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1.
J Biomech Eng ; 145(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35900843

RESUMO

Computational modeling serves an important role in childbirth-related research. Prescribed fetal descent trajectory is a key characteristic in childbirth simulations. Two major types of fully prescribed fetal descent trajectories can be identified in the literature: straight descent trajectories and curve of Carus. The straight descent trajectory has the advantage of being simpler and can serve as a reasonable approximation for relatively small fetal movements during labor, but it cannot be used to simulate the entire childbirth process. The curve of Carus is the well-recognized fetal descent trajectory with physiological significance. However, no detailed procedure to geometrically define the curve of Carus can be found in existing computational studies. This status of curve of Carus simulation in the literature hinders the direct comparison of results across different studies and the advancement of computational techniques built upon previous research. The goals of this study are: (1) propose a universal approach to derive the curve of Carus for the second stage of labor, from the point when the fetal head engages the pelvis to the point when the fetal head is fully delivered; and (2) demonstrate its utility when considering various fetal head sizes. The current study provides a detailed formulation of the curve of Carus, considering geometries of both the mother and the fetus. The maternal geometries were obtained from MRI data, and the fetal head geometries were based on laser scanning of a replica of a real fetal head.


Assuntos
Parto Obstétrico , Parto , Simulação por Computador , Parto Obstétrico/métodos , Feminino , Feto/fisiologia , Cabeça , Humanos , Parto/fisiologia , Gravidez
2.
BMC Pregnancy Childbirth ; 22(1): 254, 2022 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-35346088

RESUMO

OBJECTIVE: Our aim was to assess diagnostic accuracy in the prediction of small for gestational age (SGA <10th centile) and fetal growth restricted (FGR) (SGA <3rd centile) fetuses using three different sonographic methods in pregnancies at increased risk of fetal growth restriction: 1) fetal abdominal circumference (AC) z-scores, 2) estimated fetal weight (EFW) z-scores according to postnatal reference standard; 3) EFW z-scores according to a prenatal reference standard. METHODS: Singleton pregnancies at increased risk of fetal growth restriction seen in two university hospitals between 2014 and 2015 were studied retrospectively. EFW was calculated using formulas proposed by the INTERGROWTH-21st project and Hadlock; data derived from publications by the INTEGROWTH-twenty-first century project and Hadlock were used to calculate z-scores (AC and EFW). The accuracy of different methods was calculated and compared. RESULTS: The study group included 406 patients. Prenatal standard EFW z-scores derived from INTERGROWTH-21st project and Hadlock and co-workers performed similarly and were more accurate in identifying SGA infants than using AC z-scores or a postnatal reference standard. The subgroups analysis demonstrated that EFW prenatal standard was more or similarly accurate compared to other methods across all subgroups, defined by gestational age and birth weight. CONCLUSIONS: Prenatal standard EFW z-scores derived from either INTERGROWTH-21 st project or Hadlock and co-workers publications demonstrated a statistically significant advantage over other biometric methods in the diagnosis of SGA fetuses.


Assuntos
Retardo do Crescimento Fetal , Peso Fetal , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Feto , Idade Gestacional , Humanos , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos
3.
Comput Math Methods Med ; 2022: 5192338, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36092792

RESUMO

The angle of progression (AoP) for assessing fetal head (FH) descent during labor is measured from the standard plane of transperineal ultrasound images as the angle between a line through the long axis of pubic symphysis (PS) and a second line from the right end of PS tangentially to the contour of the FH. This paper presents a multitask network with a shared feature encoder and three task-special decoders for standard plane recognition (Task1), image segmentation (Task2) of PS and FH, and endpoint detection (Task3) of PS. Based on the segmented FH and two endpoints of PS from standard plane images, we determined the right FH tangent point that passes through the right endpoint of PS and then computed the AoP using the above three points. In this paper, the efficient channel attention unit is introduced into the shared feature encoder for improving the robustness of layer region encoding, while an attention fusion module is used to promote cross-branch interaction between the encoder for Task2 and that for Task3, and a shape-constrained loss function is designed for enhancing the robustness to noise based on the convex shape-prior. We use Pearson's correlation coefficient and the Bland-Altman graph to assess the degree of agreement. The dataset includes 1964 images, where 919 images are nonstandard planes, and the other 1045 images are standard planes including PS and FH. We achieve a classification accuracy of 92.26%, and for the AoP calculation, an absolute mean (STD) value of the difference in AoP (∆AoP) is 3.898° (3.192°), the Pearson's correlation coefficient between manual and automated AoP was 0.964 and the Bland-Altman plot demonstrates they were statistically significant (P < 0.05). In conclusion, our approach can achieve a fully automatic measurement of AoP with good efficiency and may help labor progress in the future.


