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1.
J Korean Med Sci ; 34(12): e105, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940999

RESUMO

Background: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. Methods: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. Results: The analysis included 672 Korean subjects (mean age, 44 years; range, 11-81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was 'live infant, no apparent congenital anomaly' in 195 subjects (92.42%) or 'lost to follow-up' in 16 subjects. Conclusion: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. Trial Registration: ClinicalTrials.gov Identifier: NCT01929291.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Vigilância de Produtos Comercializados , Adolescente , Adulto , Idoso , Criança , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/etiologia , Gravidez , Estudos Prospectivos , Prurido/etiologia , República da Coreia , Doenças Respiratórias/etiologia , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Adulto Jovem
2.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 471-474, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006211

RESUMO

Objective: To investigate the dose-response relationship between hemoglobin concentration and preterm birth, during pregnancy. Methods: With Zhuang ethnicity, a total of 12 780 pregnant women and their infants that admitted to Wuming、Pingguo、Jingxi、Debao、Longan and Tiandong hospitals, were recruited, in Guangxi Zhuang Autonomous Region, from January 2015 to December 2017. Non-conditional logistic regression method was used to analyze the effect of anemia on preterm birth during pregnancy. Dose-response relationship between hemoglobin concentration and preterm birth was explored, using the restrictive cubic spline model. Results: After excluding 2 053 pregnant women with hypertension or aged 35 years and over, results from the non-conditional logistic regression analysis showed that the risk of preterm birth in the anemia group was 1.29 times (OR=1.29, 95%CI: 1.04-1.59, P=0.019) of the non-anemia group in the first trimester. Data from the restricted cubic sample showed that there appeared nonlinear "L" dose-response relationship between hemoglobin concentration and preterm birth in the first trimester and "U" shape in the third trimester (non-linearity test P<0.001). Conclusion: There appeared nonlinear dose-response relationship between the hemoglobin concentration and preterm birth, both in the first and third trimesters.


Assuntos
Anemia/complicações , Retardo do Crescimento Fetal/epidemiologia , Hemoglobinas/metabolismo , Trabalho de Parto Prematuro/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Hematológicas na Gravidez , Resultado da Gravidez , Gestantes , Fatores de Risco
3.
J Matern Fetal Neonatal Med ; 32(4): 527-541, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29020827

RESUMO

OBJECTIVE: The objective of this study is to evaluate the frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes. STUDY DESIGN: Amniotic fluid (AF) was retrieved from both sacs in 90 twin gestations with preterm labor and intact membranes (gestational age between 20 and 34 6/7 weeks). Preterm labor was defined as the presence of painful regular uterine contractions, with a frequency of at least 2 every 10 min, requiring hospitalization. Fluid was cultured and assayed for matrix metalloproteinase-8. Intra-amniotic inflammation was defined as an AF matrix metalloproteinase-8 concentration >23 ng/mL. RESULTS: The prevalence of intra-amniotic inflammation for at least 1 amniotic sac was 39% (35/90), while that of proven intra-amniotic infection for at least one amniotic sac was 10% (9/90). Intra-amniotic inflammation without proven microbial invasion of the amniotic cavity was found in 29% (26/90) of the cases. Intra-amniotic inflammation was present in both amniotic sacs for 22 cases, in the presenting amniotic sac for 12 cases, and in the non-presenting amniotic sac for one case. Women with intra-amniotic inflammation observed in at least one amniotic sac and a negative AF culture for microorganisms had a significantly higher rate of adverse pregnancy outcome than those with a negative AF culture and without intra-amniotic inflammation (lower gestational age at birth, shorter amniocentesis-to-delivery interval, and significant neonatal morbidity). Importantly, there was no significant difference in pregnancy outcome between women with intra-amniotic inflammation and a negative AF culture and those with a positive AF culture. CONCLUSION: Intra-amniotic inflammation is present in 39% of twin pregnancies with preterm labor and intact membranes and is a risk factor for impending preterm delivery and adverse outcome, regardless of the presence or absence of bacteria detected using cultivation techniques.


