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1.
Med J Malaysia ; 78(1): 93-97, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36715198

RESUMO

INTRODUCTION: Terbutaline has been used as a foetal resuscitation measure to improve the intrapartum foetal heart rate abnormalities and neonatal outcome for suspected foetal compromise. Unfortunately, till date, the available data are limited to draw any recommendation. MATERIAL AND METHODS: This was a double-blind, placebocontrolled trial conducted among women planned for emergent caesarean delivery for suspected foetal compromise where 100 were randomised to receive subcutaneous terbutaline or placebo. The primary outcomes were the neonatal acid-base status, while the 5- minute Apgar score, admission to the intensive care unit and the maternal outcomes were recorded as secondary outcomes. RESULTS: Data from a total of 96 women were analysed and showed a lower incidence of neonatal acidemia (4.4% vs 10.4%) and fewer neonates born with umbilical artery pH of less than 7.20 (12.5% vs 27.1%) and 7.10 (4.2% vs 6.2%) after terbutaline injection. However, the difference in the incidence of neonatal acidaemia, mean cord pH and base excess, Apgar score or admission to the intensive care unit did not differ significantly. No difference was seen in the maternal mean arterial pressure, estimated blood loss or haematocrit after the surgery between the study groups. The only significant maternal effect was tachycardia which was more common after terbutaline injection (54.2% vs 25.0 %, p=0.003). CONCLUSION: The study shows that acute tocolysis with subcutaneous terbutaline prior to caesarean delivery has the potential to improve the neonatal outcome in suspected intrauterine foetal compromise and should be further investigated.


Assuntos
Terbutalina , Tocólise , Recém-Nascido , Gravidez , Feminino , Humanos , Terbutalina/uso terapêutico , Cesárea , Ressuscitação , Artérias Umbilicais
2.
J Matern Fetal Neonatal Med ; 36(1): 2150074, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36597808

RESUMO

OBJECTIVE: The identification of fetal growth disorders is an important clinical priority given that they increase the risk of perinatal morbidity and mortality as well as long-term diseases. A subset of small-for-gestational-age (SGA) infants are growth-restricted, and this condition is often attributed to placental insufficiency. Syndecan-1, a product of the degradation of the endothelial glycocalyx, has been proposed as a biomarker of endothelial damage in different pathologies. During pregnancy, a "specialized" form of the glycocalyx-the "syncytiotrophoblast glycocalyx"-covers the placental villi. The purpose of this study was to determine whether the concentration of maternal plasma syndecan-1 can be proposed as a biomarker for fetal growth restriction. STUDY DESIGN: A cross-sectional study was designed to include women with normal pregnancy (n = 130) and pregnant women who delivered an SGA neonate (n = 50). Doppler velocimetry of the uterine and umbilical arteries was performed in women with an SGA fetus at the time of diagnosis. Venipuncture was performed within 48 h of Doppler velocimetry and plasma concentrations of syndecan-1 were determined by a specific and sensitive immunoassay. RESULTS: (1) Plasma syndecan-1 concentration followed a nonlinear increase with gestational age in uncomplicated pregnancies (R2 = 0.27, p < .001); (2) women with a pregnancy complicated with an SGA fetus had a significantly lower mean plasma concentration of syndecan-1 than those with an appropriate-for-gestational-age fetus (p = .0001); (3) this difference can be attributed to fetal growth restriction, as the mean plasma syndecan-1 concentration was significantly lower only in the group of women with an SGA fetus who had abnormal umbilical and uterine artery Doppler velocimetry compared to controls (p = .00071; adjusted p = .0028). A trend toward lower syndecan-1 concentrations was also noted for SGA with abnormal uterine but normal umbilical artery Doppler velocimetry (p = .0505; adjusted p = .067); 4) among women with an SGA fetus, those with abnormal umbilical and uterine artery Doppler findings had a lower mean plasma syndecan-1 concentration than women with normal Doppler velocimetry (p = .02; adjusted p = .04); 5) an inverse relationship was found between the maternal plasma syndecan-1 concentration and the umbilical artery pulsatility index (r = -0.5; p = .003); and 6) a plasma syndecan-1 concentration ≤ 850 ng/mL had a positive likelihood ratio of 4.4 and a negative likelihood ratio of 0.24 for the identification of a mother with an SGA fetus who had abnormal umbilical artery Doppler velocimetry (area under the ROC curve 0.83; p < .001). CONCLUSION: Low maternal plasma syndecan-1 may reflect placental diseases and this protein could be a biomarker for fetal growth restriction. However, as a sole biomarker for this condition, its accuracy is low.