Assuntos
Apresentação no Trabalho de Parto , Ultrassonografia Pré-Natal , Feminino , Feto/diagnóstico por imagem , Humanos , Redes Neurais de Computação , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal/métodos
4.
J Obstet Gynaecol Can ; 44(9): 1028-1039.e1, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36109101

RESUMO

OBJECTIF: Améliorer les issues périnatales et réduire au minimum le risque d'erreurs chez les fournisseurs en améliorant leurs connaissances sur les stratégies de détection des artéfacts de la fréquence cardiaque maternelle per partum et sur les modes d'intervention lorsque de tels artéfacts sont soupçonnés. POPULATION CIBLE: Toutes les parturientes. OPTIONS: L'artéfact de la fréquence cardiaque maternelle peut être détecté à l'aide de caractéristiques cliniques ou de la technologie. On peut évaluer l'artéfact de la fréquence cardiaque maternelle soupçonné en posant une électrode de cuir chevelu fœtal (option à privilégier) ou en recourant à la surveillance fœtale externe optimisée par l'échographie au chevet (solution de rechange). RéSULTATS: Les artéfacts de la fréquence cardiaque maternelle per partum non détectés augmentent le risque que des rythmes anormaux ou atypiques de la fréquence cardiaque fœtale passent inaperçus, ce qui augmente le risque d'issues périnatales défavorables. BéNéFICES, RISQUES ET COûTS: L'artéfact de la fréquence cardiaque maternelle non détecté peut entraîner de graves issues périnatales défavorables (encéphalopathie hypoxo-ischémique, mort fœtale et mort néonatale) et des issues maternelles défavorables (césarienne injustifiée ou accouchement assisté). Ces issues peuvent être évitées par la détection rapide d'un tel artéfact. Le coût de la détection précoce des artéfacts de fréquence cardiaque maternelle est relativement faible (utilisation accrue des électrodes de cuir chevelu fœtal et de l'échographie au chevet avec évaluations supplémentaires par le fournisseur de soins). La réduction des événements périnataux défavorables engendre des économies considérables. Les risques sont : faux positifs d'artéfact de la fréquence cardiaque maternelle; accélération inutile de l'accouchement lorsque l'état du fœtus est normal, mais qu'on ne peut le déterminer de façon fiable; et les rares complications associées à l'utilisation accrue des électrodes de cuir chevelu fœtal. DONNéES PROBANTES: Deux recherches ont été effectuées dans PubMed. La première a été réalisée pour répertorier les articles publiés entre le 1er janvier 1970 et le 25 novembre 2021 à partir des termes MeSH fetal monitoring et artifacts (38 articles); la deuxième, pour répertorier les articles publiés au cours de la même période à partir des termes MeSH fetal monitoring et maternal heart rate (841 articles). MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.


Assuntos
Artefatos , Feto , Feminino , Humanos , Gravidez
5.
Nat Commun ; 13(1): 5403, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109585

RESUMO

While adult bone marrow (BM) hematopoietic stem and progenitor cells (HSPCs) and their extrinsic regulation is well studied, little is known about the composition, function, and extrinsic regulation of the first HSPCs to enter the BM during development. Here, we functionally interrogate murine BM HSPCs from E15.5 through P0. Our work reveals that fetal BM HSPCs are present by E15.5, but distinct from the HSPC pool seen in fetal liver, both phenotypically and functionally, until near birth. We also generate a transcriptional atlas of perinatal BM HSPCs and the BM niche in mice across ontogeny, revealing that fetal BM lacks HSPCs with robust intrinsic stem cell programs, as well as niche cells supportive of HSPCs. In contrast, stem cell programs are preserved in neonatal BM HSPCs, which reside in a niche expressing HSC supportive factors distinct from those seen in adults. Collectively, our results provide important insights into the factors shaping hematopoiesis during this understudied window of hematopoietic development.


