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1.
Theriogenology ; 195: 229-237, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36370509

RESUMO

Disturbances at the conceptus-maternal interface can have detrimental effects on pregnancy outcome. Additionally, changes in body condition and exogenously administered gonadotropins could affect ovarian and uterine function, including cell proliferation and ovulation rates, and alter endometrial receptivity. In ruminants, endometrial caruncles maintain placental function via interaction with fetal chorionic cotyledons. Here, the effects of feeding regimens on the expression of selected genes known to be involved in uterine receptivity were investigated in the caruncles of control and FSH-superovulated ewes. Sheep were grouped according to their diet: control fed (CF), overfed (OF) or underfed (UF), and were either superovulated with FSH (SOV) or untreated (CON, naturally cycling) (n = 3-5/group). Caruncular samples for the assessment of the transcript levels of 11 target genes were collected at either the early (day 5) or mid-luteal (day 10) phases of the luteal lifespan, resulting in 12 groups of animals. The day of the estrous cycle affected the expression of ITGAV, ITGB3, FGF10 and IGFBP3 mRNA. There was lower expression of MUC1, and higher expression of FGF10, ITGB3 and FN1, on day 10 in CF_SOV animals. Compared with CF, expression of integrins (ITGB3, ITGA5 and ITGA4) was higher in OF and UF, and higher transcript levels of HGF and IGFBP3 in UF animals on day 10. Expression of ITGA5, ITGB1, -3, -5 and MUC1 was greater in OF_SOV than CF_SOV at day 10. In conclusion, it appears that imbalanced nutrition, by altering the expression of genes responsible for intercellular communication, cell adhesion, and encoding for growth factors, could affect the uterine responsiveness to exogenously applied hormonal stimulation and, likely, uterine receptivity.


Assuntos
Desnutrição , Doenças dos Ovinos , Ovinos , Feminino , Animais , Gravidez , Hormônio Foliculoestimulante/farmacologia , Placenta , Implantação do Embrião , Estado Nutricional , Desnutrição/veterinária , Expressão Gênica
2.
J Steroid Biochem Mol Biol ; 225: 106202, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36241036

RESUMO

Human 3ß-hydroxysteroid dehydrogenase type I (HSD3B1) and rat type IV (HSD3B4) in placentas catalyze the conversion of pregnenolone to progesterone, which plays a key role in maintaining pregnancy. Many phenolic compounds potentially inhibit HSD3B in placentas as endocrine disruptors. In this study, the effects of 16 phenolic compounds on the activity of human HSD3B1 and rat HSD3B4 were determined and the structure-activity relationship was compared. HSD3B1 in human placental microsomes and HSD3B4 in rat placental microsomes were used to measure their activities and pregnenolone and NAD+ were used as substrates. Of the 16 phenolic compounds, 4-nonylphenol, pentabromophenol, and 2-bromophenol resulted in residual human HSD3B1 activity lower than 50 % and 4-nonylphenol and pentabromophenol resulted in residual rat HSD3B4 activity lower than 50 %. 4-Nonylphenol, pentabromophenol, and 2-bromophenol were mixed inhibitors of human HSD3B1, with Ki values of 2.31, 3.58 and 4.86 µM, respectively, while 4-nonylphenol and pentabromophenol were noncompetitive inhibitors of rat HSD3B4 with Ki values of 20.86 and 141.8 µM. Molecular docking showed that 4-nonylphenol, pentabromophenol, and 2-bromophenol docked to the active sites of human HSD3B1 and rat HSD3B4, and the shift of residue S125 in human HSD3B1 to T125 in rat HSD3B4 could explain the species-dependent difference in their inhibitory potency and mode of action. This study demonstrates that 4-nonylphenol, pentabromophenol, and 2-bromophenol are mixed inhibitors of human placental HSD3B1, while 4-nonylphenol and pentabromophenol are noncompetitive inhibitors of rat HSD3B4, possibly blocking the placental steroidogenesis.


Assuntos
Complexos Multienzimáticos , Placenta , Humanos , Feminino , Gravidez , Ratos , Animais , Simulação de Acoplamento Molecular , Complexos Multienzimáticos/química , Complexos Multienzimáticos/farmacologia , Pregnenolona/farmacologia , 3-Hidroxiesteroide Desidrogenases
3.
Sci Total Environ ; 856(Pt 1): 159060, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36174702