Assuntos
Retardo do Crescimento Fetal , Placenta , Recém-Nascido , Lactente , Gravidez , Feminino , Humanos , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/patologia , Placenta/patologia , Estudos Transversais , Sindecana-1 , Recém-Nascido Pequeno para a Idade Gestacional , Biomarcadores , Artérias Umbilicais/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ultrassonografia Doppler
3.
BMC Pregnancy Childbirth ; 23(1): 29, 2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36641425

RESUMO

BACKGROUND: Umbilical artery serum-derived exosomes (UEs) serve as messengers for maternal-fetal information exchange and cellular regulation. Intravenous remifentanil could be considered as an effective adjunct to epidural anesthesia in providing a favorable analgesia effect for cesarean section (C-section), but its effects on UEs are currently unknown. METHODS: From 01/12/2021 to 30/06/2022, eligible parturients scheduled for repeated C-section at the First Affiliated Hospital of Wenzhou Medical University were randomized to receive either an intravenous bolus (0.15 µg/kg) followed by a continuous infusion (0.075 µg/kg/min) of remifentanil or normal saline throughout the procedure. The primary outcome was the number of UEs. Secondary outcomes included the size and protein amount of UEs, the vital signs, visceral pain score, sedation score, maternal satisfaction score, Apgar score, the incidence of neonatal asphyxia, umbilical arterial pH, and the presence of complications. RESULTS: Nanoparticle tracking analysis indicated similar size of UEs between the two groups, but the number and protein amount of UEs were increased in the remifentanil group  compared to the control group (P < 0.05). In parturients receiving remifentanil, visceral pain scores were decreased, which was accompanied by the increased scores of maternal satisfaction with the anesthetic method (P < 0.05). Other maternal and neonatal outcomes were comparable between the two groups (P > 0.05). CONCLUSION: The intravenous administration of remifentanil increased the number of UEs in parturients undergoing repeated C-section under epidural anesthesia, with improved birth experience and minimal neonatal complications.


Assuntos
Anestesia Epidural , Exossomos , Dor Visceral , Recém-Nascido , Gravidez , Humanos , Feminino , Remifentanil , Analgésicos Opioides/uso terapêutico , Piperidinas , Cesárea , Artérias Umbilicais , Dor Visceral/tratamento farmacológico , Anestesia Epidural/métodos , Infusões Intravenosas
4.
J Matern Fetal Neonatal Med ; 36(1): 2153034, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36521862

