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1.
Eur J Obstet Gynecol Reprod Biol ; 240: 273-277, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352128

RESUMO

OBJECTIVE: to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice. METHODS: the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I-VI) and letters (A-E). RESULTS: Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1-1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20-25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B). CONCLUSION: the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.


Assuntos
Adenocarcinoma in Situ/cirurgia , Colo do Útero/cirurgia , Colposcopia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Colo do Útero/patologia , Feminino , Humanos , Neoplasias do Colo do Útero/patologia
2.
Gynecol Oncol ; 154(1): 163-168, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104904

RESUMO

AIM: Although obesity has been associated with endometrioid (type I) and, to a lesser extent, with serous (type II) endometrial cancer (EC), the association with the same histotypes of ovarian cancer (OC) remains unclear. Therefore, we intended to compare the role of BMI in carcinogenesis of endometrioid and the serous malignancies, at both ovarian and endometrial level. METHODS: A retrospective case-to-case study was performed in the University Hospital of Bologna (Italy), through the review of primary EC matched with the corresponding OC cases in the same period (1988-2017). RESULTS: We included 1052 women diagnosed with EC (n = 897 endometrioid, n = 52 serous) and 955 women affected by OC (n = 132 endometrioid, n = 627 serous). EC patients had higher median BMI than women diagnosed with OC (27.3 [23.4-31.9] vs 24.9 [21.7-27.5], p < 0.01). After controlling for confounding, 1 unit increase in BMI was associated with a 5% higher odds of endometrial as opposed to ovarian cancer (OR for ovarian as opposed to endometrial cancer 0.95; 95% CI 0.91-0.98, p = 0.004). CONCLUSIONS: Increasing BMI is associated with endometrial rather than ovarian cancer, among both serous and endometrioid histotypes.


Assuntos
Carcinoma Endometrioide/epidemiologia , Cistadenocarcinoma Seroso/epidemiologia , Neoplasias do Endométrio/epidemiologia , Obesidade/epidemiologia , Neoplasias Ovarianas/epidemiologia , Idoso , Índice de Massa Corporal , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Obesidade/patologia , Neoplasias Ovarianas/patologia , Estudos Retrospectivos
3.
Am J Perinatol ; 36(11): 1097-1105, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30822800

RESUMO

OBJECTIVE: Our objective was to evaluate the efficacy of perioperative multimodal pain management in reducing opioid use after elective cesarean delivery (CD). STUDY DESIGN: A single-center, double-blinded, placebo-controlled randomized trial of women undergoing elective CD. Participants were allocated 1:1 to receive the multimodal protocol or matching placebos. The multimodal protocol consisted of a preoperative dose of intravenous acetaminophen, preincision injection of subcutaneous bupivacaine, and intraoperative injection of intramuscular ketorolac. Primary outcome was total opioid intake at 48 hours postoperatively. Secondary outcomes were pain scores, time to first opioid intake, neonatal outcomes, and total outpatient opioid intake on postoperative day (POD) 7. Data were analyzed using parametric and nonparametric tests and quantile regression as appropriate. RESULTS: A total of 242 women were screened with 120 randomized, 60 to the multimodal group and 60 to control group. There was no significant difference in the primary outcome of opioid use nor in the secondary outcomes. Smokers and patients with a history of drug use had higher median postoperative opiate use and earlier administration. On POD 7, only 40% of prescribed opioids had been used, and there was no difference between the groups. CONCLUSION: This perioperative multimodal pain regimen did not reduce opioid use in 48 hours after CD. Patients who smoke or with a history of drug use required more opioids in the postoperative period. Providers significantly overprescribed opioids after CD.