RESUMO

Microplastics are ubiquitous in the environment, including in food and drinking water. Consequently, there is growing concern about the human health risks associated with microplastic exposure through diet. However, the occurrence of microplastics in the human body, particularly in mothers and fetuses, is incompletely understood because of the limited amount of data on their presence in the body and the human placenta. This study evaluated the presence and characteristics of microplastics in 17 placentas using laser direct infrared (LD-IR) spectroscopy. Microplastics were detected in all placenta samples, with an average abundance of 2.70 ± 2.65 particles/g and a range of 0.28 to 9.55 particles/g. Among these microplastics, 11 polymer types were identified. The microplastics were mainly composed of polyvinyl chloride (PVC, 43.27 %), polypropylene (PP, 14.55 %), and polybutylene succinate (PBS, 10.90 %). The sizes of these microplastics ranged from 20.34 to 307.29 µm, and most (80.29 %) were smaller than 100 µm. Most of the smaller microplastics were fragments, but fibers dominated the larger microplastics (200-307.29 µm). Interestingly, the majority of PVC and PP were smaller than 200 µm. This study provides a clearer understanding of the shape, size, and nature of microplastics in the human placenta. Importantly, these data also provide crucial information for performing risk assessments of the exposure of fetuses to microplastics in the future.


Assuntos
Microplásticos , Poluentes Químicos da Água , Humanos , Feminino , Gravidez , Plásticos , Cloreto de Polivinila , Monitoramento Ambiental , Poluentes Químicos da Água/análise , Espectrofotometria Infravermelho , Lasers , Placenta/química
4.
Physiol Rev ; 103(1): 347-389, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-35771984

RESUMO

Flexibly selecting appropriate actions in response to complex, ever-changing environments requires both cortical and subcortical regions, which are typically described as participating in a strict hierarchy. In this traditional view, highly specialized subcortical circuits allow for efficient responses to salient stimuli, at the cost of adaptability and context specificity, which are attributed to the neocortex. Their interactions are often described as the cortex providing top-down command signals for subcortical structures to implement; however, as available technologies develop, studies increasingly demonstrate that behavior is represented by brainwide activity and that even subcortical structures contain early signals of choice, suggesting that behavioral functions emerge as a result of different regions interacting as truly collaborative networks. In this review, we discuss the field's evolving understanding of how cortical and subcortical regions in placental mammals interact cooperatively, not only via top-down cortical-subcortical inputs but through bottom-up interactions, especially via the thalamus. We describe our current understanding of the circuitry of both the cortex and two exemplar subcortical structures, the superior colliculus and striatum, to identify which information is prioritized by which regions. We then describe the functional circuits these regions form with one another, and the thalamus, to create parallel loops and complex networks for brainwide information flow. Finally, we challenge the classic view that functional modules are contained within specific brain regions; instead, we propose that certain regions prioritize specific types of information over others, but the subnetworks they form, defined by their anatomical connections and functional dynamics, are the basis of true specialization.


Assuntos
Objetivos , Placenta , Animais , Encéfalo/fisiologia , Feminino , Humanos , Mamíferos , Gravidez , Tálamo/fisiologia
5.
Methods Mol Biol ; 2558: 1-10, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36169851

RESUMO

Procedures are described for the purification of the mitochondrial-bound enzymes human and bovine monoamine oxidases A and B (MAO A and B) from placental and liver tissue sources, respectively. Enzyme purification follows isolation of the mitochondria and preparation of outer membrane particles. The membrane-bound enzymes are solubilized by treatment of membranes with phospholipases and detergent extraction. Functional bovine MAO B is purified by polymer fractionation and differential centrifugation. Functional human MAO A is purified by ion-exchange DEAE-Sepharose chromatography.


Assuntos
Detergentes , Mitocôndrias Hepáticas , Animais , Bovinos , Feminino , Humanos , Mamíferos , Monoaminoxidase , Fosfolipases , Placenta , Polímeros , Gravidez
6.
Horm Metab Res ; 54(2): 76-83, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35130568

