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SARS-CoV-2 Infection: A Clinical and Histopathological Study in Pregnancy. BIOLOGY 2023; 12:biology12020174. [PMID: 36829453 PMCID: PMC9953179 DOI: 10.3390/biology12020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
During pregnancy, SARS-CoV-2 infection is associated with several adverse outcomes, including an increased risk of pre-eclampsia, preterm delivery, hypertensive disorders, gestational diabetes, and fetal growth restriction related to the development of placenta vascular abnormalities. We analyzed human placenta from full-term, uncomplicated pregnancies with SARS-CoV-2 infection during the first, second, or third trimesters of gestation. We studied, by the immunohistochemistry technique, the expression of CD34 and podoplanin (PDPN) as markers of vasculogenesis to find any differences. As secondary outcomes, we correlated maternal symptoms with placental histological alterations, including fibrin deposits, lymphocyte infiltration in the villi, edema, and thrombi. Our results showed a PDPN expression around the villous stroma as a plexiform network around the villous nucleus of fetal vessels; significant down-regulation was observed in the villous stroma of women infected during the third trimester. CD34 showed no changes in expression levels. During SARS-CoV-2 infection, the most common maternal symptoms were fever, anosmia, ageusia and asthenia, and the majority were treated with paracetamol, corticosteroids and azithromycin. Patients that required multiple symptomatic treatments evidenced a large amount of fibrin deposition in the villi. Certainly, PDPN plays a key role in healthy placental vasculogenesis and thus in its proper physiology, and SARS-CoV-2 surely alters its normal expression. Further studies are necessary to understand what mechanisms are being altered to try to avoid possible complications for both the mother and fetus in terms of the contagions that will still occur.
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Boskabadi H, Zakerihamidi M, Sadeghian MH, Avan A, Ghayour-Mobarhan M, Ferns GA. Nucleated red blood cells count as a prognostic biomarker in predicting the complications of asphyxia in neonates. J Matern Fetal Neonatal Med 2016; 30:2551-2556. [PMID: 27809621 DOI: 10.1080/14767058.2016.1256988] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nucleated-red-blood-cells (NRBC) count in umbilical cord of newborns is been suggested as a sign of birth asphyxia. The present study was conducted to explore the value of NRBC count in prognosis of asphyxiated neonates. METHODS Sixty-three neonates with asphyxia were followed up for two years. Maternal and neonatal information was recorded follow by clinical and laboratory evaluation. NRBC-level was determined per 100 white-blood-cells (WBC). After discharge, follow-up of asphyxiated infants was performed using Denver II test at 6, 12, 18 and 24 months. Neonates were divided into two groups, with favorable and unfavorable outcome based on developmental delay or death. RESULTS We observed that NRBC count with more than 11 per 100 WBC, had sensitivity of 85% and specificity of 90% in predicting complications of asphyxia, while in absolute NRBC count with more than 1554, the sensitivity and specificity were 85% and of 87%, respectively. Combination of NRBC + HIE (hypoxic ischemic encephalopathy) grade had a high-predictive power for determining the prognosis of asphyxia in neonates. CONCLUSION We demonstrate that NRBC/100 WBC and absolute NRCB count can be used as prognostic marker for neonatal asphyxia, which in combination with the severity of asphyxia could indicate high infant mortality, and complications of asphyxia. Further studies in a larger and multi center setting trail are warranted to investigate the value of NRBC and HIE in asphyxiate term infants.
