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Bhattacharya R, Chaudhary M, Bhattacharjee S, Kukadiya R, Shahu S, Shah D, Patel MR. Clinical Profile of Patients Presenting With Eclampsia at a Semi-urban Tertiary Care Center. Cureus 2024; 16:e65651. [PMID: 39205718 PMCID: PMC11352022 DOI: 10.7759/cureus.65651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Pregnancies complicated by hypertensive disorders contribute to enormous burden on economy and health-care facilities. Eclampsia is one of the clinical markers of near-miss mortality. To achieve optimal outcomes, efforts should be directed at both periphery and tertiary care levels. This study aimed to compare the feto-maternal outcome in patients presenting with eclampsia and a matched control population. Methodology A comparative observational study was conducted among 70 cases and 70 controls. Detailed history and general and obstetrical examinations were carried out. Data was extracted from case files, labor room, and ICU records. Maternal and fetal outcomes were noted from January 2023 to January 2024. Statistical software STATA 14.2 (StataCorp LLC, College Station, Texas, USA) was used for data analysis. Observational descriptive statistics and chi-square and Fisher extract tests were applied. Results In our study, the incidence of eclampsia was 0.7% (70 per 1000 live births). The maternal mortality rate was 102.8/100000 live births and the perinatal mortality rate was 10.2/ 1000 live births in our study. The study observed a relatively young aged population and a significant bulk of cases belonged to late gestation or post-partum. Events like HELLP syndrome, abruption, liver, and renal failure were found to be frequently linked to eclampsia. Neonatal asphyxia (P-0.005), NICU requirement 41.43% vs 29% (P<0.01) preterm delivery 45.7% vs 14% (P=<0.001), and low birth weight were more commonly observed among the cases than the controls. Conclusions Eclampsia was found to be a significant contributor to elevated rates of morbidity and mortality in mothers and newborns. Poor antenatal care, severe anemia, and late referrals were some of the modifiable risk factors. Health care and economic burden on society is immense due to the significant utilization of intensive care and high dependency units.
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Affiliation(s)
- Rumi Bhattacharya
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Milankumar Chaudhary
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | | | - Romil Kukadiya
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Sheetal Shahu
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Dipal Shah
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Mamta R Patel
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
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Mahajan KS, Dewani D, Duragkar S. Umbilical Artery Doppler Indices in Hypertensive Disorders of Pregnancy: Impact on Fetal Outcomes. Cureus 2023; 15:e50876. [PMID: 38249223 PMCID: PMC10799235 DOI: 10.7759/cureus.50876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are associated with increased maternal and fetal risks. Doppler ultrasound indices of the umbilical artery have shown promise in predicting adverse fetal outcomes in HDP patients. This observational study investigated the correlation between abnormal umbilical artery Doppler indices and adverse fetal outcomes in HDP patients. Methodology Over a two-year period from 2020 to 2022, in Acharya Vinoba Bhave Rural Hospital, central India, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Comprehensive clinical assessments, laboratory investigations, and Doppler studies of the umbilical artery were performed. Doppler indices assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were defined based on birth weight and neonatal intensive care unit admissions. Chi-square or Fisher's exact test was used for analyzing the relationship between qualitative data, while an independent-sample t-test was employed for quantitative data. Results Abnormal umbilical artery Doppler indices, including an elevated S/D ratio, RI, and PI, demonstrated a positive correlation with adverse fetal outcomes in HDP patients. These findings highlight the significance of umbilical artery Doppler indices as reliable indicators for anticipating adverse fetal outcomes in HDP patients. Conclusions Abnormal Doppler indices in the umbilical artery, including an elevated S/D ratio, RI, and PI, appear to be valuable predictors for adverse fetal outcomes in patients with HDP. Monitoring these indices can aid in risk stratification and improve the management of pregnancies complicated by HDP.