Assuntos
Líquido Amniótico/microbiologia , Corioamnionite/epidemiologia , Metaloproteinase 8 da Matriz/análise , Trabalho de Parto Prematuro/etiologia , Gravidez de Gêmeos , Adulto , Amniocentese , Líquido Amniótico/enzimologia , Análise de Variância , Corioamnionite/microbiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/microbiologia , Gravidez , Resultado da Gravidez , Fatores de Risco
4.
Eur J Obstet Gynecol Reprod Biol ; 233: 53-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30572188

RESUMO

OBJECTIVES: To study the pregnancy outcomes in women with type 2 diabetes mellitus (T2DM) and to relate these to maternal risk factors. METHODS: We conducted a retrospective study of 419 women with T2DM (index group)- who attended our diabetes in pregnancy clinic at the Hamad Women's Hospital, Doha, between March 2015 and December 2016 -and 1419 normoglycaemic women (control group). RESULTS: Compared with the controls, T2DM women were older (mean age 34.7 ± 6.9 vs 29.6 ± 5.5 years; p < 0.001) and had a higher BMI (34.5 ± 6.7 vs 28.8 ± 6.1 kg/m2; p < 0.001). The incidence of macrosomia, shoulder dystocia and stillbirth were similar in the two groups, while that of pre-term labour, pre-eclampsia, caesarean section (CS), large for gestational age (LGA), neonatal ICU (NICU) admission, and neonatal hypoglycaemia were significantly higher in the T2DM compared to the control group (p < 0.05). Multivariate regression analysis showed that first trimester HbA1C was associated with an increased risk of LGA (OR 1.17; 95% CI [1.01-1.36]), pre-eclampsia (OR 1.26; 95% CI [1.02-1.54]), neonatal hypoglycaemia (OR 1.32; 95% CI 1.10-1.60) and NICU admission (OR 1.32; 95% CI 1.10-1.60). Pre-pregnancy BMI was associated with increased risk of LGA (OR 1.04; 95%CI [1.00-1.08]), macrosomia (OR 1.06; 95%CI [1.00-1.12]) and CS (OR 1.05; 95% CI [1.01-1.09]). Last trimester HbA1c was associated with an increased risk of LGA [OR 1.53, 95% CI [1.13-2.10)] and CS (OR 1.37, 95% CI [1.01-1.87]). CONCLUSION: T2DM is associated with adverse pregnancy outcomes compared to the normal control in Qatar. Maternal obesity and glycaemic control before and during pregnancy are the main determinants of pregnancy outcomes in women with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Hemoglobina A Glicada/administração & dosagem , Gravidez em Diabéticas/fisiopatologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Ganho de Peso na Gestação , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Insulina/uso terapêutico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Metformina/uso terapêutico , Obesidade/complicações , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Gravidez em Diabéticas/tratamento farmacológico , Catar , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Ginekol Pol ; 89(5): 256-261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30084477

RESUMO

OBJECTIVES: Our aim is to evaluate the laboratory results and proteinuria levels of preeclamptic women and their relation-ships to maternal and fetal outcomes. MATERIAL AND METHODS: One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal out-comes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses. RESULTS: A statistically significant positive correlation was observed between neonatal intensive care unit needs and pro-teinuria levels. Fetal growth restriction, respiratory distress syndrome and sepsis were observed as the level of proteinuria increased, but the result was not statistically significant. Eclampsia was observed only in patients with massive proteinuria, and it was statistically significant. An increase in cesarean sections, placental abruptions, antihypertensive drug needs and blood product replacement rates was observed as the amount of proteinuria increased in preeclamptic women, but the results were not statistically significant. CONCLUSIONS: The severity of preeclampsia cannot be determined by the level of proteinuria. However, when massive proteinuria is detected, the clinician should be more cautious about maternal and fetal complications.