4.
Prenat Diagn ; 39(5): 361-368, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30740743

RESUMO

OBJECTIVES: To determine the association between medications intake in early pregnancy and variation in the fetal fraction (FF) in pregnant women undergoing cell-free DNA (cfDNA) testing. METHODS: We performed a retrospective cohort study of women (n = 1051) undergoing cfDNA testing at an academic center. The exposed group included women taking medications (n = 400; 38.1%), while the nonexposed group consisted of women taking no medications (n = 651; 61.9%). Our primary outcome was FF. We performed univariate and multivariate analyses as appropriate. RESULTS: The FFs were 8.8% (6.6-12.1), 8.7% (6.3-11.6), and 7.7% (5.1-9.3) among women taking 0, 1, and two or more medications, respectively (P < 0.01). Using multivariable linear mixed effects model, the mean FF was significantly lower among those taking two or more medications compared with the nonexposed group. FF was directly correlated with gestational age at the time of cfDNA testing and inversely correlated with maternal obesity. Exposure to metformin was associated with 1.8% (0.2-3.4) lower mean FF when compared with the nonexposed group (P = 0.02). Obesity and intake of two or more medications were associated with higher hazard ratio of having a low FF less than 4%. CONCLUSIONS: Exposure to metformin or two or more medications was associated with decreased FF, and obesity is associated with delay in achieving adequate FF percentage. These findings should be considered while counseling patients on test limitations.

5.
J Matern Fetal Neonatal Med ; 32(17): 2897-2904, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29534635

RESUMO

Objective: As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. Methods: We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. Results: We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians', African women's mean Hb and Ht were respectively 0.24 (95%CI 0.3-0.17) g/dl and 0.7 (95%CI 0.8-0.5) % lower, while Asian mothers' were 0.11 (95%CI 0.19-0.03) g/dl and 0.3 (95%CI 0.5-0.1) % inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (-1, 95%CI -1.3 to -0.6, and -0.4, 95%CI -0.7 to -0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95%CI 0.5-0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95%CI 11-11.5) g/dl and 32.8 (95%CI 32.3-33.4) % in the first trimester, 10.4 (95%CI 10.1-10.6) g/dl and 30.2 (95%CI 29.6-30.8) % in the second trimester, 10.1 (95%CI 9.8-10.3) g/dl and 30.6 (95%CI 30-31.1) % in the third trimester. Conclusions: We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.


Assuntos
Anemia/etnologia , Hematócrito , Hemoglobinas/metabolismo , Complicações Hematológicas na Gravidez/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Anemia/sangue , Grupo com Ancestrais do Continente Asiático , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Itália/epidemiologia , Paridade , Gravidez , Complicações Hematológicas na Gravidez/sangue , Valores de Referência , Estudos Retrospectivos
6.
J Matern Fetal Neonatal Med ; 32(2): 271-278, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28936902

RESUMO

OBJECTIVE: To determine the association between maternal obesity and delivery due to chorioamnionitis prior to labor onset, among expectantly managed women with preterm premature rupture of membranes (pPROM). METHODS: This was a secondary analysis of a multicenter randomized trial of magnesium sulfate versus placebo to prevent cerebral palsy or death among offspring of women with anticipated delivery at 24-31-week gestation. After univariable analysis, Cox proportional hazard evaluated the association between maternal obesity and chorioamnionitis, while Laplace regression investigated how obesity affects the gestational age at delivery of the first 20% of women developing the outcome of interest. RESULTS: A total of 164 of the 1942 women with pPROM developed chorioamnionitis prior to labor onset. Obese women had a 60% increased hazard of developing such complication (adjusted HR 1.6, 95%CI 1.1-2.1, p = .008), prompting delivery 1.5 weeks earlier, as the 20th survival percentile was 27.2-week gestation (95%CI 26-28.6) among obese as opposed to 28.8 weeks (95%CI 27.4-30.1) (p = .002) among nonobese women. CONCLUSIONS: Maternal obesity is a risk factor for chorioamnionitis prior to labor onset. Future studies will determine if obesity is important enough to change the management of latency after pPROM according to maternal BMI.


