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1.
Arch Gynecol Obstet ; 308(2): 499-505, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35996034

RESUMO

OBJECTIVE: Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms. STUDY DESIGN: A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991-2017 in a tertiary medical center. Kaplan-Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders. RESULTS: During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16-1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03-1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14-3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies." When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01-1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9-2.8; p = 0.103). CONCLUSION: Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.


Assuntos
Neoplasias Ovarianas , Neoplasias Uterinas , Humanos , Gravidez , Feminino , Cesárea/efeitos adversos , Estudos de Coortes , Fatores de Risco , Neoplasias Ovarianas/etiologia , Hospitalização , Modelos de Riscos Proporcionais , Neoplasias Uterinas/etiologia , Estudos Retrospectivos
2.
J Eur Acad Dermatol Venereol ; 34(2): 319-324, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31419350

RESUMO

BACKGROUND: Gut microbiome influences cutaneous diseases including atopic dermatitis. Possible impact of intrauterine exposure to meconium on the occurrence of dermatitis and skin rash was proposed. OBJECTIVE: We investigated the possible influence of intrauterine exposure to meconium-stained amniotic fluid (MSAF) on the occurrence of dermatitis and skin rash-related hospitalizations throughout childhood. METHODS: Singleton deliveries occurring between 1991 and 2014 at a single medical centre were divided into two study groups based on presence or lack of MSAF during delivery. Population-based cohort analysis, Kaplan-Meier survival analysis and Cox proportional hazards model were used to study the association between MSAF and cutaneous morbidity-related hospitalizations. RESULTS: A lower rate of the total dermatitis or skin eruption-related hospitalization was documented in the MSAF-exposed group; 0.78 per 1000-person years (0.9%, n = 312), as compared to 0.98 per 1000-person years in the unexposed group (1.0%, n = 1992) with a hazard ratio of 0.86 (95% CI 0.76-0.96, P = 0.011). The survival curve showed lower cumulative hospitalization rate in the MSAF-exposed group as compared to the unexposed group (log rank P = 0.01). The Cox analysis, controlled for confounders, demonstrated MSAF exposure to be an independent protective factor for dermatitis and skin rash-related hospitalizations during childhood (adjusted HR 0.878 (95% CI 0.779-0.990, P = 0.034). CONCLUSION: Fetal exposure to MSAF appears to be an independent protective factor for dermatitis and skin rash-related hospitalizations in the offspring throughout childhood and adolescence.


Assuntos
Líquido Amniótico , Dermatite/prevenção & controle , Exantema/prevenção & controle , Hospitalização , Mecônio , Fatores de Proteção , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
3.
Am J Perinatol ; 35(11): 1065-1070, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29597240

RESUMO

OBJECTIVE: The objective of this study was to investigate whether maternal bronchial asthma increases the risk for long-term respiratory morbidity of the offspring. STUDY DESIGN: A population-based cohort study compared the incidence of long-term pediatric hospitalizations due to respiratory disease of the offspring of mothers with and without bronchial asthma. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. Kaplan-Meier's survival curve was used to estimate cumulative incidence of respiratory morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. RESULTS: During the study period, 253,808 deliveries met the inclusion criteria; of which 1.3% were born to mothers with bronchial asthma (n = 3,411). During the follow-up period, children born to women with bronchial asthma had a significantly higher rate of long-term respiratory morbidity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3-1.7; p < 0.001). Specifically, the rate of childhood asthma was higher among offspring of mothers with asthma (OR = 2.3; 95% CI = 1.8-2.9; p < 0.001). Children born to women with asthma had higher cumulative incidence of respiratory morbidity, using a Kaplan-Meier's survival curve (log-rank test; p < 0.001). Using two multivariable GEE logistic regression models, controlling for the time to event, maternal age, and gestational age at delivery, maternal bronchial asthma was found to be an independent risk factor for long-term respiratory disease of the offspring (adjusted OR = 1.6; 95% CI = 1.4-1.9; p < 0.001), and specifically for bronchial asthma (adjusted OR = 2.5; 95% CI = 1.9-3.1; p < 0.001). CONCLUSION: Maternal bronchial asthma is an independent risk factor for long-term respiratory morbidity of the offspring.