RESUMO

The aim of the study was to evaluate the effects of thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) on maternal and neonatal adverse outcomes in pregnant women. A total of 296 singleton pregnant women were classified into four groups according to the thyroid auto-antibody in the first trimester. Finally, there were 97 women in TPOAb positive group (TPOAb+/TgAb-), 35 in TgAb positive group (TPOAb-/TgAb+), 85 in TPOAb and TgAb positive group (TPOAb+/TgAb+), and 79 in TPOAb and TgAb negative group (TPOAb-/TgAb-). Thyroid function, TPOAb, and TgAb were checked during pregnancy and followed up at 6 weeks, 3 months, 6 months, 9 months, and 12 months postpartum. Levothyroxine sodium tablets could be taken to maintain euthyroid antepartum. Thyroid function of women with postpartum thyroiditis (PPT) were followed up at 2 and 3 years postpartum. We observed the incidence of PPT, premature rupture of membranes (PROM), placental abruption, placenta previa, polyhydramnios, oligohydramnios, postpartum hemorrhage, preterm birth, and low birth Weight in the four groups. 19.93% of the women had PPT. The incidence of PPT in TPOAb+/TgAb-, TPOAb-/TgAb+, TPOAb+/TgAb+groups was significantly higher than that in TPOAb-/TgAb- group, respectively (16.49 vs. 6.33%, 22.86 vs. 6.33%, 35.29 vs. 6.33%, p <0.05). The incidence of PPT in TPOAb+/TgAb+group was significantly higher than that in TPOAb+/TgAb- group (35.29 vs. 16.49%, p <0.01). PPT occurred as early as 6 weeks postpartum, but mainly at 3 and 6 months postpartum in the four groups (62.50%, 75.00%, 70.00%, 80.00%). All PPT in TPOAb-/TgAb- group occurred within 6 months postpartum, while it was found at 9 months or 12 months postpartum in other three groups. There was no classical form of PPT in TPOAb-/TgAb- group, while in the other three groups, all three types (classical form, isolated thyrotoxicosis, isolated hypothyroidism) existed. At 2 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb+group was significantly lower than that in TPOAb-/TgAb- group (p <0.05). At 3 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb-, TPOAb-/TgAb+, and TPOAb+/TgAb+groups were significantly lower than that in TPOAb-/TgAb- group (p <0.05). The values of TPOAb and TgAb postpartum were significantly higher than those during pregnancy (p <0.05). The incidence of PROM in TPOAb+/TgAb- group was significantly higher than that in TPOAb-/TgAb- group (32.99 vs. 17.72%, p <0.05). The binary logistic regression for PPT showed that the OR value of TPOAb was 2.263 (95% CI 1.142-4.483, p=0.019). The OR value of TgAb was 3.112 (95% CI 1.700-5.697, p=0.000). In conclusion, pregnant women with positive thyroid auto-antibodies had an increased risk of PPT and a reduced rate of euthyroidism at 2 and 3 years postpartum. TPOAb is associated with the incidence of PROM. Both of TPOAb and TgAb were independent risk factors for PPT. TgAb deserves more attention when studying autoimmune thyroid disease (AITD) combined with pregnancy.


Assuntos
Hipotireoidismo , Nascimento Prematuro , Autoanticorpos , Feminino , Humanos , Hipotireoidismo/epidemiologia , Recém-Nascido , Iodeto Peroxidase , Placenta , Gravidez , Gestantes , Tireoglobulina
7.
Mol Cells ; 45(11): 846-854, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36380734

RESUMO

Neurons make long-distance connections via their axons, and the accuracy and stability of these connections are crucial for brain function. Research using various animal models showed that the molecular and cellular mechanisms underlying the assembly and maintenance of neuronal circuitry are highly conserved in vertebrates. Therefore, to gain a deeper understanding of brain development and maintenance, an efficient vertebrate model is required, where the axons of a defined neuronal cell type can be genetically manipulated and selectively visualized in vivo. Placental mammals pose an experimental challenge, as time-consuming breeding of genetically modified animals is required due to their in utero development. Xenopus laevis, the most commonly used amphibian model, offers comparative advantages, since their embryos ex utero during which embryological manipulations can be performed. However, the tetraploidy of the X. laevis genome makes them not ideal for genetic studies. Here, we use Xenopus tropicalis, a diploid amphibian species, to visualize axonal pathfinding and degeneration of a single central nervous system neuronal cell type, the retinal ganglion cell (RGC). First, we show that RGC axons follow the developmental trajectory previously described in X. laevis with a slightly different timeline. Second, we demonstrate that co-electroporation of DNA and/or oligonucleotides enables the visualization of gene function-altered RGC axons in an intact brain. Finally, using this method, we show that the axon-autonomous, Sarm1-dependent axon destruction program operates in X. tropicalis. Taken together, the present study demonstrates that the visual system of X. tropicalis is a highly efficient model to identify new molecular mechanisms underlying axon guidance and survival.


Assuntos
Placenta , Células Ganglionares da Retina , Feminino , Gravidez , Animais , Células Ganglionares da Retina/metabolismo , Axônios/fisiologia , Xenopus , Xenopus laevis , Mamíferos
8.
Clin Sci (Lond) ; 136(22): 1615-1629, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36383187