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Affiliation(s)
- Hassan Boskabadi
- a Department of Pediatrics , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Maryam Zakerihamidi
- b Department of Midwifery , Faculty of Medicine, Islamic Azad University of Tonekabon , Tonekabon , Iran
| | - Mohammad Hadi Sadeghian
- c Hematology and blood banking Department, Ghaem hospital, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Amir Avan
- d Department of Modern Sciences and Technologies , School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Majid Ghayour-Mobarhan
- d Department of Modern Sciences and Technologies , School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran.,e Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran , and
| | - Gordon A Ferns
- f Division of Medical Education , Brighton and Sussex Medical School , Brighton , UK
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Maeda MDFY, Nomura RMY, Niigaki JI, Francisco RPV, Zugaib M. Influence of fetal acidemia on fetal heart rate analyzed by computerized cardiotocography in pregnancies with placental insufficiency. J Matern Fetal Neonatal Med 2013; 26:1820-4. [DOI: 10.3109/14767058.2013.802304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Galazios G, Tripsianis G, Tsikouras P, Koutlaki N, Liberis V. Fetal distress evaluation using and analyzing the variables of antepartum computerized cardiotocography. Arch Gynecol Obstet 2009; 281:229-33. [PMID: 19455348 DOI: 10.1007/s00404-009-1119-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 05/04/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this study, we tried to establish cut-off values for more than one parameters of computerized cardiotocography (c CTG) in the prediction of fetal distress during labor, using a group of pregnant women with low-risk pregnancies. METHOD A retrospective study was performed. Data were collected from 167 patients for measurements of fetal heart rate (FHR) variables and perinatal outcome. Computerized CTG was performed with an Oxford Sonicaid monitor with connection to a 8000 system for CTG spontaneous analysis. The following c CTG variables were considered: FHR, number of accelerations, the presence and the number of episodes of high and low variation, the number of decelerations, short-term variation (STV), peaks of contractions (per hour) and fetal movements assessed by maternal perception (per hour). Computerized CTG recordings started not earlier than the beginning of week 38 of gestation. Immediately after delivery, blood sample was collected from umbilical artery for umbilical artery blood gas analysis (UBGA). The main UBGA parameter in cord umbilical artery that was considered for analysis was pH. pH values<7.25 were considered as suspicious for acidemia and pH values>or=7.25 as normal. RESULTS Women suspicious for fetal distress during labor presented significantly lower fetal movements (P=0.026), accelerations (P=0.018), variability (P<0.001), number of high episodes (P<0.001), higher values of FHR baseline (P<0.001) and low episodes (P<0.001). Only the number of decelerations did not differ significantly between the two groups (P=0.545). The cut-off points of 5.00 for STV and 3.00 for high episodes were determined to classify women with fetal distress, which yielded high sensitivities (34 and 52%) and specificities (96.6 and 94.9%), with positive predictive values of 81.0 and 81.3% and negative predictive values of 77.4 and 82.2%, respectively. CONCLUSIONS In conclusion, we believe that not only STV but also other components of the cCTG, mainly the presence and the number of episodes of high variation, are related to pregnancy's outcome as measured by an umbilical artery pH.
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Affiliation(s)
- Georgios Galazios
- Department of Obstetrics and Gynaecology, Medical School, Demokritus University of Thrace, Str. Sarafi 3, 68100, Alexandroupolis, Greece.