Assuntos
Asma/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Israel/epidemiologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
Diabet Med ; 33(7): 920-5, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26606683

RESUMO

AIM: o examine the association between glucose level during pregnancy and the subsequent development of long-term maternal atherosclerotic morbidity. METHODS: A retrospective case-control study was conducted. The study included all women who had at least one glucose measurement during their pregnancies. Cases were all women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity (n = 815). Controls were randomly matched by age and year of delivery (n = 6065). The atherosclerotic morbidity group was further divided by severity: major events (cardiovascular, cerebrovascular disease, chronic renal failure), minor events (hypertension, diabetes mellitus and hyperlipidaemia without target organ damage or complications) and cardiac evaluation tests (such as coronary angiography without records of atherosclerosis, cardiac scan and stress test). The mean follow-up duration for the study group was 74 months. Cox proportional hazards model was used to control for confounders. RESULTS: A significant linear association was found between glucose levels during pregnancy and long-term maternal atherosclerotic morbidity. Among the cases with severe atherosclerotic morbidity, the proportion of women with a high glucose level (> 5.5 mmol/l) was the highest, whereas in controls it was the lowest (P < 0.001). In a Cox proportional hazard model, adjusted for atherosclerotic confounders such as gestational diabetes, pre-eclampsia and obesity, a glucose level of > 5.5 mmol/l was noted as an independent risk factor for hospitalizations later in non-pregnant life (hazard ratio = 1.3, 95% confidence interval 1.1-1.5, P < 0.003). CONCLUSION: A high glucose level during pregnancy, even if within the range of slight glucose intolerance, may serve as a marker for future maternal atherosclerotic morbidity. Further long-term studies are needed to confirm our findings.


Assuntos
Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Intolerância à Glucose/epidemiologia , Hiperlipidemias/epidemiologia , Falência Renal Crônica/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Aterosclerose/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Estudos de Casos e Controles , Transtornos Cerebrovasculares/epidemiologia , Angiografia Coronária , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/metabolismo , Teste de Esforço , Feminino , Seguimentos , Intolerância à Glucose/metabolismo , Humanos , Hipertensão/epidemiologia , Modelos Lineares , Gravidez , Complicações na Gravidez/metabolismo , Modelos de Riscos Proporcionais , Estudos Retrospectivos
5.
Am J Perinatol ; 33(14): 1388-1393, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27159201

RESUMO

Objective The objective of this study was to investigate whether patients who undergo fertility treatments (ovulation induction or in vitro fertilization) have an increased risk for future maternal cardiovascular morbidity. Design A population-based study compared the incidence of long-term cardiovascular morbidity in a cohort of women with and without a previous exposure to fertility treatments. Deliveries occurred during a 25-year period, with a mean follow-up of 11.7 years. Women with known cardiovascular disease and congenital cardiovascular malformations diagnosed before the index pregnancy and multiple pregnancies were excluded. Results During the study period, 99,291 patients met the inclusion criteria; 4.1% (n = 4,153) occurred in patients with exposure to fertility treatments. Patients with exposure to fertility treatments did not have higher rates of cardiovascular morbidity. Using a Kaplan-Meier survival curve, patients with an exposure to fertility treatments had no higher cumulative incidence of cardiovascular hospitalizations. Using a Cox proportional hazards model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, exposure to fertility treatments remained unassociated with cardiovascular hospitalizations (adjusted hazard ratio = 1.1; 95% confidence interval, 0.9-1.3; p = 0.441). Conclusion In our population, during a mean follow-up period of 11.7, results showed no increased risk for cardiovascular morbidity in women undergoing fertility treatments.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fertilização in vitro , Obesidade/epidemiologia , Indução da Ovulação , Pré-Eclâmpsia/epidemiologia , Adulto , Bases de Dados Factuais , Feminino , Fertilização in vitro/efeitos adversos , Seguimentos , Humanos , Incidência , Israel/epidemiologia , Estimativa de Kaplan-Meier , Indução da Ovulação/efeitos adversos , Gravidez , Resultado da Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Br J Biomed Sci ; 68(3): 112-5, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21950201

