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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 289-293, 2020 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-32187934

RESUMO

Objective: To understand the levels of Pb, Cd, As, Hg, Mn, and Se in maternal and umbilical cord blood, and to explore the transplacental transfer efficiency (TTE). Methods: From September 2010 to December 2013, a total of 773 pregnant women and their newborns (Laizhou Bay Birth Cohort) were recruited from a second grade hospital in the south bank of Laizhou Bay, Bohai, Shandong Province. According to different detection methods, the six measured elements are classified into three groups including the Hg measurement group (595 mother-newborn pairs), the Pb measurement group (534 mother-newborn pairs), and the Cd, As, Mn and Se measurement group (244 mother-newborn pairs). The demographic characteristics of pregnant women and their newborns were obtained by the questionnaire. The concentrations of elements in maternal and umbilical cord blood were detected and the TTE of each element (elemental concentration in cord blood/elemental concentration in maternal blood) was calculated. The correlation of elements between maternal and cord blood was analyzed using Spearman's rank correlation coefficient. Results: The mean±SD of maternal age, gestational week and newborn birth weight of 773 mother-infant pairs were (28.34±4.50) years, (39.47±1.39) weeks and (3 419.47±497.39) g respectively. The median concentrations of Pb, Cd, As, Hg, Mn and As in maternal and cord blood were 31.12 and 30.02, 1.19 and 0.47, 8.05 and 6.03, 0.69 and 1.26, 100.70 and 105.55, 127.25 and 115.00 µg/L, respectively. The TTE of Pb, Cd, As, Hg, Mn, and Se was 0.98, 0.41, 0.73, 1.73, 0.96 and 0.91, respectively. Pb, Cd, Hg, Mn, and Se showed a significant positive correlation between maternal blood and cord blood, with Spearman correlation coefficients of 0.397, 0.298, 0.698, 0.555, and 0.285 (all P values<0.001). Conclusion: Each element was commonly detected in maternal blood and cord blood. The TTE of Hg was the highest.


Assuntos
Cádmio/sangue , Sangue Fetal/química , Sangue Fetal/metabolismo , Chumbo/sangue , Manganês/sangue , Troca Materno-Fetal , Mercúrio/sangue , Selênio/sangue , Cordão Umbilical/química , Biomarcadores/análise , Biomarcadores/sangue , Feminino , Humanos , Recém-Nascido , Gravidez , Oligoelementos/análise , Oligoelementos/sangue , Cordão Umbilical/irrigação sanguínea
2.
Life Sci ; 243: 117257, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31917992

RESUMO

Electrical field stimulation (EFS) has been used for decades in classical pharmacological preparations in order to characterize the mediators released by neural endings involved in smooth muscle contraction or relaxation. Since most of the human umbilical cord has no innervation, EFS has never been used in this preparation. This study aimed to investigate the effect of EFS on vascular responsiveness from human umbilical cord. Segments of the human umbilical cord were obtained from normotensive parturients and the human umbilical artery (HUA) and the human umbilical vein (HUV) were isolated and mounted in organ bath chambers. Electrical field stimulation-induced contractions in both HUA (2.35 ±â€¯1.31 mN and 3.77 ±â€¯2.31 mN for 8 Hz and 16 Hz respectively, n = 24) and HUV (3.81 ±â€¯2.54 mN and 6.26 ±â€¯4.51 mN for 8 Hz and 16 Hz respectively, n = 25). The addition of tetrodotoxin (1 µM) did not alter the EFS-induced contractions in both tissues (n = 5). Pre-incubation with atropine (10 and 100 µM), glibenclamide (10 µM) and indomethacin (10 µM) did not affect the EFS-induced contractions in both tissues. The contractions of both vessels were significantly reduced by pre-incubation of the tissues with phentolamine (10 and 100 µM). The endothelium removal almost abolished the EFS- induced contractions in both vessels (n = 5). In sandwich preparation, donor tissue (with endothelium) released a factor (s) that promoted contraction of the recipient tissue (endothelium removal) in both HUA and HUV (n = 5, respectively). Our findings indicate a potential role of endothelium-derived catecholamines in modulating HUA and HUV reactivities.


