The effect of Gestational Diabetes Mellitus on the fetal compartment.

In indicated preterm births such a Gestational Diabetes Mellitus (GDM), little is known about the role of the amnion membranes. Investigating the role of amnion membrane inflammation in response GDM may suggest novel pathophysiologic mechanisms. We hypothesize that increased GDM inflammatory mediators may weaken the amnion membrane predisposing them to infection. Maternal and fetal serum and amnion membrane biopsies were collected from 20 GDM and 38 normoglycemic subjects (control) who underwent elective cesarean sections. Cytokines and adipokines were evaluated in serum and amnion culture supernatant samples. Amnion membrane biopsies from GDM and control subjects were studied: fresh frozen for RNA analysis for Toll-like receptor expression; cultured with LPS to test membrane permeability, and inflammation LPS + anti-TLR4 for testing mechanism. GDM was associated with higher fetal serum leptin (p = 0.004) and IL-10 (p = 0.04) compared to controls. Amnion membrane explants from GDM had higher levels of IL-6 (p = 0.019), and lower expression of Claudin-4 (p = 0.007) and increased permeability (p = 0.046) compared to controls. GDM membranes treated with LPS showed an increased expression of IL-10 (p = 0.013); IL-6 (p = 0.004) and TNF-α (p = 0.0005) but did not affect membrane permeability. LPS and anti-TLR4 antibody treatment reduced the production of TNF-α in controls (p = 0.03) and GDM (p = 0.007) compared to LPS alone. Fetal inflammatory response seems more balanced in GDM and does not impact membrane permeability function even with an infectious stimulus. Light fetal membrane inflammatory response may explain lack of preterm labor in GDM. Concluding, benign inflammation in the membranes may not be harmful for pregnancy maintenance.

Evidence of in vitro differential secretion of human beta-defensins-1, -2, and -3 after selective exposure to Streptococcus agalactiae in human fetal membranes.

OBJECTIVE: The aim of this work was to characterize the individual contribution of the amnion (AMN) and choriodecidua (CHD) regions to the secretion of human beta defensins (HBD)-1, -2, and -3, after stimulation with Streptococcus agalactiae. METHODS: Full-thickness membranes were mounted on a Transwell device, constituted by two independent chambers; 1 × 10(6) CFU/ml of S. agalactiae were added to either the AMN or CHD face or to both. Secretion profiles of HBD-1, HBD-2, and HBD-3 to the culture medium were quantified by enzyme-linked immunosorbent sandwich assay (ELISA). RESULTS: Secretion profile of HBD-1 remained without significant changes; HBD-2 secretion level by the CHD increased 2.0 (2.73 ± 0.19 pg/µg) and 2.6 (3.62 ± 0.60 pg/µg) times when the stimulus was applied only to the CHD region and simultaneously to both compartments, respectively. The bacterial stimulation in the AMN induced a 2.0 times (2.06 ± 0.29 pg/µg) increase in this region. HBD-3 secretion level increased significantly in the CHD (15.65 ± 2.68 pg/µg) and the AMN (14.94 ± 1.85 pg/µg) only when both regions were stimulated simultaneously. CONCLUSION: The stimulation of human fetal membranes with S. agalactiae induced a differential and tissue-specific profile of HBD-1, HBD-2, and HBD-3 secretion.

[Preeclampsia-eclampsia: a change in utero-placental microcirculation. Immunologic, histologic, and biochemical features]. / Preeclampsia-eclampsia: una alteración en la microcirculación útero-placentaria. Aspectos inmunológicos, histológicos y bioquímicos.

BACKGROUND: To know the alterations in the microcirculation of the placenta, umbilical cord, as well as the immune and hemorrheologic disorders in preeclampsia-eclampsia. MATERIAL AND METHODS: Two groups were conformed, 30 patients each, all of them with pregnancy of more than 24-week gestation. Group A included patients with preeclampsia-eclampsia and group B (control group) included women with normal pregnancy. In all patients determinations of levels of platelets, fibrinogen, antinuclear antibodies, IgG and IgM anticardiolipin, VDRL were made; clotting times were determined, and histopathologic analyses (placenta, umbilical cord and uterus-placenta membranes) were performed. RESULTS: Platelet levels in the group A were normal in 40% and low in 60%. In group B they were normal in 83.3% and low in 16.7%. with p < 0.05. In group A fibrinogen was normal in 10% and high in 90%; in the group B it was normal in 62.1% and high 37.9%, with p < 0.05. In group A prothrombin time (PT) was normal in 40% and high in 60%; in group B it was normal in 76.7% and low in 23.3%, with p < 0.05. in group TPT was normal in 36.7% and high in 62.1%, with p > 0.05. VDRL was negative in the 100% of the women of group A and positive in the 3.3% of the controls with p > 0.05. The antinuclear antibodies were positive in 6.7% in group A, and in 23.3% in group B, p < 0.05. IgG anticardiolipin antibodies were negatives in the 100% in both groups and IgM antibodies were negative in 96.7% in the group B and 3.3% in group A, p > 0.05. Analysis of histopathologic and immune changes did not show statistic significance when comparing both groups. CONCLUSIONS: Statistical and clinical significance was observed only in the hemorrheologic changes (PT, TPT, fibrinogen and platelets) and in the newborn weight.