RESUMO

This study aims to examine the association between creatinine level during the first 20 weeks of pregnancy and the development of pre-eclampsia in the second half of the pregnancy. The study population included all registered births (n=9341) between 2001 and 2007 in a tertiary medical centre. Student's t-test and receiver operating characteristic (ROC) curves were used to determine any association. Significant association was documented between creatinine level in the first 20 weeks and the prevalence of hypertensive disorders. The mean plasma creatinine value in women with mild pre-eclampsia versus healthy women was 0.59 mg/dL +/- 0.14 versus 0.57 mg/dL +/- 0.15, respectively (P = 0.023). The mean plasma creatinine value in women with severe pre-eclampsia versus healthy women was 0.61 mg/dL +/- 0.17 versus 0.58 mg/dL +/- 0.15, respectively (P = 0.040). The mean plasma creatinine value in women with hypertensive disorders versus healthy women was 0.60 mg/dL +/- 0.15 versus 0.58 mg/dL +/- 0.15, respectively (P=0.003). The ROC curve demonstrated a significant association between creatinine level in the first 20 weeks of pregnancy and the development of mild and severe pre-eclampsia in the second half of pregnancy (area under the curve: 0.54, 95% confidence interval [CI]: 0.51-0.57, P = 0.02, and 0.56, 95% CI: 0.50-0.62, P = 0.033, respectively). Higher creatinine levels during the first 20 weeks of pregnancy are associated with a higher risk of developing mild and severe pre-eclampsia.


Assuntos
Creatinina/sangue , Pré-Eclâmpsia/sangue , Adulto , Biomarcadores/sangue , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue , Curva ROC , Adulto Jovem
7.
J Dev Orig Health Dis ; 10(4): 429-435, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30587264

RESUMO

Other than obesity, no definitive insights have been gained regarding the apparent association between mode of delivery and long-term endocrine and metabolic outcomes in the offspring. We aimed to determine whether elective cesarean delivery (CD) impacts on long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton-term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent CD and those delivered vaginally (VD). Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. Cox and a Weibull regression models were used to control for confounders. During the study period 131,880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11,768) and 91.1% (n=120,112) were VDs. The survival curve demonstrated a significantly higher cumulative incidence of endo-metabolic morbidity in offspring born via CD (P=0.010). In the regression models, adjusted for maternal obesity, CD was not noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring while maternal obesity emerged as a strong predictor. We therefore conclude that CD per-se does not appear to increase the risk for long-term pediatric endo-metabolic morbidity of the offspring.

8.
J Matern Fetal Neonatal Med ; 32(9): 1478-1484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29172830

RESUMO

BACKGROUND: Low birth weight and preeclampsia are both adverse pregnancy and delivery outcomes, with possible influence on future health status. Previous studies have shown that intergenerational factors may be important prognostic information in evaluating women prior to or after conception. Our objective was to evaluate the role of intergenerational factors on the incidence of preeclampsia and low birth weight (LBW). METHODS: A retrospective population-based study was conducted. Perinatal information was gathered from 2311 familial triads, comprising mothers (F1), daughters (F2), and children (F3). All births occurred in a tertiary medical center between 1991 and 2013. A multivariate generalized estimating equation logistic regression model analysis was used to study the association between LBW and preeclampsia across generations while controlling for confounders and for clusters of families in the database. RESULTS: A total of 1490 in F1, 1616 in F2, and 2311 in F3 were included. LBW in mothers (F2), adjusted for possible confounders, was found to be a significant predictor for LBW in offspring (OR = 1.6, 95% CI 1.02-2.6, p = .043). Likewise, preeclampsia was also noted as a significant intergenerational factor following adjustments for possible confounders (OR = 2.9, 95% CI 1.4-5.8, p = .004). CONCLUSIONS: Maternal LBW and preeclampsia are both independent risk factors for recurrence in the next generation.


Assuntos
Recém-Nascido de Baixo Peso , Pré-Eclâmpsia/epidemiologia , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
J Matern Fetal Neonatal Med ; 32(16): 2657-2661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29464978

RESUMO

OBJECTIVE: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity. STUDY DESIGN: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. RESULTS: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n = 11,062), 91% were AGA (n = 214,249), and 4.3% were LGA neonates (n = 10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR = 1.4; 95%CI = 1.1-1.8; p = .015 and aOR = 1.4; 95%CI = 1.1-1.8; p = .005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR = 1.7; 95%CI = 1.2-2.5; p = .001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR = 3.2; 95%CI = 1.8-5.8; p = .001). CONCLUSIONS: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.


