Cerebroplacental ratio as an indicator of placental functioning and its relationship with early communicative gestures acquisition / El índice cerebroplacentario como indicador del funcionamiento placentario y su relación con la adquisición temprana de gestos comunicativos

Background: Gestures are linked to developmental and neurological development. Cerebroplacental ratio (CPR) has proven to be a good predictor of neurological damage within the growth-restricted fetuses’ population. However, its usefulness in the general population has not been studied for this purpose. The aim of this study was to evaluate the usefulness of CPR as a predictor of gesture acquisition. Method: A prospective cohort of 35 singleton pregnancies with normally grown fetuses was recruited. Doppler indices for the umbilical artery (UA), middle cerebral artery (MCA) and cerebroplacental ratio (CPR) at 36–40 weeks of gestation were recorded. MacArthur-Bates I Communication Skills Development Questionnaires (SCDI) at 12 (±1) months of age were applied. Based on their gesture performance, they were divided into Normal Scores (NS), and Low Scores (LS). Results: The independent samples t-test analysis revealed a significant difference between the NS group and LS in terms of CPRz scores (t=2.706, p=.011). CPR z-scores values showed a positive correlation with early gesture centiles (R2=0.145, p=.029) and late gesture centiles (R2=0.178, p=.014). Conclusion: CPR within the last weeks of pregnancy could be of potential utility to predict gesture acquisition.(AU)

Antecedentes: Los gestos están relacionados con el desarrollo y el neurodesarrollo. El índice cerebroplacentario (ICP) ha demostrado ser un buen predictor de daño neurológico en la población de fetos con restricción de crecimiento. Sin embargo, su utilidad en la población general no ha sido estudiada con este propósito. El objetivo de este estudio fue evaluar la utilidad del ICP como predictor de la adquisición de gestos. Método: Se reclutó una cohorte prospectiva de 35 embarazos únicos con fetos de crecimiento normal. Se registraron los índices Doppler de la arteria umbilical (UA), la arteria cerebral media (ACM) y el ICP a las 36-40 semanas de gestación. Se aplicaron los Cuestionarios de Desarrollo de Habilidades de Comunicación MacArthur-Bates I (SCDI) a los 12 (+/−1) meses de edad. Con base en el desempeño en gestos, se dividieron en puntajes normales (NS) y puntajes bajos (LS). Resultados: El análisis de prueba t de muestras independientes reveló una diferencia significativa entre el grupo NS y LS en términos de puntajes ICPz (t=2.706, p=.011). Los valores de las puntuaciones z del ICP mostraron una correlación positiva con los percentiles de gestos tempranos (R2=.145, p=.029) y percentiles de gestos tardíos (R2=.178, p=.014). Conclusión: El ICP en las últimas semanas de embarazo podría tener una utilidad potencial para predecir la adquisición de gestos.(AU)

High total cholesterol and triglycerides levels increase arginases metabolism, impairing nitric oxide signaling and worsening fetoplacental endothelial dysfunction in gestational diabetes mellitus pregnancies.

Maternal physiological dyslipidemia (MPD) supports fetal development in human pregnancy. However, some women develop maternal supraphysiological dyslipidemia (MSPD: increased total cholesterol (TC) and triglycerides (TG) levels). MSPH is present in normal and also in gestational diabetes mellitus (GDM) pregnancies. MSPD and GDM associate with fetoplacental endothelial dysfunction, producing alterations in nitric oxide (NO)-L-arginine/arginase metabolism. Nevertheless, the effect of MSPD on GDM, and how this synergy alters fetoplacental endothelial function is unknown. Therefore, the aim of this study was to evaluate in human umbilical vein endothelial cells, the effects of MSPD in GDM and how these pathologies together affect the fetoplacental endothelial function. 123 women at term of pregnancy were classified as MPD (n = 40), MSPD (n = 35), GDM with normal lipids (GDM-MPD, n = 23) and with increased lipids (GDM-MSPD, n = 25). TC ≥291 mg/dL and TG ≥275 mg/dL were considered as MSPD. Endothelial NO synthase (eNOS), human cationic amino acid transporter 1 (hCat1), and arginase II protein abundance and activity, were assayed in umbilical vein endothelial cells. In MSPD and GDM-MSPD, TC and TG increased respect to MPD and GDM-MPD. eNOS activity was reduced in MSPD and GDM-MSPD, but increased in GDM-MPD compared with MPD. However, decreased tetrahydrobiopterin levels were observed in all groups compared with MPD. Increased hCat1 protein and L-arginine transport were observed in both GDM groups compared with MPD. However, the transport was higher in GDM-MSPD compared to GDM-MPD. Higher Arginase II protein and activity were observed in GDM-MSPD compared with MPD. Thus, MSPD in GDM pregnancies alters fetal endothelial function associated with NO metabolism.

