasound MDM/MDS. In the CSP group, there was no difference in the ß-hCG level between superficial and deep implantation types. ß-hCG levels demonstrated no significant differences among simple and complicated LLIEP. CONCLUSION: This study established the serum ß-hCG profile in LLIEP in the first trimester. The exponential increase of ß-hCG levels was similar to that of normal intrauterine pregnancies. The ß-hCG levels were not associated with placentation complexity of CSP. Higher ß-hCG levels did not implicate less success in conservative surgical management.
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Gonadotropina Coriónica Humana de Subunidad beta/sangre , Embarazo Ectópico/patología , Adulto , Estudios de Casos y Controles , Cesárea/efectos adversos , Femenino , Humanos , Imagen por Resonancia Magnética , Embarazo , Primer Trimestre del Embarazo , Embarazo Ectópico/sangre , Embarazo Ectópico/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía PrenatalRESUMEN
BACKGROUND/PURPOSE: To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial embolization (TAE). METHODS: An emergency PPH rescue system including the 24-hour-available TAE was established in 2004. TAE with gelatine sponge particles placed on bilateral uterine or internal iliac arteries served as the first-line treatment for intractable PPH. Delivery methods, parity, causes of bleeding, clinical vital signs, coagulopathy, success rate, resumption of menstruation, and subsequent pregnancy outcome after TAE were recorded. RESULTS: From the years 2005 to 2013, 301 women experienced PPH, of whom 178 had controllable PPH and 123 intractable PPH. Tachycardia and disseminated intravascular coagulation were significant risk factors for intractable PPH. All of the women with intractable PPH underwent TAE, and 89 (72.3%) were transferred by ground transport to receive treatment in this system. The mean travel distance was 15 km ± 12.5 km. The mean time of order to angiography room was 24.9 minutes ± 14.2 minutes. The mean blood loss before TAE was 2247 mL ± 1482 mL (range, 900-11,110 mL). The first TAE successfully controlled bleeding in 118 of the 123 (95.9%) women with intractable PPH. Of the 70 women with complete follow-up, 69 (98.6%) recovered menstruation. Twenty-three women tried to get pregnant and 19 (82.6%) of them succeeded, giving birth to 12 full-term live infants. CONCLUSION: TAE was safe and effective in treating intractable primary PPH with a high success rate and preservation of menstruation and fertility.
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Embolización Terapéutica/métodos , Hemorragia Posparto/terapia , Embolización de la Arteria Uterina/métodos , Adulto , Femenino , Fertilidad , Humanos , Arteria Ilíaca/fisiopatología , Transferencia de Pacientes , Hemorragia Posparto/fisiopatología , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Arteria Uterina/fisiopatologíaRESUMEN
OBJECTIVE: To examine the epidemiologic data of closed medical claims from Taiwanese civil courts against obstetric departments and identify high-risk diseases. DESIGN: A retrospective descriptive study. SETTING/STUDY PARTICIPANTS: The verdicts from the national database of the Taiwan judicial system that pertained to obstetric departments were reviewed. Between 2003 and 2012, a total of 79 closed medical claims were included. MAIN OUTCOME MEASURES: The epidemiologic data of litigations including the results of adjudication and the disease and outcome of the alleged injury. RESULTS: A majority of the disputes (65.9%) were fetus-related. Four disease categories accounted for 78.5% of all claims including (i) perinatal maternal complications (25.3%); (ii) errors in antenatal screening or ultrasound diagnoses (21.5%); (iii) fetal hypoxemic-ischemia encephalopathy (16.5%); and (iv) brachial plexus injury (15.2%). Six cases (7.6%) resulted in an indemnity payment with a mean amount of $109 205. Fifty-one cases (64.6%) were closed in the district court. The mean incident-to-litigation closure time was 52.9 ± 29.3 months. All cases with indemnity payments were deemed negligent or were at least determined to be controversial by a medical appraisal, while all defendants whose care was judged as appropriate by a medical appraisal won their lawsuits. CONCLUSIONS: Almost 93% of clinicians win their cases but spend 4.5 years waiting for final adjudication. The court ruled against the clinician only if there was no appropriate response during a complication or if there was no follow-up or further testing for potential critical diseases.