Assuntos
Peso ao Nascer , Diabetes Mellitus/epidemiologia , Hipotireoidismo/epidemiologia , Obesidade/epidemiologia , Nascimento a Termo , Adulto , Criança , Diabetes Mellitus/etiologia , Feminino , Humanos , Hipotireoidismo/etiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Obesidade/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Placenta ; 29(3): 225-40, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18262643

RESUMO

Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.


Assuntos
Placenta/diagnóstico por imagem , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Implantação do Embrião , Feminino , Humanos , Modelos Biológicos , Tamanho do Órgão , Placenta/citologia , Placenta/patologia , Doenças Placentárias/diagnóstico por imagem , Doenças Placentárias/patologia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Múltipla/fisiologia , Tumor Trofoblástico de Localização Placentária/diagnóstico por imagem , Ultrassonografia
11.
Placenta ; 29(11): 921-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18799213

RESUMO

Doppler velocimetry is the ideal clinical tool to assess placental performance in high-risk pregnancies. It also has value in predicting later complications and outcome in pregnancies which appear uncomplicated. All three circulations (fetal, placental and maternal) may be interrogated by Doppler technology. In the following review, we present basic physics aspects of Doppler and discuss mainly Doppler investigation of the fetal-placental circulation (umbilical artery, intraplacental circulation) as well as the uterine arteries. The assessment of umbilical blood flow provides information on blood perfusion of the fetal-placental unit. The diastolic blood flow velocity component in umbilical artery increases with advancing gestation. In pregnancies complicated by placental dysfunction, there may be a reduction in the number of functional villi and/or small blood vessels with, as a result, increased impedance, reflected, mainly, by a decrease in end-diastolic velocity. When the resistance increases even more, there is no diastolic forward velocity (absent end-diastolic velocity). Further increase in the resistance causes reversed end-diastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. Doppler assessment of the umbilical arteries was found to improve outcome of high-risk pregnancies, and reduce hospital admissions. On the contrary, routine Doppler ultrasound in low risk or unselected populations does not seem to confer benefit on mother or newborn. Uterine artery Doppler is a useful test in predicting pregnancies at high risk of developing complications related to uteroplacental insufficiency. It identifies women who may benefit from increased antenatal surveillance or prophylactic therapy. Three-dimensional power Doppler sonography can provide new insights into placental pathophysiology.


Assuntos
Placenta/irrigação sanguínea , Placenta/diagnóstico por imagem , Circulação Placentária , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Feminino , Humanos , Gravidez , Ultrassonografia Pré-Natal
12.
Placenta ; 29(7): 593-601, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18471873

RESUMO

The aim of the present study was to examine the effect of lipopolysaccharide (LPS) on the secretion of the pro-inflammatory cytokine interleukin-1beta (IL-1beta) and of its natural inhibitor interleukin-1 receptor antagonist (IL-1Ra), by perfused human term and preterm placental tissue. Eight term and eight preterm placentae were collected immediately after delivery; four term and four preterm placentae were perfused with control medium (without LPS) and the other four term and four preterm placentae were perfused with medium containing LPS. The release of IL-1beta into the maternal compartment by term placenta was significantly higher than the release by preterm placenta (p<0.001). However, there were no significant differences between IL-1beta levels released into the fetal compartments of term and preterm placentae. No significant differences were observed in the release of IL-1Ra into the maternal and fetal compartments of term placenta, when compared to preterm placenta. Exposure to LPS significantly decreased the capacity of term placenta to release IL-1beta into the maternal compartment (p<0.001) and increased the capacity of term placenta to release IL-1Ra into the maternal and fetal compartments (p<0.001 and p=0.017, respectively). However, the capacity of preterm placentae to release IL-1beta and IL-Ra into the maternal and fetal compartments was not affected by LPS. IL-1beta was expressed by both term and preterm placentae before and after perfusion (+/- LPS), by epithelial cells of the amnion, chorion, by syncytiotrophoblast and stromal cells of villous tissue and by the decidua. IL-1Ra in term and preterm placentae was expressed before perfusion mainly in epithelial cells of the amnion. After perfusion of term placentae (+/- LPS), additional IL-1Ra expression was seen in epithelial cells of the amnion and in syncytiotrophoblast and stromal cells of villous tissue and by the decidua. However, perfusion of preterm placentae (+/- LPS) did not affect IL-1Ra expression. The localization of IL-1beta and IL-1Ra in both term and preterm human placental tissue suggests a their physiologic role. The data presented indicates that the IL-1 system in term and preterm placentae seems to be differently affected by LPS. Down-regulation in the release of the pro-inflammatory cytokine IL-1beta and the up-regulation of its antagonist (IL-1Ra) may be a part of the inflammatory response to infection in human term, but not preterm, placentae. The IL-1 system in term and preterm placentae seems to be differently affected by LPS.


