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1.
Cells ; 10(2)2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578631

RESUMO

Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.


Assuntos
/complicações , Placenta/irrigação sanguínea , Placenta/patologia , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Infecciosas na Gravidez/etiologia , Trombose/etiologia , Adulto , Antígenos CD/análise , /virologia , Caderinas/análise , Claudina-5/análise , Endotélio/irrigação sanguínea , Endotélio/patologia , Endotélio/virologia , Feminino , Humanos , Recém-Nascido , Microvasos/patologia , Microvasos/virologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/virologia , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/virologia , Trombose/patologia , Trombose/virologia , Adulto Jovem , Fator de von Willebrand/análise
2.
Obstet Gynecol ; 136(5): 1072-1073, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093423

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
3.
Obstet Gynecol ; 136(5): e90-e99, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093425

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
4.
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 408-419, ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138639

RESUMO

Las enfermedades cardiovasculares representan la mayor causa de morbimortalidad a nivel mundial. Si bien presenta un descenso en la población general, en las mujeres tiende a mantenerse estable la prevalencia de enfermedad coronaria. Varios factores propios de la mujer predisponen a que esto ocurra, incluyendo el embarazo, mediado tanto por los cambios hematológicos y cardiovasculares característicos de la gestación; como por patologías asociadas, principalmente trastornos hipertensivos del embarazo y diabetes gestacional. Su presencia se ha asociado fuertemente a la aparición a futuro de otras patologías de alto riesgo cardiovascular como hipertensión crónica, dislipidemia y diabetes mellitus. Dado el impacto que esto representa, se hace imperante la identificación de grupos de alto riesgo y la implementación de medidas preventivas, así como de diagnóstico precoz y tratamientos adecuados con el fin de disminuir complicaciones materno-fetales en las etapas perinatal y posparto.


Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Although there is a decrease in general population, the prevalence of coronary heart disease remains stable in women. Several factors typical of womenkind predispose to cardiovascular disease, including pregnancy, mediated by hematological and cardiovascular changes characteristic of it; and by associated pathologies, mainly hypertensive disorders and diabetes. The presence of these diseases has been strongly associated with future presence of other conditions of high cardiovascular risk such as chronic hypertension, dyslipidemia and diabetes mellitus. Given this impact, the identification of high-risk groups and the implementation of preventive measures, as well as early diagnosis and adequate treatment in order to reduce both maternal and fetal complications in perinatal and postpartum stages becomes imperative.


Assuntos
Humanos , Feminino , Gravidez , Pré-Eclâmpsia , Complicações Cardiovasculares na Gravidez/etiologia , Doenças Cardiovasculares/complicações , Diabetes Gestacional , Hipertensão/complicações , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Sistema Cardiovascular/fisiopatologia , Fatores de Risco , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Doenças Metabólicas
5.
Intern Med ; 59(9): 1119-1124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378653

RESUMO

Objective Cardiovascular disease increases the risk of maternal mortality. This study examined the risk factors for cardiovascular events in pregnant women with cardiovascular disease. Methods This was a case-control study conducted in 2 phases at Japanese maternal and fetal care centers. The primary survey, using an interviewer-administered questionnaire, investigated whether the institutions had managed pregnant women with cardiovascular disease from April 2014 to March 2016. From 424 individual facilities surveyed, 135 facilities were found to have experience in managing pregnant women. In the secondary survey, the 135 institutions were asked to complete a web-based questionnaire, which collected detailed clinical information about cases, including cardiovascular disease, cardiovascular events, maternal background, and the perinatal outcome. Results Information on 302 pregnant women with cardiovascular disease was collected. None of the 302 patients died. There were 25 women with cardiovascular events (cardiovascular event group) and 277 women without cardiovascular events (non-cardiovascular event group); the two groups were compared. No significant differences were found in the perinatal outcomes. Medication use before pregnancy was identified as a risk factor for cardiovascular events (adjusted odds ratio, 23.28; 95% confidence interval, 8.15-66.47; p<0.001). In pregnant women with cardiovascular disease, New York Heart Association (NYHA) functional class II or III before pregnancy was associated with a higher risk of cardiovascular events in comparison to NYHA functional class I (p<0.001 for both). Conclusion Medication use before pregnancy and NYHA functional class >I were risk factors for cardiovascular events in pregnant women with cardiovascular disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Japão/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Resultado da Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
6.
J Cardiovasc Magn Reson ; 22(1): 2, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-31902370