Assuntos
Vasos Sanguíneos/fisiologia , Estimulação Elétrica , Cordão Umbilical/irrigação sanguínea , Adulto , Atropina/farmacologia , Vasos Sanguíneos/efeitos dos fármacos , Glibureto/farmacologia , Humanos , Indometacina/farmacologia , Contração Muscular/efeitos dos fármacos , Tetrodotoxina/farmacologia , Adulto Jovem
3.
J Matern Fetal Neonatal Med ; 33(2): 184-190, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886779

RESUMO

Objective: To investigate whether intact umbilical cord milking (I-UCM) can aggravate infection or result in other undesirable complications in preterm infants with premature prolonged rupture of membranes (PPROM).Methods: Neonates vaginally delivered between 28 and 37 weeks' gestation and complicated by PPROM before birth were randomly divided into two groups according to the cord clamping procedure: I-UCM before clamping and immediate cord clamping (ICC). Various parameters of the study participants were compared between the two groups.Results: Of 102 preterm infants, 48 and 54 were randomly allocated to the I-UCM and ICC groups, respectively. There were no significant differences between the two groups regarding hematological parameters (platelet count, white blood count, neutrophil ratio, and C-reactive protein) or neonatal outcomes (probable or certain neonatal infection, respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage) (p > .05). However, preterm neonates in the I-UCM group had higher serum hemoglobin and hematocrit levels (p < .05) and received fewer blood transfusions (p < .05) than those in the ICC group.Conclusion: Milking the umbilical cord to a preterm neonate with PPROM will not aggravate neonatal infection or result in other undesirable complications. This simple procedure will improve hemoglobin values and hematocrit levels and may lessen the need for transfusion during the neonatal period.


Assuntos
Infecções Bacterianas/etiologia , Parto Obstétrico/métodos , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro/sangue , Cordão Umbilical/irrigação sanguínea , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/prevenção & controle , Transfusão de Sangue , Feminino , Ruptura Prematura de Membranas Fetais/sangue , Humanos , Recém-Nascido , Doenças do Prematuro/prevenção & controle , Gravidez
4.
Life Sci ; 234: 116792, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31465733

RESUMO

AIMS: Assisted reproductive technologies (ART) have been widely used to treat infertility, which may impact on fetuses and offspring. This study investigated the effects of in vitro fertilization-embryo transfer (IVF-ET) on angiotensin II (AII)-mediated vasoconstrictions in umbilical cord vein, and explored possible reprogrammed methylation mechanism. MATERIALS AND METHODS: Human umbilical cords were randomly divided into ordinary pregnancy and IVF-ET pregnancy. Vascular studies with AII as well as its specific receptor antagonists losartan and PD123,319 were conducted. Real-time quantitative PCR, Western blotting, and methylation analysis by bisulfite sequencing were performed with the cord vessel samples. KEY FINDINGS: In IVF-ET group, the maximal response to AII in umbilical vessels was significantly greater than that in the ordinary pregnancy. Using losartan and PD123,319, angiotensin receptor subtype 1 (AT1R) was found mainly responsible for the enhanced contraction in the umbilical vein of IVF-ET pregnancy. Decreased mRNA expression of DNMT3A was found in umbilical vein of IVF-ET group. Hypomethylation of the AGTR1 gene (gene encoding AT1R) in the umbilical veins of the IVF group was found. The data suggested that the IVF-ET treatments altered AII-mediated vasoconstrictions in umbilical veins, which could be partially attributed to the increased expression of AT1R. SIGNIFICANCE: The hypo-methylation of the AGTR1 gene caused by IVF-ET might play important roles in altered vasoconstrictions, impacting on cardiovascular systems in the long run.


Assuntos
Angiotensina II/metabolismo , Metilação de DNA , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Receptor Tipo 1 de Angiotensina/genética , Cordão Umbilical/irrigação sanguínea , Vasoconstrição , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 2 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Imidazóis/farmacologia , Losartan/farmacologia , Gravidez , Piridinas/farmacologia , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia
5.
Int J Gynaecol Obstet ; 147(1): 96-101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299100