Assuntos
Proteína Antagonista do Receptor de Interleucina 1/metabolismo , Interleucina-1beta/metabolismo , Lipopolissacarídeos/farmacologia , Placenta/efeitos dos fármacos , Nascimento Prematuro , Nascimento a Termo , Feminino , Humanos , Lipopolissacarídeos/administração & dosagem , Técnicas de Cultura de Órgãos , Perfusão , Placenta/metabolismo , Gravidez , Nascimento Prematuro/metabolismo , Nascimento a Termo/metabolismo , Fatores de Tempo
13.
J Matern Fetal Neonatal Med ; 21(5): 331-5, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18446661

RESUMO

OBJECTIVE: To investigate pregnancy outcome in women suffering from idiopathic vaginal bleeding (IVB) during the second half of pregnancy. METHODS: A comparison between patients admitted to the hospital due to bleeding during the second half of pregnancy and patients without bleeding was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the analysis. Stratified analyses using the Mantel-Haenszel technique and a multiple logistic regression model were performed to control for confounders. RESULTS: During the study period, 173,621 singleton deliveries occurred at our institute. Of these, 2077 (1.19%) were complicated with bleeding upon admission during the second half of pregnancy. After excluding cases with bleeding due to placental abruption, placenta previa, cervical problems, etc., 67 patients were classified as having IVB (0.038%). Independent risk factors associated with IVB, using a backward, stepwise multivariable analysis were oligohydramnios (OR=6.2; 95% CI 3.1-12.7; p < 0.001), premature rupture of membranes (OR=3.4; 95% CI 1.8-6.2; p < 0.001), intrauterine growth restriction (IUGR, OR 5.6; 95% CI 2.5-12.2; p < 0.001), and Jewish ethnicity (OR=1.9; 95% CI 1.0-3.5; p=0.036). These patients subsequently were more likely to deliver preterm (<37 weeks, 56.7% vs. 7.3%; mean gestational age of 33.6+/-5.7 weeks vs. 39.2+/-2.1 weeks; p < 0.001) and by cesarean delivery (CD, 35.8% vs. 12.1%, OR=4.0; 95% CI 2.4-6.6; p < 0.001). Higher rates of low Apgar scores (<7) at 1 and 5 minutes were noted in these patients (OR=10.3; 95% CI 5.9-17.8; p < 0.001 and OR=17.8; 95% CI 7.1-44.5; p < 0.001, respectively). Moreover, perinatal mortality rate among patients admitted due to idiopathic bleeding was significantly higher as compared to patients without bleeding (9.6% vs. 1.2%, OR=8.4; 95% CI 3.3-21.2; p < 0.001). However, when controlling for preterm delivery, using the Mantel-Haenszel technique, the association lost its significance. CONCLUSION: Idiopathic vaginal bleeding during the second half of pregnancy is a risk factor for adverse perinatal outcome, mostly due to its significant association with preterm delivery. Careful surveillance, including fetal monitoring, is suggested in these cases in order to reduce the adverse perinatal outcome.