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Affiliation(s)
- Kalyani S Mahajan
- Obstetrics and Gynecology, Symbiosis Medical College for Women, Symbiosis International University, Pune, IND
| | - Deepika Dewani
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sakshi Duragkar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Duragkar S, Mahajan KS, Dewani D. Uterine Artery Doppler Indices as Predictor of Adverse Fetal Outcome in Hypertensive Disorders of Pregnancy: An Observational Study. Cureus 2023; 15:e49265. [PMID: 38143695 PMCID: PMC10746569 DOI: 10.7759/cureus.49265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health. The utility of Doppler indices in predicting adverse fetal outcomes in HDP patients remains an area of active research. This observational study aimed to assess the correlation between abnormal uterine artery Doppler indices and adverse fetal outcomes in HDP patients. Methods Over a two-year period, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Detailed clinical assessments, laboratory investigations, and Doppler studies of the uterine artery were conducted. The Doppler indices that were assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were classified based on appearance, pulse, grimace, activity, and respiration (APGAR) scores, birth weight, NICU admissions, and perinatal deaths. Statistical analyses were performed to evaluate the predictive value of Doppler indices. Results Abnormal uterine artery Doppler indices, specifically an elevated S/D ratio and the presence of a diastolic notch showed a positive correlation with adverse fetal outcomes. However, Doppler indices such as PI and RI did not demonstrate a significant correlation with adverse fetal outcomes in HDP patients. These findings suggest that the S/D ratio and the presence of a diastolic notch in uterine artery Doppler studies hold potential as predictive markers for adverse fetal outcomes in HDP patients. Conclusion Uterine artery Doppler indices, specifically the S/D ratio and the presence of a diastolic notch, appear to be valuable predictors for adverse fetal outcomes in patients with hypertensive disorders of pregnancy. These findings underscore the importance of regular monitoring of uterine artery Doppler flow in the management of HDP to identify pregnancies at higher risk for adverse fetal outcomes.
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Affiliation(s)
- Sakshi Duragkar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kalyani S Mahajan
- Obstetrics and Gynecology, Symbiosis Medical College for Women, Symbiosis International University, Pune, IND
| | - Deepika Dewani
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Li M, Yue C. Abnormal uterine artery Doppler ultrasound during gestational 21-23 weeks associated with pre-eclampsia. Int J Gynaecol Obstet 2023; 161:264-270. [PMID: 36049891 DOI: 10.1002/ijgo.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess whether abnormal uterine artery Doppler ultrasound during weeks 21-23 of pregnancy was associated with an increased risk of pre-eclampsia. METHODS Our retrospective cohort study analyzed uterine artery ultrasound parameters in singleton pregnant women at 21-23 weeks of pregnancy and assessed the association between abnormal ultrasound findings and the risk of pre-eclampsia. Multivariate logistic regression analysis was conducted to estimate the relative risk between uterine artery ultrasound and pre-eclampsia. RESULTS Compared with normal results, unilateral pulsatile index abnormality (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.71-3.10), bilateral pulsatile index anomalies (OR 6.21, 95% CI 3.53-10.95), unilateral resistance index abnormality (OR 2.36, 95% CI 1.75-3.17), bilateral resistance index anomalies (OR 2.83, 95% CI 1.27-6.32), unilateral notch (OR 3.66, 95% CI 2.03-6.62), bilateral notch (OR 5.80, 95% CI 3.30-10.20) were associated with pre-eclampsia. For every 0.1 increase in the median multiple of mean pulsatile index, the risk of pre-eclampsia increased by 13%; for every 0.1 increase in the median multiple of mean resistance index, the risk of pre-eclampsia increased by 22%. CONCLUSION Multiples of the median for the pulsatile and resistance indices are an effective evaluation tool. Abnormal uterine artery ultrasound indices are strongly associated with the development of pre-eclampsia.
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Affiliation(s)
- Meng Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chaoyan Yue
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Kurjak A, Medjedovic E, Stanojević M. Use and misuse of ultrasound in obstetrics with reference to developing countries. J Perinat Med 2023; 51:240-252. [PMID: 36302110 DOI: 10.1515/jpm-2022-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
Abstract
Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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Karadas B, Acar-Sahan S, Kantarci S, Uysal N, Horoz E, Kaya-Temiz T. Comparison of relaxant effects of nifedipine and NS11021 on isolated umbilical arteries of healthy and preeclamptic pregnant women. Eur J Obstet Gynecol Reprod Biol 2023; 280:168-173. [PMID: 36508854 DOI: 10.1016/j.ejogrb.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Baris Karadas
- Izmir Katip Celebi University Faculty of Medicine, Department of Pharmacology Izmir, Turkey.
| | - Selin Acar-Sahan
- Izmir Katip Celebi University Faculty of Medicine, Department of Pharmacology Izmir, Turkey.
| | - Sercan Kantarci
- University of Health Sciences Tepecik Training and Research Hospital Department of Obstetrics and Gynecology Izmir, Turkey
| | - Nusret Uysal
- Izmir Katip Celebi University Faculty of Medicine, Department of Pharmacology Izmir, Turkey
| | - Ersan Horoz
- Izmir Katip Celebi University Faculty of Medicine, Department of Pharmacology Izmir, Turkey.
| | - Tijen Kaya-Temiz
- Izmir Katip Celebi University Faculty of Medicine, Department of Pharmacology Izmir, Turkey.