RESUMO

OBJECTIVE: Preeclampsia and fetal growth disorders are pregnancy-specific conditions that share common pathophysiological mechanisms. Yet, why some patients develop preeclampsia while others experience fetal growth restriction, or a combination of both clinical presentations, is unknown. We propose that the difference in severity of the maternal inflammatory response can contribute to the clinical phenotypes of preeclampsia vs. small for gestational age (SGA). To assess this hypothesis, we measured maternal plasma concentrations of the soluble isoform of suppression of tumorigenicity-2 (sST2), a member of the interleukin-1 receptor family that buffers proinflammatory responses. Previous reports showed that serum sST2 concentrations rise in the presence of intravascular inflammation and Th1-type immune responses and are significantly higher in patients with preeclampsia compared to those with normal pregnancy. The behavior of sST2 in pregnancies complicated by SGA has not been reported. This study was conducted to compare sST2 plasma concentrations in normal pregnancies, in those with preeclampsia, and in those with an SGA fetus. METHODS: This retrospective cross-sectional study included women with an SGA fetus (n = 52), women with preeclampsia (n = 106), and those with normal pregnancy (n = 131). Maternal plasma concentrations of sST2 were determined by enzyme-linked immunosorbent assay. Doppler velocimetry of the uterine and umbilical arteries was available in a subset of patients with SGA (42 patients and 43 patients, respectively). RESULTS: (1) Women with an SGA fetus had a significantly higher median plasma concentration of sST2 than normal pregnant women (p = .008); (2) women with preeclampsia had a significantly higher median plasma concentration of sST2 than those with normal pregnancy (p < .001) and those with an SGA fetus (p < .001); (3) patients with SGA and abnormal uterine artery Doppler velocimetry had a higher median plasma concentration of sST2 than controls (p < .01) and those with SGA and normal uterine artery Doppler velocimetry (p = .02); (4) there was no significant difference in the median plasma sST2 concentration between patients with SGA who had normal uterine artery Doppler velocimetry and controls (p = .4); (5) among patients with SGA, those with abnormal and those with normal umbilical artery Doppler velocimetry had higher median plasma sST2 concentrations than controls (p = .001 and p = .02, respectively); and (6) there was no significant difference in the median plasma sST2 concentrations between patients with SGA who did and those who did not have abnormal umbilical artery Doppler velocimetry (p = .06). CONCLUSIONS: Preeclampsia and disorders of fetal growth are conditions characterized by intravascular inflammation, as reflected by maternal plasma concentrations of sST2. The severity of intravascular inflammation is highest in patients with preeclampsia.


Assuntos
Retardo do Crescimento Fetal , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Recém-Nascido , Estudos Retrospectivos , Estudos Transversais , Recém-Nascido Pequeno para a Idade Gestacional , Artérias Umbilicais , Inflamação
5.
J Matern Fetal Neonatal Med ; 36(1): 2152670, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36482725

RESUMO

OBJECTIVE: The aim of this study was to determine if appropriately grown fetuses (those that are not small-for-gestational-age) with a raised umbilical artery pulsatility index (>95th centile) in the mid third trimester are at increased risk of placental dysfunction and adverse outcome. METHODS: This is a 5-year retrospective cohort study using routinely collected data. Inclusion criteria were singleton, non-anomalous pregnancies having a growth scan with umbilical artery Doppler velocimetry between 28 + 0 and 33 + 6 weeks' gestation. Small-for-gestational-age fetuses were excluded. Cases were classified as group 1 (those with an umbilical artery pulsatility index >95th centile at any scan during target window) or group 2 (those where the umbilical artery pulsatility index was ≤95th centile at all scans). p-Values and odds ratios were calculated. Logistic regression was used to compute odds ratios adjusted for baseline estimated weight z-score, gestational age at delivery, and labor induction. RESULTS: After exclusions, there were 202 pregnancies in group 1 and 7950 in group 2. Differences in baseline characteristics between the groups include age (median age was 30 for group 1 and 32 for group 2, p < .001), smoking (group 1 were more likely to smoke, p < .001) and labor induction (more common in group 1, p = .03). Among those delivering ≥34 + 0, group 1 were more likely to be small-for-gestational-age and have an abnormal cerebro-placental ratio at the final scan (OR 6.76, CI 4.23-10.80 and OR 5.07, CI 3.37-7.63 respectively), and to develop features of growth restriction (OR 9.85, CI 6.27-15.49). Group 1 were also more likely to deliver <37 + 0 weeks' gestation (OR 1.71, CI 1.13-2.58) and to have birthweight <10th or <3rd centile (OR 5.26, CI 3.65-7.58 and OR 6.13, CI 3.00-12.54 respectively). These associations remained significant when adjusted for estimated weight at the initial scan. CONCLUSIONS: These data suggest that raised umbilical artery pulsatility index in an appropriately grown fetus at 28 + 0 to 33 + 6 weeks' gestation is associated with subsequent development of growth restriction markers and an increased risk of moderate and severe small-for-gestational-age at birth. This is independent of the estimated weight of these babies at the index scan.