Assuntos
Medula Óssea , Células-Tronco Hematopoéticas , Animais , Feminino , Feto , Hematopoese , Camundongos , Parto , Gravidez
6.
Commun Biol ; 5(1): 974, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109592

RESUMO

Leydig cells in fetal testes play crucial roles in masculinizing fetuses through androgen production. Gene knockout studies have revealed that growth factors are implicated in fetal Leydig cell (FLC) differentiation, but little is known about the mechanisms regulating this process. We investigate this issue by characterizing FLC progenitor cells using single-cell RNA sequencing. The sequence datasets suggest that thymosin ß10 (Tmsb10) is transiently upregulated in the progenitors. While studying the function of Tmsb10, we reveal that platelet-derived growth factor (PDGF) regulates ciliogenesis through the RAS/ERK and PI3K/AKT pathways, and thereby promotes desert hedgehog (DHH)-dependent FLC differentiation. Tmsb10 expressed in the progenitor cells induces their differentiation into FLCs by suppressing the RAS/ERK pathway. Through characterizing the transiently expressed Tmsb10 in the FLC progenitors, this study unveils the molecular process of FLC differentiation and shows that it is cooperatively induced by DHH and PDGF.


Assuntos
Androgênios , Sistema de Sinalização das MAP Quinases , Androgênios/metabolismo , Feto , Humanos , Masculino , Fosfatidilinositol 3-Quinases/metabolismo , Fator de Crescimento Derivado de Plaquetas/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Timosina
7.
Front Immunol ; 13: 976289, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105800

RESUMO

The HLA class Ib molecule is an alloantigen that causes transplant rejection on behalf of individual human and plays an important role in maternal-fetal immune tolerance. Early studies on HLA class Ib focused on the mechanism of HLA-G-induced immune escape, but in recent years, studies on the mechanism of HLA-G have deepened and gradually explored the mechanism of HLA-E and HLA-F, which are also HLA class Ib molecules. In the maternal-fetal interface, trophoblast cells express HLA class Ib molecules to protect the fetus from maternal immune cells by binding to inhibitory receptors of decidual immune cells (DICs) and shifting Th1/Th2 balance toward Th2 bias. Further studies on the molecular mechanism of HLA class Ib molecules provide a reference for its application in the field of clinical assisted reproduction.


Assuntos
Feto , Antígenos HLA-G , Família , Antígenos HLA-G/genética , Antígenos HLA-G/metabolismo , Humanos , Tolerância Imunológica , Trofoblastos/metabolismo
8.
J Clin Pharmacol ; 62 Suppl 1: S18-S29, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106788

RESUMO

Medicines and vaccines prescribed to pregnant women often have not had pregnant women or lactating women included in clinical trials and products are often not approved by regulatory agencies for use in pregnant women. As a result, practitioners may need to prescribe medicines and give vaccines to this special population with limited drug efficacy and safety information available. Multiple regulatory guidance documents regarding the development of medications for pregnant and lactating women have been developed to encourage drug development and the investigation of medicines and vaccines used in this population. However, clinical, regulatory, ethical, and drug development challenges are encountered when designing clinical trials that include pregnant women and their fetuses, in which innovative methods and trial designs are essential. This article provides an overview of an industry perspective on maternal-fetal drug development that includes a review of the regulatory landscape for developing medicines for pregnant women and their fetuses, trial designs that include pregnant women, identification of gaps and challenges, and strategies for potential maternal-fetal drug development considerations for the future development of medicines and vaccines for pregnant women. Early involvement and discussion of drug and vaccine products with multiple stakeholders, including therapeutic experts, patients, physicians, and regulators, is encouraged to optimize the development of safe and effective medicines and vaccines for pregnant women and their fetuses.


Assuntos
Lactação , Vacinas , Ensaios Clínicos como Assunto , Feminino , Feto , Humanos , Gravidez , Gestantes
9.
Clin Perinatol ; 49(3): 573-586, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36113923

RESUMO

Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.


Assuntos
Feto , Diagnóstico Pré-Natal , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética/métodos , Gravidez , Cuidado Pré-Natal , Diagnóstico Pré-Natal/métodos
11.
BMC Med Imaging ; 22(1): 154, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056307