T2* Placental Magnetic Resonance Imaging in Preterm Preeclampsia: An Observational Cohort Study.

Placental dysfunction underlies the cause of pregnancies complicated by preeclampsia. The use of placental magnetic resonance imaging to provide an insight into the pathophysiology of preeclampsia and thus assess its potential use to inform prognosis and clinical management was explored. In this prospective observational cohort study, 14 women with preterm preeclampsia and 48 gestation-matched controls using 3-Tesla magnetic resonance imaging at median of 31.6 weeks (interquartile range [IQR], 28.6-34.6) and 32.2 weeks (IQR, 28.6-33.8), respectively, were imaged. The acquired data included T2-weighted images and T2* maps of the placenta, the latter an indicative measure of placental oxygenation. Placentae in women with preeclampsia demonstrated advanced lobulation, varied lobule sizes, high granularity, and substantial areas of low-signal intensity on T2-weighted imaging, with reduced entire placental mean T2* values for gestational age (2 sample t test, t=7.49) correlating with a reduction in maternal PlGF (placental growth factor) concentrations (Spearman rank correlation coefficient 0.76) and increased lacunarity values (t=3.26). Median mean T2* reduced from 67 ms (IQR, 54-73) at 26.0 to 29.8 weeks' gestation to 38 ms (IQR, 28-40) at 34.0 to 37.9 weeks' gestation in the control group. In women with preeclampsia, median T2* was 23 ms (IQR, 20-23) at 26.0 to 29.8 weeks' gestation and remained low (22 ms [IQR, 20-26] at 34.0-37.8 weeks' gestation). Histological features of maternal vascular malperfusion were only found in placentae from women with preeclampsia. Placental volume did not differ between the control group and women with preeclampsia. Placental magnetic resonance imaging allows both objective quantification of placental function in vivo and elucidation of the complex mechanisms underlying preeclampsia development.

First-trimester placental function in levothyroxine-using pregnant women: a case-control study.

We aimed to compare the pregnancy-associated plasma protein-A (PAPP-A) and the uterine artery pulsatility index (UtA PI) levels of euthyroid pregnant women using levothyroxine vs. a control group of uncomplicated pregnancies and to evaluate the effects of different levothyroxine dosages on pregnancy outcomes. We retrospectively evaluated 206 levothyroxine-using pregnant women by looking at their basic placental function markers and obstetric outcomes. A sample of 449 women whose pregnancies concluded with uncomplicated term deliveries composed of our control group. To examine the relationship between the levothyroxine dosages and the frequency of pregnancy complications, levothyroxine users were divided into different groups according to the 75, 100, and 150 mcg cutoffs. The median PAPP-A MoM levels of levothyroxine users were significantly lower at 0.94 vs. 1.11 (p < .001) and the median mean UtA PI was significantly higher than the control group at 2.08 vs. 1.74 (p < .0001). The median birth weight was significantly lower for the levothyroxine users' group at 3292 g vs. 3427 g (p < .0001). Using 75, 100, and 150 mcg dose cutoffs, PAPP-A MoM, mean UtA PI and obstetric complication frequencies were not significantly different among levothyroxine users. Significant changes in placental function markers have been observed in euthyroid levothyroxine-using pregnant women during the first trimester. However, the frequency of obstetric complications does not appear to be dose dependent.

Identification of amniotic fluid metabolomic and placental transcriptomic changes associated with abnormal development of cloned pig fetuses.

Piglets cloned by somatic cell nuclear transfer (SCNT) show a high incidence of malformations and a high death rate during the perinatal period. To investigate the underlying mechanisms for abnormal development of cloned pig fetuses, we compared body weight, amniotic fluid (AF) metabolome, and placental transcriptome between SCNT- and artificial insemination (AI)-derived pig fetuses. Results showed that the body weight of SCNT pig fetuses was significantly lower than that of AI pig fetuses. The identified differential metabolites between the two groups of AF were mainly involved in bile acids and steroid hormones. The levels of all detected bile acids in SCNT AF were significantly higher than those in AI AF. The increase in the AF bile acid levels in SCNT fetuses was linked with the downregulation of placental bile acid transporter expression and the abnormal development of placental folds (PFs), both of which negatively affected the transfer of bile acids from AF across the placenta into the mother's circulation. Alteration in the AF steroid hormone levels in cloned fetuses was associated with decreased expression of enzymes responsible for steroid hormone biosynthesis in the placenta. In conclusion, cloned pig fetuses undergo abnormal intrauterine development associated with alteration of bile acid and steroid hormone levels in AF, which may be due to the poor development of PFs and the erroneous expression of bile acid transporters and enzymes responsible for steroid hormone biosynthesis in the placentas.