Assuntos
Pré-Eclâmpsia/fisiopatologia , Resultado da Gravidez , Proteinúria/complicações , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Trabalho de Parto Prematuro/etiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
6.
Dis Markers ; 2018: 7628957, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29997715

RESUMO

Irisin, an adipomyokine identified in 2012, has been investigated in association with common pregnancy complications, including gestational diabetes mellitus, preeclampsia, and intrauterine growth restriction. The objective of this study is to examine the potential role of irisin in preterm birth (PTB) by comparing its level between mothers with term and preterm labor. Maternal peripheral blood and cord blood samples were collected from 30 mothers who delivered prematurely and from 35 mothers who delivered at term. Irisin concentrations were measured in all samples using ELISA, and four common single nucleotide polymorphisms in the irisin gene were determined (rs16835198, rs726344, rs3480, and rs1746661). Univariable and multivariable regression modeling was applied to evaluate maternal and cord blood irisin concentrations in relation to preterm/term labor. Irisin concentration in umbilical cord blood was found to be associated with PTB in the univariable model (p = 0.046). On the other hand, no differences in maternal blood irisin levels between mothers with preterm and term deliveries were established. To the best of our knowledge, this is the first study determining irisin levels in term and preterm deliveries in maternal peripheral blood and umbilical cord blood. Our study shows a possible association between cord blood irisin concentration and PTB occurrence.


Assuntos
Sangue Fetal/metabolismo , Fibronectinas/metabolismo , Trabalho de Parto Prematuro/etiologia , Regulação para Cima , Adulto , Estudos de Casos e Controles , Feminino , Fibronectinas/sangue , Fibronectinas/genética , Estudos de Associação Genética , Idade Gestacional , Humanos , Mães , Trabalho de Parto Prematuro/metabolismo , Polimorfismo de Nucleotídeo Único , Gravidez , Adulto Jovem
7.
Int J Infect Dis ; 73: 18-26, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29885371

RESUMO

BACKGROUND: The aim was to establish the incidence of adverse outcomes with brucellosis infection during pregnancy. METHODS: Ovid Medline (1946-), Ovid Embase (1974-), and Web of Science (Clarivate Analytics) (1900-), the World Health Organization website and Google were searched September 27, 2017 for (i) outcomes with brucellosis diagnosed during pregnancy and (ii) studies with retrospective diagnosis of maternal brucellosis following adverse pregnancy outcomes. RESULTS: Sixty studies met inclusion criteria. In 65 pregnancies from 28 case reports and 9 small case series (<10 women), there were 20 spontaneous abortions (SAs) (31%), 2 intra-uterine fetal deaths (IUFDs) (3%) and 11 cases of congenital brucellosis (17%). In 14 larger case series there were 181 SAs in 679 pregnancies (27%), 19 IUFDs in 458 pregnancies (4%), and 44 preterm infants (12%) plus 6 infants with congenital brucellosis (2%) in 362 pregnancies. SA, IUFD and preterm delivery incidence were increased with meta-analysis of the 5 case series with controls. Nine studies described brucellosis seroprevalence with adverse pregnancy outcomes with no increased seroprevalence in the two studies with controls. CONCLUSIONS: Brucellosis almost certainly causes SA with increasing evidence that it also leads to IUFD and prematurity. Congenital brucellosis occurs in approximately 2% of infants exposed in-utero.