Assuntos
Placenta , Artérias Umbilicais , Recém-Nascido , Gravidez , Humanos , Feminino , Adulto , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Placenta/irrigação sanguínea , Artérias Umbilicais/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Estudos de Coortes , Feto , Retardo do Crescimento Fetal/diagnóstico por imagem , Idade Gestacional , Ultrassonografia Pré-Natal , Ultrassonografia Doppler
6.
Eur J Obstet Gynecol Reprod Biol ; 280: 168-173, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36508854

RESUMO

OBJECTIVES: Potassium (K+) channel openers and calcium (Ca2+) channel blockers are currently used to treat acute severe hypertension in pregnancy. We aimed to investigate the vasorelaxant effect of NS11021, a potent and specific big-conductance Ca2+-activated K+ (BKCa) channel activator, and to compare it with the vasorelaxant effect of nifedipine on human umbilical arteries (HUAs) isolated from healthy and preeclamptic pregnants. STUDY DESIGN: A total of 29 HUAs were isolated immediately after delivery from 14 healthy and 15 preeclamptic pregnant with severe features. The concentration-dependent relaxation responses were obtained to nifedipine and NS11021 on HUAs precontracted with endothelin-1 (ET-1) (10-8 M) in an isolated tissue bath. RESULTS: Both nifedipine and NS11021 caused concentration-dependent relaxation responses in HUAs from healthy and preeclamptic pregnants. While the maximum responses (Emax) and pD2 values of nifedipine did not change significantly in both groups, the Emax and pD2 values of NS11021 were significantly decreased in the preeclampsia group (Emax ± SEM; %75.57 ± 4.53 and %43.75 ± 14.00 and pD2 ± SEM; 6.92 ± 0.26 and 5.24 ± 0.53 respectively, p < 0.05). In addition, the pD2 value of NS11021 was not significantly different from that of nifedipine in the control group, but decreased significantly in the preeclampsia group (pD2 ± SEM 7.1 ± 0.41 and 5.2 ± 0.53, p < 0.05, respectively). CONCLUSIONS: Efficacy and potency of NS11021 decreased in HUAs from preeclamptic pregnants. Also, NS11021 is less potent than nifedipine in the preeclampsia group. BKCa channels may have a role in the pathogenesis of preeclampsia, however, further experimental studies are needed to elucidate that.


Assuntos
Nifedipino , Pré-Eclâmpsia , Humanos , Feminino , Gravidez , Nifedipino/farmacologia , Pré-Eclâmpsia/tratamento farmacológico , Gestantes , Artérias Umbilicais , Vasodilatadores/farmacologia
7.
Acta Obstet Gynecol Scand ; 102(2): 174-180, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36504253

RESUMO

INTRODUCTION: Umbilical arterial pH of less than 7 is often used as the threshold below which the risks of neonatal death and adverse long-term neurological outcomes are considered to be higher. Yet within the group with pH <7, the risks have not been further stratified. Here, we aimed to investigate the predictors of adverse long-term outcomes of this group of infants. MATERIAL AND METHODS: This was a retrospective study of 248 infants born after 34 weeks of gestation in a tertiary obstetric unit, between 2003 and 2017, with cord arterial pH <7 or base excess ≤-12 mmol/L at birth. The infants were categorized into two groups: (1) intact survivors, or (2) neonatal/infant deaths or cerebral palsy or developmental delay. The umbilical arterial pH and base excess levels, Apgar scores, mode of delivery, gestational age, small for gestational age, birth in the era before the implementation of neonatal hypothermic therapy, and the presence of a known sentinel event, were compared between the groups using univariate analysis followed by multivariate analysis. RESULTS: Among the 248 infants, there were 222 intact survivors (89.5%) and 26 infants with poor outcomes (10.5%), including eight deaths (3.2%) and 18 (7.3%) with cerebral palsy and/or developmental delay. Univariate analysis showed that infants with adverse outcomes had significantly lower cord arterial pH (6.85 vs 6.95, with p < 0.001), lower cord arterial base excess (-19.95 vs -15.90 mmol/L, p < 0.001), a higher proportion of having AS at 5 min <7 (65.4% vs 13.1%, p < 0.001), and a higher proportion of having a sentinel event (34.6% vs 16.7%, p = 0.034). Multivariate analysis confirmed cord arterial pH of <6.9 and an Apgar score at 5 min <7 as independent prognostic factors (the adjusted odds ratios were 4.64 and 6.62, respectively). The risk of adverse outcome increased from 4.3% when the arterial pH was between 6.9 and <7, to 30% when the pH was <6.9. CONCLUSIONS: Infants born with umbilical artery pH <7 still have a high chance of 89.5% to become intact survivors. A cord arterial pH of <6.9 and an Apgar score at 5 min <7 are independent prognostic factors for neonatal/infant death or adverse long-term neurological outcomes.