Idiopathic Purpura With Gray Platelets: an Acquired Form of Gray Platelet Syndrome.

An acquired, transient bleeding disorder that predominantly affects children in Southeast Asia has been reported for the last 4 decades. The condition has been named idiopathic purpura with gray platelets (IPGP) or acquired platelet dysfunction with eosinophilia. In a retrospective review from a private pediatric clinic over an 8-year period, 10 consecutive children were diagnosed as IPGP with a mean age of 8.4 (3.7 to 16.2) years. Eosinophilia (>0.5×10/L) was absent in 1, while gray platelets were consistently found in all cases with a mean proportion of 64.5% (40% to 80%). Platelet aggregation tests were performed in 9 patients with abnormal responses consistent with platelet storage pool defect. All children recovered completely and spontaneously from 1 to 4 months after diagnosis without specific therapy. In an otherwise well child who presents abruptly with easy bruising and a platelet count >100×10/L, IPGP can be readily recognized as an acquired form of gray platelet syndrome. Eosinophilia is common but not mandatory for diagnosis.

Assessment of partograph utilization and associated factors among obstetric care givers at public health institutions in central zone, Tigray, Ethiopia.

OBJECTIVES: Partograph is one of the best effective obstetric tools used to monitoring labor and prevent prolonged or obstructed labor which accounts for about 22% of maternal deaths in Ethiopia. This study was aimed to assess partograph utilization and associated factors among obstetric care givers. Facility based cross sectional study was used in the randomly selected health facilities. Total 220 obstetric care givers were selected using simple random sampling technique. Data were entered and analyzed using SPSS version 22.0. Bivariate and multivariate logistic regression analysis was used to identify the associations of each explanatory variable with the outcome variable. Finally, odds ratio with its 95% confidence interval and p-value of 0.05 was used to identify significant variables. RESULT: Out of 198 obstetric care providers, 73.3% used partograph to monitor progress of labor. Those who were diploma holders (AOR = 3.8, CI = 2.2-6.2), receiving basic emergency obstetrics and new born care training (AOR = 5.6, CI 1.1-28.5), age between 20 and 29 years-old (AOR = 0.1, CI = 0.01-0.50), and male health care providers (AOR = 0.37, CI = 0.44-0.95) were factors significantly associated with partograph utilization. Partograph utilization in this study was below the WHO recommendation. Especial emphasizes and interventions should be given to increase partograph utilization.

Situación actual de la preeclampsia / No disponible

No disponible

[TO THE STATE OF THE FETOPLACENTAL COMPLEX IN WOMEN WITH THE THREAT OF ABORTION].

The goal is a comprehensive study of the morphofunctional state of the mother-placenta-fetus system in placental insufficiency and infection. 250 pregnant and puerperas for the period 2008-2014 were examined. Detection of bacterial flora was carried out in 35 pregnant women aged 20.4±0.8 years with the threat of abortion from an early gestation period and a prolonged persistent infection of the genitals, bacterial vaginosis. Methods are applied: culture, ion chromatography, gas-liquid chromatography with mass spectrometry. The presence of placental insufficiency was found in 32.0% of patients. In the vagina, Staphylococcus epidermidis, Escherichia coli (culture method), in the vagina and placenta of the bacteria of the genus Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae (IC method) were detected; Proponibacterium, Bacteroides Afipia, Helocobacter musteloe, Actinomyces, Candida albicans. In the placental suspension, Pentadiecanoic acid, 14-methyl, methyl ester, Octadecanoic acid, methyl ester, 9-Octadecanoic acid, methyl ester (E), 9-Octadecanoic acid, methyl ester (Z), 9-12 Octadecanoic acid, methyl Ester (EE), Eicosanoic acid, methyl ester, 12,15 Octadecanoic acid, methyl ester (ZZZ). CONCLUSIONS: 1. The spectrum of detected microorganisms indicates the possibility of detecting not only aerosols, but also facultative anaerobes, capsular bacteria, facultative intracellular parasites using chromatomass spectrometry. 2. The detected infectious factor, which causes placental insufficiency, is confirmed by morphotopographic diagnosis.