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Study on the Correlation between the Levels of HtrA3 and TGF- β2 in Late Pregnancy and Preeclampsia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4453646. [PMID: 35035835 PMCID: PMC8759857 DOI: 10.1155/2022/4453646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/15/2021] [Accepted: 11/25/2021] [Indexed: 12/05/2022]
Abstract
Preeclampsia (PE) is a common and proprietary complication during pregnancy. The correlation was found between the levels of HtrA3 and TGF-β 2 and preeclampsia (PE). This study aimed to detect the HtrA3 and TGF-β2 in different parts of the third trimester (maternal serum, placenta). The 102 pregnant women who were eligible for enrollment in the obstetric examination at Tengzhou Maternity and Child Health Hospital from June 2020 to December 2020 were selected as the research objects. 28 cases diagnosed with PE were set up as the observation group 1, and 24 cases diagnosed with severe PE were set up as the observation group 2. Select 50 normal pregnant women as the control group and research the expressions of HtrA3 and TGF-β2 in maternal blood and placental tissues of patients with PE. ELISA was used to measure the concentration of HtrA3 and TGF-β2 in maternal blood. The distribution of HtrA3 and TGF-β2 in the placenta was observed by immunohistochemical techniques (IHC) and mean optical density value (MOD). S/D was measured by using color Doppler ultrasonic. The concentration of HtrA3 and TGF-β2 in the maternal blood and placenta tissue was higher in severe PE compared with PE and normotensive pregnancy, respectively (P < 0.05). There is a negative correlation between the level of HtrA3 and TGF-β2 and the birthweight of newborns both in maternal plasma and placenta tissue in preeclampsia and positive correlation between HtrA3 and TGF-β2 levels and S/D. HtrA3 and TGF-β2 may correlate with severity of PE and their neonatal adverse outcomes.
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Adekanmi AJ, Roberts A, Morhason-Bello IO, Adeyinka AO. Utilization of Uterine and Umbilical Artery Doppler in the Second and Third Trimesters to Predict Adverse Pregnancy Outcomes: A Nigerian Experience. WOMEN'S HEALTH REPORTS 2022; 3:256-266. [PMID: 35262064 PMCID: PMC8896215 DOI: 10.1089/whr.2021.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
Abstract
Objective: To assess the utility of uterine and umbilical artery Doppler in the second and third-trimester in predicting adverse pregnancy outcomes. Methodology: In a prospective longitudinal study, the demographic, clinical, Doppler ultrasound parameters of the uterine and umbilical arteries of 84 consecutive women attending the antenatal clinic at 22–24 weeks and 116 women at 30–34 weeks gestation and pregnancy outcomes were documented and analyzed. Results: Pregnant women with adverse pregnancy outcomes had significantly higher second-trimester mean uterine systolic/diastolic (S/D) ratio (p = 0.001), pulsatility index (PI; p = 0.003), umbilical artery S/D (p = 0.016), and resistivity index (RI; p = 0.041) as well as higher third-trimester uterine S/D and PI. While pregnancies with adverse fetal outcomes showed significantly higher uterine artery S/D and PI at the second trimester, third-trimester uterine showed higher S/D, RI, and PI and umbilical artery PI than in women with normal fetal outcomes. The combination of uterine PI and early diastolic notch were predictors of maternal outcomes and correctly predicted 73% (p < 0.001) in the second trimester. By the third trimester, the uterine PI alone was the best predictor and accurately predicted about 62% of maternal outcomes (p = 0.028). In addition, the second-trimester uterine S/D and early diastolic notch and uterine PI in the third trimester correctly predicted 79% and 78% of fetal outcomes, respectively. Conclusion: Among unselected pregnant women population, the second-trimester Doppler parameters are better predictors of maternal adverse pregnancy outcomes, while adverse fetal outcome prediction by uterine and umbilical Doppler at the second- and the third-trimester parameters are comparable.
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Affiliation(s)
- Ademola J. Adekanmi
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adebola Roberts
- Department of Obstetrics and Gynaecology, and College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Imran O. Morhason-Bello
- Department of Obstetrics and Gynaecology, and College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute of Medical Research and Advanced Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abiodun O. Adeyinka
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ali S, Heuving S, Kawooya MG, Byamugisha J, Grobbee DE, Papageorghiou AT, Klipstein-Grobusch K, Rijken MJ. Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review. BMJ Open 2021; 11:e049799. [PMID: 34857564 PMCID: PMC8640672 DOI: 10.1136/bmjopen-2021-049799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES This systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC). DESIGN We searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020. SETTING Observational or interventional studies from LMICs. PARTICIPANTS Singleton pregnancies of any risk profile. INTERVENTIONS Umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava. PRIMARY AND SECONDARY OUTCOME MEASURES Perinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO). RESULTS We identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations. CONCLUSION Local evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative. PROSPERO REGISTRATION NUMBER CRD42019128546.