RESUMO

BACKGROUND: The aim of this study was to evaluate the accuracy and reliability of a semiautomated volumetric approach (5D CNS+™) when examining fetuses with an apparent abnormal anatomy of the central nervous system (CNS). METHODS: Stored 3D volumes extracted from a cohort of > 1.400 consecutive 2nd and 3rd trimester pregnancies (range 15-36 gestational weeks) were analyzed using the semiautomatic software tool 5D CNS+™, enabling detailed reconstruction of nine diagnostic planes of the fetal brain. All 3D data sets were examined and judged for plane accuracy, the need for manual adjustment, and fetal CNS anomalies affecting successful plane reconstruction. RESULTS: Based on our data of 91 fetuses with structural cerebral anomalies, we were able to reveal details of a wide range of CNS anomalies with application of the 5D CNS+™ technique. The corresponding anatomical features and consecutive changes of neighboring structures could be clearly demonstrated. Thus, a profound assessment of the entire altered CNS anatomy could be achieved in nearly all cases. The comparison with matched controls showed a significant difference in volume acquisition (p < 0.001) and in need for manual adjustment (p < 0.001) but not in the drop-out rates (p = 0.677) of both groups. CONCLUSION: 5D CNS+™ is applicable in the majority of cases with brain lesions and constitutes a reliable tool even if the integrity of the fetal CNS is compromised by structural anomalies. Using volume data that were acquired in identical cutting sections needed for conventional biometry allows for detailed anatomic surveys grossly independent of the examiner's experience.


Assuntos
Imageamento Tridimensional , Ultrassonografia Pré-Natal , Sistema Nervoso Central/diagnóstico por imagem , Feminino , Feto/anormalidades , Feto/diagnóstico por imagem , Humanos , Imageamento Tridimensional/métodos , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal/métodos
12.
Implement Sci ; 17(1): 60, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064428

RESUMO

BACKGROUND: Reducing the rate of stillbirth is an international priority. At least half of babies stillborn in high-income countries are small for gestational-age (SGA). The Growth Assessment Protocol (GAP), a complex antenatal intervention that aims to increase the rate of antenatal detection of SGA, was evaluated in the DESiGN type 2 hybrid effectiveness-implementation cluster randomised trial (n = 13 clusters). In this paper, we present the trial process evaluation. METHODS: A mixed-methods process evaluation was conducted. Clinical leads and frontline healthcare professionals were interviewed to inform understanding of context (implementing and standard care sites) and GAP implementation (implementing sites). Thematic analysis of interview text used the context and implementation of complex interventions framework to understand acceptability, feasibility, and the impact of context. A review of implementing cluster clinical guidelines, training and maternity records was conducted to assess fidelity, dose and reach. RESULTS: Interviews were conducted with 28 clinical leads and 27 frontline healthcare professionals across 11 sites. Staff at implementing sites generally found GAP to be acceptable but raised issues of feasibility, caused by conflicting demands on resource, and variable beliefs among clinical leaders regarding the intervention value. GAP was implemented with variable fidelity (concordance of local guidelines to GAP was high at two sites, moderate at two and low at one site), all sites achieved the target to train > 75% staff using face-to-face methods, but only one site trained > 75% staff using e-learning methods; a median of 84% (range 78-87%) of women were correctly risk stratified at the five implementing sites. Most sites achieved high scores for reach (median 94%, range 62-98% of women had a customised growth chart), but generally, low scores for dose (median 31%, range 8-53% of low-risk women and median 5%, range 0-17% of high-risk women) were monitored for SGA as recommended. CONCLUSIONS: Implementation of GAP was generally acceptable to staff but with issues of feasibility that are likely to have contributed to variation in implementation strength. Leadership and resourcing are fundamental to effective implementation of clinical service changes, even when such changes are well aligned to policy mandated service-change priorities. TRIAL REGISTRATION: Primary registry and trial identifying number: ISRCTN 67698474. Registered 02/11/16. https://doi.org/10.1186/ISRCTN67698474 .


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Natimorto , Atenção à Saúde , Feminino , Feto , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1292-1295, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36085674

RESUMO

The fetal heart rate (fHR) plays an important role in the determination of the good health of the fetus. Beside the traditional Doppler ultrasound technique, non-invasive fetal electrocardiography (fECG) has become an interesting alternative. However, extracting clean fECG from abdominal ECG (aECG) recordings is a challenging task due to the presence of the maternal ECG component and various noise sources. In this context, we propose a deep residual convolutional autoencoder network trained on synthetic aECG simulations followed by a transfer learning phase on real aECG recordings to extract the cleanest fECG. Afterwards, we propose to use a non-negative matrix factorization based approach on the obtained fECG to estimate the fHR. Our method is evaluated on three publicly available databases demonstrating that it can provide significant performance improvement against comparative methodologies. Clinical relevance- The presented method has the advantage of estimating the fetal heart rate from a single-channel abdominal electrocardiogram without prior knowledge on the noise sources nor the maternal R-peak locations.


