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2.
Thromb Haemost ; 119(1): 87-91, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30597503

RESUMO

OBJECTIVE: Randomized trials showed no improvement in pregnancy outcomes with the use of low molecular weight heparin (LMWH) to prevent placenta-mediated pregnancy complications (PMPCs) among thrombophilic women. However, the effect of treatment on placental findings was not examined. We aimed to examine the occurrence of placental vascular lesions in thrombophilic women treated with LMWH dose adjusted according to anti-factor Xa compared with a fixed dose. STUDY DESIGN: This study was a secondary analysis of a randomized trial designed to examine whether LMWH dose adjusted according to anti-factor Xa levels compared with a fixed dose would reduce the risk of PMPC. Eligible women were randomly allocated in a 1:1 ratio to either a fixed dose of 40 mg daily LMWH (fixed dose group) or adjusted dose according to anti-factor Xa levels (adjusted dose group). Placentas were examined by the same perinatal pathologist who was blinded to group allocation. The primary outcome for this analysis was the incidence of maternal placental vascular lesions. RESULTS: During the study period, 88 placentas were examined; 41 and 47 from the fixed and adjusted dose groups, respectively. Demographics, obstetrics and types of thrombophilias were similar between the groups. Maternal placental vascular lesions were observed in 23 (56.1%) and 21 (44.68%) placentas (p = 0.28) and foetal placental vascular lesions in 2 (4.88%) and 1 (2.13%) placentas (p = 0.59) in the fixed and adjusted groups, respectively. CONCLUSION: Adjusted dose of enoxaparin according to anti-factor Xa levels compared with a fixed dose did not affect placental vascular lesions in thrombophilic women.


Assuntos
Enoxaparina/administração & dosagem , Placenta/efeitos dos fármacos , Trombofilia/tratamento farmacológico , Adolescente , Adulto , Anticoagulantes/uso terapêutico , Interpretação Estatística de Dados , Esquema de Medicação , Fator Xa/análise , Inibidores do Fator Xa/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Obstetrícia , Placenta/patologia , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Resultado da Gravidez , Tromboembolia Venosa/prevenção & controle , Adulto Jovem
3.
Fetal Diagn Ther ; 40(2): 141-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26562683

RESUMO

AIMS: To examine the occurrence of chorioamnionitis and abruption among women who had a spontaneous preterm birth (SPTB), the correlation between clinical and placental findings, and the impact of these complications on neonatal outcome after delivery. METHODS: This was a retrospective case-control study conducted between 2008 and 2012 at a single teaching hospital. The study group included all women who had an SPTB (23-36 weeks). Placentas were cultured and underwent histological examination. RESULTS: A total of 478 women were included. The mean gestational age at delivery was 32.6 ± 3.1 weeks. Overall, 260 (54.4%) women had either clinical and/or histological abruption or chorioamnionitis. Clinical chorioamnionitis was diagnosed before birth in 14 (2.9%) women, while histological chorioamnionitis (HCA) in 84 (17.4%). Overall, 38 neonates had infection. Placental cultures were negative in 65.8% (25/38) of these neonates, and in 77.1% (27/38), HCA was ruled out. Logistic regression analysis revealed that neonatal morbidity and mortality were correlated with gestational age at delivery (p = 0.02), not with placental pathology (p = 0.08). CONCLUSIONS: Half of the women with PTB had clinical or histological abruption, chorioamnionitis or both. A partial correlation was found between clinical and placental findings. The main determinant of neonatal outcome was gestational age at delivery and not placental findings.


Assuntos
Descolamento Prematuro da Placenta/patologia , Corioamnionite/patologia , Placenta/patologia , Nascimento Prematuro/mortalidade , Descolamento Prematuro da Placenta/epidemiologia , Descolamento Prematuro da Placenta/microbiologia , Estudos de Casos e Controles , Corioamnionite/epidemiologia , Corioamnionite/microbiologia , Feminino , Idade Gestacional , Humanos , Placenta/microbiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/patologia , Estudos Retrospectivos
4.
Eur J Obstet Gynecol Reprod Biol ; 173: 38-42, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24332916

RESUMO

OBJECTIVE: To examine the incidence of placental lesions among women who delivered isolated small for gestational age newborns (isolated-SGA) at term compared to placentas from non-isolated-SGA born at term, early SGA and appropriate for age newborns (AGA). STUDY DESIGN: A case-control study conducted at a university teaching hospital. Placentas of women who delivered a newborn with a birthweight less than the 10th percentile were included. Group A (study group): isolated-SGA delivered at term. Group B (1st control group): Term SGA accompanied antepartum with oligohydramnios or maternal hypertension (non-isolated-SGA). Group C (2nd control group): early SGA delivered before 34 weeks. Group D (3rd control group): placentas of low risk women who delivered AGA newborns at term. A total of 307 placentas were included: 72, 81, 60 and 94 placentas from Groups A, B, C, and D respectively. The primary outcome was the incidence of placental lesions that characterize SGA. RESULTS: The most frequent placental lesion found among all groups was maternal obstructive lesions, which appeared in 45.8% and 45.7% of placentas from groups A and B respectively (p=0.98). The incidence among group A was significantly higher than in group D (20.2%) (p=0.0006) and lower than in group C (76.7%) (p=0.0004). The incidence of any placental lesion that characterized SGA among group A (69.4%) was 7.9 times higher than in group D (22.3%) (p<0.0001) and comparable to group B (61.7%) (p=0.3). The incidence of any placental lesion was highest among group C (83.3%). CONCLUSIONS: The incidence of placental lesions was comparable among term SGA regardless of whether isolated or not and significantly higher than among AGA newborns.