RESUMO

OBJECTIVE: To elucidate classification of coiling of the umbilical cord around fetal neck (CUFN) by ultrasound and forming factors of entanglement angle of CUFN. METHODS: From January 2006 to December 2012, color Doppler ultrasonic was used to observe the blood flow vector of umbilical artery, and prospective descriptive observation was made for entanglement direction and type of 707 single fetuses taking prenatal examination in our hospital during the middle and late trimester of pregnancy and having umbilical cord echo around the neck. The relationship of position of fetus, position of placenta and entanglement direction of umbilical cord with the entanglement angle of umbilical cord is analyzed. RESULTS: Among the 707 fetuses, 634 had one circle of coiling, 43 had two circles of coiling, two had three circles of coiling, and 28 had CUFN. According to entanglement direction, 361 had entanglement from left to right and 318 had entanglement from right to left According to entanglement type, 305 were C-shaped type (43.14%), 85 were O-shaped type (12.02%), 289 were α-shaped type (40.88%), and 28 were L-shaped type (3.96%). CONCLUSION: Color Doppler ultrasound was used to detect the entanglement direction of umbilical cord and establish the five-type classification of umbilical cord around the neck, laying the foundation for the feasibility of establishing the normalization of diagnostic standard of umbilical cord around the neck.


Assuntos
Cordão Nucal/diagnóstico , Cordão Umbilical/diagnóstico por imagem , Adulto , Feminino , Feto/irrigação sanguínea , Humanos , Cordão Nucal/classificação , Cordão Nucal/patologia , Gravidez , Estudos Prospectivos , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/irrigação sanguínea
7.
Pathologica ; 111(1): 13-17, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31217617

RESUMO

Umbilical cord hemangioma is an uncommon benign vascular neoplasm arising from the free segment of the umbilical cord, distinct from placental and fetal insertion, and is thought to originate from endothelial cells of the umbilical vessels. Cystic changes in the umbilical cord rarely occur as a consequence of the damage to the amnionic surface of the cord caused by the presence of the hemangioma. Until now, a total of 8 cases of umbilical cord hemangioma associated with cystic changes in the umbilical cord have been reported in the literature, however, among these cases, only one showed an associated cyst derived from inclusion of the amniotic epithelium, and the remaining seven cases consisted of hemangiomas with associated pseudocyst of the umbilical cord. We herein report a case of umbilical cord hemangioma with an associated amnionic epithelial inclusion cyst. Clinicopathological features and differential diagnostic considerations are also discussed.


Assuntos
Âmnio/patologia , Cistos , Hemangioma , Neoplasias Primárias Múltiplas , Complicações Neoplásicas na Gravidez , Cordão Umbilical/irrigação sanguínea , Cordão Umbilical/patologia , Adulto , Cistos/diagnóstico , Cistos/patologia , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico , Hemangioma/patologia , Humanos , Gravidez
8.
J Med Case Rep ; 13(1): 149, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31101065

RESUMO

BACKGROUND: Abnormalities in the number of vessels can be found for both the umbilical artery and vein. We sometimes encounter cases of a decreased number of umbilical cord vessels, such as a single umbilical artery. In contrast, there may be an increase from three to four vessels within the umbilical cord. A supernumerary umbilical vein is particularly very rare, and it is generally found in combination with congenital anomalies. We report a case of a partial supernumerary umbilical vein. CASE PRESENTATION: The previous pregnancy of a 37-year-old healthy Japanese woman (gravida 2, para 1) had been uncomplicated, and the resulting child was alive and well. Prenatal examination at 36 weeks of gestation revealed the coexistence of a four-vessel part and a normal three-vessel part of the umbilical cord. A healthy female neonate weighing 2726 g was born at 38 weeks of gestation. The umbilical cord measured 40 cm in length; the four-vessel part continued to a distance of 18 cm from the surface of the infant's body, and the remaining umbilical cord comprised three vessels. On histological examination, the fetal side of the umbilical cord had two arteries and two veins, and the placental side had two arteries and one vein. Isolated supernumerary umbilical veins tend to be overlooked. We consider that it is important to evaluate the number of umbilical cord vessels in the second trimester using ultrasound combined with color Doppler in at least three sites: the insertion sites on both the fetal abdomen and placenta, and the free loop of the umbilical cord. CONCLUSIONS: Prenatal diagnosis of isolated supernumerary umbilical cord vessels tends to be overlooked. However, supernumerary vessels of the umbilical can be associated with fetal congenital anomalies. The number of vessels within the umbilical cord must be examined because the detection of such abnormalities may lead to the prenatal diagnosis of other congenital anomalies.