Low Soluble Fms-Like Tyrosine Kinase-1, Endoglin, and Endothelin-1 Levels in Women With Confirmed or Suspected Preeclampsia Using Proton Pump Inhibitors.

Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and endoglin levels and decreased placental growth factor levels. Proton pump inhibitors (PPIs) decrease trophoblast sFlt-1 and endoglin secretion in vitro. PPIs are used during pregnancy to combat reflux disease. Here, we investigated whether PPIs affect sFlt-1 in women with confirmed/suspected preeclampsia, making use of a prospective cohort study involving 430 women. Of these women, 40 took PPIs (6 esomeprazole, 32 omeprazole, and 2 pantoprazole) for 8 to 45 (median 29) days before sFlt-1 measurement. Measurements were only made once, at study entry between weeks 20 and 41 (median 33 weeks). PPI use was associated with lower sFlt-1 levels, with no change in placental growth factor levels, both when compared with all non-PPI users and with 80 gestational age-matched controls selected from the non-PPI users. No sFlt-1/placental growth factor alterations were observed in women using ferrous fumarate or macrogol while, as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower placental growth factor levels. The PPI use-associated decrease in sFlt-1 was independent of the application of antihypertensive drugs and also occurred when restricting our analysis to patients with hypertensive disease of pregnancy at study entry. PPI users displayed more cases with preexisting proteinuria, less gestational hypertension, and a lower number of neonatal sepsis cases. Finally, their plasma endoglin and endothelin-1 levels were lower while sFlt-1 levels correlated positively with both. In conclusion, PPI use associates with low sFlt-1, endoglin, and endothelin-1 levels, warranting prospective trials to investigate the therapeutic potential of PPIs in preeclampsia.

Transplacental nutrient transfer in the human in vivo determined by 4 vessel sampling.

BACKGROUND: The intrauterine environment and especially the fetal nutritional conditions affect lifelong health. There are few human in vivo studies on fetal nutrition. The importance to test experimentally based concepts of fetal nutrition in a human in vivo setting is becoming increasingly apparent. A way of testing nutrient transfer in human is 4-vessel sampling, which implies blood sampling from artery and vein on both sides of the placenta. Here we give a brief review of the studies using the 4-vessel sampling method. METHOD: We performed systematic searches in Ovid MEDLINE and EMBASE (Ovid) from 1946 to May 2016. The following search terms were used to identify eligible articles: [placenta] AND [glucose/blood glucose] OR [amino acids] OR [lipids] OR [cholesterol] OR [nutrient] AND [blood sample] OR [biological transport] OR [transport/transfer/exchange] OR [maternal-fetal exchange] AND [humans]. RESULTS: The search retrieved 623 studies. After abstract scanning 25 full text articles were evaluated and seven articles describing 4-vessel sampling were identified. The studies had from 14 to 77 participants and reported placental transfer of different nutrients (glucose, lactate, amino acids and arachidonic acid). CONCLUSION: Few studies have used 4 vessel sampling to study placental nutrient transfer in human pregnancies. Overall these studies indicate that the transfer of nutrients between the mother and the fetus is highly "dynamic," i.e. most nutrients may pass either way on both the maternal and fetal sides of the placenta. Furthermore, the concept that the placenta is a metabolically highly active organ affecting transfer of glucose, amino acids and lipids, fits the human in vivo data. The 4-vessel method can provide essential information on the transfer between the mother, placenta and fetus of virtually any compound.

First Trimester Detection of Placental Disease: Challenges and Opportunities.

It is generally agreed that placental pathology accounts for the majority of perinatal morbidity and mortality. If a placental prodrome could be diagnosed in vivo, risk for maternal or fetal complications could be estimated and acted upon before clinical symptoms are apparent. This is especially relevant in early diagnoses of gestational diabetes mellitus, which can be controlled through carefully monitored diet and activity changes. To meet this important need, there have been increased efforts to identify early gestation biomarkers of placental dysfunction using innovative imaging technologies. Here we outline innovative quantitative markers of placental shape and their relationship to placental function, clinical implications of these quantifiers, and the most recent mathematical models that utilize placental images to delineate at risk from normal pregnancies. We propose that novel contexts of readily available placental measures and routine collection of in vivo placental images in all pregnancies may be all that are needed to advance the identification of early risk determination of complicated pregnancies from placental images.