Assuntos
Aborto Espontâneo/etiologia , Brucelose/complicações , Morte Fetal/etiologia , Trabalho de Parto Prematuro/etiologia , Complicações Infecciosas na Gravidez , Feminino , Humanos , Gravidez , Estudos Retrospectivos
8.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 45(2): 94-96, abr.-jun. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-172927

RESUMO

Presentamos el caso de una paciente que tuvo un parto pretérmino en la semana 34, y estaba diagnosticada de polihidramnios asociado a una imagen ecográfica, inicialmente clasificada como cotiledón placentario accesorio. Tras el análisis histológico se determinó que esa estructura correspondía a un corioangioma gigante, y podría, en nuestra opinión, ser el causante del cuadro clínico que desarrolló la paciente. Dado el reducido número de estudios, y las nuevas posibilidades de tratamiento, consideramos podría ser interesante la exposición del caso


We report the case of a patient with preterm labour at 34 weeks with polyhydramnios associated with an obstetric scan finding initially defined as accessory placental cotyledon. At the histological examination, this was found to be a giant chorioangioma, which in our opinion could be the cause of the patient's clinical symptoms. Due to the lack of studies in the literature and new treatment possibilities, we consider that publication of the case may be of interest


Assuntos
Humanos , Feminino , Gravidez , Hemangioma/complicações , Poli-Hidrâmnios/etiologia , Doenças Placentárias , Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal , Trabalho de Parto Prematuro/etiologia
9.
BMJ Case Rep ; 20182018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29507014

RESUMO

Placental chorioangioma is the most common type of a benign placental tumour that occurs in 1% of pregnancies. A large chorioangioma is associated with adverse pregnancy outcomes. We present a case of placental abruption necessitating preterm delivery after multiple amnioreductions for polyhydramnios caused by a large chorioangioma. If antenatal diagnosis of a significant chorioangioma is made as the cause of polyhydramnios, caution should be taken when performing rapid amnioreductions.


Assuntos
Descolamento Prematuro da Placenta/etiologia , Hemangioma/complicações , Poli-Hidrâmnios/etiologia , Complicações Neoplásicas na Gravidez , Adulto , Líquido Amniótico , Cesárea , Feminino , Idade Gestacional , Hemangioma/patologia , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Placenta/patologia , Poli-Hidrâmnios/terapia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Resultado da Gravidez , Ultrassonografia Pré-Natal
10.
Iran J Kidney Dis ; 12(2): 132-134, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29507277

RESUMO

Preeclampsia is the most common cause of proteinuria with hypertension during pregnancy. Primary kidney disease and kidney disease secondary to systemic disorders may rarely occur during pregnancy, resulting in proteinuria. A 34-year-old woman was admitted to our hospital with abdominal distention and lower extremity edema. The pregnancy was terminated at the 24th week of gestation due to preterm labor. Even after the delivery, proteinuria and renal deterioration continued to progress. The M-peak was not found on serum and urine protein electrophoresis. The serum free light chains assay showed absolute elevation of lambda chains at 1013.9 mg/L with a decreased kappa to lambda ratio of 0.05. Kidney biopsy revealed light chain deposition disease with lambda light chain deposits on immunofluorescence. Bone marrow examination was compatible with multiple myeloma. To our knowledge, this is the first reported case of light chain deposition disease associated with multiple myeloma during pregnancy.


Assuntos
Cadeias kappa de Imunoglobulina/análise , Cadeias lambda de Imunoglobulina/análise , Nefropatias/imunologia , Rim/imunologia , Mieloma Múltiplo/imunologia , Complicações Neoplásicas na Gravidez/imunologia , Adulto , Biópsia , Feminino , Imunofluorescência , Idade Gestacional , Humanos , Cadeias kappa de Imunoglobulina/sangue , Cadeias lambda de Imunoglobulina/sangue , Rim/fisiopatologia , Rim/ultraestrutura , Nefropatias/diagnóstico , Microscopia Eletrônica , Mieloma Múltiplo/diagnóstico , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Proteinúria/etiologia , Proteinúria/fisiopatologia , Natimorto
11.
J Obstet Gynaecol ; 38(6): 789-795, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29537316