Assuntos
Placenta/irrigação sanguínea , Ultrassonografia Pré-Natal , Artérias Umbilicais/anormalidades , Cordão Umbilical/irrigação sanguínea , Veias Umbilicais/anormalidades , Adulto , Feminino , Humanos , Recém-Nascido , Placenta/patologia , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Artérias Umbilicais/diagnóstico por imagem , Cordão Umbilical/diagnóstico por imagem , Veias Umbilicais/diagnóstico por imagem
9.
Neonatology ; 115(4): 392-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30974440

RESUMO

Noninvasive ventilation for preterm infants at birth has been recommended and universally adopted. The umbilical cord is often clamped immediately in order to provide the support the infant needs for stabilization. However, recent scientific data from experimental studies that involve animals in transition and human studies using physiological measurements at birth have increased awareness as to how little we know about how these interventions interact and integrate with the infant's changing physiology. It has become clear that in apneic infants the larynx is closed immediately after birth, which can completely negate the effect of noninvasive ventilation of the lung. For this reason, stimulating and supporting spontaneous breathing could enhance the success of noninvasive ventilation. Animal data also demonstrated that the large swings in blood pressure, blood flow, and oxygenation caused by immediate cord clamping can be avoided by postponing cord clamping until lung aeration has been established. In this review we will focus on these "game changers" that have the potential to completely change the approach used in stabilizing preterm infants at birth.


Assuntos
Parto Obstétrico/métodos , Feto/irrigação sanguínea , Recém-Nascido Prematuro/fisiologia , Cordão Umbilical/irrigação sanguínea , Animais , Constrição , Feminino , Hemodinâmica , Humanos , Recém-Nascido , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo para o Tratamento
10.
Trials ; 20(1): 225, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992034

RESUMO

BACKGROUND: The Cord Pilot Trial compared two alternative policies for cord-clamping at very preterm birth at eight UK tertiary maternity units: clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports views and experiences of the women who participated in the trial (261 randomised), based on data from two self-completed questionnaires. METHODS: Women were given or posted the first questionnaire between 4 and 8 weeks after birth, and posted a second similar questionnaire at 1 year. Both questionnaires included three questions about experiences of participating in the trial: (1) If time suddenly went backwards and you had to do it all over again, would you agree to participate in the Cord Pilot Trial?; (2) Please tell us if there was anything about the Cord Pilot Trial that you think could have been done better; and (3) Please tell us if there was anything about the Cord Pilot Trial, or your experiences of joining the trial, that you think were particularly good. RESULTS: One hundred and eighty-six women completed the first questionnaire and 133 completed the second. At both time points, 90% responded 'probably' or 'definitely' to participating in the trial again. More women randomised to deferred clamping responded 'definitely yes' than those allocated immediate clamping (78% versus 67% first questionnaire). Women were positive about the level of information and explanations, the friendly and caring staff, and the benefits for their baby and others as a result of participating in the trial. Suggestions for how the trial could be done better included being approached earlier, better staff communication about the trial, more information overall, and better timing of follow-up. CONCLUSIONS: Women were largely positive about participating in the trial. Nevertheless, they had suggestions for how the study could have been improved. These suggestions have implications for the design of future trials. TRIAL REGISTRATION: ISRCTN21456601 . Registered on 28 February 2013.


Assuntos
Lactente Extremamente Prematuro , Cordão Umbilical/cirurgia , Constrição , Feminino , Humanos , Recém-Nascido , Gravidez , Projetos de Pesquisa , Inquéritos e Questionários , Fatores de Tempo , Cordão Umbilical/irrigação sanguínea
11.
Biomed Res Int ; 2019: 9185059, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30886867