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) is rare and potentially life-threatening; its etiology remains unclear. Imaging characteristics on cardiovascular magnetic resonance (CMR) and their prognostic significance have rarely been studied. We sought to determine CMR's prognostic value in PPCM by using T1 and T2 mapping techniques. METHODS: Data from 21 PPCM patients from our CMR registry database were analyzed. The control group comprised 20 healthy age-matched females. All subjects underwent comprehensive contrast-enhanced CMR. T1 and T2 mapping using modified Look-Locker inversion recovery and T2 prep balanced steady-state free precession sequences, respectively. Ventricular size and function, late gadolinium enhancement (LGE), myocardial T1 value, extracellular volume (ECV), and T2 value were analyzed. Transthoracic echocardiography was performed at baseline and during follow-up. The recovered left ventricular ejection fraction (LVEF) was defined as LVEF ≥50% on echocardiography follow-up after at least 6 months of the diagnosis. RESULTS: CMR imaging showed that the PPCM patients had severely impaired LVEF and right ventricular ejection fraction (LVEF: 26.8 ± 10.6%; RVEF: 33.9 ± 14.6%). LGE was seen in eight (38.1%) cases. PPCM patients had significantly higher native T1 and ECV (1345 ± 79 vs. 1212 ± 32 ms, P < 0.001; 33.9 ± 5.2% vs. 27.1 ± 3.1%, P < 0.001; respectively) and higher myocardial T2 value (42.3 ± 3.7 vs. 36.8 ± 2.3 ms, P < 0.001) than did the normal controls. After a median 2.5-year follow-up (range: 8 months-5 years), six patients required readmission for heart failure, two died, and 10 showed left ventricular function recovery. The LVEF-recovered group showed significantly lower ECV (30.7 ± 2.1% vs. 36.8 ± 5.6%, P = 0.005) and T2 (40.6 ± 3.0 vs. 43.9 ± 3.7 ms, P = 0.040) than the unrecovered group. Multivariable logistic regression analysis showed ECV (OR = 0.58 for per 1% increase, P = 0.032) was independently associated with left ventricular recovery in PPCM. CONCLUSIONS: Compared to normal controls, PPCM patients showed significantly higher native T1, ECV, and T2. Native T1, ECV, and T2 were associated with LVEF recovery in PPCM. Furthermore, ECV could independently predict left ventricular function recovery in PPCM.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Adulto , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Variações Dependentes do Observador , Período Periparto , Valor Preditivo dos Testes , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
7.
Eur J Obstet Gynecol Reprod Biol ; 245: 39-44, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31838399

RESUMO

OBJECTIVES: To evaluate the effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version (ECV) on perinatal outcomes. To determine factors associated with a higher risk of occurrence of transient fetal bradycardia during and after ECV. STUDY DESIGN: Prospective study in 286 women after the 36th week of gestation with a fetus in breech presentation who have undergone an ECV attempt. The study analyses the incidence of transient fetal bradycardia during and immediately after ECV, the time interval to complete adjustment of fetal bradycardia, the factors associated with the occurrence of transient fetal bradycardia, cardiotocography (CTG) changes after ECV and perinatal outcomes. All the data were statistically analyzed. RESULTS: The ECV was successful in 51 % (146/286). Transient fetal bradycardia occurred during and after ECV in 81 cases (28.3 %). A successful version was a factor significantly associated with fetal bradycardia (54; 37.0 % versus 27; 19.3 %; p < 0.01). Clinically significant hypotension of the mother was accompanied by transient fetal bradycardia in 12 cases (4.2 %). After the successful ECV there was no significant difference in the percentage of vaginal deliveries between subgroups with and without transient fetal bradycardia (85.2 % versus 83.7 %; p = 1.00). Nor in occurrence of acute fetal distress during labor (18.5 % versus 15.6 %; p = 0.65). In cases of a successful ECV transient CTG changes after ECV had no effect on the incidence of acute fetal distress during labor (23.5 % versus 15.7 %; p = 0.49). CONCLUSIONS: Transient fetal bradycardia and other heart rate changes during and immediately after ECV was not associated with a higher incidence of acute fetal distress during labor and did not affect perinatal outcomes. Higher occurrence of transient bradycardia after ECV was associated only with successful ECV. Transient hypotension of the mother as one of the causes of transient fetal bradycardia during ECV should be considered.