RESUMO

Cell-free fetal DNA (cffDNA) is released into the maternal circulation from trophoblastic cells during pregnancy, is detectable from 4 weeks and is representative of the entire fetal genome. The presence of this cffDNA in the maternal bloodstream has enabled clinical implementation of non-invasive prenatal diagnosis (NIPD) for monogenic disorders. Detection of paternally inherited and de novo mutations is relatively straightforward, and several methods have been developed for clinical use, including quantitative polymerase chain reaction (qPCR), and PCR followed by restriction enzyme digest (PCR-RED) or next-generation sequencing (NGS). A greater challenge has been in the detection of maternally inherited variants owing to the high background of maternal cell-free DNA (cfDNA). Molecular counting techniques have been developed to measure subtle changes in allele frequency. For instance, relative haplotype dosage analysis (RHDO), which uses single nucleotide polymorphisms (SNPs) for phasing of high- and low-risk alleles, is clinically available for several monogenic disorders. A major drawback is that RHDO requires samples from both parents and an affected or unaffected proband, therefore alternative methods, such as proband-free RHDO and relative mutation dosage (RMD), are being investigated. cffDNA was thought to exist only as short fragments (<500 bp); however, long-read sequencing technologies have recently revealed a range of sizes up to ∼23 kb. cffDNA also carries a specific placental epigenetic mark, and so fragmentomics and epigenetics are of interest for targeted enrichment of cffDNA. Cell-based NIPD approaches are also currently under investigation as a means to obtain a pure source of intact fetal genomic DNA.


Assuntos
Ácidos Nucleicos Livres , Feminino , Gravidez , Humanos , Ácidos Nucleicos Livres/genética , Placenta , Diagnóstico Pré-Natal/métodos , Haplótipos , DNA/genética
9.
BMC Vet Res ; 18(1): 404, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36380376

RESUMO

This study aimed to correlate the pulsed wave spectral indices of the middle uterine artery at both sides with placental development in jenny within mid-late pregnancies, and establish umbilical Doppler values for different ages and different gestational months. Twenty Equus Asinus pregnant jennies 260-450 kg (average, 320 ± 10 kg) were examined from 5 to 9 months of pregnancy with different ages (4-14 years). Monthly B-mode ultrasound examination was performed on both the combined thickness of the uterus and placenta (CTUP; mm) and umbilical artery cross-sectional diameter, and Doppler mode examination was performed on both the middle uterine (MUA at right [R] and left [L] sides) and umbilical arteries to measure both Doppler indices that expressed by resistance (RI) and pulsatility indices (PI), and blood flow rate. CTUP was elevated within pregnancy time at different ages (P < 0.05). L. PI was significantly declined throughout different ages (P < 0.05), but this declining trend was not observed in L. RI. The L. blood flow rate (R; bpm) was elevated among different ages and different months (P < 0.05). Both RI and PI were significantly decreased from 5 to 9 month of gestation period in jennies (P < 0.05).. The umbilical arteries cross-sectional diameter (Umb A; mm), was elevated among different ages and different months, while both Doppler indices were declined. A positive correlation was found (between both Doppler indices of both umbilical and uterine arteries P < 0.001). There was elevated vascular perfusion in uterine and umbilical arteries associated with reduced both Doppler indices along the course of pregnancy at different ages.


Assuntos
Equidae , Artérias Umbilicais , Feminino , Gravidez , Animais , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/fisiologia , Placenta/diagnóstico por imagem , Ultrassonografia Pré-Natal/veterinária , Velocidade do Fluxo Sanguíneo , Ultrassonografia Doppler/veterinária , Útero/diagnóstico por imagem , Hemodinâmica , Envelhecimento , Perfusão/veterinária
10.
Malar J ; 21(1): 336, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36380370