Assuntos
Paralisia Cerebral , Doenças do Recém-Nascido , Recém-Nascido , Gravidez , Feminino , Lactente , Humanos , Estudos Retrospectivos , Concentração de Íons de Hidrogênio , Paralisia Cerebral/epidemiologia , Cordão Umbilical , Artérias Umbilicais , Índice de Apgar , Sangue Fetal
8.
Medicina (Kaunas) ; 58(12)2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36556956

RESUMO

The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton's jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.


Assuntos
Complicações do Trabalho de Parto , Cordão Umbilical , Gravidez , Feminino , Humanos , Artérias Umbilicais , Veias Umbilicais , Placenta , Feto
9.
Sci Rep ; 12(1): 21519, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36513654

RESUMO

This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children's Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0-12.9, 13.0-15.9, 16.0-18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0-7.9, 8.0-10.9, 11.0-13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.


Assuntos
Acidose , Doenças Fetais , Gravidez , Recém-Nascido , Feminino , Criança , Humanos , Índice de Apgar , Japão/epidemiologia , Parto Obstétrico , Artérias Umbilicais , Acidose/epidemiologia , Estudos Retrospectivos
10.
Nutrients ; 14(23)2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36501150

RESUMO

Antenatal Doppler disturbances are associated with fetal hypoxia and may induce a brain-sparing vascular redistribution at the expense of splanchnic circulation, possibly predisposing to gut complications. We aimed to compare several gastrointestinal outcomes among very-low-birthweight (VLBW) preterm infants with different antenatal Doppler features. VLBW infants born between 2010-2022 were retrospectively included and stratified into the following clusters based on antenatal Doppler characteristics: normal Doppler (controls); absent or reversed end-diastolic flow in the umbilical artery (UA-AREDF) alone or also in the ductus venosus (UA+DV-AREDF); and abnormal Doppler with or without brain-sparing redistribution. The following outcomes were evaluated: time to reach full enteral feeds (FEF), feeding intolerance (FI), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP). Overall, 570 infants were included. Infants born following UA+DV-AREDF had significantly higher FI, NEC, and SIP rates and achieved FEF later compared to controls. Increased FI prevalence and a longer time to FEF compared to controls were also observed among UA-AREDF infants and in the presence of brain-sparing redistribution, which also increased NEC rates. Antenatal Doppler abnormalities exacerbate the gastrointestinal risks of preterm infants. Detailed knowledge of Doppler features can aid in identifying those at highest risk of intestinal complications who may benefit from tailored enteral feeding management.


Assuntos
Enterocolite Necrosante , Recém-Nascido Prematuro , Recém-Nascido , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Enterocolite Necrosante/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Artérias Umbilicais/diagnóstico por imagem
11.
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
12.
Orphanet J Rare Dis ; 17(1): 414, 2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371215

