Exacerbated Activation of the NLRP3 Inflammasome in the Placentas from Women Who Developed Chronic Venous Disease during Pregnancy.

Chronic venous disease (CVD) comprises a spectrum of morphofunctional disorders affecting the venous system, affecting approximately 1 in 3 women during gestation. Emerging evidence highlights diverse maternofetal implications stemming from CVD, particularly impacting the placenta. While systemic inflammation has been associated with pregnancy-related CVD, preliminary findings suggest a potential link between this condition and exacerbated inflammation in the placental tissue. Inflammasomes are major orchestrators of immune responses and inflammation in different organs and systems. Notwithstanding the relevance of inflammasomes, specifically the NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3)- which has been demonstrated in the placentas of women with different obstetric complications, the precise involvement of this component in the placentas of women with CVD remains to be explored. This study employs immunohistochemistry and real-time PCR (RT-qPCR) to examine the gene and protein expression of key components in both canonical and non-canonical pathways of the NLRP3 inflammasome (NLRP3, ASC-apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain-caspase 1, caspase 5, caspase 8, and interleukin 1ß) within the placental tissue of women affected by CVD. Our findings reveal a substantial upregulation of these components in CVD-affected placentas, indicating a potential pathophysiological role of the NLRP3 inflammasome in the development of this condition. Subsequent investigations should focus on assessing translational interventions addressing this dysregulation in affected patient populations.

Segmental arterial mediolysis leading to spontaneous rupture of splenic artery and fatal hemorrhage in pregnancy.

We report an unexpected death of a 22-year-old primigravida who was admitted to the hospital with sudden abdominal pain two days before a scheduled delivery. During an emergency caesarean section due to intrauterine asphyxia, intraabdominal bleeding was observed with no apparent source of bleeding. Newly formed blood clots in the subdiaphragmatic space and arterial bleeding near the splenic hilum required a surgery on the next day. Hemorrhagic shock led to multiple organ failure on the fourth day of admission. The autopsy revealed ruptured splenic artery at the pancreatic tail and near the splenic hilum. Microscopically, different stages of segmental arterial mediolysis were observed in partially thinned and aneurysmatic artery.

Alteraciones clínico-metabólicas en mujeres con diabetes gestacional previa / Clinical metabolic disorders in women with previous gestational diabetes

Conocer la frecuencia de diabetes y otros factores de riesgo cardiovascular en mujeres con diabetes mellitus gestacional (DMG) previa. Se evaluaron 92 mujeres con DMG previa, a quienes no se les había diagnosticado diabetes, que asistieron a la pesquisa posparto inicial o anual durante 2008. Se determinó presión arterial, circunferencia abdominal (CA) e índice de masa corporal (IMC). Se practicó prueba de tolerancia oral a la glucosa, medición de niveles de insulina y lípidos séricos. Se estableció la presencia de síndrome metabólico (SM), aplicando los criterios ATP III e índice de resistencia a la insulina mediante el modelo Homa-R. Se usó t Student para la asociación de variables. La media de edad fue 34,7 ± 6,6 años y del período posparto, 3,5 ± 2,6 años. En 8,7 por ciento se hizo el diagnóstico de diabetes, 32,6 por ciento intolerancia a la glucosa y 12,0 por ciento, glucemia alterada en ayunas. 62,1 por ciento presentaba obesidad abdominal, 62,5 por ciento, algún tipo de dislipidemia y 23,80 por ciento, elevación de la presión arterial. 46,4 por ciento reunía los criterios de SM y 29,6 por ciento mostró un índice HOMA-R > 2,5. Las cifras de CA, IMC, triglicéridos, glucemia basal, glucemia 2 horas post-carga, e insulina 2 horas poscarga fueron más altas (P< 0,05) en mujeres con anormalidades de la tolerancia a la glucosa que en aquellas con tolerancia normal. Las mujeres con DMG previa muestran una elevada frecuencia de alteraciones clínicas y metabólicas que representan un potencial incremento del riesgo cardiovascular en un grupo poblacional relativamente joven