RESUMO

Introduction: Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed ("stripped") two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume-of which they are deprived when early cord clamping is carried out-completing placental transfusion in a shorter time than delayed cord clamping. The aim of this narrative review is to analyse the literature regarding umbilical cord milking in term and late-preterm infants and to assess all possible benefits and limits of this procedure in clinical practice, especially in comparison to immediate and delayed cord clamping. Methods: We analysed literature data concerning maternal, as well as neonatal, outcomes for term and late-preterm (gestational age ≥ 34 weeks) newborns who received umbilical cord milking. Results: Most studies show comparable benefits for both umbilical cord milking and delayed cord clamping, especially in terms of haematological parameters when compared to immediate cord clamping. Umbilical cord milking may be a feasible procedure also for newborns requiring resuscitation. Conclusions: Literature data concerning positive effects of umbilical cord milking are encouraging and suggest that umbilical cord milking may be a quick and effective method to provide placental transfusions to depressed infants. However, the lack of standardised procedures and the variation in evaluated outcomes as well as the limited number of patients enrolled in trials, along with the retrospective nature of some of them, prevent recommending umbilical cord milking as a routine procedure.


Assuntos
Recém-Nascido Prematuro/sangue , Nascimento Prematuro/sangue , Cordão Umbilical/irrigação sanguínea , Transfusão de Sangue , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/fisiopatologia , Nascimento a Termo , Cordão Umbilical/patologia
12.
Pediatr Allergy Immunol ; 30(4): 443-450, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30801809

RESUMO

BACKGROUND: Fetal growth restriction is associated with higher risks of childhood respiratory morbidity. Fetal blood flow adaptations might contribute to these associations. We examined the associations of fetal umbilical, cerebral, and pulmonary blood flow with wheezing patterns, lung function, and asthma in childhood. METHODS: In a population-based prospective cohort study among 903 children, we measured fetal umbilical, cerebral, and pulmonary blood flow by pulsed-wave Doppler at a median gestational age of 30.3 (95% range 28.8-32.3) weeks. We obtained information about wheezing patterns until the age of 6 years by questionnaires. Lung function was measured by spirometry and information about current asthma was obtained by questionnaire at the age of 10 years. RESULTS: Results showed a non-significant relationship between a higher umbilical artery pulsatility index (PI) and umbilical artery PI/cerebral artery PI ratio, indicating fetal blood flow redistribution at the expense of the trunk, with higher risks of early wheezing (OR [95% CI]: 2.07 (0.70-6.10) and 2.74 (0.60, 12.62) per unit increase, respectively). A higher pulmonary artery time velocity integral, indicating higher pulmonary vascular resistance, was associated with a higher risk of late/persistent wheezing (Z-score 1.14 [1.01-1.29]). A higher middle cerebral artery PI was associated with a higher FEV1 /FVC (Z-score [95% CI]: 0.21 [0.01-0.42]). Results did not materially change after additional adjustment for birth and growth characteristics. CONCLUSION: Third-trimester fetal blood flow patterns might be related to childhood respiratory health. These findings should be considered as hypothesis generating and need further replication.


Assuntos
Asma/epidemiologia , Encéfalo/irrigação sanguínea , Pulmão/irrigação sanguínea , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Cordão Umbilical/irrigação sanguínea , Criança , Estudos de Coortes , Feminino , Sangue Fetal , Feto , Humanos , Pulmão/metabolismo , Grupos Populacionais , Gravidez , Estudos Prospectivos , Fluxo Sanguíneo Regional , Testes de Função Respiratória , Sons Respiratórios , Ultrassonografia Doppler de Pulso
13.
Chemosphere ; 218: 869-878, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30609491

RESUMO

In utero exposure to toxic heavy metals and deficient or excessive essential trace elements during pregnancy may have adverse effects on pregnant women and their offsprings, which are of great concern. The objective of the present study was to characterize serum concentrations of multiple trace elements at multiple time points during pregnancy in Chinese women. Three thousand four hundred and sixteen pregnant women in total were included from MABC (Ma'anshan Birth Cohort) study. Fasting sera in the morning and questionnaires were obtained at three separate follow-up visits. Nineteen trace elements from serum samples were analyzed, including aluminum (Al), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd), barium (Ba), thallium (Tl), lead (Pb), calcium (Ca), magnesium (Mg), mercury (Hg) and molybdenum (Mo). The total detection rates for most elements were 100% rather than Ni (99.98%), As (99.97%), Cd (99.6%), Ba (99.9%), Pb (99.8%), Hg (99.8%). The concentration distributions of 19 elements varied vastly. Median concentrations for all trace elements ranged from 38.5 ng/L to 102.9 mg/L. The moderate interclass correlation coefficients (ICCs) were observed for Co, Cu, Se and Hg, ranging from 0.40 to 0.62; the lower ICCs, ranging from 0.13 to 0.32 were for Fe, Zn, Cd, Ba, Tl, Mg and Mo. The intraclass correlation effects were not observed for the remaining elements, such as Al, V, Cr, Mn, Ni, As and Pb. The concentrations of each element between three time points were significantly different; significant differences were also found between any two time points except for Ni, Cd and Mo. Many factors could affect the levels of trace elements, and a very important factor of them was season. Consequently, a single measurement of elements in sera seems not enough to describe exposure levels throughout pregnancy; additionally, season affected exposure levels of trace elements with moderate ICCs showed certain regularity. Future analyses should take sampling seasons into consideration carefully.