RESUMO

BACKGROUND: To analyze the ultrasound imaging and clinical characteristics of fetuses with umbilical artery thrombosis (UAT), explore the potential causes of UAT and construct a prognostic prediction model to guide clinical practice. METHODS: This was a retrospective cohort study of fetal UAT cases examined at two academic tertiary referral care centers from 2014 to 2020. The basic information of the participants was obtained by interview during follow-up, and data on clinical treatment, delivery conditions, diagnosis and confirmation were obtained through medical records. Probable causes of thrombosis were explored by comparative analysis of the UAT group to the control group and by further regression analysis. Multivariable logistic regression models were used to evaluate risk factors for adverse pregnancy outcomes. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the prognostic prediction model. RESULTS: Thirty fetuses with UAT were included in this study. UAT occurred mostly in the third trimester of pregnancy, and there was an obvious predominance of right UAT. An abnormal pregnancy history (53.3%) was the most common comorbidity, followed by gestational diabetes mellitus (GDM) (20.0%). GDM and umbilical cord (UC) abnormalities were found to be independent risk factors for the development of UAT. After comprehensive decision-making, over two-thirds of the patients with UAT received urgent treatment, and less than one-third received expectant management. Surprisingly, there were no significant differences in fetal outcomes between the urgent treatment and expectant management groups. Multivariate logistic regression analysis showed that gestational age (GA) at clinical diagnosis and UC abnormalities were independent risk factors for adverse pregnancy outcomes (OR 0.781, p = 0.042; OR 16.779, p = 0.023, respectively). Based on this, we constructed a comprehensive prognostic prediction model. The area under the ROC curve (AUC) was 0.877 (95% CI 0.698-0.970; p < 0.001), which suggested that the combination of GA and UC abnormalities was a better predictor for fetal outcomes in our setting. CONCLUSION: In summary, maternal GDM and fetal UC abnormalities are independent risk factors for UAT. UAT is more frequently observed on the right side. Moreover, poor clinical outcomes for fetuses with UAT are ascribed mainly to GA and UC abnormalities, which should be comprehensively evaluated to choose the appropriate treatment.


Assuntos
Trombose , Artérias Umbilicais , Gravidez , Recém-Nascido , Feminino , Humanos , Artérias Umbilicais/diagnóstico por imagem , Recém-Nascido Pequeno para a Idade Gestacional , Ultrassonografia Pré-Natal/métodos , Estudos Retrospectivos , Seguimentos , Diagnóstico Pré-Natal , Trombose/diagnóstico
13.
Medicine (Baltimore) ; 101(44): e31379, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343019

RESUMO

RATIONALE: HELLP syndrome, a rare but serious obstetric complication, is often overdiagnosed due to its nonspecific symptoms and inappropriate clinical testing. PATIENT CONCERNS: A 30-year-old nulliparous pregnant Chinese woman at gestational age of 28+1 weeks was admitted to our hospital because Doppler ultrasonography at a local hospital had detected loss of fetal umbilical artery end-diastolic blood flow lasting 12 hours. On admission to our hospital, the patient showed elevated blood pressure (148/84 mm Hg), but blood pressure and laboratory indicators after admission were normal. However, the patient developed abdominal pain during hospitalization. INTERVENTIONS: Dexamethasone was given after admission to our hospital to promote fetal lung maturation, magnesium sulfate was given to protect fetal brain nerves, and maternal blood pressure was closely monitored. In addition, fetal umbilical artery blood flow was dynamically monitored. After three days in hospital with normal blood pressure, the patient developed abdominal pain accompanied by diarrhea. She was positive for Murphy's sign and laboratory tests showed no obvious abnormalities. Acute cholecystitis was suspected, but symptomatic and supportive treatment did not relieve abdominal pain and her blood pressure increased progressively to 212/130 mm Hg. Magnesium sulfate was given immediately to prevent spasm, and nitroglycerin was administered intravenously against hypertension. Liver enzymes, blood coagulation, and routine urinalysis were abnormal. The patient was diagnosed with HELLP syndrome, and an emergency cesarean section was performed. DIAGNOSIS: HELLP syndrome. OUTCOMES: After the cesarean section, platelet (PLT) count continuously decreased and transaminase and bilirubin levels continously increased. The newborn was transferred to the neonatal intensive care unit after birth and discharged at a corrected gestational age of 34 weeks. By postoperative day 6, laboratory indicators had returned to normal and the patient was discharged. LESSONS SUBSECTIONS: Our case highlights that HELLP syndrome is a serious complication, and it should be diagnosed carefully and not arbitrarily on the basis of some abnormal indicators and stable clinical manifestations. Accurate early identification, active monitoring and management are essential for improving prognosis and avoiding maternal or infant mortality.