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Garcia GS, Mariani Neto C, Araujo Júnior E, Garcia RL, Nardozza LMM, Moron AF. Fetal acidemia prediction through short-term variation assessed by antepartum computerized cardiotocography in pregnant women with hypertension syndrome. Arch Gynecol Obstet 2008; 278:125-8. [DOI: 10.1007/s00404-007-0537-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 12/10/2007] [Indexed: 11/24/2022]
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Anceschi MM, Ruozi-Berretta A, Piazze JJ, Cosmi E, Cerekja A, Meloni P, Cosmi EV. Computerized cardiotocography in the management of intrauterine growth restriction associated with Doppler velocimetry alterations. Int J Gynaecol Obstet 2005; 86:365-70. [PMID: 15325854 DOI: 10.1016/j.ijgo.2004.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 05/03/2004] [Accepted: 05/10/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To verify the reliability of computerized cardiotocography (cCTG) in the prediction of the oxygen metabolism status of fetuses with growth restriction and Doppler velocimetry alterations. METHODS From 24 third-trimester cesarean section performed because of intrauterine growth restriction (IUGR) and Doppler velocimetry alterations, there were 11 cases of fetal heart rate alterations (Dawes-Redman criteria were not satisfied) and 13 cases of reactive cCTG. Fetal lung maturity was detected by amniocentesis and blood samples for umbilical blood gas analysis (UBGA) were collected before the first neonatal breath from the umbilical artery in a double-clamped segment of the cord. RESULTS Umbilical cord gas analysis showed arterial cord blood pH to be 7.20 or less in 11 newborns (45.8%), 7.10 or less in 6 (25%), and 7.00 or less in 3 (12.5%). Linear regression analysis showed short-term variation (STV) in the fetal heart rate to be significantly correlated with umbilical artery pH (r = 0.49; P = 0.01) and pCO2 (r = -0.50; P = 0.01). There were no significant correlations between cCTG and the other UBGA parameters considered. Receiver operator curves permitted to calculate the STV values at which pathological neonatal UBGA values can be expected (pH < 7.00 and pCO2 > 80 mmHg). A short-term variation less than 4.5 ms was found to predict acidemia with a sensitivity of 100% and a specificity of 70% (positive predictive value, 33%; negative predictive value, 100%), and hypercarbia with a sensitivity of 100% and a specificity of 77.8% (positive predictive value, 55.6%; negative predictive value, 100%). CONCLUSION In view of the results of this study, 4.5 ms for STV may be a threshold below which timing of delivery should be decided in cases of fetal growth restriction.
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Affiliation(s)
- M M Anceschi
- Department of Gynecology, Perinatology and Child Health, University 'La Sapienza' of Rome, Viale Regina Elena 324 - 00161, Rome, Italy.
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Ruozi-Berretta A, Piazze JJ, Cosmi E, Cerekja A, Kashami A, Anceschi MM. Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus. J Perinat Med 2005; 32:426-9. [PMID: 15493720 DOI: 10.1515/jpm.2004.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate whether computerized CTG (cCTG) is a reliable method of predicting neonatal outcome in pregnancies complicated by pregestational diabetes at term. PATIENTS AND METHODS We considered 27 pregnant women affected by pregestational diabetes and 46 normal pregnancies as controls that fulfilled the following criteria: singleton, Caucasian, euglycemic pregnancies at term (>37 weeks gestational age). All women delivered by cesarean section (CS), with an antepartum cCTG performed within one hour before the CS and an UBGA available at birth. No patient was in labor during FHR monitoring. RESULTS Among cCTG parameters, accelerations 15 bpm, HV min, HV ms and STV were significantly lower in comparison to controls. We observed that in the diabetic pregnant women the parameter STV was not able to predict or to linearly regress with the most important UBGA parameters: pH and pCO2. Contrarily, in normal pregnancies, the STV linearly regressed with both the pH (p < 0.03) and pCO2 (p<0.04). CONCLUSIONS Computerized FHR criteria may not be applicable to fetuses in pregestational diabetic pregnancies at term. Therefore some criteria should perhaps be modified for a correct interpretation of cCTG in these pregnancies.
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Affiliation(s)
- Angelo Ruozi-Berretta
- Institute of Gynecology, Perinatology and Child Health, University La Sapienza, Rome, Italy.