Assuntos
Algoritmos , Frequência Cardíaca Fetal , Progressão da Doença , Eletrocardiografia , Feminino , Feto , Humanos , Gravidez
14.
J Clin Pharmacol ; 62 Suppl 1: S67-S78, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106777

RESUMO

Delivering safe clinical trials of novel therapeutics is central to enable pregnant women and their babies to access medicines for better outcomes. This review describes clinical monitoring of fetal well-being and safety. Current pregnancy surveillance includes regular antenatal checks of blood pressure and urine for signs of gestational hypertension. Fetal and placental development is assessed routinely using the first-trimester "dating" and mid-trimester "anomaly" ultrasound scans, but the detection of fetal anomalies can continue throughout pregnancy using targeted sonography or magnetic resonance imaging (MRI). Serial sonography can be used to assess fetal size, well-being, and placental function. Carefully defined reproducible imaging parameters, such as the head circumference (HC), abdominal circumference (AC), and femur length (FL), are combined to calculate an estimate of the fetal weight. Doppler analysis of maternal uterine blood flow predicts placental insufficiency, which is associated with poor fetal growth. Fetal doppler analysis can indicate circulatory decompensation and fetal hypoxia, requiring delivery to be expedited. Novel ways to assess fetal well-being and placental function using MRI, computerized cardiotocography (CTG), serum circulating fetoplacental proteins, and mRNA may improve the assessment of the safety and efficacy of maternal and fetal interventions. Progress has been made in how to define and grade clinical trial safety in pregnant women, the fetus, and neonate. A new system for improved safety monitoring for clinical trials in pregnancy, Maternal and Fetal Adverse Event Terminology (MFAET), describes 12 maternal and 18 fetal adverse event (AE) definitions and severity grading criteria developed through an international modified Delphi consensus process. This fills a vital gap in maternal and fetal translational medicine research.


Assuntos
Hipertensão Induzida pela Gravidez , Ultrassonografia Pré-Natal , Feminino , Feto/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Placenta , Gravidez
15.
J Clin Pharmacol ; 62 Suppl 1: S53-S66, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106782

RESUMO

One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy- and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit-like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development.


Assuntos
Doenças Fetais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/tratamento farmacológico , Criança , Eletrocardiografia , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/tratamento farmacológico , Feto , Humanos , Recém-Nascido , Gravidez , Prognóstico
17.
Sci Signal ; 15(751): eabi5453, 2022 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-36099339

RESUMO

The premature rupture of the amniotic sac, a condition referred to as a preterm prelabor rupture of membranes (pPROM), is a leading cause of preterm birth. In some cases, these ruptured membranes heal spontaneously. Here, we investigated repair mechanisms of the amnion, a layer of epithelial cells in the amniotic sac closest to the embryo. Macrophages migrated to and resided at rupture sites in both human and mouse amnion. A process called epithelial-mesenchymal transition (EMT), in which epithelial cells acquire a mesenchymal phenotype and which is implicated in tissue repair, was observed at rupture sites. In dams bearing macrophage-depleted fetuses, the repair of amnion ruptures was compromised, and EMT was rarely detected at rupture sites. The migration of cultured amnion epithelial cells in wound healing assays was mediated by EMT through transforming growth factor-ß (TGF-ß)-Smad signaling. These findings suggest that fetal macrophages are crucial in amnion repair because of their ability to induce EMT in amnion epithelial cells.


Assuntos
Ruptura Prematura de Membranas Fetais , Nascimento Prematuro , Âmnio , Animais , Transição Epitelial-Mesenquimal , Feminino , Feto , Humanos , Recém-Nascido , Macrófagos , Camundongos
18.
Biomed Pharmacother ; 154: 113613, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36058146

RESUMO

Acetaminophen is among the most widely used analgesics; however, the proportion and mechanism of transplacental transfer of unbound acetaminophen with actual pharmacological activity remain unknown. Our hypothesis is that acetaminophen gradually penetrates the blood-placenta barrier to reach the fetus. A multiple microdialysis coupled to liquid chromatography with photodiode array detection method was developed to monitor acetaminophen levels in the maternal blood, placenta, fetus, and amniotic fluid of a pregnant rat and investigate this hypothesis. The pharmacokinetic data indicates that acetaminophen exhibits a nonlinear behavior in the maternal blood within the dosage regimen of 100 and 300 mg/kg. In addition, acetaminophen penetrates the placenta, fetus, and amniotic fluid during treatment. The transplacental transfer ratio represented by the area under the concentration curve (AUC) ratio for the conceptus (the collective term for the fetus, placenta, and amniotic fluid) and maternal blood (AUCtissue/AUCblood) was approximately 11-23 % after acetaminophen (100 and 300 mg/kg) administration. However, the transporter of multidrug resistance-associated protein (MRP) inhibitor MK-571 did not significantly change the transplacental transfer ratio. This basic study provides constructive information for the clinical application of acetaminophen in pregnant women.