RESUMO

Women (n = 300) at 'low risk' for a preterm birth (PTB), a singleton pregnancy and for a 16-24 week period of gestation (POG) were randomised to undergo cervical length (CL) measurement by transvaginal sonography (TVS) or not. The aim was to see if routine CL measurement and treatment of a short CL reduced the PTB rate. 'Low risk' was defined by an absence of a prior abortion or PTB of a singleton infant (>16 to <37 weeks) due to a spontaneous preterm labour (PTL) or a preterm pre-labour rupture of membranes (pPROM). The PTB rate was similar in the screened and unscreened group (10.3 and 8%, respectively, p = .433). In the screened group, women who delivered at 'term' or 'moderate to late' preterm (32 to <37 weeks) had a significantly higher mean CL (3.46 ± 0.41 and 3.48 ± 0.65 cm, respectively) than the women who delivered 'very' preterm (28 to 31 + 6 weeks; 2.05 ± 0.5 cm; p = .01). A short CL ≤2.5 cm was observed in two primigravidas (2/147 or 1.3%). They delivered at 28 + 3 and 30 + 6 weeks POG, respectively, despite treatment with vaginal progesterone and rescue cerclage in one. Their neonates were discharged in a good condition. In our low risk cohort, a routine second trimester CL measurement did not reduce the overall PTB rate. However, it identified two primigravidas at risk of having a 'very' PTB.Clinical Trials Registry (CTRI), India: Registration number CTRI/2016/01/010438 Impact statement What is already known on this subject? In women with a singleton pregnancy who are at a 'low risk' for preterm birth (PTB), a short cervical length (CL) at mid trimester measured by transvaginal sonography (TVS) identifies those at risk for a PTB. This risk may be reduced by the treatment with vaginal progesterone. At present, though evidence in favour of CL measurement in low-risk women exists, it is not established as a part of antenatal care. What do the results of this study add? A routine second trimester CL measurement in low risk women did not reduce the PTB rate. However, screening for a short CL helped to identify two primigravidas at risk for a 'very' PTB. It may be possible that detection and treatment of a short CL averted an 'extremely' PTB (<28 weeks) in these two women. What are the implications of these findings for clinical practice and/or further research? Future studies should assess the outcome of women with a short mid-trimester CL to see whether its treatment resulted in pregnancy prolongation and an improved neonatal outcome.


Assuntos
Medida do Comprimento Cervical/estatística & dados numéricos , Trabalho de Parto Prematuro/epidemiologia , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Adulto , Coeficiente de Natalidade , Medida do Comprimento Cervical/métodos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Medição de Risco/métodos , Fatores de Risco , Adulto Jovem
12.
J Obstet Gynaecol Res ; 44(5): 831-839, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29436080

RESUMO

The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses. The perinatal survival following FLP improved significantly with advances in the technique after its introduction. The recent survival rates of both twins and at least one twin are 70% and more than 90%, respectively. However, there is still an 11-14% risk of long-term neurodevelopment impairment. The premature rupture of membranes that leads to preterm labor is a common complication after FLP. FLP is a valuable treatment option for feto-fetal transfusion syndrome in triplets and for TTTS after 26 weeks. FLP for selective intrauterine growth restriction may be potentially beneficial when accompanied by abnormal Doppler findings and oligohydramnios. FLP is the optimal treatment option for TTTS at 16-26 weeks of gestation. FLP appears to be applicable in triplets, TTTS after 26 weeks and cases of selective intrauterine growth restriction with abnormal Doppler findings and oligohydramnios. FLP is the most common and successful fetal intervention. Improvement in the neurodevelopmental outcomes after FLP is a future focus.