Assuntos
Corioamnionite/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/terapia , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Corioamnionite/terapia , Feminino , Humanos , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Obesidade/complicações , Obesidade/terapia , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/terapia , Estudos Retrospectivos , Fatores de Tempo
7.
Obstet Gynecol ; 132(1): 102-106, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29889763

RESUMO

Spontaneous preterm birth is a leading cause of perinatal morbidity and mortality; however, accurate identification of women who will deliver prematurely after the onset of uterine contractions is still challenging, because less than 10% actually give birth within 7 days of presentation. Risk stratification in women with preterm contractions would allow targeting of interventions such as corticosteroids, magnesium sulfate, and maternal transfer to a perinatal center to those who will indeed deliver preterm. Moreover, unnecessary treatments associated with potential complications could be avoided in symptomatic women who are unlikely to deliver preterm. Fetal fibronectin testing and cervical length measurement are the most used methods to assess the risk of preterm birth among symptomatic women. Interventional studies in singleton gestations suggest that assessment of cervical length, unlike fetal fibronectin testing, improves diagnostic accuracy and leads to better perinatal outcomes.


Assuntos
Medida do Comprimento Cervical/estatística & dados numéricos , Trabalho de Parto Prematuro/diagnóstico , Nascimento Prematuro/diagnóstico , Medição de Risco/métodos , Adulto , Colo do Útero/diagnóstico por imagem , Feminino , Fibronectinas/análise , Humanos , Recém-Nascido , Gravidez
8.
J Perinat Med ; 46(9): 1016-1021, 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-29257759

RESUMO

AIM: To assess the effect of maternal age, height, early pregnancy body mass index (BMI) and ethnicity on birth weight. SUBJECTS AND METHODS: A cross-sectional study was conducted on more than 42,000 newborns. Ethnicity was defined by maternal country of birth or, when missing (<0.6% of records), by citizenship. The effect of maternal characteristics on birth weight was evaluated with general linear models. RESULTS: Maternal height and BMI, although not age, significantly affected birth weight. Among Italian babies, 4.7% of newborns were classified as appropriate-for-gestational age (AGA) (birth weight between the 10th and the 90th centile) according to the country-specific Italian Neonatal Study (INeS) charts and were re-classified as either large-(LGA) (birth weight >90th centile) or small-(SGA) (birth weight <10th centile) for gestational age (GA) after adjustment for maternal characteristics. On the contrary, 1.6% of Italian newborns were classified as SGA or LGA according to the INeS charts and re-classified as AGA after adjustment. Maternal ethnicity had a significant impact on birth weight. Specifically, babies born to Senegalese mothers were the lightest, whilst babies born to Chinese mothers were the heaviest. CONCLUSIONS: Maternal height and early pregnancy BMI, should be considered in the evaluation of birth weight. The effect of ethnicity suggests the appropriateness of ethnic-specific charts. Further studies are necessary to determine if changes in birth weight classification, may translate into improved detection of subjects at risk of adverse outcomes.


Assuntos
Peso ao Nascer , Recém-Nascido Pequeno para a Idade Gestacional , Idade Materna , Obesidade , Adulto , Índice de Massa Corporal , Estudos Transversais , Grupos Étnicos , Feminino , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Itália/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de Risco
9.
Obstet Gynecol ; 130(6): 1386-1387, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29189684
10.
Obstet Gynecol ; 130(4): 765-769, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28885402

RESUMO

Obstetric hemorrhage remains the most common cause of maternal mortality worldwide. It is believed that increased fibrinolytic activity, secondary to release and activation of endothelial tissue plasminogen activator, is involved in its pathogenesis. Tranexamic acid (TXA), an antifibrinolytic agent, has been shown to be beneficial in trauma patients if used within 3 hours of injury. A recent large randomized controlled trial showed that TXA given to hemorrhaging women within 3 hours after delivery was associated with decreased risk of death resulting from bleeding with no increase in thromboembolic complications. Limited evidence suggests that prophylactic TXA reduces blood loss at the time of delivery and decreases transfusion rates in the obstetric population. Tranexamic acid appears to be a safe and effective option in the treatment of obstetric hemorrhage. In addition, the limited available evidence supports the need for a well-designed adequately powered clinical trial to test its benefit as a prophylactic agent.