Use of a bayesian hierarchical model to study the allometric scaling of the fetoplacental weight ratio / Utilização de modelo hierárquico bayesiano para estudar a relação alométrica entre o peso placentário e peso ao nascer

Objectives: to propose the use of a Bayesian hierarchical model to study the allometric scaling of the fetoplacental weight ratio, including possible confounders. Methods: data from 26 singleton pregnancies with gestational age at birth between 37 and 42 weeks were analyzed. The placentas were collected immediately after delivery and stored under refrigeration until the time of analysis, which occurred within up to 12 hours. Maternal data were collected from medical records. A Bayesian hierarchical model was proposed and Markov chain Monte Carlo simulation methods were used to obtain samples from distribution a posteriori. Results: the model developed showed a reasonable fit, even allowing for the incorporation of variables and a priori information on the parameters used. Conclusions: new variables can be added to the modelfrom the available code, allowing many possibilities for data analysis and indicating the potential for use in research on the subject.

Objetivos: propor a utilização de um modelo Hierárquico Bayesiano para estudar a relação alométrica existente entre o peso ao nascer e o peso placentário, incluindo possíveis fatores interferentes. Métodos: foram analisados os dados de 26 gestações únicas, com idade gestacional entre 37 e 42 semanas. As placentas foram coletadas imediatamente após o parto e conservadas sob refrigeração até o momento da análise, o que ocorreu em até 12 horas. Os dados maternos foram obtidos de prontuários médicos. Finalmente, foi elaborado um modelo hierárquico bayesiano e, para obter amostras da distribuição a posteriori, foram utilizados métodos de simulação Markov Chain Monte Carlo. Resultados: o modelo obtido apresentou um ajuste razoável, permitindo ainda a incorporação de variáveis e informações a priori, sobre os parâmetros utilizados. Conclusões: a partir da disponibilização do código, novas variáveis podem ser adicionadas ao modelo, permitindo muitas possibilidades para a análise dos dados, mostrando potencial para ser utilizado em pesquisas na área.

Use of biochemical tests of placental function for improving pregnancy outcome.

BACKGROUND: The placenta has an essential role in determining the outcome of pregnancy. Consequently, biochemical measurement of placentally-derived factors has been suggested as a means to improve fetal and maternal outcome of pregnancy. OBJECTIVES: To assess whether clinicians' knowledge of the results of biochemical tests of placental function is associated with improvement in fetal or maternal outcome of pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised, cluster-randomised or quasi-randomised controlled trials assessing the merits of the use of biochemical tests of placental function to improve pregnancy outcome.Studies were eligible if they compared women who had placental function tests and the results were available to their clinicians with women who either did not have the tests, or the tests were done but the results were not available to the clinicians. The placental function tests were any biochemical test of placental function carried out using the woman's maternal biofluid, either alone or in combination with other placental function test/s. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, extracted data and assessed trial quality. Authors of published trials were contacted for further information. MAIN RESULTS: Three trials were included, two quasi-randomised controlled trials and one randomised controlled trial. One trial was deemed to be at low risk of bias while the other two were at high risk of bias. Different biochemical analytes were measured - oestrogen was measured in one trial and the other two measured human placental lactogen (hPL). One trial did not contribute outcome data, therefore, the results of this review are based on two trials with 740 participants.There was no evidence of a difference in the incidence of death of a baby (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.36 to 2.13, two trials, 740 participants (very low quality evidence)) or the frequency of a small-for-gestational-age infant (RR 0.44, 95% CI 0.16 to 1.19, one trial, 118 participants (low quality evidence)).In terms of this review's secondary outcomes, there was no evidence of a clear difference between women who had biochemical tests of placental function compared with standard antenatal care for the incidence of stillbirth (RR 0.56, 95% CI 0.16 to 1.88, two trials, 740 participants (very low quality evidence)) or neonatal death (RR 1.62, 95% CI 0.39 to 6.74, two trials, 740 participants, very low quality evidence)) although the directions of any potential effect were in opposing directions. There was no evidence of a difference between groups in elective delivery (RR 0.98, 95% CI 0.84 to 1.14, two trials, 740 participants (low quality evidence)), caesarean section (one trial, RR 0.48, 95% CI 0.15 to 1.52, one trial, 118 participants (low quality evidence)), change in anxiety score (mean difference -2.40, 95% CI -4.78 to -0.02, one trial, 118 participants), admissions to neonatal intensive care (RR 0.32, 95% CI 0.03 to 3.01, one trial, 118 participants), and preterm birth before 37 weeks' gestation (RR 2.90, 95% CI 0.12 to 69.81, one trial, 118 participants). One trial (118 participants) reported that there were no cases of serious neonatal morbidity. Maternal death was not reported.A number of this review's secondary outcomes relating to the baby were not reported in the included studies, namely: umbilical artery pH < 7.0, neonatal intensive care for more than seven days, very preterm birth (< 32 weeks' gestation), need for ventilation, organ failure, fetal abnormality, neurodevelopment in childhood (cerebral palsy, neurodevelopmental delay). Similarly, a number of this review's maternal secondary outcomes were not reported in the included studies (admission to intensive care, high dependency unit admission, hospital admission for > seven days, pre-eclampsia, eclampsia, and women's perception of care). AUTHORS' CONCLUSIONS: There is insufficient evidence to support the use of biochemical tests of placental function to reduce perinatal mortality or increase identification of small-for-gestational-age infants. However, we were only able to include data from two studies that measured oestrogens and hPL. The quality of the evidence was low or very low.Two of the trials were performed in the 1970s on women with a variety of antenatal complications and this evidence cannot be generalised to women at low-risk of complications or groups of women with specific pregnancy complications (e.g. fetal growth restriction). Furthermore, outcomes described in the 1970s may not reflect what would be expected at present. For example, neonatal mortality rates have fallen substantially, such that an infant delivered at 28 weeks would have a greater chance of survival were those studies repeated; this may affect the primary outcome of the meta-analysis.With data from just two studies (740 women), this review is underpowered to detect a difference in the incidence of death of a baby or the frequency of a small-for-gestational-age infant as these have a background incidence of approximately 0.75% and 10% of pregnancies respectively. Similarly, this review is underpowered to detect differences between serious and/or rare adverse events such as severe neonatal morbidity. Two of the three included studies were quasi-randomised, with significant risk of bias from group allocation. Additionally, there may be performance bias as in one of the two studies contributing data, participants receiving standard care did not have venepuncture, so clinicians treating participants could identify which arm of the study they were in. Future studies should consider more robust randomisation methods and concealment of group allocation and should be adequately powered to detect differences in rare adverse events.The studies identified in this review examined two different analytes: oestrogens and hPL. There are many other placental products that could be employed as surrogates of placental function, including: placental growth factor (PlGF), human chorionic gonadotrophin (hCG), plasma protein A (PAPP-A), placental protein 13 (PP-13), pregnancy-specific glycoproteins and progesterone metabolites and further studies should be encouraged to investigate these other placental products. Future randomised controlled trials should test analytes identified as having the best predictive reliability for placental dysfunction leading to small-for-gestational-age infants and perinatal mortality.