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Ayres-de-Campos D, Costa-Santos C, Bernardes J. Prediction of neonatal state by computer analysis of fetal heart rate tracings: the antepartum arm of the SisPorto® multicentre validation study. Eur J Obstet Gynecol Reprod Biol 2005; 118:52-60. [PMID: 15596273 DOI: 10.1016/j.ejogrb.2004.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 03/04/2004] [Accepted: 04/13/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the capacity of computer analysis of antepartum cardiotocographs performed by SisPorto 2.0 in predicting neonatal outcome. STUDY DESIGN A prospective observational study was conducted in eight tertiary care centres in Europe and Australia, involving pregnant women in the absence of labor, scheduled for elective caesarean section, whose last fetal heart rate (FHR) tracing was performed within 4h of delivery. After exclusion of fetal malformations, multiple pregnancies, tracings with less than 30 min, tracings with more than 15% signal loss, difficult fetal extractions, and anesthesia complications, a total of 345 cases were analyzed. Computer quantification of cardiotocographic parameters was compared with newborn Apgar score, umbilical artery pH, metabolic acidosis and neonatal hypoxic-ischemic encephalopathy, by means of receiver operating characteristic (ROC) curves. RESULTS Acceleration number, mean short-term variability, percentage of abnormal short-term variability and percentage of abnormal long-term variability had an excellent discriminative capacity to predict 1-min Apgar scores under or equal to 4 (areas under the ROC curve 0.96-1.00). The same parameters showed a slightly lower capacity to predict 5-min Apgar scores under or equal to 6 (areas under the ROC curve 0.81-0.89). The best cut-off values for these parameters, derived from the previously referred calculations, detected all cases of hypoxic-ischemic encephalopathy (n = 2). Cardiotocographic parameters showed a lower discriminative capacity in prediction of umbilical artery pH <7.20 (maximum area under the ROC curve 0.66) and <7.15 (maximum area under the ROC curve 0.69). CONCLUSIONS Computerized quantification of accelerations and variability in the antepartum allows a good prediction of 1 and 5-min Apgar scores, and to a much lesser degree umbilical artery pH.
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Affiliation(s)
- Diogo Ayres-de-Campos
- Departamento de Ginecologia e Obstetrícia, Faculdade Medicina da Universidade do Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal.
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Anceschi MM, Piazze JJ, Ruozi-Berretta A, Cosmi E, Cerekja A, Maranghi L, Cosmi EV. Validity of short term variation (STV) in detection of fetal acidemia. J Perinat Med 2003; 31:231-6. [PMID: 12825479 DOI: 10.1515/jpm.2003.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS We aimed to establish a cut-off for short term variation (STV) in msec in electronic FHR tracings as a single parameter for the prediction of neonatal acidemia and hypercarbia at birth. METHODS 195 consecutive cases of singleton pregnancies between 26 to 42 weeks' gestation delivered by cesarean section, with an antepartum tracing performed within 4 hours from birth and umbilical artery gas analysis (UBGA) available at birth. RESULTS A positive correlation (r = 0.27, p < 0.0001) was found when STV was regressed against gestational age. We also found significant correlations between STV and UBGA parameters (pH [r = 0.12, p < 0.05] and pCO2 [r = -0.17, p < 0.01]). In order to evaluate the influence of gestational age on STV values, we subdivided patients into three subgroups (< 34 weeks: n = 31; 35-37 weeks: n = 37, and > 37 wks: n = 127). Only in the subgroup < 34 wks, STV < 5.1 msec was a significant predictor of acidemia (pH < 7.0), (sensitivity: 100%, specificity: 61%, p < 0.05); in the same subgroup STV < 4.9 msec predicted pCO2 > 60 mmHg with a sensitivity: 71.4% and a specificity: 62.5% (p < 0.02). CONCLUSION In cases < 34 weeks' gestation, STV values below 4.9 msec and 5.1 msec are able to predict umbilical artery pH < 7.0 and PCO2 > 60 mmHg, respectively.
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Affiliation(s)
- Maurizio M Anceschi
- Institute of Gynecology, Perinatology and Child Health, University La Sapienza, Rome, Italy.
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Abstract
Babies who are small due to intrauterine growth restriction are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Through multiple antenatal testing modalities a sequence of deteriorating fetal status can be documented in such cases. The nature of this compromise is best reflected by the combination of fetal biometry, biophysical profile scoring and arterial and venous Doppler. This combination accurately defines fetal states and therefore risk of stillbirth or poor transition to extrauterine life. In the preterm neonate, fetal factors, gestational age and neonatal course interact significantly to impact on short- and long-term outcomes. The potential for iatrogenic prematurity is great and ongoing appraisal of peripartum management is critical. An integrated management protocol accounting for these factors is examined in this review.
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Affiliation(s)
- A A Baschat
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore 21201-1703, USA.
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