Assuntos
Antifibrinolíticos/administração & dosagem , Hemorragia Pós-Parto/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Feminino , Humanos , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Resultado do Tratamento
12.
Sci Rep ; 6: 34710, 2016 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-27725717

RESUMO

Preterm labor caused by uterine contractions is a major contributor to neonatal morbidity and mortality. Treatment intended to reduce uterine contractions include tocolytic agents, such as indomethacin. Unfortunately, clinically used tocolytics are frequently inefficient and cross the placenta causing fetal side effects. Here we show for the first time in obstetrics the use of a targeted nanoparticle directed to the pregnant uterus and loaded with a tocolytic for reducing its placental passage and sustaining its efficacy. Nanoliposomes encapsulating indomethacin and decorated with clinically used oxytocin receptor antagonist were designed and evaluated in-vitro, ex-vivo and in-vivo. The proposed approach resulted in targeting uterine cells in-vitro, inhibiting uterine contractions ex-vivo, while doubling uterine drug concentration, decreasing fetal levels, and maintaining the preterm birth rate in vivo in a pregnant mouse model. This promising approach opens new horizons for drug development in obstetrics that could greatly impact preterm birth, which currently has no successful treatments.


Assuntos
Indometacina/farmacologia , Lipossomos/administração & dosagem , Terapia de Alvo Molecular/métodos , Nanoestruturas/administração & dosagem , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Tocolíticos/farmacologia , Útero/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Composição de Medicamentos , Feminino , Expressão Gênica , Antagonistas de Hormônios/química , Antagonistas de Hormônios/metabolismo , Humanos , Indometacina/farmacocinética , Lipossomos/química , Camundongos , Nanoestruturas/química , Placenta/metabolismo , Gravidez , Ligação Proteica , Receptores de Ocitocina/metabolismo , Tocolíticos/farmacocinética , Contração Uterina/efeitos dos fármacos , Útero/metabolismo , Vasotocina/análogos & derivados , Vasotocina/química , Vasotocina/metabolismo
13.
J Physiol ; 594(23): 7015-7025, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27506899

RESUMO

KEY POINTS: Nitric oxide is essential in the vascular adaptation to pregnancy, as knockout mice lacking nitric oxide synthase (NOS3) have abnormal utero-placental perfusion, hypertension and growth restriction. We previously showed with ex vivo studies on transgenic animals lacking NOS3 that adverse intrauterine environment alters fetal programming of vascular reactivity in adult offspring. The current research shows that altered vascular reactivity correlates with higher blood pressure in vivo. Our data suggest that higher blood pressure depends on both genetic background (NOS3 deficiency) and uterine environment, becomes more evident with age (> 7 postnatal weeks), activity and stress, is gender specific (preponderant among males), and can be affected by the sleep-awake cycle. In utero or early postnatal life (< 7 weeks), before onset of hypertension, may represent a potential window for intervention to prevent future cardiovascular disorders. ABSTRACT: Nitric oxide is involved in the vascular adaptation to pregnancy. Using transgenic animals, we previously showed that adverse intrauterine environment alters vascular reactivity in adult offspring. The aim of our study was to determine if altered vascular programming is associated with abnormal blood pressure (BP) profiles in vivo. Mice lacking a functional endothelial nitric oxide synthase (KO, NOS3-/- ) and wild-type mice (WT, NOS3+/+ ) were crossbred to generate homozygous NOS3-/- (KO), maternally derived heterozygous NOS3+/- (KOM: mother with adverse intrauterine environment from NOS3 deficiency), paternally derived heterozygous NOS3+/- (KOP: mother with normal in utero milieu) and NOS3+/+ (WT) litters. BP was measured in vivo at 7, 14 and 21 weeks of age. After univariate analysis, multivariate population-averaged linear regression models were used to identify factors affecting BP. When compared to WT offspring, systolic (SBP), diastolic (DBP) and mean (MAP) BP progressively increased from KOP, to KOM, and peaked among KO (P < 0.001), although significance was not reached for KOP. Higher BP was also associated with male gender, older age (> 7 postnatal weeks), higher locomotor activity, daytime recordings, and recent blood pressure transducer insertion (P < 0.001). Post hoc analysis showed that KOM had higher SBP than KOP (P < 0.05). Our study indicates that adverse intrauterine environment contributes, along with multiple other factors, to account for hypertension; moreover, in utero or early postnatal life may represent a possible therapeutic window for prevention of cardiovascular disease later in life.