RESUMO

BACKGROUND: Eotaxin-1 concentrations in plasma have been inversely associated with malaria exposure, malaria infection and pregnancy, but the effect of these conditions on the levels of the related chemokines eotaxin-2 and eotaxin-3 remains unknown. METHODS: Eotaxin-2 and -3 concentrations were measured in 310 peripheral or placental plasma samples from pregnant and non-pregnant individuals from Papua New Guinea (malaria-endemic country) and Spain (malaria-naïve individuals) with previous data on eotaxin-1 concentrations. Correlations between eotaxin concentrations were examined with the Spearman's test. Differences in eotaxin concentrations among groups were evaluated with the Kruskal-Wallis or Mann Whitney tests. The pairwise Wilcoxon test was performed to compare eotaxin-2 concentration between peripheral and placental matched plasmas. Univariable and multivariable linear regression models were estimated to assess the association between eotaxins and Plasmodium infection or gestational age. RESULTS: Eotaxin-2 concentrations in plasma showed a weak positive correlation with eotaxin-3 (rho = 0.35, p < 0.05) concentrations. Eotaxin-2 concentrations in the malaria-exposed non-pregnant group were significantly lower than the in the malaria-naive non-pregnant and the malaria-exposed pregnant groups. Eotaxin-3 plasma concentrations were lower in malaria-exposed than in non-exposed groups (p < 0.05), but no differences were found associated to pregnancy. Eotaxin-2 and eotaxin-3 plasma concentrations were negatively correlated with anti-Plasmodium IgG levels: PfDBL5ε-IgG (rhoEo2 = - 0.35, p = 0.005; rhoEo3 =- 0.37, p = 0.011), and eotaxin-3 was negatively correlated with PfDBL3x-IgG levels (rhoEo3 =- 0.36; p = 0.011). Negative correlations of eotaxin-2 and 3 in plasma were also observed with atypical memory B cells (rhoEo2 = - 0.37, p < 0.001; rhoEo3= - 0.28, p = 0.006), a B cell subset expanded in malaria-exposed individuals. In addition, a borderline negative association was observed between eotaxin-3 concentrations and Plasmodium infection (adjusted effect estimate, ß = - 0.279, 95% CI - 0.605; 0.047, p = 0.091). Moreover, eotaxin-2 placental concentrations were significantly increased compared to peripheral concentrations in the malaria-exposed pregnant group whereas the contrary was observed in the non-exposed pregnant group (p < 0.005). CONCLUSION: Although a clear epidemiological negative association is observed between eotaxins concentrations and malaria exposure and/or infection, pregnancy may alter this association for eotaxin-2. Further research is required to understand the role of these chemokines in this disease and in combination with pregnancy.


Assuntos
Malária Falciparum , Malária , Complicações Infecciosas na Gravidez , Complicações Parasitárias na Gravidez , Feminino , Gravidez , Humanos , Quimiocina CCL11 , Quimiocina CCL26 , Quimiocina CCL24 , Placenta , Malária/complicações , Imunoglobulina G , Malária Falciparum/complicações , Plasmodium falciparum
11.
PLoS Pathog ; 18(11): e1010924, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36383559

RESUMO

Malaria during pregnancy is a major global health problem caused by infection with Plasmodium falciparum parasites. Severe effects arise from the accumulation of infected erythrocytes in the placenta. Here, erythrocytes infected by late blood-stage parasites adhere to placental chondroitin sulphate A (CS) via VAR2CSA-type P. falciparum erythrocyte membrane protein 1 (PfEMP1) adhesion proteins. Immunity to placental malaria is acquired through exposure and mediated through antibodies to VAR2CSA. Through evolution, the VAR2CSA proteins have diversified in sequence to escape immune recognition but retained their overall macromolecular structure to maintain CS binding affinity. This structural conservation may also have allowed development of broadly reactive antibodies to VAR2CSA in immune women. Here we show the negative stain and cryo-EM structure of the only known broadly reactive human monoclonal antibody, PAM1.4, in complex with VAR2CSA. The data shows how PAM1.4's broad VAR2CSA reactivity is achieved through interactions with multiple conserved residues of different sub-domains forming conformational epitope distant from the CS binding site on the VAR2CSA core structure. Thus, while PAM1.4 may represent a class of antibodies mediating placental malaria immunity by inducing phagocytosis or NK cell-mediated cytotoxicity, it is likely that broadly CS binding-inhibitory antibodies target other epitopes at the CS binding site. Insights on both types of broadly reactive monoclonal antibodies may aid the development of a vaccine against placental malaria.


Assuntos
Malária Falciparum , Malária , Humanos , Feminino , Gravidez , Antígenos de Protozoários , Malária Falciparum/parasitologia , Epitopos , Anticorpos Antiprotozoários , Anticorpos Monoclonais , Microscopia Crioeletrônica , Placenta/metabolismo , Plasmodium falciparum/metabolismo , Eritrócitos/parasitologia , Sulfatos de Condroitina/metabolismo
12.
Afr Health Sci ; 22(2): 187-193, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407362