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Affiliation(s)
- Sam Ali
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Simelina Heuving
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michael G Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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Medjedovic E, Kurjak A. The Importance of Doppler Analysis of Uterine Circulation in Pregnancy for a Better Understanding of Preeclampsia. Med Arch 2021; 75:424-430. [PMID: 35169369 PMCID: PMC8802687 DOI: 10.5455/medarh.2021.75.424-430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The etiology of preeclampsia has still not been completely explained. Early identification of women with the risk of developing preeclampsia is a key goal of antenatal care. OBJECTIVE To investigate risk factors for preeclampsia from the history, laboratory and ultrasound findings (Doppler). METHODS Pregnant women with normal Doppler sonography in the second trimester of pregnancy were classified as a control group, while pregnant women with impaired Doppler in the second trimester were considered as the investigated group with presumably increased risk for preeclampsia. A total number of 80 patients was included in the study (40 patients in each group). RESULTS The difference of urea, uric acid and lactate dehydrogenase (LDH) in the serum of the control and investigated group was statistically significant, while the differences were not statistically significant for creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The presence of a notch sign during assessment of blood flow in uterine arteries in subjects in the investigated group with the diagnosis of preeclampsia had the specificity of 47.62%, and sensitivity of 88.89%. The positive predictive value of a notch sign during assessment of blood flow in uterine arteries as a marker for diagnosis of preeclampsia in the second trimester of pregnancy was 90.91%, and its negative. Systolic and diastolic blood pressure are dependent variables which are predicting preeclampsia, whilst a notch sign in uterine arteries was designated as an independent variable predicting preeclampsia. CONCLUSION From the laboratory tests the following parameters were considered as the risk factors for preeclampsia: increasing levels of urea, uric acid, and LDH. Notch sign was considered to be a very strong predictor of preeclampsia, especially if present bilaterally. Doppler sonography in the second trimester of pregnancy is a good predictor for early diagnosis of preeclampsia.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Department of Gynecology, Obstetrics and Reproductive medicine, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Asim Kurjak
- Department of Gynecology, Obstetrics and Reproductive medicine, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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11
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The possibility of clinical use for the oxidative stress marker in correlation with blood flow parameters in pregnancy-induced hypertension. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Introduction: In pregnancy-induced hypertension (PIH) there is a disorder in placental blood flow which causes intrauterine fetal hypoxia, and oxidative stress has a significant role in this condition. The aims of this research were to analyze the relation of thiobarbituric acid reactive substance (TBARS), as a marker of oxidative stress and absent end-diastolic flow (AEDF), as well as the relation of TBARS and cerebroplacental ratio (CPR).
Methods: The research included 200 pregnant women in the gestation period from 28th to 40th, 100 were in a control group and 100 were with PIH. The CPR and TBARS were analyzed in all examined pregnant women. The CPR was calculated by dividing the Doppler indices of the middle cerebral artery by the umbilical artery.
Results: Mean value of TBARS in the group with the PIH who had AEDF was in the interval of high values - 43.22 μmol/l. The result shows that through the application of Spearman’s coefficient, the correlation results in a statistically significant correlation between CPR and TBARS values: ρ = - 0.249, p = 0.0001.
Conclusion: PIH has a very high level of oxidative stress, especially in pregnant women with absent end-diastolic flow in the umbilical artery and pathologic CPR. The Spearman’s test results in statistical significance and negative correlation, which means that in higher TBARS values, values of CPR are lower and vice versa, which indicates a possibility of clinical application of TBARS.
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Shinde T, Bhalerao A. Evaluation of Uterine Artery Doppler (Mean Pulsatility Index) at 11-14 Weeks of Gestation as Predictor of Hypertensive Disorders of Pregnancy: A Prospective Observational Study. J Obstet Gynaecol India 2021; 71:27-32. [PMID: 33814796 PMCID: PMC7960858 DOI: 10.1007/s13224-020-01360-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The etiology and pathophysiology of hypertensive disorders of pregnancy remains enigmatic, and till date, no test can accurately predict it. Early screening may allow vigilant antenatal surveillance, timely delivery and thus substantially reduce maternal and perinatal morbidity and mortality. Our study aims to evaluate the predictive value of uterine artery mean pulsatility index (PI) at 11-14 weeks and find a reference value for hypertensive disorders of pregnancy. METHODS A prospective study of 240 antenatal women using non-probability simple random sampling was carried out in a tertiary care center. Mean uterine artery PI was obtained at 11-14 weeks of gestation. Pregnancies were followed till delivery and 7 days postpartum. The major end point was development of hypertensive disorders of pregnancy. Maternal and neonatal outcomes were also assessed. RESULTS The predictability of uterine artery mean pulsatility index (PI) at 11-14 weeks for hypertensive disorders of pregnancy was significantly high with an odds ratio of 174.45 (95% CI 65.31-549.13; p < 0.0001), sensitivity (89.3%), specificity (95.8%), positive predictive value(90.5%) and negative predictive value (95.1%). CONCLUSION Uterine artery mean PI at 11-14 weeks of gestation is a cost-effective predictive test for hypertensive disorders of pregnancy, and the recommended reference value for Indian population of is 2.28.