Assuntos
Pressão Sanguínea , Desenvolvimento Fetal/fisiologia , Óxido Nítrico Sintase Tipo III/genética , Animais , Feminino , Frequência Cardíaca , Locomoção , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Óxido Nítrico Sintase Tipo III/fisiologia , Telemetria , Útero
14.
Am J Perinatol ; 33(7): 646-57, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26862726

RESUMO

Objective To investigate whether different antenatal care models could account for differences in operative delivery rates and adverse neonatal outcomes among low-risk pregnant women, and to identify independent variables associated with delivery modes and adverse neonatal outcomes. Study design Retrospective cohort from a single center of singleton, term, live births between January 2012 and June 2014. Rates of cesarean deliveries, operative vaginal deliveries, and neonatal morbidities were analyzed among women followed by private obstetrician-gynecologists versus national health system providers (certified nurse midwifes supervised by obstetrician-gynecologists), and adjusted for potential confounders. Results Among the 2,831 women in our cohort, obstetric and neonatal outcomes were independent of obstetric providers. After we controlled for confounders, private patients having more than four antenatal ultrasound examinations were more likely to undergo cesarean delivery than public patients with four or fewer sonographic assessments (five to eight prenatal scans: relative risk ratio, 3.3; 95% confidence interval [CI] 1.4-8; nine or more prenatal scans: relative risk ratio, 4.1; 95% CI 1.2-14). Conclusions Multiple prenatal ultrasound examinations in low-risk obstetric populations appear to be an independent and potentially modifiable risk factor for cesarean deliveries.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Prática Privada/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Humanos , Itália , Modelos Logísticos , Análise Multivariada , Gravidez , Cuidado Pré-Natal/economia , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
15.
Anticancer Res ; 34(8): 4345-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25075069

RESUMO

AIM: To assess the efficacy and safety of conservative surgical approach for microinvasive cervical cancer with regards to cone margins status and lymph vascular space invasion (LVSI). PATIENTS AND METHODS: This was a multicentre retrospective cohort study of 153 women diagnosed with microinvasive cervical cancer over a 10 years period (1993-2003). RESULTS: In conservatively-treated women (n=80), neither cancer mortality nor disease relapse after 184.5 ± 20.5 months of follow-up was detected. Residual disease in women who underwent secondary surgery was significantly related to positive margins on the primary cone excision (p=0.005) while no correlation with LVSI emerged. CONCLUSION: Conization can represent the definitive treatment for stage IA1, if surgical margins are cancer-free, independently of LVSI. A conservative surgical approach could also be considered in women with IA2 cervical cancer when preservation of fertility is strongly requested. A close long-term surveillance should be scheduled for conservatively-treated women.


Assuntos
Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Preservação da Fertilidade , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
16.
Reprod Biomed Online ; 29(3): 370-81, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24928355

RESUMO

This study evaluated the impact of different phenotypes of polycystic ovary syndrome (PCOS) on early trophoblast invasion and placentation. Pregnant patients with different PCOS phenotypes and healthy pregnant women, matched for age and body mass index, were enrolled. Histological analysis of trophoblastic and decidual tissue and macroscopic and microscopic assessment of the placentas were performed. Implantation-site vessels with endovascular trophoblast differed significantly among PCOS phenotypes. Placental weight, thickness, density and fetal-placental weight ratio were significantly different in the full-blown and non-polycystic ovary (PCO) phenotypes versus the ovulatory and non-hyperandrogenic phenotypes. The incidence of macroscopic placental lesions was only significantly different between controls and the full-blown and non-PCO phenotypes. The overall incidence of microscopic placental lesions was significantly different among PCOS phenotypes and was significantly higher in the full-blown and non-PCO phenotypes than in the ovulatory and non-hyperandrogenic phenotypes. The rates of chorionic villitis and intervillositis were significantly higher in full-blown and non-PCO phenotypes than in ovulatory and non-hyperandrogenic phenotypes. In conclusion, alterations in early trophoblast invasion and placentation observed in PCOS vary widely according to phenotype.