Assuntos
Síndrome HELLP , Humanos , Recém-Nascido , Gravidez , Feminino , Lactente , Adulto , Síndrome HELLP/diagnóstico , Síndrome HELLP/terapia , Cesárea , Artérias Umbilicais/diagnóstico por imagem , Sulfato de Magnésio/uso terapêutico , Dor Abdominal
14.
J R Soc Interface ; 19(196): 20220579, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36349448

RESUMO

Fetal growth and maturation are highly intertwined with placental development during pregnancy. Here we used placental vascular morphology measurements (depth and span) as well as the umbilical artery (UA) diameter of previously published studies on three different mouse strains (C57BL6/J, CD-1 and BALB/c), which were exposed to different conditions (combination antiretroviral therapy, chronic maternal hypoxia and malaria infection) at different embryonic days, to test the hypothesis that placental vascularization and specifically the UA size affect conceptus weight. Interaction of each study parameter with embryonic day, strain and exposure to treatments are studied to investigate the stability of the scaling relationships across and/or within strains and conditions. In addition, the effect of UA diameter on the placental growth measurements (depth and span) is studied. These results show that the power-law scaling relationship of conceptus weight and placental depth with the UA diameter is conserved across strains and conditions with the scaling exponent of approximately 3/8 and 5/8, respectively. By contrast, the relationship between conceptus weight and either the placental span or depth is different between strains and conditions, suggesting multiple mechanisms of vascular adaptation.


Assuntos
Placenta , Artérias Umbilicais , Gravidez , Feminino , Animais , Camundongos , Desenvolvimento Fetal , Camundongos Endogâmicos C57BL
16.
Acta Obstet Gynecol Scand ; 101(12): 1431-1439, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36214456

RESUMO

INTRODUCTION: The aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries. MATERIAL AND METHODS: An e-questionnaire was sent via REDCap with "click thru" links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings. RESULTS: A total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from ≥32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (≤32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively. CONCLUSIONS: The diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynamics are less frequently assessed but more so in early rather than late fetal growth restriction. Further standardization is needed for the definition of cerebral blood flow redistribution.


Assuntos
Retardo do Crescimento Fetal , Artérias Umbilicais , Gravidez , Feminino , Humanos , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/terapia , Artérias Umbilicais/diagnóstico por imagem , Ultrassonografia Pré-Natal , Inquéritos e Questionários , Biomarcadores , Ultrassonografia Doppler , Idade Gestacional
17.
J Matern Fetal Neonatal Med ; 35(25): 10239-10245, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36117422

RESUMO

INTRODUCTION: A large fall in insulin requirements (FIR) in women with diabetes is associated with adverse clinical outcomes but previous studies have not examined its relation with serial ultrasound parameters. OBJECTIVE: To determine whether FIR is associated with alteration in umbilical artery Doppler parameters and fetal growth restriction (FGR) in women with preexisting diabetes. METHODS: Serial obstetric Doppler ultrasounds were conducted 2 weekly from 28 weeks gestation in women with Type 1 and Type 2 diabetes who were being treated with insulin. Estimated fetal weight (EFW), head circumference:abdominal circumference (HC:AC) ratio and umbilical artery doppler parameters (SD ratio) and pulsatility index (PI) were measured. Information on insulin dose was collected prospectively throughout pregnancy and women with FIR ≥ 15% were considered cases. Linear mixed effect models were used to assess the association between FIR and ultrasound parameters. RESULTS: One hundred and forty two women were included in the study (type 1 diabetes n = 41, type 2 diabetes n = 101). Thirty women demonstrated FIR ≥ 15%. There was no significant difference in the change of S/D ratio or PI over the third trimester in cases with FIR ≥ 15%, compared to the rest of the cohort, before or after adjusting for type of diabetes. Likewise there was no difference in EFW and HC:AC ratio with advancing gestation before or after adjusting for variables known to influence fetal growth. FGR rates (3.3 vs 8% p = 0.298) and high S/D ratio > 95% (13.3 vs 8%, p = 0.296) were similar between the two groups. CONCLUSIONS: FIR ≥ 15% was not associated with changes in placental flow or FGR however larger studies are needed to evaluate this further.