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Mala Praxis/legislación & jurisprudencia , Servicio de Ginecología y Obstetricia en Hospital/legislación & jurisprudencia , Adulto , Femenino , Humanos , Embarazo , Estudios Retrospectivos , TaiwánRESUMEN
OBJECTIVE: To evaluate the ability of second-trimester placental volume and vascular indices to predict small-for-gestational-age (SGA) birth weight pregnancies. MATERIAL AND METHODS: Women with singleton pregnancies were prospectively evaluated at 17-20 weeks of gestation. Second-trimester placental volume and vascular indices were obtained and calculated using volume organ computer-aided analysis and three-dimensional (3D) power Doppler ultrasound. Participants were followed until delivery and their medical records were reviewed, including maternal age, parity and pregestational body weight and body height, as well as the gestational age, birth weight and gender of the fetus. RESULTS: Of the 163 women with complete follow-up, 20 gave birth to SGA and 143 to appropriate-for-gestational-age (AGA) neonates. The mean second-trimester placental volume was significantly lower in the SGA than in the AGA group (170.6 ± 49.8 vs. 213.5 ± 75.8 cm(3), p = 0.015). None of the vascular indices, including the vascularization index, flow index and vascularization flow index, differed significantly between the two groups. We also found that the optimum cutoff for placental volume at a gestational age of 17-18 weeks was 189.7 cm(3). DISCUSSION: Second-trimester placental volume was positively correlated with neonatal birth weight. Second-trimester placental volume measured on 3D ultrasound may be predictive of SGA neonates.
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Velocidad del Flujo Sanguíneo , Recién Nacido Pequeño para la Edad Gestacional , Neovascularización Fisiológica , Placenta/irrigación sanguínea , Placenta/diagnóstico por imagen , Segundo Trimestre del Embarazo , Adulto , Peso al Nacer/fisiología , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Neovascularización Fisiológica/fisiología , Tamaño de los Órganos , Placenta/fisiología , Valor Predictivo de las Pruebas , Embarazo , Segundo Trimestre del Embarazo/fisiología , Estudios Prospectivos , Ultrasonografía Prenatal/normasRESUMEN
In cases of arginine depletion, lymphocyte proliferation, cytokine production and CD3ζ chain expression are all diminished. In addition to myeloid suppressor cells, polymorphonuclear cells (PMN) also exert T-cell immune suppressive effects through arginase-induced l-arginine depletion, especially during pregnancy. In this study, we investigated how arginase/l-arginine modulates neonatal lymphocyte proliferation. Results showed that the neonatal plasma l-arginine level was lower than in adults (48·1 ± 11·3 versus 86·5 ± 14·6 µm; P = 0·003). Neonatal PMN had a greater abundance of arginase I protein than adult PMN. Both transcriptional regulation and post-transcriptional regulation were responsible for the higher arginase I expression of neonatal PMN. Exogenous l-arginine enhanced neonate lymphocyte proliferation but not that of adult cells. The RNA-binding protein HuR was important but was not the only modulation factor in l-arginine-regulated neonatal T-cell proliferation. l-Arginine-mediated neonatal lymphocyte proliferation could not be blocked by interleukin-2 receptor blocking antibodies. These results suggest that the altered arginase/l-arginine cascade may be one of the mechanisms that contribute to altered neonatal immune responses. Exogenous l-arginine could enhance neonate lymphocyte proliferation through an interleukin-2-independent pathway.
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Arginina/farmacología , Proliferación Celular/efectos de los fármacos , Interleucina-2/metabolismo , Activación de Linfocitos/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Linfocitos T/efectos de los fármacos , Adulto , Factores de Edad , Arginasa/metabolismo , Arginina/sangre , Células Cultivadas , Proteínas ELAV/metabolismo , Femenino , Sangre Fetal/metabolismo , Humanos , Recién Nacido , Neutrófilos/efectos de los fármacos , Neutrófilos/enzimología , Embarazo , Receptores de Interleucina-2/metabolismo , Linfocitos T/inmunología , Linfocitos T/metabolismo , Factores de Tiempo , Adulto JovenRESUMEN
PURPOSE: The objective of this study is to compare the chromosomal distribution of early miscarriages with or without embryonic poles. MATERIALS AND METHODS: It was a retrospective study of 223 women who underwent dilation and curettage (D&C) between 1995 and 2013 for early miscarriages. The presence or absence of a fetal pole was evaluated by abdominal or transvaginal ultrasound. Cytogenetic tests of products of conception following culture were determined in both groups. RESULTS: Of the 223 early miscarriages, 143 had embryos and 80 did not. The abnormality rate differed significantly (61.5 % vs. 46.3 %, p < 0.05), with trisomy 18, 21 and 45X found only in miscarriages with embryos. There were no significant differences between groups in rates of triploidy, tetraploidy, mosaicism, structure and double abnormality. The female abortus rate was higher in miscarriages with or without embryonic poles, as well as in groups with normal and abnormal karyotypes. CONCLUSIONS: Chromosome distribution differs in miscarriages with or without embryonic poles. The ultrasound findings might offer different direction to determine the causes of early miscarriages. The higher female abortus rate may be associated with early selection.