Assuntos
Doenças Placentárias/epidemiologia , Placenta/patologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Doenças Placentárias/patologia , Gravidez
5.
Semin Arthritis Rheum ; 39(6): 515-20, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19481237

RESUMO

OBJECTIVE: Kikuchi Fujimoto disease (KFD) is a rare, benign disorder, usually characterized by cervical lymphadenopathy. Most available data on KFD has come from the Far East. We examined the characteristics of KFD in Israel. METHODS: A retrospective analysis of the records of all patients diagnosed as KFD in seven medical centers in Israel and all the cases previously reported as having occurred in Israel in the literature. RESULTS: Nineteen patients were included, 13 new cases and six from the literature. Mean age of patients was 23 (range 9-50) years. Female/male ratio was 1.1:1. Cervical lymphadenopathy, the hallmark of KFD in the Far East (97%), was less frequent in Israel (44%). However, Israeli patients presented more often with generalized (26%) or retroperitoneal (21%) lymphadenopathy (P < 0.01). Systemic signs such as fever (73%), night sweats (21%), weight loss (21%), hepatomegaly or splenomegaly (25%), and elevated sedimentation rate (52%) were more common in Israeli patients compared to most reports from other parts of the world, excluding Germany (P < 0.05). Leukopenia was evident in most Israeli patients (72%) in contrast to other countries (P < 0.01). Clinical presentation of KFD in Germany was comparable to Israel in most aspects. CONCLUSION: The clinical presentation of KFD in Israel often resembles a systemic disease with fever, leukopenia and generalized or retroperitoneal lymphadenopathy in more than half of the cases, contrary to the presentation in the Far East, which typically includes cervical lymphadenitis, and less frequently, systemic manifestations.


Assuntos
Linfadenite Histiocítica Necrosante/epidemiologia , Cervicalgia/patologia , Adolescente , Adulto , Criança , Feminino , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/patologia , Humanos , Israel/epidemiologia , Linfonodos/patologia , Doenças Linfáticas/complicações , Doenças Linfáticas/patologia , Masculino , Pessoa de Meia-Idade , Pescoço , Cervicalgia/etiologia , Estudos Retrospectivos , Adulto Jovem
6.
Am J Hum Genet ; 82(1): 39-47, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18179883

RESUMO

The WNT-signaling pathway plays a major role during mammalian embryogenesis. We report a novel autosomal-recessive syndrome that consists of female to male sex reversal and renal, adrenal, and lung dysgenesis and is associated with additional developmental defects. Using a candidate-gene approach, we identified a disease-causing homozygous missense mutation in the human WNT4 gene. The mutation was found to result in markedly reduced WNT4 mRNA levels in vivo and in vitro and to downregulate WNT4-dependent inhibition of beta-catenin degradation. Taken together with previous observations in animal models, the present data attribute a pivotal role to WNT4 signaling during organogenesis in humans.


Assuntos
Anormalidades Múltiplas/genética , Organogênese , Proteínas Wnt/genética , Análise Mutacional de DNA , Feminino , Genes Recessivos , Humanos , Masculino , Mutação de Sentido Incorreto , Esteroides/urina , Síndrome , Proteínas Wnt/metabolismo , Proteína Wnt4
7.
Harefuah ; 144(8): 590-2, 596, 2005 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-16146161

RESUMO

This is a case study of malformed conjoined twins in a spontaneous triplet pregnancy. A 20-year-old primigravida spontaneously delivered at 22 weeks gestation a normal 425-gram male newborn followed by a delivery of a 525 grams pygopagus conjoined male twins. One twin had omphalocele, missing ears, cleft palate and dysmorphic figures while the other had imperforated anus and dysmorphic figures. The Apgar scores were 2/0. The placenta was monochorionic/diamniotic with single umbilical artery supplying both conjoined twins. Conjoined twin in a triplet pregnancy may be diagnosed by ultrasound as early as the first trimester. Failure in diagnosis of the condition resulted in early delivery of three premature infants. All three infants died after delivery.


Assuntos
Trigêmeos , Gêmeos Unidos , Anormalidades Múltiplas , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez
8.
Harefuah ; 144(5): 317-8, 384, 2005 May.
Artigo em Hebraico | MEDLINE | ID: mdl-15931892

RESUMO

This is a case study of a 31 year-old woman who presented for a routine follow-up examination at 33 weeks of gestation. A 9-cm intrauterine membranous cystic structure, floating in the amniotic fluid, with 3 internal round structures attached on a stalk in close proximity to the placental insertion of the umbilical cord was demonstrated in sonography. A color Doppler study of the cyst was normal and also revealed a normal systolic/diastolic flow ratio in the umbilical arteries. The cyst was not reported on extended sonographic scans at 15 weeks and 24 weeks gestation. The patient delivered spontaneously at term giving birth to a 3300 grams healthy newborn. The pathologic diagnosis was cystic degeneration of subchorionic intervillous thrombi.


Assuntos
Cistos/patologia , Doenças Placentárias/patologia , Complicações na Gravidez/patologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez
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