Early versus delayed cord clamping of term births in Shatby Maternity University Hospital / Pinzamiento precoz frente a pinzamiento tardío del cordón umbilical en nacimientos a término del Hospital Materno-Infantil de Shatby

Background. The optimal timing for cord clamping; early versus delayed in the third stage of labour, is a controversial subject. There are no formed practice guidelines. Objective. To compare the potential benefits and harms of early versus late clamping in term infants in Shatby Maternity Hospital. Methods. A randomized study was conducted on 100 primigravide full term single pregnancy admitted and delivered spontaneously at Shatby Maternity University Hospital. They were divided into two groups (each 50) where in the first group the umbilical cord was clamped immediately 'early cord clamping' (ECC) and where the 2nd group the umbilical cord was clamped after pulsation had been ceased” delayed cord clamping” (DCC) and then Apgar score, Hemoglobin level, random blood sugar, oxygen saturation and bilirubin after 72 h of labour of newborn were compared and analyzed. Results. There was no statistical significant difference between both groups as regards Apgar score, haemoglobin, Random blood sugar and bilirubin while, there was a statistical significant difference as regard O2 saturation. Conclusion. Delayed cord clamping is likely to result in better neonatal outcome (AU)

Antecedentes. El momento óptimo para el pinzamiento del cordón umbilical, precoz frente al tardío durante el expulsivo del parto, es un tema polémico. No existen unas directrices prácticas formales. Objetivo. Comparar los beneficios y daños potenciales del pinzamiento precoz frente al tardío en recién nacidos a término en el Hospital Materno-Infantil de Shatby. Métodos. Estudio aleatorizado de 100 embarazos únicos a término en primigrávidas que ingresaron y dieron a luz de manera espontánea en el Hospital Materno-Infantil de Shatby. Quedaron divididas en 2 grupos (de 50 integrantes cada uno) en los que se realizó un pinzamiento precoz del cordón umbilical en el primero y un pinzamiento tardío del cordón umbilical en el segundo. A las 72 h del parto se compararon y analizaron la puntuación de Apgar y los valores de hemoglobina, glucemia aleatoria, saturación de oxígeno y bilirrubina. Resultados. No se apreció una diferencia estadística significativa entre ambos grupos con respecto a la puntuación en el test de Apgar, ni tampoco en los valores de hemoglobina, glucemia aleatoria y bilirrubina, si bien existió una diferencia estadísticamente significativa con respecto a la saturación de O2. Conclusión. Un pinzamiento tardío del cordón umbilical podría derivar en un mejor resultado neonatal (AU)