To know the frequency of diabetes and other cardiovascular risk factors in women with previous gestational diabetes mellitus (GDM). 92 women with previous GDM, without diagnosis of diabetes, who underwent initial or annual postpartum diabetes screening during 2008, were assessed. Blood pressure, abdominal circumference and body mass index were measured. They were tested for an oral glucose tolerance test (OGTT) and determination of plasma insulin and lipid levels. Metabolic syndrome (MS) was diagnosed according ATP III criteria and the HOMA-R model was used for the insulin resistance index calculation. Student’s t test was used for variables association. The average age was 34.7 ± 6.6 years and postpartum period, 3.5 ± 2.6 years. 8.7 percent was diagnosed with diabetes, 32.6 percent with impaired glucose tolerance and 12.0 percent with impaired fasting glucose. 62.1 percent showed abdominal obesity, 62.5 percent presented some type of dyslipidemia and 23.8 percent, high blood pressure. 46.4 percent met the criteria for MS, and 29.6 percent showed a HOMA-R Index > 2.5. Abdominal circumference, body mass index, blood pressure, triglycerides, basal glucose, 2-h post-load glucose and 2-h post-load insulin values were higher (P< 0.05) in women with abnormal glucose tolerance than those with normal glucose tolerance. Women with previous GDM show a high frequency of clinical and metabolic abnormalities that point towards a potential increase of cardiovascular risk in a relatively young population

Alterações histopatológicas em placentas humanas relacionadas às síndromes hipertensivas / Histopathological changes in human placentas related to hypertensive disorders

OBJETIVO: determinar a prevalência de alterações histopatológicas em placentas humanas, relacionadas às síndromes hipertensivas. MÉTODOS: estudo de corte transversal, que comparou as alterações histopatológicas identificadas em 43 placentas oriundas de gestantes do grupo de hipertensas (GrHip) com as de 33 placentas de gestantes do grupo de normotensas (GrNor). Foram analisados o peso, volume e ocorrência macro e microscópica de infartos, coágulos, hematomas, aterose (obliteração parcial, espessamento de camadas e presença de vasos hialinizados) e alterações de Tenney-Parker (ausentes, discretas e proeminentes), bem como a localização de infartos e coágulos (central, periférico ou associação de ambos). Para a análise estatística foram usados os testes do χ2 e t de Student, bem como médias, desvios padrões e percentuais. Considerou-se como significante um p<0,05. RESULTADOS: o estudo macroscópico revelou que as placentas do GrHip, se comparadas às do GrNor, apresentaram menor peso (461,1 versus 572,1 g) e volume (437,4 versus 542,0 cm³) e percentuais aumentados de infartos (51,2 versus 45,5 por cento; p<0,05; OR=1,15) e de coágulos (51,2 versus 15,1 por cento; p<0,05; OR=5,4). Nos GrHip e GrNor, os infartos microscópicos ocorreram em 83,7 e 45,5 por cento; p<0,05; OR=4,3, respectivamente. A aterose e as alterações de Tenney-Parker associaram-se estatisticamente às síndromes hipertensivas (p<0,05). CONCLUSÕES: os dados obtidos permitem associar menor peso e volume placentário, maior percentual de infartos macro e microscópicos, coágulos, aterose e alterações de Tenney-Parker às placentas relacionadas com gestações que cursaram com síndromes hipertensivas.

PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm³), higher infarction (51.2 versus 45.5 percent; p<0.05: OR=1.15) and clots (51.2 versus 15.1 percent; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5 percent (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.

Estudo da morfologia vascular do leito placentário na hipertensão arterial crônica / Morphology of the vascular placental bed in chronic arterial hypertension

OBJETIVO: Analisar os padrões histopatológicos das artérias do leito placentário em gestações complicadas por hipertensão arterial crônica (HAC) comparando-os com o de grávidas normais. MÉTODOS: Biópsias de leito placentário, segundo técnica de Robertson et al.1, foram realizadas em pacientes com idade gestacional igual ou superior a 28 semanas, submetidas a cesárea, após a dequitação. O grupo controle (GC) foi composto por 25 pacientes normais e o grupo de estudo composto por 13 pacientes com HAC leve (HL), 11 pacientes com HAC moderada (HM) e 11 pacientes com HAC grave (HG). As classes de hipertensão foram consideradas leve (PAD 90 - 100 mmHg), moderada (PAD 100 - 110 mmHg) e grave (PAD3 > 110mmHg). Os padrões histológicos das artérias espiraladas foram classificados em: padrão inalterado, modificações fisiológicas, desorganização da camada média, alterações hiperplásicas, necrose e aterose aguda. RESULTADOS: 1) Os achados anormais foram predominantes no grupo de hipertensas, sendo mais freqüente nos grupos HM e HG. 2) O achado anormal mais prevalente foi a desorganização da camada média, com distribuição semelhante nos grupos HM e HG. 3) Os padrões normais ocorreram nos grupos GC e HL, com distribuição semelhante entre si.