RESUMO

Background: Malaria during pregnancy escalates the damaging consequence to the mother and neonate. The usage of intermittent preventive treatment of malaria (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for averting the deleterious consequences of malaria in pregnancy. This study evaluated the effectiveness of, and compliance with the use of SP for malaria among pregnant women in Port Harcourt Rivers State, Nigeria. Method: A total of 300 samples of maternal peripheral blood (MPB), 84 neonatal cord blood (NCB) and 84 placental blood (PLB) were collected from consenting mothers. Malaria parasitaemia were analysed using standard parasitological methods, and bio-data of consenting mothers were collected through questionnaires and from ANC records. Results: Out of the samples examined for MPB, 59(19.7%) tested positive to malaria. Those with only primary education (57.1%) and women of age ≤ 20yrs (25%) had higher prevalence. Women who took SP had significantly lower prevalence (17.6%) than those that took other drugs (36.4%) (p < 0.05). Malaria prevalence was highest among women who had 3 months interval between each dose (39.1%), followed by those of 2months (23.7%) and those of 1 month (7.0%) (p < 0.05). The primigravidaes (22.8%) had an insignificantly higher prevalence than secundigravidae (19.4%) and multigravidae (15.9%). Also, 30.5% of women who registered in their third trimester of pregnancy had a significantly higher malaria parasitaemia than those who registered during their first 8.10%, or second trimesters, 19.4%. Of the 84 MPB-NCB-PLB pairedamples examined, 16.7%, 8.3% and 25% respectively were infected with malaria parasitaemia. On frequency of compliance, mothers who took SP once (37.5%) had a significantly higher MPB parasitaemia than those who took it twice (7.84%) and those of thrice (6.25%). Neonatal cord blood parasitaemia prevalence revealed that those that took SP once, that is, 25%, had a higher prevalence than others like those of twice (5.88%) and thrice (0%) respectively. Conclusion: The use and compliance of SP reduced the prevalence of malaria among pregnant women and their new-borns.


Assuntos
Antimaláricos , Malária , Complicações Parasitárias na Gravidez , Humanos , Recém-Nascido , Feminino , Gravidez , Adulto Jovem , Adulto , Gestantes , Nigéria/epidemiologia , Complicações Parasitárias na Gravidez/epidemiologia , Complicações Parasitárias na Gravidez/prevenção & controle , Antimaláricos/uso terapêutico , Placenta , Malária/epidemiologia , Malária/prevenção & controle , Malária/tratamento farmacológico , Parasitemia/epidemiologia , Parasitemia/prevenção & controle , Parasitemia/tratamento farmacológico
13.
Eur Rev Med Pharmacol Sci ; 26(21): 7905-7911, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36394739

RESUMO

OBJECTIVE: This study evaluated the correlation between placental lakes and non-reassuring fetal status. SUBJECTS AND METHODS: We analyzed data from pregnant women who underwent fetal echocardiography at the Fujian Maternity and Child Health Hospital. Women with singleton pregnancies at a gestational age of 20-24 weeks were included. Sociodemographic and clinical data were collected. Pregnant women with (case group) and without (control group) placental lakes were screened, and their placental Doppler ultrasound data and pregnancy outcome were recorded. Univariate and multivariable analyses were done to evaluate the correlation between the volume of placental lakes and the non-reassuring fetal status. RESULTS: A total of 1,728 pregnant women (156 with placental lakes) were included in this study. There were no significant differences in age of delivery and BMI between the pregnant women with placental lakes and the control group. The non-reassuring fetal status rate in the case group was higher than that in the control population, without statistical significance (5.8% vs. 3.5%, p=0.226). Subgroup analysis showed that a higher volume of placental lakes was positively associated with non-reassuring fetal status risk, with an odds ratio (OR) (95% CI) of 1.90 (1.29-2.66) (p for trend < 0.001). This positive correlation persisted even after adjustment for confounding factors. CONCLUSIONS: Taken together, our analyses demonstrated a graded increase in the non-reassuring fetal status rate with increased volume of placental lakes. Thus, robust clinical monitoring of placental lakes would help in timely detection of non-reassuring fetal status.


Assuntos
Lagos , Placenta , Criança , Feminino , Humanos , Gravidez , Lactente , Estudos Retrospectivos , Estudos Prospectivos , Resultado da Gravidez
14.
BMC Pregnancy Childbirth ; 22(1): 847, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397012

RESUMO

BACKGROUND: Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases. METHODS: We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups-blood transfusion and non-transfusion-to compare the maternal characteristics and pregnancy outcomes. RESULTS: In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group. CONCLUSIONS: In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.


Assuntos
Descolamento Prematuro da Placenta , Coagulação Intravascular Disseminada , Hemorragia Pós-Parto , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Placenta , Morte Fetal/etiologia , Natimorto , Transfusão de Sangue , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Dacarbazina
15.
Rev Colomb Obstet Ginecol ; 73(3): 283-316, 2022 09 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36331304

RESUMO

Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia. Materials and methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80%, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus draftedfive recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic. Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the "intervention bundle" model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals. If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta. Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.


Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de "paquete de intervención" como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.