Assuntos
Doenças em Gêmeos , Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal/cirurgia , Fetoscopia/métodos , Idade Gestacional , Fotocoagulação a Laser/métodos , Trabalho de Parto Prematuro/etiologia , Avaliação de Resultados (Cuidados de Saúde) , Gravidez de Gêmeos , Feminino , Fetoscopia/efeitos adversos , Humanos , Fotocoagulação a Laser/efeitos adversos , Gravidez
13.
Cell Physiol Biochem ; 45(1): 378-388, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29402774

RESUMO

BACKGROUND/AIMS: To detect the expression of the TRPC3 channel protein in the tissues of women experiencing preterm labor and investigate its interaction with T lymphocytes, providing a theoretical basis for the clinical prevention of threatened preterm labor and the development of drug-targeted therapy. METHODS: Forty-seven women experiencing preterm labor and 47 women experiencing normal full-term labor were included in this study. All included women underwent delivery via cesarean section; uterine samples were obtained at delivery. The expression of TRPC3 in uterine tissue was detected by immunohistochemistry, real-time quantitative reverse transcription-PCR, and western blot assay. Activation of T lymphocytes in peripheral blood and uterine tissue were detected by flow cytometry. A TRPC3-/- mouse model of inflammation-induced preterm labor was established; expression of TRPC3, Cav3.1, and Cav3.2 were analyzed in mouse uterine tissue. Activation of T lymphocytes in female mouse and human peripheral blood samples was determined using flow cytometry. RESULTS: In women experiencing preterm labor, expression of TRPC3 and the Cav3.1 and Cav3.2 proteins was significantly increased; in addition, the percentage of CD3+, CD4+, and CD8+ T cells in peripheral blood was significantly decreased. TRPC3 knockout significantly delayed the occurrence of preterm labor in mice. The muscle tension of ex vivo uterine strips was lower, Cav3.1 and Cav3.2 protein expression was lower, and the percentage of CD8+ T lymphocytes was significantly increased in wild-type mice subjected to an inflammation-induced preterm labor than in wild-type mice experiencing normal full-term labor. CONCLUSION: TRPC3 is closely related to the initiation of labor. TRPC3 relies on Cav3.1 and Cav3.2 proteins to inhibit inflammation-induced preterm labor by inhibiting the activation of T cells, in particular CD8+ T lymphocytes.


Assuntos
Inflamação , Trabalho de Parto Prematuro/patologia , Linfócitos T/imunologia , Canais de Cátion TRPC/metabolismo , Adulto , Animais , Canais de Cálcio Tipo T/genética , Canais de Cálcio Tipo T/metabolismo , Feminino , Genótipo , Humanos , Inflamação/etiologia , Lipopolissacarídeos/toxicidade , Ativação Linfocitária , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Músculo Liso/metabolismo , Músculo Liso/patologia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/metabolismo , Gravidez , Linfócitos T/citologia , Linfócitos T/metabolismo , Canais de Cátion TRPC/genética , Útero/metabolismo , Útero/patologia
14.
J Gynecol Obstet Hum Reprod ; 47(4): 171-173, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29391293

RESUMO

Trichomonas vaginalis is a very common, sexually transmitted, infection that may sometimes be asymptomatic or cause vaginitis and urethritis. Recently, it has been associated with adverse obstetric outcomes such as preterm delivery, low birth weight and premature rupture of membranes. Trichomonas vaginalis can be vertically transmitted at birth. It has been found in pharynx and low respiratory tract of neonates with respiratory disease. It has also been involved in some cases of intellectual disability. The recommended treatment is a 2g metronidazole oral single dose, even for asymptomatic patients. This treatment is effective against Trichomonas and its use is safe during pregnancy. We report here a case of Trichomonas vaginalis infection diagnosed during pregnancy in a patient with severe preterm labor. The patient being allergic to nitroimidazole antibiotics, she did not receive any treatment. She finally gave birth at 34 weeks of gestation (WG) and 5 days, with no other adverse outcome than small prematurity.