OBJECTIVES: To analyze histopathological patterns of placental bed arteries in pregnancies complicated by chronic arterial hypertension. Alterations were considered according to clinical classification of the hypertensive disorders as mild (MG); moderate (MoG) and severe (SG) for comparison with uncomplicated pregnancies, control group (CG). METHODS: Placental bed biopsy was performed in 60 pregnant women; the study group was comprised of pregnant women with hypertension, subdivided in 13 with severe chronic hypertension (CH), 11 with moderate CH and 11 with mild CH, and results were compared to 25 placental bed biopsies from uncomplicated pregnancies. All the pregnant women had a gestational age of at least 28 weeks of gestation with a live fetus and were submitted to cesarean section. Hypertension was considered mild with diastolic blood pressure (DBP) 90 I? 100 mmHg, moderate DBP 100 I? 110 mmHg and severe DBP = 110 mmHg. Placental bed variables selected for histological analysis were: unaltered patterns, physiological changes, medial layer disorganization, medial and intimal hyperplasic changes, acute necrosis and atherosis. RESULTS: In cases with SG and MoG there was predominance of abnormal histophysiological findings: medial layer disorganization and hyperplasic changes, with a statistically significant difference when compared to MG and CG. Alteration in the medial layer was observed in these cases. The normal pattern, unaltered patterns and physiologic changes were more frequent in CG and MG. Physiological changes were the most usual finding, further, there was no acute necrosis or atherosis. CONCLUSION: 1. Abnormal histophysiological findings were predominant in hypertensive pregnant women compared to the normotensive ones; 2. These patterns were more frequent, according to the severity of the hypertensive disorders: Severe, Moderate and Mild; 3. More significant abnormal findings were a change in the medial layer, mainly in...

Gestación interrumpida del segundo trimestre complicada con miocardiopatía dilatada / A pregnancy interrupted in the second trimester complicated by dilated myocardopathy

Presentamos un caso de miocardiopatía dilatada asociada a interrupción de la gestación en la semana 19, que requirió la evacuación inmediata de los restos ovulares mediante microcesárea ante el deterioro progresivo cardiorrespiratorio desde el ingreso. Se llegó al diagnóstico tras no encontrar causa evidenciable alguna a pesar de toda la batería de pruebas de laboratorio realizadas. El ecocardiograma reveló la dilatación del ventrículo izquierdo con hipocinesia generalizada y disfunción sistólica. La paciente precisó de tratamiento intensivo similar al de la insuficiencia cardíaca para estabilizarla. La evolución favorable fue sorprendente y a los 6 meses no presenta secuelas (AU)

We report a case of dilated cardiomyopathy linked to a missed abortion in the 19th week, requiring immediate evacuation of products of pregnancy by means of a microcaesarean because of cardiorespiratory deterioration following admission to hospital. Diagnosis was made excluding other possibilities in spite of extensive laboratory tests, as there was no obvious cause for this. Echocardiogram showed left ventricular dilatation with general hypokinesis and systolic dysfunction. The patient required intensive care to stabilize her cardiac insufficiency. Surprisingly, her evolution was favourable, and after six months she has no sequelae (AU)

Miocardiopatía periparto como causa de insuficiencia cardíaca durante la gestación / Peripartum cardiomyopathy as a cause of heart failure during pregnancy