Assuntos
Placenta/fisiopatologia , Placentação/fisiologia , Síndrome do Ovário Policístico/fisiopatologia , Trofoblastos/fisiologia , Adulto , Feminino , Humanos , Fenótipo , Placenta/patologia , Síndrome do Ovário Policístico/patologia , Gravidez , Trofoblastos/patologia
17.
Steroids ; 88: 36-43, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24945113

RESUMO

Alterations in lipid pattern and increased risk for obstetric/neonatal complications have been observed in patients with polycystic ovary syndrome (PCOS). Pregnancy leads to physiologic changes in lipoprotein metabolism, and alterations in lipid profile have been related with adverse pregnancy outcomes. Based on these considerations, the aim of the present prospective controlled clinical study was to test the hypothesis that the changes in the lipid profile in patients with PCOS during pregnancy are characteristic and potentially related to the increased risk of obstetric/neonatal complications. One hundred and fifty nonobese PCOS women and 150 age- and body mass index (BMI)-matched healthy controls were enrolled. Serum lipids, glucose, insulin, and androgens levels were serially assayed in all subjects before and throughout pregnancy. Serum low-density lipoprotein (LDL) and triglyceride (TG) concentrations were significantly (P<0.05) higher in PCOS group than in healthy controls at each assessment. Throughout pregnancy, serum LDL and TG levels increased significantly (P<0.05) in both groups, although the change from pre-pregnancy values was significantly (P<0.05) greater in PCOS patients than in healthy controls. A significant (P<0.05) relationship was observed between serum LDL and TG changes and changes in both insulin sensitivity indexes and androgen levels in PCOS patients alone. After adjusting for maternal age, pre-pregnancy BMI and lipid levels, body weight gain, and insulin-resistance markers, serum TG concentrations during pregnancy were directly and independently associated with obstetric complications in both groups, whereas serum LDL levels only in PCOS patients. We can conclude that nonobese PCOS patients had specific changes in lipid profile during pregnancy, and that the lipid pattern typical of PCOS may account for the more frequent adverse pregnancy outcomes. PCOS-related hormonal and metabolic features, such as insulin resistance and high androgen levels, may mediate this phenomenon.


Assuntos
Lipídeos/sangue , Síndrome do Ovário Policístico/sangue , Adulto , Feminino , Humanos , Síndrome do Ovário Policístico/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Risco
18.
J Clin Endocrinol Metab ; 99(8): 2942-51, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24873996

RESUMO

CONTEXT: Polycystic ovary syndrome (PCOS) and pregnancy are conditions characterized by an increased low-grade chronic inflammation state. A higher incidence of pregnancy complications has been detected in pregnant PCOS women. OBJECTIVE: The objective of the study was to test the hypothesis that the low-grade chronic inflammation state typical of PCOS patients persists during gestation and is exacerbated by pregnancy and contributes to the increased risk of obstetric/neonatal complications. DESIGN: This was a prospective controlled clinical study. SETTING: The study was conducted at the Academic Department of Obstetrics and Gynecology of the "Pugliese-Ciaccio" Hospital of Catanzaro (Catanzaro, Italy). PATIENTS: One hundred fifty pregnant PCOS women and 150 age- and body mass index-matched healthy pregnant controls participated in the study. INTERVENTIONS: INTERVENTIONS included serial clinical, biochemical, and ultrasonographic assessments before and throughout pregnancy. MAIN OUTCOME MEASURES: Serum levels of white blood cell count (WBC), C-reactive protein (CRP), and ferritin were measured. RESULTS: Pregnant women with PCOS had higher WBC, CRP, and ferritin levels at study entry and at all gestational ages than controls. Changes in serum WBC and ferritin levels were significantly higher in PCOS than in controls starting from the 12th week of gestation whereas those in CRP from the 20th week of gestation. By multivariable Cox proportional hazard analysis, in the PCOS group, a significant association with the risk of adverse obstetric/neonatal outcomes was found for WBC [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.31-1.64; P = .010], CRP (HR 1.19, 95% CI 1.06-1.34; P = .019), and ferritin levels (HR 1.12, 95% CI 1.03-1.26; P = .011). CONCLUSIONS: In PCOS patients, the low-grade chronic inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes.