Assuntos
Placenta Prévia , Gravidez , Humanos , Feminino , Colômbia , Consenso , Placenta , Vagina
16.
Front Endocrinol (Lausanne) ; 13: 1039051, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36407306

RESUMO

Objective: We aimed to investigate the secular prevalence of gestational diabetes mellitus (GDM) and evaluate its adverse pregnancy outcomes among pregnant women in Hebei province, China. Methods: We analyzed the data from the monitoring information management system for pregnant women in 22 hospitals of Hebei province, China. In this study, 366,212 individuals with singleton live births from 2014 to 2021 were included, of whom 25,995 were diagnosed with gestational diabetes. We described the incidence of common complications and further analyzed the clinical characteristics in GDM patients and the relationship between GDM and adverse pregnancy outcomes. Results: The top 3 pregnancy complications in Hebei province are anemia, gestational hypertension, and GDM. The average incidence of GDM was 7.10% (25,995/366,212). The incidence rate of GDM significantly increased from 2014 to 2021 (χ2 trend = 7,140.663, P < 0.001). The top 3 regions with GDM incidence were Baoding (16.60%), Shijiazhuang (8.00%), and Tangshan (3.80%). The incidence of GDM in urban pregnant women (10.6%) is higher than that in rural areas (3.7%).The difference between the GDM and Non-GDM groups was statistically significant in terms of maternal age, gravidity, parity, education level, and incidence of pregnancy complications (gestational hypertension, heart diseases, and anemia) (P < 0.05). GDM individuals were at significantly increased risk of most assessed adverse pregnancy outcomes, including premature delivery, Cesarean delivery, uterine inertia, neonatal intensive care unit (NICU) admission, Apgar (activity-pulse-grimace-appearance-respiration) score at 1 min, and macrosomia (P < 0.05). The multivariate logistic regression analysis showed that GDM was an independent risk factor in terms of premature birth, Cesarean delivery, uterine inertia, placental abruption, NICU admission, and macrosomia. Conclusion: The risk of adverse pregnancy outcome in pregnant women with GDM is significantly increased. In order to reduce the occurrence of adverse pregnancy outcomes, effective interventions are needed.


Assuntos
Diabetes Gestacional , Hipertensão Induzida pela Gravidez , Doenças do Recém-Nascido , Complicações na Gravidez , Nascimento Prematuro , Inércia Uterina , Humanos , Recém-Nascido , Feminino , Gravidez , Diabetes Gestacional/diagnóstico , Resultado da Gravidez/epidemiologia , Macrossomia Fetal/epidemiologia , Prevalência , Placenta , Complicações na Gravidez/epidemiologia , Aumento de Peso , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , China/epidemiologia
17.
J Obstet Gynaecol Can ; 44(11): 1193-1208.e1, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36410937

RESUMO

OBJECTIVE: To provide clear and concise guidelines for the diagnosis and management of preterm prelabour rupture of membranes (PPROM) TARGET POPULATION: All patients with PPROM <37 weeks gestation BENEFITS, HARMS, AND COSTS: This guideline aims to provide the first Canadian general guideline on the management of preterm membrane rupture. It includes a comprehensive and up-to-date review of the evidence on the diagnosis, management, timing and method of delivery. EVIDENCE: The following search terms were entered into PubMed/Medline and Cochrane in 2021: preterm premature rupture of membranes, PPROM, chorioamnionitis, Nitrazine test, ferning, commercial tests, placental alpha microglobulin-1 (PAMG-1) test, insulin-like growth factor-binding protein-1 (IGFBP-1) test, ultrasonography, PPROM/antenatal corticosteroids, PPROM/Magnesium sulphate, PPROM/ antibiotic treatment, PPROM/tocolysis, PPROM/preterm labour, PPROM/Neonatal outcomes, PPROM/mortality, PPROM/outpatient/inpatient, PPROM/cerclage, previable PPROM. Articles included were randomized controlled trials, meta-analyses, systematic reviews, guidelines, and observational studies. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: All prenatal and perinatal health care providers. SUMMARY STATEMENTS: RECOMMENDATIONS.


Assuntos
Ruptura Prematura de Membranas Fetais , Trabalho de Parto Prematuro , Recém-Nascido , Feminino , Humanos , Gravidez , Placenta , Canadá , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/terapia , Idade Gestacional
18.
BMC Genomics ; 23(1): 760, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36411408

RESUMO

BACKGROUND: Retained placenta (RP) is a prevalent disorder in cattle with many health-related and economic costs for the farm owners. Its etiology has not been clarified yet and there is no definite therapy for this disorder. In this study we conducted RNA-seq, hematologic and histologic experiments to survey the causes of RP development. METHODS: Blood samples were collected from 4 RP and 3 healthy cows during periparturtion period for hematological assessments followed by placentome sampling within 30 min after parturition. Cows were grouped as RP and control in case the placenta was retained or otherwise expelled, respectively. Total RNA was extracted from placentome samples followed by RNA-sequencing. RESULTS: We showed 240 differentially expressed genes (DEGs) between the RP and control groups. Enrichment analyzes indicated immune system and lipid metabolism as prominent over- and under-represented pathways in RP cows, respectively. Hormonal assessments showed that estradiol-17ß (E2) was lower and cortisol tended to be higher in RP cows compared to controls at the day of parturition. Furthermore, histologic experiment showed that villi-crypt junctions remain tighter in RP cows compared to controls and the crypts layer seemed thicker in the placentome of RP cows. Complete blood cell (CBC) parameters were not significantly different between the two groups. CONCLUSION: Overall, DEGs derived from expression profiling and these genes contributed to enrichment of immune and lipid metabolism pathways. We suggested that E2 could be involved in development of RP and the concentrations of P4 and CBC counts periparturition might not be a determining factor.