Assuntos
Doenças do Recém-Nascido/etiologia , Complicações do Trabalho de Parto/etiologia , Hemorragia Uterina/complicações , Adulto , Feminino , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Fatores de Risco
14.
Placenta ; 28 Suppl A: S14-22, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17383721

RESUMO

Maurice Panigel demonstrated by X-rays, almost 40 years ago, placental maternal blood jets in non-human primates. Although to researchers the importance of the placenta is evident, in clinical obstetrical imaging, the fetus takes precedence. The placenta is imaged almost as an after thought and mostly to determine its location in the uterus. In animal species, the placenta was imaged with techniques which would be considered too invasive (or too costly for routine use) in humans, many pioneered by Panigel: radioangiography, radioisotopes scintigraphy, thermography, magnetic resonance imaging (MRI) and spectroscopy, positive emission tomography (PET) and single photon emission computed tomography (SPECT). Ultrasound allows for detailed, and, as far as is known, safe analyses of not only placental structure in the human but also its function. Earlier, only 2-dimensional grey-scale was available and more than 20 years ago, placental grading was popular. Later, colour imaging and spectral Doppler analysis of blood velocity both in the umbilical artery and within the placenta as well as the uterus and fetal vessels became essential and, more recently, the use of ultrasound contrast agents has been described, albeit not yet in a clinical setting. Three-dimensional ultrasound permits evaluation of the placenta in several planes, more precise depiction of internal vasculature as well as more accurate volume assessment. Several medical disorders of the pregnant woman or her fetus begin or end in the placenta, and ultrasound is the optimal investigation method. Obvious examples include pre-eclampsia and other forms of hypertension in pregnancy, less than optimal fetal growth (i.e. intrauterine growth restriction), triploidy (and its placental manifestation: partial mole), non-immune hydrops as well as several infectious processes. Ultrasound is also particularly suited to evaluate specific placental conditions, such as abnormal placentation (placenta previa and accrete for instance), gestational trophoblastic disease and placental tumors (e.g. chorioangioma).


Assuntos
Diagnóstico por Imagem , Placenta/patologia , Complicações na Gravidez/patologia , Útero/patologia , Animais , Feminino , Humanos , Histerossalpingografia , Placenta/diagnóstico por imagem , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia , Útero/diagnóstico por imagem
15.
Int J Gynaecol Obstet ; 98(3): 232-6, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17490669

RESUMO

OBJECTIVE: The study was aimed to determine whether the method of placental removal at the time of the cesarean delivery is associated with postpartum complications such as postpartum fever and wound infection. In addition it was aimed to identify other complications following cesarean delivery. METHODS: A prospective observational study was conducted, including 426 women who underwent cesarean deliveries between January 2004 and March 2005, in a tertiary medical center. A multivariable logistic regression model, with backward elimination, was constructed in order to identify independent risk factors associated with the occurrence of wound infection or fever. A sample size of about 150 subjects in each group was needed to demonstrate a difference of 15% between the two methods of placental removal, with a probability of 95% and power of 80%. RESULTS: Manual removal of the placenta occurred in 269 operations while in 157 women the placenta was removed in a spontaneous method. No statistically significant differences were noted between the two methods of removal of the placenta regarding the risk for fever (7.8% in the group of the manual removal, as compared with 5.1% in the group of the spontaneous method; P=0.284) or for wound infection (3.7% in the group of the manual removal compared with 5.1% in the group of the spontaneous method; P=0.495). Using a multivariable logistic regression model, with backward elimination, the following risk factors were identified for postcesarean fever, or wound infection: unskilled surgeon (OR 3.2, 95% CI 1.4-7.8), number of previous cesarean deliveries (OR 1.8, 95% CI 1.3-2.6) and maternal hypertension (OR 3.3, 95% CI 2.0-38.5). CONCLUSION: The method of placental removal during cesarean delivery is not associated with the risk for either wound infection or postpartum fever.


Assuntos
Cesárea/efeitos adversos , Placenta/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Cesárea/métodos , Competência Clínica , Feminino , Febre/etiologia , Humanos , Hipertensão/complicações , Internato e Residência , Israel , Razão de Chances , Gravidez , Estudos Prospectivos
16.
J Cancer Res Clin Oncol ; 142(1): 287-93, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26337160