Patologia das membranas / Membrane pathologies

As patologias das membranas såo classificadas e relatadas, procurando-se correlacionar os dados fornecidos pela moderna propedêutoica obstétrica com os achados anatomopatológicos. As membranas såo estudadas em relaçåo à sua inserçåo, âmnion nodoso, brida amniótica, inflamaçåo. Såo fornecidas interpretaçöes clínicas de exame que investigam as patologias das membranas durante o acompanhamento pré-natal

Cultivo de liquido amniótico en pacientes sometidas a cesarea en el Instituto Materno Perinatal (Ex-H.M.L) / Amniotic fluid culture in pregnancy with cesarean section into Instituto Materno Perinatal of Lima (Ex-H.M.L)

Los objetivos del estudio fueron identificar los germenes mas frecuentes en el liquido amniotico de pacientes sometidas a cesarea y surelación con la integridad de las membranas ovulares. Se realizó un estudio prospectivo de 100 pacientes sometidos a cesarea y su relación con la integridad de las membranas ovulares. se realizó un estudio prospectivo de 100 pacientes sometidas a cesarea seleccionadas por metodo aleatorio simple. La muestra de liquido amniótico fue tomada en forma esteril durante el acto operatorio y cultivada en medios de aerobiosis y anaerobiosis. Se encontro 21 por ciento de cultivos positivos, de los cuales 90 por ciento fueron en pacientes con membranas rotas y 10 por ciento con membranas integras. Los gérmenes encontrados fueron Acinetobacter sp. 38.10 por ciento y Stafilococo aureus 28.57 por ciento. El 52.6 por ciento de cultivos positivos correspondieron a rotura de membranas menor de 6 horas. Concluimos que los gérmenes mas frecuentes aislados de líquido amniotico de pacientes cesareadas son aeróbicos a diferencia de estudios extranjeros. El hallazgo de 52.6 por ciento de cultivos positivos de pacientes con rotura de membranas menor de 6 horas, difiere de los actuales esquemas de administración de antibioticos a partir de las 6 horas. Los casos de cultivos positivos con membranas integras, estarian en relación con otras vías de contaminación de liquido amniotico, que ameritan estudios posteriores

A study of placentas from Wuchereria bancrofti microfilaraemic and amicrofilaraemic mothers.

The prevalence of transplacental transfer of microfilariae and structural lesions in the placentas of amicrofilaraemic (n = 10) and Wuchereria bancrofti microfilaraemic (n = 10) pregnant women from the prenatal care unit of the Hospital das Clinicas, Recife, Brazil, was investigated. Study participants were selected by filtration (3 microns/13 mm) of nocturnal (2300-0100 h) venous blood. A detailed histopathological examination was performed to detect abnormalities in the placenta, the cord and the foetal membranes. Both study groups had similar obstetric profiles. Parasitaemia was present during labour in nine of ten microfilaraemic women, but no microfilariae were found by filtration of 5-10 ml cord blood. No macroscopic abnormalities were seen in placentas from microfilaraemic mothers; two placentas from the amicrofilaraemic cases contained, respectively, infarcted areas and cysts at the cut surface. Microscopy failed to detect microfilariae in the intervillous spaces, chorionic and decidual vessels, or the umbilical cord. Thus, transplacental transfer of Wuchereria bancrofti microfilariae seems to be a rare phenomenon, and microfilaraemia does not appear to be a risk factor for placental pathology.

[The placenta from the pediatric point of view]. / La placenta desde el punto de vista pediátrico.

The integrity of the placenta is subject to numerous pathological processes that may make it less efficient, affecting the growth and development of the fetus. Some of these processes have been pointed out to illustrate the fact that perinatal evaluation is incomplete when placental examination is absent. The understanding of many perinatal events will be facilitated when this organ has been more routinely examined and the findings correlated with materno-fetal history and infant development.