Assuntos
Doenças dos Bovinos , Placenta Retida , Gravidez , Feminino , Humanos , Bovinos , Animais , Placenta Retida/genética , Placenta Retida/veterinária , Transcriptoma , Placenta , RNA
19.
Biomed Pharmacother ; 156: 113964, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36411641

RESUMO

Placental complication arises due to various risk factors occurring during the pregnancy period, leading to an increased morbidity rate. Placenta related disorders are one of primary reason for pregnancy related complications and the clinical incidences are seen to be on the rise. Most of the common disorders associated with placenta are pre-eclampsia, recurrent spontaneous abortions, intra-uterine growth restriction etc. Several studies have been done to understand the genetics and immunological attributes leading to the development of placenta associated complications. In the recent years, studies were able to establish and identify ncRNAs found specifically in foetal tissues such as the placenta. The aberrant expression patterns of ncRNA associated with placenta has been linked to disorders such as pre-eclampsia. Since ncRNA play a major role in regulating biological processes like trophoblast growth, migration and invasion, their aberrant expression could very well lead to complications like spontaneous pregnancy loss. This review article focuses on the association of ncRNAs - miRNAs, lncRNAs, CircRNAs in placenta associated complications as well as the different ncRNA based therapies. Deciphering the exact mechanism involved in the regulation and development of placenta through ncRNA will help in using it as a biomarker for early diagnosis. Understanding the therapeutic opportunities of ncRNAs in placental disorders will result in better treatment strategies.


Assuntos
Aborto Espontâneo , Pré-Eclâmpsia , Complicações na Gravidez , RNA Longo não Codificante , Feminino , Gravidez , Humanos , Pré-Eclâmpsia/genética , Pré-Eclâmpsia/metabolismo , Placenta/metabolismo , Aborto Espontâneo/metabolismo , RNA não Traduzido/genética , RNA não Traduzido/metabolismo , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Complicações na Gravidez/genética , Complicações na Gravidez/metabolismo
20.
J Matern Fetal Neonatal Med ; 35(25): 7119-7125, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36411677

RESUMO

OBJECTIVE: To determine the principal prognostic factors and neonatal outcomes associated with perinatal death in cases of early-onset intrauterine growth restriction (IUGR) due to placental insufficiency and to define the cutoff point for the risk of perinatal death. METHODS: A retrospective cohort study conducted with 198 pregnant women with a diagnosis of early-onset IUGR (as detected before the 32nd week of gestational age). The association between the dependent variable (perinatal death) and the independent variables was investigated using a multivariate logistic regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine the sensitivity and specificity of the adjusted model. A significance level of 5% was established for the entire statistical analysis. RESULTS: Perinatal deaths occurred in 89 (44.9%) of the 198 fetuses with early-onset IUGR. Birthweight <800 grams (OR: 14.73; 95%CI: 4.13-52.54; p < .001), postnatal need for mechanical ventilation (OR: 24.56; 95%CI: 5.58-108.08; p < .001) and postnatal use of an oxygen hood (OR: 0.09; 95%CI: 0.02-0.39; p = .001) remained significantly associated with neonatal death in the multivariate model. The sensitivity, specificity, positive and negative predictive values for birthweight <800 grams and need for mechanical ventilation as predictors of death were, respectively, 84%, 91%, 88%, 88% and 93%, 71%, 60% and 96%, while the values for use of an oxygen hood were, respectively, 15%, 62%, 15% and 62%. CONCLUSION: The principal determinants of perinatal death in fetuses with early-onset IUGR were birthweight <800 grams, gestational age at delivery <30 weeks and postnatal need for mechanical ventilation as risk factors while postnatal use of an oxygen hood was found to constitute a protective factor.


Assuntos
Morte Perinatal , Insuficiência Placentária , Recém-Nascido , Feminino , Gravidez , Humanos , Retardo do Crescimento Fetal/etiologia , Retardo do Crescimento Fetal/diagnóstico , Peso ao Nascer , Morte Perinatal/etiologia , Estudos Retrospectivos , Prognóstico , Placenta , Oxigênio
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