La miocardiopatía periparto es una rara forma de insuficiencia cardíaca que afecta a mujeres durante el embarazo tardío o puerperio, con consecuencias potencialmente letales. El cuadro clínico es el de una insuficiencia cardíaca congestiva, que a veces se puede pasar por alto debido a que puede tener síntomas similares a los de un embarazo normal, como la disnea. El tratamiento es similar al empleado en otros tipos de disfunción ventricular izquierda; sin embargo, a veces se requieren modificaciones del tratamiento estándar para seguridad de la madre y del feto o lactante. Salvo pocas excepciones, el parto vaginal con la abreviación del período expulsivo mediante fórceps es preferible en mujeres con enfermedad cardíaca, y un control hemodinámico exhaustivo de la paciente durante el puerperio inmediato es de extrema importancia. La mortalidad de este proceso se encuentra en torno al 30-40 por ciento, casi siempre durante los 3 primeros meses posparto, aunque alrededor del 50 por ciento de las pacientes tiene una marcada mejoría de la función ventricular (AU)

Hipertension inducida por el embarazo analisis de 185 casos / Hypertension induced by pregnancy, analysis of 185 cases

Se analizaron 3.369 historias clinicas de embarazadas que acuden a tener su parto en el hospital San Gabriel de la ciudad de La Paz, se encontro que el 5.49 por ciento (185) casos cursan con HIE preeclampsia leve 46 por ciento, preeclampsia severa 47 por ciento, eclampsismo 4 por ciento y eclampsia 3 por ciento. No hubo mortalidad materna, se aplico el tratamiento en base a sulfato de magnesio, nifedipino o alfa metil dopa y diazepan. La mortalidad perinatal fue de 11 casos que corresponde al 6 por ciento. Se confirma que la HIE se presenta en mujeres primigestas nuliparas, la cobertura de prenatal es de un 70 por ciento, la internacion es tardia en un 18 por ciento, la prematurez es 7.2 por ciento, el apgar de nacimiento es de 6 o mas en el 72 por ciento al minuto y 92 por ciento a los 5 minutos. El 100 por ciento de las eclampticas terminaron en cesarea, la frecuencia de estaoperacion fue en el 16 por ciento. Por los datos encontrados la edad, paridad, estado civil, grado de instruccion no tuvieron relevancia a excepcion de la paridad que fue un factor importante la primigestacion en el 58 por ciento, por lo que se concluye que el control prenatal de amplia cobertura, precoz y de calidad se constituye en la mejor estrategia para disminuir la morbimortalidad materna y perinatal por esta causa

Placental bed lesions and infant birth weight in hypertensive pregnant women

Sixty pregnant women with systemic arterial hypertension, whose pregnancies were interrupted by cesarean section at the Maternity Ward of Hospital de Clínicas de Porto Alegre between May 1989 and October 1990, were examined. Specimens of the placental bed were collected by biopsy and the presence of acute atheromatosis and/or fibrinoid necrosis was investigated. The patients were divided into two groups according to the presence or absence of vascular lesions. The biopsy findings of the placental bed were compared with adequate weight at birth related to gestational age, and to the following clinical parameters of the mother: arterial blood pressure, serum creatinine, serum uric acid and proteinuria. Twenty-seven (45 percent) patients presented vascular lesions in the placental bed compatible with acute atheromatosis and/ or fibrinoid necrosis. The presence of vascular changes in the placental bed correlated significantly to diminished weight of the newborn, in terms of the mean weight and in terms of small-for-gestational-age infants, non-nephrotic proteinuria (>=300 mg/24h) and increased levels of uric acid (>=5.5 mg/dl)

Retardo de crecimiento intrauterino (RCIU): incidencia y repercusión perinatal / Intrauterine growth retardation (IUGR): incidence and repercussion

Se analizaron las historias de las pacientes consultantes al Servicio de Perinatología entre el 1ro de junio de 1982 al 30 de octubre de 1986. Se escogieron 96 casos de R.C.I.U., confirmados al nacer. Se analizó su incidencia la cual fue de 8,70% y cuyo motivo de consulta principal fueron los problemas hipertensivos. Se encontraron factores asociados que pueden constituir señal de alarma en el diagnóstico de estos casos. La forma más frecuente de interrumpir el embarazo fue por medio de la cesárea, motivado en un 50% de las veces por sufrimiento fetal crónico y/o agudo. Un tercio de los casos tenían algún tipo de depresión neonatal. La morbi-mortalidad perinatal fue baja si la comparamos con otras publicaciones y su principal motivo fueron los problemas de hipoxia y anoxia, por lo que, en este punto es donde debemos dirigir nuestros esfuerzos para mejorar los resultados perinatales, amén de realizar un diagnóstico precoz