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Affiliation(s)
- Trupti Shinde
- NKP Salve Institute of Medical Sciences, Nagpur, 201, Kesar Heritage, Plot 258, Sector 28, Vashi, Navi Mumbai, 400703 India
| | - Anuja Bhalerao
- NKP Salve Institute of Medical Sciences, Nagpur, 494, Old Ramdaspeth, Nagpur, 440010 India
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Baser E, Celik IH, Bilge M, Kasapoglu T, Isik DU, Yalvac ES, Tapisiz OL, Ozdemirci S. Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 28 0/7-33 6/7 Gestational Weeks. Fetal Pediatr Pathol 2020; 39:467-475. [PMID: 31997690 DOI: 10.1080/15513815.2020.1716900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (280/7-336/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Istemi Han Celik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Melek Bilge
- Department of Obstetrics, Clinic Ministry of Health Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Konya, Turkey
| | - Taner Kasapoglu
- Department of Obstetrics and Gynecology, Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Dilek Ulubas Isik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Ethem Serdar Yalvac
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Omer Lutfi Tapisiz
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Safak Ozdemirci
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
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Bauer I, Hartkopf J, Kullmann S, Schleger F, Hallschmid M, Pauluschke-Fröhlich J, Fritsche A, Preissl H. Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review. BMJ Open Sport Exerc Med 2020; 6:e000658. [PMID: 32206341 PMCID: PMC7078670 DOI: 10.1136/bmjsem-2019-000658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
Before and during pregnancy, women often aim to improve their lifestyle so as to provide a healthier environment for their developing child. It remains unresolved, however, as to whether physical activity (PA) during pregnancy poses a possible risk or whether it might even have beneficial effects on the developing child. There is increasing evidence that PA during pregnancy is indeed beneficial to maternal physiological and psychological health and that it is generally not detrimental to the fetal cardiovascular system and neuronal function in the developing child. This also led to international recommendations for PAs during pregnancy. In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.
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Affiliation(s)
- Ilena Bauer
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Julia Hartkopf
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Schleger
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Manfred Hallschmid
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences; Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls University Tübingen, Tübingen, Germany
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15
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Babic I, Mejia A, Wrobleski JA, Shen M, Wen SW, Moretti F. Intraplacental Villous Artery Doppler as an Independent Predictor for Placenta-Mediated Disease and Its Comparison with Uterine Artery Doppler and/or Placental Biochemical Markers in Predictive Models: A Prospective Cohort Study. Fetal Diagn Ther 2019; 47:292-300. [PMID: 31726454 DOI: 10.1159/000503963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate intraplacental villous artery (IPVA) Doppler as a predictor for placenta-mediated diseases (PMDs), to compare its predictive value with uterine artery (UtA) Doppler and placental biochemical markers, and to assess its value in predictive PMD models. METHODS IPVA and UtA indices (pulsatility index [PI] and resistance index [RI]) were recorded at 18-24 weeks of gestation in a cohort of 117 women. The predictive values of IPVA, UtA, and placental biochemical markers were analyzed and compared between the PMD group (the women who developed preeclampsia or intrauterine growth restriction) and the non-PMD group (the women who remained healthy throughout pregnancy and 3 months postpartum) using the receiver-operating characteristic curves. Logistic regression was used to compare predictive models for PMDs based on IPVA, UtA, and/or biochemical markers. RESULTS 31 (26.5%) women developed PMD (17 preeclampsia and 14 intrauterine growth restriction). IPVA PI was significantly higher in the PMD group than in the non-PMD group (p = 0.001). UtA PI and RI values remained nonsignificant between both groups (p = 0.066 and 0.104, respectively). IPVA PI from the 3 main branches of the placenta, and specifically the central main stem villi, showed a strong association with PMDs in comparison to UtA (p = 0.03 and 0.001 vs. 0.29). Model prediction including IPVA and UtA PI with or without placental biomarkers did not add any further significance to IPVA PI alone (p = 0.03, 0.41, and 0.36). CONCLUSIONS IPVA PI appears superior to UtA PI or RI and placental biomarkers in PMD prediction. Model prediction for PMDs including IPVA, UtA Doppler, and biochemical markers did not enhance prediction values compared to IPVA Doppler alone.