Assuntos
Acetaminofen , Troca Materno-Fetal , Acetaminofen/metabolismo , Líquido Amniótico/metabolismo , Animais , Cromatografia Líquida , Feminino , Feto/metabolismo , Humanos , Placenta/metabolismo , Gravidez , Ratos
19.
Dis Markers ; 2022: 1664474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36046373

RESUMO

Background: Increasing evidence reveals that iron deficiency during pregnancy causes adverse pregnancy outcomes. Thus far, the mechanisms underlying iron deficiency-associated preterm birth are mostly limited to animal studies. Whether the suggested mechanisms exist in human requires further investigation. The goal of this study was to characterize the iron metabolism in both the maternal side and fetal side in pregnant women with preterm birth. Methods: Serum and placenta samples were collected from 42 pregnant women divided into four groups according to the gestational week. Indicators of iron metabolism, including serum iron, serum hepcidin, placental tissue iron, ferroportin (FPN), transferrin receptor 1 (TfR1), and ferritin, were surveyed using enzyme-linked immunosorbent assays (Elisa), Western blots, and real-time quantitative polymerase chain reactions (qRT-PCR). Results: Significant reduction of maternal serum iron was observed in women with preterm birth relative to those with full-term birth, indicative of worsen iron deficiency in those mothers with preterm birth. Meanwhile, the maternal hepcidin levels were notably diminished in women with preterm birth, whereas the fetal hepcidin levels were comparable between the two groups. Moreover, the placental iron stores were remarkably reduced in the preterm group, associated with reduced concentration of TfR1 and increased FPN concentration relative to the normal controls. In other words, the ratio of placental FPN mass to TfR1 mass (PIDI index) was strikingly increased in the preterm group. Conclusions: Dysregulated iron homeostasis in both the maternal and fetal sides was implicated in preterm births, and disordered regulations in maintaining the placental iron equilibrium were also presumed to account for the compromised fetal iron supply.


Assuntos
Deficiências de Ferro , Nascimento Prematuro , Feminino , Feto/metabolismo , Hepcidinas , Humanos , Recém-Nascido , Ferro , Placenta/metabolismo , Gravidez , Nascimento Prematuro/metabolismo
20.
BMC Pregnancy Childbirth ; 22(1): 681, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057566

RESUMO

BACKGROUND: Coexistence of molar pregnancy with living fetus represents a challenge in diagnosis and treatment. The objective of this study to present the outcome of molar pregnancy with a coexisting living fetus who were managed in our University Hospital in the last 5 years. METHODS: We performed a retrospective analysis of patients who presented with molar pregnancy with a coexisting living fetus to our Gestational Trophoblastic Clinic, Mansoura University, Egypt from September, 2015 to August, 2020. Clinical characteristics of the patients, maternal complications as well as fetal outcome were recorded. The patients and their living babies were also followed up at least 6 months after delivery. RESULTS: Twelve pregnancies were analyzed. The mean maternal age was 26.0 (SD 4.1) years and the median parity was 1.0 (range 0-3). Duration of the pregnancies ranged from 14 to 36 weeks. The median serum hCG was 165,210.0 U/L (range 7662-1,200,000). Three fetuses survived outside the uterus (25%), one of them died after 5 months because of congenital malformations. Histologic diagnosis was available for 10 of 12 cases and revealed complete mole associated with a normal placenta in 6 cases (60%) and partial mole in 4 cases (40%). Maternal complications occurred in 6 cases (50%) with the most common was severe vaginal bleeding in 4 cases (33.3%). There was no significant association between B-hCG levels and maternal complications (P = 0.3). CONCLUSION: Maternal and fetal outcomes of molar pregnancy with a living fetus are poor. Counseling the patients for termination of pregnancy may be required. TRIAL REGISTRATION: The study was approved by Institutional Research Board (IRB), Faculty of Medicine, Mansoura University (number: R.21.10.1492).


Assuntos
Mola Hidatiforme , Neoplasias Uterinas , Adulto , Feminino , Feto/patologia , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/tratamento farmacológico , Mola Hidatiforme/patologia , Idade Materna , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/tratamento farmacológico
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