Regulación de las modificaciones óseas en la madre durante la gestación / Regulation of bone modifications in the mother during pregnancy

El embarazo constituye un modelo donde se produce el desarrollo del esqueleto fetal en un corto lapso de tiempo. Este logro se lleva a cabo bajo la tutela del propio feto, que gobierna este proceso a través de las señales generadas en la denominada unidad feto-placentaria. El organismo materno sufre un proceso de adaptación donde se produce un drástico reajuste en mecanismos implicados en el recambio óseo. Entre los cambios más evidentes detectables en sangre materna están los incrementos con la edad gestacional de los niveles de calcitriol, de la hormona de crecimiento de origen placentario, del factor de crecimiento similar a la insulina tipo I (IGF-1), de estrógenos, y de prolactina. También aumentan la osteoprotegerina y el ligando activador del receptor del factor nuclear kappa-B (RANKL). El fenómeno conduce a estados transitorios de deterioro óseo, que se alargan hasta que la lactancia concluye. El proceso en su conjunto está todavía insuficientemente explorado. Presentamos una actualización de los cambios que afectan a la madre y de los que tienen su origen en la placenta (AU)

Pregnancy defines a model where the development of the fetal skeleton occurs in a short lapse of time. This achievement is accomplished under the control of the own fetus, who regulates the process through the signals generated in the so-called feto-placental unit. The maternal organism undergoes an adaptation process in which a drastic readjustment of mechanisms involved in the bone turnover takes place. Among the most obvious changes detected in maternal blood there are the increases in calcitriol, placental growth hormone, insulin-like growth factor -1 (IGF-1), estrogens and prolactin. There are also increases in osteoprotegerin and in the ligand of the receptor activator of nuclear factor kappa (RANKL). The phenomenon leads to transitory states of bone deterioration, which extends up to the end of lactation. The whole process is still insufficiently explored. We present an update of the changes affecting the mother and of those that arise in the placenta (AU)

Insulin therapy and fetoplacental vascular function in gestational diabetes mellitus.

NEW FINDINGS: What is the topic of this review? This review focuses on the effects of insulin therapy on fetoplacental vasculature in gestational diabetes mellitus and the potentiating effects of adenosine on this therapy. What advances does it highlight? This review highlights recent studies exploring a potential functional link between insulin receptors and their dependence on adenosine receptor activation (insulin-adenosine axis) to restore placental endothelial function in gestational diabetes mellitus. Gestational diabetes mellitus (GDM) is a disease that occurs during pregnancy and is associated with maternal and fetal hyperglycaemia. Women with GDM are treated via diet to control their glycaemia; however, a proportion of these patients do not achieve the recommended values of glycaemia and are subjected to insulin therapy until delivery. Even if a diet-treated GDM pregnancy leads to normal maternal and newborn glucose levels, fetoplacental vascular dysfunction remains evident. Thus, control of glycaemia via diet does not prevent GDM-associated fetoplacental vascular and metabolic alterations. We review the available information regarding insulin therapy in the context of its potential consequences for fetoplacental vascular function in GDM. We propose the possibility that insulin therapy to produce normoglycaemia in the mother and newborn may require additional therapeutic measures to restore the normal metabolic condition of the vascular network in GDM. A role for A1 and A2A adenosine receptors and insulin receptors A and B as well as a potential functional link in the cell signalling associated with the activation of these receptors is proposed. This possibility could be helpful for the planning of strategies, including adenosine receptor-improved insulin therapy, for the treatment of GDM patients, thereby promoting the wellbeing of the growing fetus, newborn and mother.

Obstructive sleep apnea is associated with alterations in markers of fetoplacental wellbeing.