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Affiliation(s)
- Inas Babic
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, .,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada,
| | - Alberto Mejia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie-Anne Wrobleski
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Minxue Shen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Felipe Moretti
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Das NS, Dheen ST, Ling EA, Bay BH, Srinivasan DK. Therapeutic Prospects in Preeclampsia - A Mini-Review. Curr Med Chem 2019; 26:4786-4798. [PMID: 30836908 DOI: 10.2174/0929867326666190228115423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preeclapmsia (PE) is characterized by early onset symptoms such as elevated blood pressure, proteinuria and edema in the pregnant woman, and may result in seizures in the affected female. Currently, there are no therapeutic drugs available to treat this condition, but there are interventions to regulate the symptoms based on the gestational period of the fetus, although the largely favored option is delivery of the fetus and placenta. OBJECTIVE A search for biomolecules associated with PE was conducted so as to identify diagnostic markers and therapeutic leads. RESULTS The literature search resulted in the identification of biomolecules such as Corin and Placental Protein 13 (PP13), among others that are associated with PE. Thereby, giving an insight into the various mechanistic pathways involved in the causation of PE. However, it is also evident that PE cannot be solely attributed to any single mechanism but is due to an interplay of different factors that have led to the development of this disease condition. CONCLUSION The identified biomarkers would ultimately help in understanding this complex disease and perhaps lead to the discovery of potential effective molecular targets for clinical trials, thereby providing a valuable therapeutic option for affected pregnant women.
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Affiliation(s)
- N S Das
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S T Dheen
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E A Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - B H Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D K Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Placental bed research: II. Functional and immunological investigations of the placental bed. Am J Obstet Gynecol 2019; 221:457-469. [PMID: 31288009 DOI: 10.1016/j.ajog.2019.07.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/01/2019] [Accepted: 07/02/2019] [Indexed: 01/14/2023]
Abstract
Research on the placenta as the interface between the mother and the fetus has been undertaken for some 150 years, and in 2 subsequent reviews, we attempted to summarize the situation. In the first part, we described the discovery of unique physiological modifications of the uteroplacental spiral arteries, enabling them to cope with a major increase in blood flow necessary to ensure proper growth of the fetus. These consist of an invasion of the arterial walls by trophoblast and a progressive disappearance of its normal structure. Researchers then turned to the pathophysiology of the placental bed and in particular to its maternal vascular tree. This yielded vital information for a better understanding of the so-called great obstetrical syndromes (preeclampsia, fetal growth restriction, premature labor and delivery, placenta accreta). Systematic morphological investigations of the uteroplacental vasculature showed that preeclampsia is associated with decreased or failed transformation of spiral arteries and the persistence of endothelial and smooth muscle cells in segments of their myometrial portion. Here we report on recent functional investigations of the placental bed, including in situ biophysical studies of uteroplacental blood flow and vascular resistance, and manipulation of uteroplacental perfusion. These new methodologies have provided a novel way of identifying pregnancies in which remodeling is impaired. In animals it is now possible to manipulate uteroplacental blood flow, leading to an enhancement of fetal growth; this opens the way to trials in abnormal human pregnancies. In this second part, we explored a new, extremely important area of research that deals with the role of specific subsets of leukocytes and macrophages in the placental bed. The human first-trimester decidua is rich in leukocytes called uterine natural killer cells. Both macrophages and uterine natural killer cells increase in number from the secretory endometrium to early pregnancy and play a critical role in mediating the process of spiral artery transformation by inducing initial structural changes. It seems therefore that vascular remodeling of spiral arteries is initiated independently of trophoblast invasion. Dysregulation of the immune system may lead to reproductive failure or pregnancy complications, and in this respect, recent studies have advanced our understanding of the mechanisms regulating immunological tolerance during pregnancy, with several mechanisms being proposed for the development of tolerance to the semiallogeneic fetus. In particular, these include several strategies by which the trophoblast avoids maternal recognition. Finally, an important new dimension is being explored: the likelihood that pregnancy syndromes and impaired uteroplacental vascular remodeling may be linked to future maternal and even the child's cardiovascular disease risk. The functional evidence underlying these observations will be discussed.