Assuntos
Sangue Fetal/química , Metais Pesados/sangue , Oligoelementos/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Gravidez , Estações do Ano , Fatores de Tempo , Cordão Umbilical/irrigação sanguínea , Adulto Jovem
14.
J Steroid Biochem Mol Biol ; 186: 154-160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30359690

RESUMO

Clinical and epidemiological evidence supports that pregnancies carrying a male fetus are more vulnerable to infections and preterm birth, probably due to testosterone immunosuppressive properties. In human placentas, testosterone lowers the expression of CYP27B1, the vitamin D (VD)-activating enzyme, diminishing cathelicidin synthesis, a potent VD-dependent antimicrobial peptide (AMP). VD also stimulates other AMPs, including defensins. To get insights into the increased male vulnerability mechanisms, we investigated the relationship between fetal sex and the immunoendocrine milieu at the fetoplacental unit. For this, umbilical vein serum and placental samples were collected from healthy newborns. In males' serum, testosterone levels were significantly higher and negatively associated with TNF-α, a cytokine that strengthens the immune response. Males showed lower serum TNF-α and increased levels and gene expression of the immunosuppressive cytokine IL-10. Only in female samples there was a positive association (P < 0.05) between AMPs and both TNF-α and CYP27B1 and between 25-hydroxyvitamin D3 and IL-1ß serum levels. Accordingly, VD-metabolites (25-hydroxyvitamin D3, calcitriol) significantly stimulated IL-1ß gene expression in cultured trophoblasts. Interestingly, IL-1ß mRNA correlated positively with defensins (P < 0.05) in males, but not with cathelicidin expression, which was significantly diminished in comparison to females. Our data suggest that high umbilical serum testosterone and IL-10 in males could explain reduced TNF-α levels and lack of association between VD-dependent innate immunity markers and proinflammatory cytokines expression in the fetoplacental unit. Altogether, our observations imply a restricted basal immune milieu in males compared to females, which may help understand the higher male susceptibility to adverse perinatal outcomes.


Assuntos
Testosterona/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Feminino , Humanos , Imunidade Inata , Recém-Nascido , Interleucina-10/sangue , Interleucina-10/imunologia , Masculino , Placenta/química , Placenta/imunologia , Gravidez , Testosterona/imunologia , Fator de Necrose Tumoral alfa/imunologia , Cordão Umbilical/irrigação sanguínea , Cordão Umbilical/imunologia , Adulto Jovem
15.
Birth ; 46(3): 411-427, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30264508

RESUMO

BACKGROUND: Enhanced placental transfusion reduces adverse neonatal outcomes, including death. Despite being endorsed by the World Health Organization in 2012, the method has not been adopted widely in practice. METHODS: We performed a systematic literature search and included quality improvement projects on placental transfusion at birth and studies on barriers to implementation. We extracted information on population, methods of implementation, obstacles to implementation, and strategies to overcome them. RESULTS: We screened 99 studies out of which 18 were included in the review. The preferred methods of implementation were protocol development (86% of studies) reinforced by targeted education (64% of studies) and multidisciplinary team involvement (43% of studies). Barriers to implementation were mentioned in 12 studies and divided into four categories: general factors such as lack of staff awareness (5 studies) and professional resistance to change (5 studies); obstetrician-specific concerns, including the impact during cesarean (3 studies) and the risk of postpartum hemorrhage (3 studies); pediatrician-specific concerns, including the need for resuscitation (5 studies), risk of jaundice (3 studies), and polycythemia (2 studies); and logistical difficulties. The main strategies to facilitate placental transfusion at birth included effective multidisciplinary team collaboration, protocol development, targeted education, and constructive feedback sessions. CONCLUSIONS: Placental transfusion implementation requires a multidisciplinary approach, with obstetricians, midwives, nurses, and pediatricians central to adoption of the practice. Understanding the obstacles to implementation informs strategies to increase placental transfusion adoption of practice worldwide. We suggest a stepwise approach to implementation and enhancement of placental transfusion into practice.