Assuntos
Bradicardia/embriologia , Bradicardia/fisiopatologia , Frequência Cardíaca Fetal/fisiologia , Versão Fetal/efeitos adversos , Adolescente , Adulto , Bradicardia/etiologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/etiologia , Idade Gestacional , Humanos , Hipotensão/epidemiologia , Hipotensão/etiologia , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/etiologia , Resultado da Gravidez , Estudos Prospectivos , Adulto Jovem
9.
Curr Vasc Pharmacol ; 18(3): 282-293, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30963974

RESUMO

BACKGROUND: In Marfan Syndrome (MFS), aortic dilatation is one of the main cardiovascular manifestations which deteriorate due to the physiological changes during pregnancy. We aimed to assess the up-to-date management and outcomes of aortic root dilation and dissection (AoD) in pregnancy with MFS. PATIENTS AND METHODS: A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Original studies published between January 1, 2001 and December 31, 2018 and which described the management and/or outcomes of AoD during or after pregnancy in women with MFS were included. Literature searches were conducted. The PubMed search was performed using terms "Marfan Syndrome" [Mesh] and "Pregnancy" [Mesh] whereas the Google Scholar search was for "Marfan" and "Pregnancy", all words anywhere in the article. RESULTS: The literature search yielded 177 articles on PubMed and 13,900 articles on Google Scholar. Assessment of full-text articles for eligibility after removal of duplicates from both databases yielded 12 eligible studies to be included in the final review. CONCLUSION: Women with MFS are at high risk of aortic dissection during pregnancy and women with aortic root 41-45 mm should consider avoiding pregnancy. Guideline-specific management of aortic aneurysms in pregnancy will reduce the risk of dissection. Diagnosis and Management of MFS need a multidisciplinary approach and team that should start working early in pregnancy. Further studies are needed to optimize medical and surgical approaches in addition to preconception counselling in highrisk subjects.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Implante de Prótese de Valva Cardíaca , Síndrome de Marfan/complicações , Complicações Cardiovasculares na Gravidez/cirurgia , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Implante de Prótese Vascular/efeitos adversos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Síndrome de Marfan/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/etiologia , Resultado da Gravidez , Medição de Risco , Fatores de Risco , Resultado do Tratamento
10.
Cardiol Clin ; 38(1): 139-148, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31753173

RESUMO

Studies suggest that patients with aortic stenosis have increased risk in pregnancy and delivery and during anesthesia and surgery, although there are significant degrees of uncertainty as to the exact risks and best way to manage such patients. This article reviews current literature regarding impact of aortic stenosis on pregnancy and anesthesia during noncardiac surgery. There are shortcomings in the scientific evidence. Most of the available studies are observational and often retrospective and therefore there is a great deal of bias. This leads to difficulty in drawing conclusions in terms of how to apply the published information to clinical management.


Assuntos
Estenose da Valva Aórtica/complicações , Complicações Cardiovasculares na Gravidez/etiologia , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Gravidez , Medição de Risco
11.
Ginekol Pol ; 91(12): 755-763, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33447995