Asunto(s)
Aborto Espontáneo/genética , Aberraciones Cromosómicas , Pérdida del Embrión/genética , Pérdida del Embrión/patología , Embrión de Mamíferos/citología , Complicaciones del Embarazo/genética , Adulto , Legrado/métodos , Femenino , Humanos , Cariotipo , Embarazo , Estudios RetrospectivosRESUMEN
A 36-year-old woman, gravida 3, para 1 (previous cesarean section), with one medical abortion, and no history of systemic diseases presented an unremarkable medical history during prenatal visits. The final prenatal ultrasound at 38 weeks of gestation showed a vertex presentation, a weight of 2600 g, a normal amniotic fluid level, and the placenta located on the posterior wall of the uterus. Fetal cardiotocography conducted before delivery reported a reactive heart rate without decelerations. The Doppler wave analysis of the fetal umbilical artery was normal (the ratio of peak-systolic flow velocity to the end-diastolic flow velocity was 2.5) without the absence or reversal of end-diastolic velocity. The total score of the fetal biophysical profile by ultrasound was 8. The night before the scheduled cesarean section, she experienced heightened anxiety and was unable to sleep, noting "crazy" fetal movements throughout the night. During the cesarean section, it was discovered that the umbilical cord was wrapped around the newborn's legs, resembling ankle shackles. The fetal weight was 2740 g, and Apgar scores were 9 at the first minute and 10 at the fifth minute. The motility of the neonatal legs was normal without cyanosis or neurological adverse outcomes.
RESUMEN
The relationship between exposure to air pollutants and fetal growth outcomes has shown inconsistency, and only a limited number of studies have explored the impact of air pollution on gestational hypertension and birth outcomes. This study aimed to evaluate how maternal exposure to air pollutants and blood pressure could influence fetal birth outcomes. A total of 55 women with gestational hypertension and 131 healthy pregnant women were enrolled in this study. Data pertaining to personal characteristics, prenatal examinations, outdoor air pollutant exposure, and fetal birth outcomes were collected. The study revealed that fetal birth weight and abdominal circumference exhibited a significant reduction among women with gestational hypertension compared to healthy pregnant women, even after adjustments for body mass index, gestational age, and exposure to air pollutants had been made. Moreover, maternal exposure to outdoor air pollutants displayed a notable correlation with decreased birth length of fetuses. Consequently, the study concluded that maternal blood pressure and exposure to outdoor air pollutants during pregnancy potentially stand as pivotal factors influencing fetal birth outcomes.
Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Hipertensión Inducida en el Embarazo , Exposición Materna , Humanos , Embarazo , Femenino , Adulto , Contaminación del Aire/efectos adversos , Peso al Nacer , Resultado del Embarazo , Recién NacidoRESUMEN
Neonates who are born preterm (PT) are usually characterized by immature physiological development, and preterm birth (PTB) is the leading cause of neonatal morbidity and mortality if intensive medical care is not available to PTB neonates. Early prediction of a PTB enables medical personnel to make preparations in advance, protecting the neonate from the subsequent health risks. Therefore, many studies have worked on identifying invasive or noninvasive PT biomarkers. In this study, we collected amniocentesis-derived (at the second trimester of gestation) amniotic fluid (AF) samples. At delivery, AF samples were classified into PTB or full-term birth (FTB). We first applied protein mass spectrometry technology to globally screen AF proteins, followed by specific protein validation with ELISA. We identified four protein biomarkers of PTB, including lactotransferrin (LTF), glutathione-disulfide reductase (GSR), myeloperoxidase (MPO) and superoxide dismutase 2 (SOD2). Further analyses demonstrated that their abundances were negatively correlated with neonatal weight and gestational age. In addition, by mimicking survival rate analysis widely used in tumor biology, we found that LTF and SOD2 were prognostic factors of gestational age, with higher levels denoting shorter gestational age. Finally, using the abundances of the four protein biomarkers, we developed a prediction model of PTB with an auROC value of 0.935 (sensitivity = 0.94, specificity = 0.89, p value = 0.0001). This study demonstrated that the abundances of specific proteins in amniotic fluid were not only the prognostic factors of gestational age but also the predictive biomarkers of PTB. These four AF proteins enable identification of PTB early in the second trimester of gestation, facilitating medical intervention to be applied in advance.