Assuntos
Transfusão de Sangue/métodos , Parto Obstétrico/métodos , Equipe de Assistência ao Paciente , Placenta/irrigação sanguínea , Cordão Umbilical/irrigação sanguínea , Constrição , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Gravidez
16.
J Obstet Gynaecol ; 39(1): 49-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30246578

RESUMO

We report prophylactic amnioinfusion (AI) for variable decelerations in umbilical cord compression without oligohydramnios as an early sign of deterioration. We performed a transabdominal AI in cases without oligohydramnios using the ultrasonography findings of umbilical cord compression (i.e. sandwich sign [SWS]) and variable decelerations (VD) in a foetal heart rate. Thirteen cases and 21 AIs were analysed. Nine (69%) cases were of a foetal growth restriction and 4 (31%) had umbilical hyper-coiled cords. VD frequency (p < .0001), umbilical artery pulsatility index (PI) (p < .01) and ductus venous PI (0.66 vs. 0.48; p < .05) significantly decreased, and an umbilical venous (UV) flow volume (121 vs. 197 ml/min/kg; p < .05) significantly increased after AI. The umbilical artery diastolic blood flow abnormalities and UV pulsation improved. In conclusion, AI improves the umbilical cord compression even without oligohydramnios. The SWS is an important marker of deterioration to severe oligohydramnios and latent foetal damage. IMPACT STATEMENT What is already known on this subject? Antepartum variable decelerations due to umbilical cord compression are significantly associated with the deceleration in labour. In particular, foetal hypoxia leads to other adverse events such as foetal distress, hypoxic-ischemic encephalopathy, and pulmonary arterial hypertension after birth. Amnioinfusion has been shown to be effective in patients who also have oligohydramnios. What do the results of this study add? Amnioinfusion may be effective in the cases with ultrasonography findings of umbilical cord compression (i.e. sandwich sign) and in cases with variable decelerations in foetal heart rate, but without oligohydramnios. What are the implications of these findings for clinical practice and/or further research? Amnioinfusion may be helpful to prevent adverse events including oligohydramnios and anhydroamnios.


Assuntos
Constrição Patológica/terapia , Sofrimento Fetal/terapia , Cordão Umbilical/irrigação sanguínea , Adulto , Biomarcadores , Constrição Patológica/diagnóstico por imagem , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Injeções , Oligo-Hidrâmnio/prevenção & controle , Gravidez , Fluxo Pulsátil , Ultrassonografia Pré-Natal , Cordão Umbilical/diagnóstico por imagem
17.
J Matern Fetal Neonatal Med ; 32(4): 646-649, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28969479

RESUMO

OBJECTIVE: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection. DESIGN: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4+ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants. METHODS: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively. RESULTS: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p = .05): this difference persisted at 1 month of life. All newborns showed negative viral load. CONCLUSIONS: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia.


Assuntos
Anemia/prevenção & controle , Parto Obstétrico/métodos , Infecções por HIV , Complicações Infecciosas na Gravidez , Cordão Umbilical/irrigação sanguínea , Adulto , Anemia/sangue , Anemia/congênito , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Constrição , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fatores de Tempo , Adulto Jovem
18.
Cytotherapy ; 20(11): 1345-1354, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30322708