Assuntos
Diabetes Mellitus Tipo 2 , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido , Feminino , Gravidez , Humanos , Insulina , Estudos Prospectivos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Placenta , Artérias Umbilicais/diagnóstico por imagem , Retardo do Crescimento Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal , Peso Fetal , Idade Gestacional
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 3959-3962, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-36085920

RESUMO

The umbilical cord is the link between fetus and the placenta. It consists of one vein and two arteries, encased inside Wharton's jelly. In this study, the influence of morphological parameters of umbilical arteries, namely the wall-lumen ratio and lumen diameter, on the stress distribution in Wharton's jelly is analyzed using a 3D finite element model. The lumen diameter of the arteries is varied from 0.4 mm to 2.0 mm in steps of 0.4 mm. The variation of average and maximum effective stresses in the Wharton's jelly with wall-lumen ratio is analyzed. Further, differences in stresses between the placental and fetal ends of umbilical cord are analyzed. Results show that, the average and maximum effective stresses at both ends of the umbilical cord vary nonlinearly with the wall-lumen ratio. For all the considered lumen diameters, the average effective stress is found to decrease with an increase in wall-lumen ratio at both the ends. An increase in the lumen diameter is found to be associated with a nonlinear decrease in average stress ratios. Clinical Relevance- The results of this study could be useful for the early diagnosis of fetal abnormalities and might be helpful to develop better treatment strategies.


Assuntos
Geleia de Wharton , Feminino , Humanos , Placenta , Gravidez , Artérias Umbilicais/diagnóstico por imagem , Cordão Umbilical
19.
Artigo em Inglês | MEDLINE | ID: mdl-36078758

RESUMO

OBJECTIVE: This study aimed to describe neurodevelopment in fetal growth restriction children at the age of six. Secondly, we tried to demonstrate influencing factors that can improve or exacerbate this development, as well as predictive factors that might select a population at risk to assist with early childhood support. METHOD: It was a study of 70 children affected with FGR. FGR was based on these definitions: birth weight below the 3rd percentile or birth weight below the 10th percentile with an abnormal hemodynamic Doppler study. Neurodevelopment was assessed at 6 years old by means of Batelle Development Inventory. A global development quotient under a 100 score was considered a neurodevelopment delay. All variables regarding pregnancy care, delivery episode, postpartum, neonatal care, sociodemographic issues, and the need for support in the first years were studied. RESULTS: The mean gestational age at diagnosis was 33.14 weeks (standard deviation (SD = 4.31), with 32.9% of early-onset diagnoses. The mean gestational age at delivery was 35.61 (SD = 3.21), and the cesarean rate was 64.3%. The average age of the children at the moment of the evaluation was 76.20-month-old (SD = 3.70). The mean global development quotient was 97.28 (SD = 13.97). We were able to record a 57.1% of global development delay. In the cases of cognition, only 17.1% of the children registered a delay. Motor and communication skills were the most frequently affected. We discovered that socioeconomic status was positively related to the global development quotient, as well as both gestational age at delivery and middle cerebral artery pulsatility index was positively related to the global development quotient. CONCLUSIONS: We found a higher neurodevelopment delay rate (57.1%). We could relate a higher gestational age at delivery and a higher MCA percentile with better global neurodevelopment quotients.


Assuntos
Retardo do Crescimento Fetal , Artérias Umbilicais , Peso ao Nascer , Criança , Pré-Escolar , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Artérias Umbilicais/diagnóstico por imagem
20.
Artigo em Inglês | MEDLINE | ID: mdl-36123246

RESUMO

Doppler ultrasound when used appropriately is an invaluable tool in monitoring high risk twin pregnancy. There are no recent multicentre randomised controlled trials examining the value of routine umbilical artery doppler (UA), middle cerebral artery doppler (MCA), cerebroplacental ratio (CPR), uterine artery doppler (UtA) and ductus venosus doppler in uncomplicated twins. Thus, there is lack of international consensus in relation to incorporation of doppler ultrasound in the routine surveillance of uncomplicated multiples. In this chapter we will discuss how twins differ from singletons in their growth trajectories and progression of doppler abnormalities. International clinical guidelines are reviewed. Recommendations for doppler surveillance (routine or selective) with reference to recent studies are made.


Assuntos
Gravidez de Gêmeos , Ultrassonografia Pré-Natal , Gravidez , Feminino , Humanos , Retardo do Crescimento Fetal/diagnóstico por imagem , Fluxo Pulsátil , Artérias Umbilicais/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Ultrassonografia Doppler , Idade Gestacional
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