Assuntos
Inflamação/complicações , Inflamação/epidemiologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Proteína C-Reativa/análise , Estudos de Casos e Controles , Doença Crônica , Feminino , Ferritinas/sangue , Humanos , Inflamação/sangue , Contagem de Leucócitos , Síndrome do Ovário Policístico/sangue , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez/epidemiologia , Adulto Jovem
19.
Obstet Gynecol ; 121(3): 561-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23635619

RESUMO

OBJECTIVE: To compare the maternal and neonatal risks of elective repeat cesarean delivery compared with pregnancy continuation at different gestational ages, starting from 37 weeks. METHODS: We analyzed the composite maternal and neonatal outcomes of repeat cesarean deliveries studied prospectively over 4 years at 19 U.S. centers. Maternal outcome was a composite of pulmonary edema, cesarean hysterectomy, pelvic abscess, thromboembolism, pneumonia, transfusion, or death. Composite neonatal outcome consisted of respiratory distress, transient tachypnea, necrotizing enterocolitis, sepsis, ventilation, seizure, hypoxic-ischemic encephalopathy, neonatal intensive care unit admission, 5-minute Apgar of 3 or lower, or death. Outcomes after elective repeat cesarean delivery without labor at each specific gestational age were compared with outcomes for all who were delivered later as a result of labor onset, specific obstetric indications, or both. RESULTS: Twenty-three thousand seven hundred ninety-four repeat cesarean deliveries were included. Elective delivery at 37 weeks of gestation had significantly higher risks of adverse maternal outcome (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.06-2.31), whereas elective delivery at 39 weeks of gestation was associated with better maternal outcome when compared with pregnancy continuation (OR 0.51, 95% CI 0.36-0.72). Elective repeat cesarean deliveries at 37 and 38 weeks of gestation had significantly higher risks of adverse neonatal outcome (37 weeks OR 2.02, 95% CI 1.73-2.36; 38 weeks OR 1.39 95% CI 1.24-1.56), whereas delivery at 39 and 40 weeks of gestation presented better neonatal outcome as opposed to pregnancy continuation (39 weeks OR 0.79, 95% CI 0.68-0.92; 40 weeks OR 0.57, 95% CI 0.43-0.75). CONCLUSION: In women with prior cesarean delivery, 39 weeks of gestation is the optimal time for repeat cesarean delivery for both mother and neonate.


Assuntos
Recesariana/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Idade Gestacional , Sistema de Registros , Adulto , Recesariana/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Gravidez , Resultado da Gravidez , Medição de Risco , Adulto Jovem
20.
Am J Perinatol ; 30(8): 649-54, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23271380

RESUMO

OBJECTIVE: To determine if preincubation with prostaglandin E1 (PGE1) and E2 (PGE2) enhances oxytocin-induced myometrial contractility in vitro. STUDY DESIGN: Myometrial strips from 13 women were incubated with PGE1 (10-5 mol/L or 10-6 mol/L), PGE2 (10-5 mol/L or 10-6 mol/L) or solvent before adding cumulative concentrations of oxytocin (10-10 to 10-6 mol/L). The area under the contraction curve was calculated after addition of each agent. One- and two-way analysis of variance was used for comparison (significance p < 0.05). RESULTS: PGE2 10-5 mol/L reduced response to oxytocin 10-9 to 10-6 mol/L (p < 0.05). PGE2 reduced spontaneous myometrial contractility as compared with PGE1 (p < 0.05). A dose-dependent negative effect of prostaglandins was detected on oxytocin 10-8 mol/L (10-5 mol/L > 10-6 mol/L; p < 0.05). CONCLUSION: Contrary to the hypothesis, neither PGE1 nor PGE2 enhanced oxytocin-induced myometrial contractility; in fact, PGE2 decreased contractility.


Assuntos
Alprostadil/administração & dosagem , Dinoprostona/administração & dosagem , Miométrio/efeitos dos fármacos , Ocitocina/farmacologia , Contração Uterina/efeitos dos fármacos , Adulto , Análise de Variância , Área Sob a Curva , Sinergismo Farmacológico , Feminino , Humanos , Técnicas de Cultura de Tecidos , Contração Uterina/fisiologia
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