RESUMO

OBJECTIVE: Cell cycle plays a fundamental role in the physiology of hematopoietic stem and progenitor cells. In the present study we used a negative selection system to obtain an immature cell population-enriched for cord blood-derived CD34+ cells-and we determined its proliferation, expansion and differentiation patterns as a function of the cell cycle status. The effects of hydroxyurea (HU) were also assessed. RESULTS: As compared with cells in synthesis (S)/Gap2 (G2)/mitosis (M), cells in quiescent state (G0)/Gap1 (G1) showed a higher proliferation potential in vitro. At culture onset, G0, G1 and S/G2/M cells corresponded with 63%, 33% and 4%, respectively. Treatment with HU before culture resulted in an increase in the proportion of cells in G1 with a concomitant decrease in S/G2/M cells, without affecting the proportion of cells in G0. After 3 days of culture in the presence of recombinant cytokines, the vast majority of the cells (90%) were in G1, and by day 8, G0, G1 and S/G2/M cells corresponded with 18%, 67% and 15%, respectively. HU also induced an increase in colony-forming cell (CFC) frequency, in the proliferation and expansion capacities of cultured cells under myeloid conditions, and favored the development of the erythroid lineage. CONCLUSION: Our results show that the in vitro proliferation, expansion and differentiation potentials of immature hematopoietic cells are determined, at least in part, by their cell cycle status and that the cell cycle modifier HU significantly influences the growth of human hematopoietic cells. These results are of potential relevance for the development of ex vivo expansion protocols.


Assuntos
Antígenos CD34/metabolismo , Ciclo Celular/fisiologia , Sangue Fetal/citologia , Células-Tronco Hematopoéticas/citologia , Hidroxiureia/farmacologia , Células Sanguíneas/citologia , Ciclo Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Ensaio de Unidades Formadoras de Colônias , Humanos , Cordão Umbilical/irrigação sanguínea
19.
Value Health ; 21(9): 1077-1082, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30224112

RESUMO

BACKGROUND: Several public cord blood banks are struggling financially, and the question remains as to whether additional allocations of funds to them are justified. OBJECTIVES: To estimate the social benefits of public cord blood bank inventory net of cord blood banks' operational costs. METHODS: We used publicly available data from the Health Resources and Service Administration on the number of annual cord blood transplants as well as the patient age distribution in 2010, and the survival estimates between 2008 and 2012 for the several diseases treated by cord blood transplantation. Data on aggregate annual costs to the cord blood industry for recruitment, processing, and storage were obtained from published work. We used estimated increases in life expectancy due to treatment using umbilical cord blood and value for life-years gained to estimate the social benefits of the public cord blood inventory annually. RESULTS: We found that the annual social benefits of between $500 million and $1.5 billion outweigh the current operational annual costs of running cord blood banks of $60 to $70 million by a significant margin. CONCLUSIONS: We estimated that the annual social benefit of having a cord blood system far outweighs its costs, by more than an order of magnitude. Thus, the social benefits of maintaining the US public cord blood banking system at the present time far outweigh the costs of collecting, storing, and distributing cord blood. This suggests that there is a potential justification for government intervention to align social benefits and costs. Nevertheless, simple fixes may produce unintended consequences, and so a careful design for subsidies is needed.


Assuntos
Bancos de Sangue/economia , Sangue Fetal , Cordão Umbilical/irrigação sanguínea , Análise Custo-Benefício , Humanos
20.
J Perinatol ; 38(9): 1190-1196, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29973664

RESUMO

OBJECTIVE: To evaluate the feasibility and safety of umbilical cord milking (UCM) in neonates who are depressed at birth. STUDY DESIGN: This is a quasi-randomized, non-blinded, controlled trial on infants (≥35 weeks) who were depressed at birth. UCM (cord milked three times) was performed during the even months and the neonates born during the odd months were in the control group. Primary outcome was feasibility and safety. RESULTS: A total of 101 infants were enrolled (50 UCM group and 51 control group) between January 2015 and October 2016. UCM was performed in 95% of infants (59/62) who qualified to receive UCM. There were no significant differences in resuscitation delay, resuscitation efforts, and short-term outcomes between the two groups. CONCLUSIONS: UCM is feasible for term and late preterm infants who are depressed at birth. A larger clinical trial is needed to evaluate long-term benefits of UCM in neonates with HIE.


Assuntos
Transfusão de Sangue/métodos , Sangue Fetal , Recém-Nascido Prematuro/fisiologia , Circulação Placentária , Ressuscitação/métodos , Constrição , Estudos de Viabilidade , Feminino , Humanos , Índia , Recém-Nascido , Masculino , Gravidez , Cordão Umbilical/irrigação sanguínea
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