BACKGROUND: Obstructive sleep apnea (OSA) has been associated with adverse fetal outcomes in some studies. Second trimester Down syndrome screening markers reflect fetal and fetoplacental wellbeing. We aimed to compare markers of fetal and feto-placental wellbeing in women with OSA and low risk controls. METHODS: A retrospective case-control study of pregnant women with OSA and available second trimester markers was performed. Controls were screened for sleep disordered breathing (SDB) at the time of delivery using a questionnaire. Women at low risk for OSA were selected. Marker levels were adjusted for gestational age and race and reported as multiples of median and later adjusted for body mass index (BMI). RESULTS: Twenty-four OSA cases and 166 controls were identified. Women with OSA had a higher mean BMI when compared to controls (37.1 ± 12.7 versus 24.1 ± 5.1, p = 0.03). Estriol (uE3) multiples of the median (MoM) levels were lower in women with OSA compared to controls, even after adjusting for BMI, 0.74 (interquartile range (IQR) 0.45) versus 1.06 (IQR 0.38), respectively, p = 0.026. Once adjusted for BMI, alpha feto-protein (AFP) MoM levels were no longer significantly different in women with OSA compared to controls. CONCLUSION: OSA is associated with reduced serum uE3 levels, independently of BMI, possibly indicating fetal distress.

Efeito da enrofloxacina sobre a interação blastocisto endométrio e seu reflexo no desenvolvimento placentário e fetal em ratas / Effect of enrofloxacin on the blastocyst endometrial interactions and their impact on placental and fetal development in rats

Estudos têm mostrado efeitos tóxicos da enrofloxacina em diversos tecidos. Assim, testou-se a hipótese de que a enrofloxacina pode interferir no desenvolvimento placentário e gerar efeitos adversos ao feto. A enrofloxacina (Baytril(r)) foi administrada em ratas, na dose de 5mg/kg, diariamente, IM, durante toda a gestação. As placentas foram analisadas morfologicamente, morfometricamente e imuno-histoquimicamente aos sete, 14 e 21 dias de prenhez. Os resultados mostraram que a enrofloxacina reduziu o número de sítios de implantação, o peso e a área total do disco placentário aos 14 e 21 dias de desenvolvimento, além dos elementos constituintes da placenta. A análise histoquímica não revelou alterações significativas no teor de fibras colágenas, elásticas e reticulares. O teste de Tunel mostrou atividade apoptótica apenas nas placentas com 14 dias de desenvolvimento de ambos os grupos, sendo mais intensa no grupo tratado. Não foi observado nenhum indício de malformação na cabeça, no tronco e nos membros dos neonatos. No entanto, houve uma redução significativa no número e no peso dos neonatos no grupo tratado, porém sem afetar o seu comprimento. Assim, concluiu-se que a enrofloxacina administrada na dosagem de 5mg/kg durante prenhez em ratas interfere no número de embriões implantados e no desenvolvimento placentário. Isto sugere cautela na administração da enrofloxacina durante a gestação, pois a exposição contínua a esse antibiótico pode ter reflexos na redução do número e do peso da prole...

Some studies have shown the toxic effects of enrofloxacin in various tissues. Thus, the hypothesis that enrofloxacin could interfere with placental development and generate adverse effects to the fetus was tested in this study. Enrofloxacin (Baytril(r)) was administered in the dose of 5mg/kg daily, i.m., throughout gestation in rats. The placentas were analyzed morphologically, morphometrically, and immunohistochemically on the 7, 14, and 20th days of pregnancy. The results showed that enrofloxacin reduced the number of implantation sites, weight, and placental disk total area at 14 and 20 days of development, in addition to the element components of the placenta. The histochemical analysis did not reveal significant changes in the content of collagen, reticular, and elastic fibers. The TUNEL test showed apoptosis only in placenta development at 14 days in both groups and more intense in the treated group. Head, trunk, and limb malformations were not observed in the neonates. A significant reduction in the number and weight of neonates were observed in the treated group, however, without affecting their length. Thus, it was concluded that the administration of enrofloxacin, at the dosage of 5 mg/kg during pregnancy in rats, interferes in the number of implanted embryos and placental development. This suggests caution in the administration of enrofloxacin during pregnancy because continuous exposure to this antibiotic may have adverse effects, reducing the number and weight of the offspring...

Cytofluorimetric platelet analysis.

Blood platelets are highly specialized cells that drive hemostatic events and tissue repair mechanisms at the site of vascular injury. Their peculiar morphology and certain functional characteristics can be analyzed by flow cytometry (FCM). Specifically, platelet activation, a hallmark of prothrombotic states and inflammatory conditions, is associated with changes in expression of both surface and intracellular antigens that are recognized by specific monoclonal antibodies. Assessment of platelet activation status as ex vivo or in vitro reactivity to specific agonists has become relevant in particular conditions (namely, cardiovascular diseases, hematological malignancies, monitoring of pharmacological antiaggregation). In addition, aberrant surface marker expression that characterizes inherited and acquired platelet function disorders is also detected by FCM. This review discusses the main applications of FCM in platelet analyses, which are relevant for both research and clinical settings.