RESUMO

OBJECTIVES: Determine the strengths and weakness of a symptomatic screening for COVID-19 in pregnant women. Analyze the clinical presentation, management, and outcomes. DESIGN: Descriptive retrospective observational study. SETTING: Mancha-Centro Hospital (Spain). MATERIAL AND METHODS: Population: Symptomatic pregnant women with confirmed diagnosis of COVID-19. Between the 12th of March and 17th of April 2020, all the symptomatic pregnancies were screened with diagnostic test for SARS-CoV-2. Data collection was done by reviewing the medical records and telephone interviews. MAIN OUTCOME MEASURES: Clinical characteristics, management, treatment, and obstetric and neonatal outcomes. RESULTS: Twenty patients with positive COVID-19 diagnostic test out of thirty-four suspected. The most common symptoms were fever (70%), cough (65%) and myalgia (35%). A unique symptom of presentation in 20% of cases. COVID-19 pneumonia was diagnosed in 30% by chest X-ray and one case had pulmonary embolism associated diagnosed by CT-Scan. Thromboprophylaxis was indicated in 16 out of 20 patients. Eight women finished their pregnancy during the observation period. Type of birth: 25% natural birth, 12.5% assisted vaginal delivery and 62.5% caesarean section. We had three severe cases, two of them with intensive care support. All neonates had negative test for COVID 19 infection. CONCLUSIONS: We recommend universal screening of all pregnant woman for COVID-19 during the pandemic because of the limits of the symptomatic screening seen in this studio and the ratio of asymptomatic pregnancies with positive test for COVID-19 recently published.


Assuntos
/fisiopatologia , Cesárea , Tosse/fisiopatologia , Febre/fisiopatologia , Pulmão/diagnóstico por imagem , Mialgia/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Adulto , Antibacterianos , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Proteína C-Reativa/metabolismo , /metabolismo , Cuidados Críticos , Parto Obstétrico , Disgeusia/fisiopatologia , Dispneia/fisiopatologia , Inibidores Enzimáticos/uso terapêutico , Extração Obstétrica , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Idade Gestacional , Heparina de Baixo Peso Molecular/uso terapêutico , Hospitalização , Humanos , Hidroxicloroquina/uso terapêutico , Contagem de Linfócitos , Linfopenia/fisiopatologia , Pessoa de Meia-Idade , Obesidade Materna/complicações , Oxigenoterapia , Pré-Eclâmpsia , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/terapia , Nascimento Prematuro , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Respiração Artificial , Estudos Retrospectivos , Espanha
12.
J Card Surg ; 34(12): 1591-1597, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31794127

RESUMO

OBJECTIVES: Pregnancy has been recognized as a predisposing factor for acute aortic dissection (AAD) although its occurrence is quite rare. Currently, no trial and few prospective studies exist about this catastrophic event. The present review and meta-analysis aims to update information on clinical presentation, potential risk factors, treatment, and outcome of acute dissection during pregnancy and puerperium. METHODS: A comprehensive search of three databases was performed to identify all patients reported in articles published from January 1987. A proportional single-arm meta-analysis with random-effects model was used to pool these variables: risk factors, pregnancy/postpartum occurrence, surgical characteristics, and outcomes. RESULTS: A total of 11 reports and 85 patients with pregnancy-related AAD were available for this study. The prevalence of connective tissue disorders was 62%, Marfan syndrome being the most common. Out of 76 patients, 46 (61%) had dissection during pregnancy and 30 (39%) during puerperium; 40% of events occurred in primigravidae and 60% in multigravidae. Type A and type B dissection occurred in 67% vs 33% of patients. Surgery was performed in 73% of cases with a maternal and fetal mortality of 23% and 27%, respectively. CONCLUSIONS: Throughout pregnancy, AAD is quite rare but fatal, especially in Marfan and Loeys-Dietz syndromes, while isolated bicuspid aortic valve is not a risk factor. Even in Marfan syndrome, pathogenesis and evolution of the disease are still unclear. Occurrence of dissection also during puerperium indicates the need for continuous counselling and aortic size monitoring in women at-risk.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Complicações Cardiovasculares na Gravidez , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/terapia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/terapia
13.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 826-832, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874472

RESUMO

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions: Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.