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Surico D, Bordino V, Cantaluppi V, Mary D, Gentilli S, Oldani A, Farruggio S, Melluzza C, Raina G, Grossini E. Preeclampsia and intrauterine growth restriction: Role of human umbilical cord mesenchymal stem cells-trophoblast cross-talk. PLoS One 2019; 14:e0218437. [PMID: 31206561 PMCID: PMC6576763 DOI: 10.1371/journal.pone.0218437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/02/2019] [Indexed: 12/27/2022] Open
Abstract
Background Oxidative stress is involved in the pathogenesis and maintenance of pregnancy-related disorders, such as intrauterine growth restriction (IUGR) and preeclampsia (PE). Human umbilical cord mesenchymal stem cells (hUMSCs) have been suggested as a possible therapeutic tool for the treatment of pregnancy-related disorders in view of their paracrine actions on trophoblast cells. Objectives To quantify the plasma markers of peroxidation in patients affected by PE and IUGR and to examine the role of oxidative stress in the pathophysiology of PE and IUGR in vitro by using hUMSCs from physiological and pathological pregnancies and a trophoblast cell line (HTR-8/SVneo). Study design In pathological and physiological pregnancies the plasma markers of oxidative stress, arterial blood pressure, serum uric acid, 24h proteinuria, weight gain and body mass index (BMI) were examined. Furthermore, the pulsatility index (PI) of uterine and umbilical arteries, and of fetal middle cerebral artery was measured. In vitro, the different responses of hUMSCs, taken from physiological and pathological pregnancies, and of HTR-8/SVneo to pregnancy-related hormones in terms of viability and nitric oxide (NO) release were investigated. In some experiments, the above measurements were performed on co-cultures between HTR-8/SVneo and hUMSCs. Results The results obtained have shown that in pathological pregnancies, body mass index, serum acid uric, pulsatility index in uterine and umbilical arteries and markers of oxidative stress were higher than those found in physiological ones. Moreover, in PE and IUGR, a relation was observed between laboratory and clinical findings and the increased levels of oxidative stress. HTR-8/SVneo and hUMSCs showed reduced viability and increased NO production when stressed with H2O2. Finally, HTR-8/SVneo cultured in cross-talk with hUMSCs from pathological pregnancies showed a deterioration of cell viability and NO release when treated with pregnancy-related hormones. Conclusion Our findings support that hUMSCs taken from patients affected by PE and IUGR have significant features in comparison with those from physiologic pregnancies. Moreover, the cross-talk between hUMSCs and trophoblast cells might be involved in the etiopathology of IUGR and PE secondary to oxidative stress.
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Affiliation(s)
- Daniela Surico
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
| | - Valerio Bordino
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Nephrology-Kidney Transplantation Unit and Center for Autoimmune and Allergic Diseases (CAAD), University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - David Mary
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Sergio Gentilli
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Alberto Oldani
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Serena Farruggio
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Carmela Melluzza
- Department of Translational Medicine, Gynecologic Unit, University East Piedmont, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Raina
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
| | - Elena Grossini
- Department of Translational Medicine, AGING PROJECT, University East Piedmont, Novara, Italy
- Department of Translational Medicine, Laboratory of Physiology/Experimental Surgery, University East Piedmont, Novara, Italy
- * E-mail:
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Shao J, Wu X, Liu X, Qi J, Qi Z. THE CORRELATION BETWEEN NECK CIRCUMFERENCE AND UMBILICAL ARTERY BLOOD FLOW IN PHYSIOLOGIC PREGNANCIES. ACTA ENDOCRINOLOGICA-BUCHAREST 2018; 14:268-271. [PMID: 31149269 DOI: 10.4183/aeb.2018.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To study the correlation between neck circumference(NC) and umbilical artery blood flow in physiologic pregnancies. Methods One hundred and one healthy pregnant woman in the third trimester were enrolled. Anthropometric measurements and ultrasonic testing were done. Results The women with NC ≥34.7cm had a more elevated umbilical artery pulsatility index(PI) and systolic/diastolic ratio (S/D) than the women with NC <34.7cm (P<0.01). NC were positively correlated with PI(r=0.224,P=0.024) and S/D ratio(r=0.415,P=0.0001). In multivariate analysis, NC was independently associated with PI (β=0.026, P=0.016) and S/D ratio (β=0.132, P=0.0001). Conclusions Obesity has an adverse impact on feto-placetal vessels, and NC was superior to body mass index.