Assuntos
Trabalho de Parto Prematuro/etiologia , Complicações Infecciosas na Gravidez/microbiologia , Tricomoníase/complicações , Trichomonas vaginalis/patogenicidade , Adulto , Feminino , Humanos , Gravidez
15.
World Neurosurg ; 113: e373-e382, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29454125

RESUMO

BACKGROUND: Neoplasms rarely present during pregnancy; however, increases in plasma volume, hormone release-induced growth, and tumor hypervascularity can cause rapidly progressive symptoms of varying severity, ranging from those not requiring intervention to those necessitating emergent operations. Here we describe an algorithm for the management of symptomatic neoplasms in the obstetric population and provide recommendations for surgical indications and timing. METHODS: Patients who presented to the skull base clinic at a large tertiary care hospital between 2010 and 2016 were reviewed to identify those who presented with a skull base tumor during pregnancy. RESULTS: Our study cohort comprised 9 women with a skull base tumor during pregnancy. Four patients presented with symptoms that necessitated emergent skull base surgery, and 5 underwent surgery after delivery or were followed with continued surveillance. All operated patients had a World Health Organization grade I or II meningioma or schwannoma. There were no maternal complications. Based on our experience with this cohort, we have created a management algorithm. CONCLUSIONS: Management of a symptomatic tumor during pregnancy requires balancing the potential for curing the mother and the risk of harming the fetus. Trimester of pregnancy is the most critical factor in evaluating the need for urgent management. The second trimester is the optimal time for surgery, associated with the lowest risk for spontaneous abortion or preterm birth. The first and third trimesters are associated with increased risk of miscarriage and preterm labor, respectively. Induction of labor for preterm delivery, followed by surgery, may be appropriate in the early third trimester. Regardless of the perceived risk, however, all pregnant women with an emergent presentation should be offered surgery, regardless of trimester.


Assuntos
Complicações Neoplásicas na Gravidez/cirurgia , Neoplasias da Base do Crânio/cirurgia , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Adenoma/cirurgia , Adulto , Algoritmos , Carcinoma Adenoide Cístico/cirurgia , Cesárea , Terapia Combinada , Irradiação Craniana , Craniotomia , Emergências , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/radioterapia , Meningioma/cirurgia , Mucocele/cirurgia , Neurilemoma/cirurgia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Complicações Neoplásicas na Gravidez/radioterapia , Trimestres da Gravidez , Neoplasias da Base do Crânio/radioterapia , Centros de Atenção Terciária/estatística & dados numéricos
18.
Reproduction ; 155(2): 207-218, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29358306

RESUMO

Preterm birth is a prevalent cause of neonatal deaths worldwide. Inflammation has been implicated in spontaneous preterm birth involved in the processes of uterine contractility and membrane rupture. Parkinson protein 7 (PARK7) has been found to play an inflammatory role in non-gestational tissues. The aims of this study were to determine the expression of PARK7 in myometrium and fetal membranes with respect to term labour onset and to elucidate the effect of PARK7 silencing in primary myometrium and amnion cells on pro-inflammatory and pro-labour mediators. PARK7 mRNA expression was higher in term myometrium and fetal membranes from women in labour compared to non-labouring samples and in amnion from preterm deliveries with chorioamnionitis. In human primary myometrial cells transfected with PARK7 siRNA (siPARK7), there was a significant decrease in IL1B, TNF, fsl-1 and poly(I:C)-induced expression of pro-inflammatory cytokine IL6, chemokines (CXCL8, CCL2), adhesion molecule ICAM1, prostaglandin PGF2α and its receptor PTGFR. Similarly, amnion cells transfected with siPARK7 displayed a decrease in IL1B-induced expression of IL6, CXCL8 and ICAM1. In myometrial cells transfected with siPARK7, there was a significant reduction of NF-κB RELA transcriptional activity when stimulated with fsl-1, flagellin and poly(I:C), but not with IL1B or TNF. Collectively, our novel data describe a role for PARK7 in regulating inflammation-induced pro-inflammatory and pro-labour mediators in human myometrial and amnion cells.