Assuntos
Doenças Cardiovasculares/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Morte Materna , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Causas de Morte , China/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
15.
Cells ; 8(11)2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31703340

RESUMO

Hypertensive pregnancy has been associated with reduced nitric oxide (NO), bioavailability, and increased activity of matrix metalloproteinases (MMPs). However, it is unclear if MMPs activation is regulated by NO during pregnancy. To this end, we examined activity of MMP-2 and MMP-9 in plasma, placenta, uterus and aorta, NO bioavailability, oxidative stress, systolic blood pressure (SBP), and fetal-placental development at the early, middle, and late pregnancy stages in normotensive and Nω-Nitro-L-arginine methyl-ester (L-NAME)-induced hypertensive pregnancy in rats. Reduced MMP-2 activity in uterus, placenta, and aorta and reduced MMP-9 activity in plasma and placenta with concomitant increased NO levels were found in normotensive pregnant rats. By contrast, increased MMP-2 activity in uterus, placenta, and aorta, and increased MMP-9 activity in plasma and placenta with concomitant reduced NO levels were observed in hypertensive pregnant rats. Also, elevated oxidative stress was displayed by hypertensive pregnant rats at the middle and late stages. These findings in the L-NAME-treated pregnant rats were also followed by increases in SBP and associated with fetal growth restrictions at the middle and late pregnancy stages. We concluded that NO bioavailability may regulate MMPs activation during normal and hypertensive pregnancy.


Assuntos
Hipertensão/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Óxido Nítrico/sangue , Complicações Cardiovasculares na Gravidez/metabolismo , Animais , Biomarcadores , Pressão Sanguínea/efeitos dos fármacos , Ativação Enzimática , Feminino , Idade Gestacional , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Metabolismo dos Lipídeos/efeitos dos fármacos , Peroxidação de Lipídeos , Metaloproteinase 2 da Matriz/sangue , Metaloproteinase 9 da Matriz/sangue , NG-Nitroarginina Metil Éster/farmacologia , Estresse Oxidativo , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Complicações Cardiovasculares na Gravidez/etiologia , Ratos
16.
PLoS One ; 14(10): e0223478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584982

RESUMO

BACKGROUND: Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension. METHODS: An analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant. RESULTS: A total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or "self-referred" from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01-1.87), preterm delivery at <34 weeks' gestation (adjusted RR, 2.74; 95% CI, 1.40-5.36) and preterm delivery at <37 weeks' gestation (adjusted RR, 1.89; 95% CI, 1.25-2.85), compared to women with chronic/gestational hypertension. CONCLUSION: Women with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/etiologia , Resultado da Gravidez , Adolescente , Adulto , Causas de Morte , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Vigilância em Saúde Pública , Adulto Jovem
17.
Clin Ter ; 170(5): e364-e367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612194

RESUMO

In the last 40 years, the number of elderly patients that require Assisted Reproductive Technologies (ART) has risen enormously, especially after heterolougus fertilization techniques have become available. In recent years, the incidence of peripartum cardiomyopathy (PPCM) has substantially grown, as a consequence of the combined effect of increased maternal age, consequent high prevalence of hypertension and metabolic syndrome (MS). That cohort of women may be exposed to a greater number of cardiac, obstetric and anesthesio-logical complications, therefore the incidence of medico-legal issues, litigation, liabilities and claims over the past years has significantly risen. Cardiovascular and hormonal changes during pregnancy can challenge even the healthiest of individuals, and in that pregnant population the risk is even greater. These patients should be monitored before the ART, during pregnancy, delivery and puerperium, to avoid heart failure, thrombotic problems, embolic complications, stroke and death. Management issues regarding pregnancy and delivery are elaborate, including anesthesia considerations. This new population of women needs an accurate cardiac risk stratification with a thorough cardiovascular history and examination, 12 lead ECG, and transthoracic echocardiogram. Therefore, a comprehensive multidisciplinary assessment and management can provide the best opportunity to improve maternal and neonatal outcomes.


Assuntos
Síndrome Metabólica/etiologia , Complicações Cardiovasculares na Gravidez/etiologia , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Síndrome Metabólica/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Gestantes , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco
18.
Medicina (Kaunas) ; 55(10)2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31569595

RESUMO

Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms "cardiomyopathy", "ischaemic heart disease", "arrhythmias", "hypertension", "peripartum period", "diabetes", "advanced maternal age" "anesthesia", "maternal morbidity and mortality" and "litigation". Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.


Assuntos
Doenças Cardiovasculares/etiologia , Idade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Doenças Cardiovasculares/diagnóstico , Feminino , Humanos , Responsabilidade Legal , Pessoa de Meia-Idade , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Fatores de Risco
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