RESUMO

OBJECTIVE: To investigate whether an association exists between a history of fertility treatments and future risk of female malignancies. STUDY DESIGN: A population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of fertility treatments including in vitro fertilization (IVF) and ovulation induction (OI). Deliveries occurred between the years 1988-2013, with a mean follow-up duration of 12 years. Excluded from the study were women with known genetic predisposition for malignancies or known malignancies prior to the index pregnancy. Female malignancies were divided into specific types including ovarian, uterine, breast and cervix. Kaplan-Meier survival curve was used to estimate cumulative incidence of malignancies. Cox proportional hazard models were used to estimate the adjusted hazard ratios (HRs) for female malignancy. RESULTS: During the study period, 106,031 women met the inclusion criteria; 4.1 % (n = 4363) occurred in patients following fertility treatments. During the follow-up period, patients with a history of IVF treatments had a significantly increased risk of being diagnosed with ovarian and uterine cancer as compared to patients after OI and patients with no history of fertility treatments. Cox proportional hazard models were constructed for ovarian and uterine cancer separately, controlling for confounders such as maternal age and obesity. A history of IVF treatment remained independently associated with ovarian and uterine cancer (adjusted HR 3.9; 95 % CI 1.2-12.6; P = 0.022 and adjusted HR 4.6; 95 % CI 1.4-14.9; P = 0.011; respectively). CONCLUSION: IVF treatments pose a significant risk of subsequent long-term ovarian and uterine cancer.


Assuntos
Neoplasias da Mama/induzido quimicamente , Fármacos para a Fertilidade Feminina/efeitos adversos , Fertilidade/efeitos dos fármacos , Fertilização in vitro/efeitos adversos , Neoplasias dos Genitais Femininos/induzido quimicamente , Hospitalização/estatística & dados numéricos , Indução da Ovulação/efeitos adversos , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Israel/epidemiologia , Estadiamento de Neoplasias , Gravidez , Prevalência , Prognóstico , Fatores de Risco , Fatores de Tempo
17.
Int J Gynaecol Obstet ; 90(1): 10-5, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15913620

RESUMO

OBJECTIVE: To identify risk factors for early wound infection (diagnosed prior to discharge) following cesarean delivery. METHODS: A population-based study comparing women who have and have not developed a wound infection prior to discharge from Soroka University Medical Center, Ben Gurion University of the Negev, between 1988 and 2002. RESULTS: Of the 19,416 cesarean deliveries performed during the study period, 726 (3.7%) were followed by wound infection. Using a multivariable logistic regression model, the following risk factors were identified: obesity (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.6-3.1); hypertensive disorders (OR = 1.7; 95% CI, 1.4-2.1); premature rupture of membranes (OR = 1.5; 95% CI, 1.2-1.9); diabetes mellitus (OR = 1.4; 95% CI, 1.1-1.7); emergency cesarean delivery (OR = 1.3; 95% CI, 1.1-1.5); and twin delivery (OR = 1.6; 95% CI, 1.3-2.0). Combined obesity and diabetes (gestational and pregestational) increased the risk for wound infection 9.3-fold (95% CI, 4.5-19.2; P < .001). CONCLUSION: Independent risk factors for an early wound infection are obesity, diabetes, hypertension, premature rupture of membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates of wound infection should be provided to obese women undergoing cesarean delivery, especially when diabetes coexists.


Assuntos
Cesárea/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Diabetes Mellitus , Feminino , Humanos , Recém-Nascido , Israel/epidemiologia , Obesidade , Gravidez , Resultado da Gravidez , Análise de Regressão , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
18.
J Matern Fetal Neonatal Med ; 28(14): 1641-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25234099

RESUMO

OBJECTIVE: To investigate whether patients with a history of placental abruption have an increased risk for subsequent maternal long-term morbidity. STUDY DESIGN: A population-based study compared the incidence of long-term renal morbidity in cohort of women with and without a history of placental abruption. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Renal morbidity included kidney transplantation, chronic renal failure, hypertensive renal disease, etc. RESULTS: During the study period 99 354 deliveries met the inclusion criteria; 1.8% (n = 1807) occurred in patients with a diagnosis of placental abruption. Patients with placental abruption did not have higher cumulative incidence of renal related hospitalizations, using Kaplan-Meier survival curve. During the follow-up period patients with a history of placental abruption did not have higher rate of renal morbidity (0.2% versus 0.1%; OR 1.8; 95% CI 0.6-4.8; p = 0.261). When performing a Cox proportional hazards model, adjusted for confounders such as parity and diabetes mellitus, a history of placental abruption was not associated with renal related hospitalizations (adjusted HR, 1.6; 95% CI, 0.6-4.2; p = 0.381). CONCLUSION: Placental abruption, even though considered a part of the "placental syndrome" with possible vascular etiology, is not a risk factor for long-term maternal renal complications.