Assuntos
Âmnio/patologia , Ruptura Prematura de Membranas Fetais/patologia , Mediadores da Inflamação/metabolismo , Inflamação/complicações , Miométrio/patologia , Trabalho de Parto Prematuro/etiologia , Proteína Desglicase DJ-1/metabolismo , Âmnio/metabolismo , Células Cultivadas , Feminino , Ruptura Prematura de Membranas Fetais/metabolismo , Idade Gestacional , Humanos , Recém-Nascido , Início do Trabalho de Parto , Miométrio/metabolismo , Trabalho de Parto Prematuro/metabolismo , Trabalho de Parto Prematuro/patologia , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/metabolismo , Nascimento Prematuro/patologia , Proteína Desglicase DJ-1/genética
19.
J Med Virol ; 90(1): 93-100, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28851115

RESUMO

We aimed to explore whether maternal chronic hepatitis B virus (HBV) infection certainly affects preterm labor (birth) in pregnant women. Four databases were systematically searched up to May 31, 2017, without language restriction. Any study was included if it clearly defined exposure to chronic HBV infection, reported risk of preterm labor or birth in pregnant women, and reported relative risks (RRs) or odds ratios (ORs) or provided data for estimation. RRs (or ORs) with 95% confidence intervals were pooled using random-effects models. Statistical heterogeneity was assessed with Cochran's Q statistic and I2 statistic. Twenty-two observational studies involving 6 141 146 pregnant women (three prospective cohort studies, n = 1 116 799; 15 retrospective cohort studies, n = 5 022 513 and four case-control studies, n = 1834) were included. The risk of preterm labor was significantly intensified with chronic HBV infection compared with uninfected women, with substantial heterogeneity. Chronic HBV infection was also significantly associated with a 16% increase in the risk of preterm birth, with substantial heterogeneity. The risk of preterm birth significantly increased by 21% in HBsAg+/HBeAg+ pregnant women compared with uninfected pregnant women. Chronic HBV infection intensifies the risk of preterm labor and birth in pregnant women, but this conclusion should be interpreted with caution given the possibility of residual confounding and be confirmed by well-designed studies in the future.


Assuntos
Hepatite B Crônica/complicações , Trabalho de Parto Prematuro/etiologia , Complicações Infecciosas na Gravidez , Nascimento Prematuro/etiologia , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/virologia , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Estudos Observacionais como Assunto , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Estudos Prospectivos , Estudos Retrospectivos
20.
Gynecol Obstet Invest ; 83(3): 285-289, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29183020

RESUMO

AIM: To evaluate the clinical application of the new Hologic quantitative foetal fibronectin (qfFN) bedside test for the prediction of spontaneous preterm birth (sPTB) in patients with symptoms suggestive of spontaneous threatened preterm labour (sPTL). METHODS: A prospective observational study with 154 pregnant women presenting signs and symptoms of sPTL was conducted. These women were subjected to a qfFN test between 22 and 35 weeks of gestation For each cut-off threshold, the ability to predict sPTB at within 14 days of conducting the test and <37 weeks was assessed by calculating the positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, odds ratios, sensitivity, and specificity. RESULTS: For the outcome of delivery within 14 days of the test, qfFN <10 ng/mL had a 100% NPV and >200 ng/mL produced a 50.0% PPV; thus, qfFN added enhanced discrimination between high- and low-risk patients. The overall rate of sPTB (<37) was 13.3% (16/120), which increased progressively with increasing levels of fFN, with rates of 9.8% (8/81), 11.5% (3/26), 14.2% (1/7), 50% (3/6) within the 4 categories (fFN 0-9, 10-49, 50-200, 200+) respectively. CONCLUSIONS: The use of the qfFN testing in symptomatic patients allowed for more accurate identification of women at risk of sPTB and thus more directed management.


Assuntos
Sangue Fetal/metabolismo , Fibronectinas/sangue , Trabalho de Parto Prematuro/sangue , Trabalho de Parto Prematuro/diagnóstico , Segundo Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Adulto , Biomarcadores/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade
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