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Affiliation(s)
- J Shao
- The First Hospital of Qinhuangdao, Dept. of Ultrasound, Qinhuangdao, China
| | - X Wu
- The First Hospital of Qinhuangdao, Dept. of General Surgery, Qinhuangdao, China
| | - X Liu
- The First Hospital of Qinhuangdao, Dept. of Ultrasound, Qinhuangdao, China
| | - J Qi
- The First Hospital of Qinhuangdao, Dept. of Gynaecology and Obstetrics, Qinhuangdao, China
| | - Z Qi
- The First Hospital of Qinhuangdao, Dept. of Ultrasound, Qinhuangdao, China
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Tang P, Xu J, Xie BJ, Wang QM. Use of serum and urinary soluble sFlt-1 and PLGF in the diagnosis of preeclampsia. Hypertens Pregnancy 2016; 36:48-52. [PMID: 27834501 DOI: 10.1080/10641955.2016.1237642] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Preeclampsia (PE) is a disorder of pregnancy marked by hypertension and proteinuria with no known treatment aside from pregnancy termination. The pathogenesis of PE is poorly understood, but is thought to originate in the placenta. We assessed the value of measuring serum and urinary soluble deformylase-like tyrosine kinase receptor 1 (sFlt-1), a known target of placental factors, and placental growth factor (PLGF), a key placental signaling molecule, in the diagnosis of PE. METHODS Eighty patients with PE were classified as either exhibiting mild (44 cases) or severe (36 cases) symptoms of PE. Forty normal pregnant women were selected as controls. Serum and urinary PLGF and sFlt-1 levels, along with the ratio of sFlt-1 to PLGF, were compared across groups. RESULTS Serum and urinary sFlt-1 and sFlt-1/PLGF ratios in severe PE patients were significantly higher than those in the mild PE group, and measurements from mild PE patients were significantly higher than controls (all P values <0.01). The serum and urinary PLGF levels in severe PE patients were significantly lower than mild PE patients, and mild PE patients had significantly lower PLGF levels than controls (all P values <0.01). As expected, serum sFlt-1 and PLGF levels and ratios were highly correlated with urinary sFlt-1 and PLGF levels and ratios. CONCLUSIONS The severity of PE was closely correlated with these measurements, suggesting that they may be useful tools in the diagnosis and evaluation of PE.
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Affiliation(s)
- Ping Tang
- a Obstetrics Department , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Jing Xu
- b Department of Clinical Laboratory , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Bao-Jun Xie
- b Department of Clinical Laboratory , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Qi-Mei Wang
- a Obstetrics Department , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
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Yousuf S, Ahmad A, Qadir S, Gul S, Tali SH, Shaheen F, Akhtar S, Dar R. Utility of Placental Laterality and Uterine Artery Doppler Abnormalities for Prediction of Preeclampsia. J Obstet Gynaecol India 2016; 66:212-6. [PMID: 27651606 PMCID: PMC5016443 DOI: 10.1007/s13224-015-0837-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To find out whether placental laterality and abnormal uterine artery waveform and resistance index, as determined by antenatal ultrasonography and Doppler, can be used as a predictor for the development of preeclampsia. METHODS This prospective observational cohort study was conducted from August 2013 to October 2014. Two hundred and one (201) normotensive, primigravida women with singleton pregnancies attending the antenatal clinics without any high-risk factor for development of hypertension were subjected to ultrasonography at 18-22 weeks of gestation to determine the placenta location. All the subjects with lateral placentas were subjected to Doppler ultrasonography to look for abnormal Doppler waveform and resistance index. They were followed for the development of preeclampsia till 40 weeks of gestation or delivery. RESULT Out of the total 201 women, 71 (24.5 %) had laterally located placentas and of them 37 (52 %) developed preeclampsia, while the remaining 130 (75.5 %) had centrally located placentas and of them 14 (10.8 %) developed preeclampsia (p < 0.001). In subjects with lateral placentas alone (n = 33), 2 (6 %) developed preeclampsia while as those with lateral placentas with Doppler abnormality (n = 38), 35 (92 %) developed preeclampsia (p < 0.001). The overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio), and 95 % confidence interval was (4.30-19.98). CONCLUSION Pregnant women with lateral placentas are at significant risk for development of preeclampsia. Lateral placentas when associated with uterine artery Doppler abnormality, risk for development of preeclampsia increases significantly as compared to lateral placentas alone.
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Affiliation(s)
- Shagufta Yousuf
- Department of Gynecology and Obstetrics, Sheri Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, 190011 J and K India
| | - Abida Ahmad
- Department of Gynecology and Obstetrics, Sheri Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, 190011 J and K India
| | - Shazia Qadir
- Department of Gynecology and Obstetrics, Sheri Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, 190011 J and K India
| | - Sabia Gul
- Department of Gynecology and Obstetrics, Sheri Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, 190011 J and K India
| | - Showkat Hussain Tali
- Department of Neonatology, Surya Children’s Hospital, SV Road, Santacruz (West), Mumbai, 100054 India
| | - Feroz Shaheen
- Department of Radio-diagnosis and Neuro-radiology, SKIMS, Srinagar, 190011 India
| | | | - Rayees Dar
- Department of Biostatistics, SKIMS, Srinagar, India
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Bermúdez-Peñaloza X, Reyna-Villasmil E, Mejía-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N, Fernández-Ramírez A. Calcio sérico total e ionizado en el segundo trimestre del embarazo como predictor de preeclampsia. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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