Assuntos
Descolamento Prematuro da Placenta , Insuficiência Renal Crônica/etiologia , Adulto , Feminino , Seguimentos , Humanos , Incidência , Israel , Estimativa de Kaplan-Meier , Gravidez , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
19.
Obstet Gynecol ; 97(5 Pt 1): 747-52, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11339928

RESUMO

OBJECTIVE: To examine the significance of abnormal fetal heart rate (FHR) patterns during the second stage of labor in terms of pregnancy outcome. METHODS: A prospective observational study comparing women who had abnormal FHR patterns during the second stage of labor with women who demonstrated normal FHR patterns. RESULTS: Abnormal second-stage FHR patterns were found in 420 tracings (75%), whereas 140 tracings (25%) were normal. In a multivariable analysis, nulliparity (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.2), cord problems (OR 1.8; 95% CI 1.03, 3.3), and male sex (OR 1.5; 95% CI 1.01, 2.2) were independent factors affecting the occurrence of abnormal second-stage FHR patterns. Patients with abnormal tracings had significantly higher rates of operative delivery compared with patients with normal tracings. The newborns from the case group had significantly higher percentages of Apgar scores lower than 7 at 1 minute, arterial pH lower than 7.2, and base deficit of 12 mmol/L or higher, and six were admitted to the intensive care unit (ICU). A multiple logistic regression model found second-stage late decelerations, bradycardia less than 70 beats per minute, and the presence of abnormal FHR patterns during the first stage of labor to be independently associated with fetal acidosis (determined by pH less than 7.2 and base deficit greater than 12 mmol/L). CONCLUSION: Late decelerations, bradycardia less than 70 beats per minute, and abnormal FHR patterns during the first stage of labor might jeopardize fetal well-being, and expedited delivery should be considered.


Assuntos
Bradicardia/diagnóstico , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Taquicardia/diagnóstico , Adulto , Distribuição de Qui-Quadrado , Intervalos de Confiança , Feminino , Humanos , Recém-Nascido , Segunda Fase do Trabalho de Parto , Modelos Logísticos , Razão de Chances , Gravidez , Estudos Prospectivos , Valores de Referência , Medição de Risco , Sensibilidade e Especificidade
20.
J Psychosom Obstet Gynaecol ; 20(3): 165-9, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10497760

RESUMO

The purpose of the study was to characterize parturients who prefer to deliver without the use of analgesia. The study population consisted of 446 consecutive low risk laboring women in early active stage of labor. Data were collected prospectively by an obstetrician, using a structured questionnaire. The degree of pain was assessed by using a visual analog scale (VAS). An obstetrician and a midwife together estimated the degree of pain as was exhibited by the parturients, using the same scale. Univariate analysis found women who undertake labor without analgesia to be significantly older, with higher birth order, of Bedouin ethnicity and to be of lower educational level than those taking analgesics during labor. Women who refused analgesia had experienced and apparently expressed lower degrees of pain (mean VAS score = 7.4 and 6.7, respectively) than those who consented to analgesia (mean VAS score = 8.6 and 8.0, respectively; p < 0.001). A multiple logistic regression model found only the severity of pain (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.51-0.88; p = 0.004), as well as high maternal age (OR = 1.12, 95% CI 1.16-2.04; p = 0.038) to be independent factors affecting the decision not to accept analgesia during labor. In conclusion, parturients refusing analgesia were older and had experienced less pain during labor than women using analgesia.


Assuntos
Analgesia Obstétrica/psicologia , Complicações do Trabalho de Parto/psicologia , Dor/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adulto , Análise de Variância , Ordem de Nascimento , Feminino , Humanos , Modelos Logísticos , Idade Materna , Complicações do Trabalho de Parto/diagnóstico , Dor/diagnóstico , Medição da Dor , Paridade , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Recusa do Paciente ao Tratamento/estatística & dados numéricos
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