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Yin B, Yu X, Fu X, Liu X, Xiao J, Yu L, Nie Y, Zhang Y. Expression and influence of KATP in umbilical artery smooth muscle cells of patients with hypertensive disorders of pregnancy. Sci Rep 2024; 14:7517. [PMID: 38553483 PMCID: PMC10980746 DOI: 10.1038/s41598-024-57885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
The objective of this study is to investigate the expression and influence of adenosine triphosphate-sensitive potassium channel (KATP) in human umbilical arterial smooth muscle cells (HUASMCs) of patients with hypertensive disorders of pregnancy (HDP). Western blotting was used to detect the protein expression levels of KATP inwardly rectifying potassium channel (Kir)6.1 and sulphonylurea receptor (SUR)2B subunits in HUASMCs from patients with normal parturients (NP), gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE) and chronic hypertension with superimposed preeclampsia (CHSP), respectively. There was no significant difference in the protein expression of Kir6.1 subunit in NP group, GH group, CH group, PE group and CHSP group (P > 0.05). The protein expression of SUR2B subunit was gradually decreased in NP group, GH group, CH group, PE group and CHSP group, with statistically significant difference among the groups (P < 0.05). The altered expression level of KATP SUR2B subunit may be involved in the pathogenesis of HDP. The severity of HDP may be related to the degree of decrease of SUR2B subunit.
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Affiliation(s)
- Benlan Yin
- Department of Obstetrics, The Affiliated Hospital of Southwest Medical University, No.8, Kangcheng Road, Luzhou, 646000, Sichuan, China
| | - Xiaotong Yu
- Department of Clinical Medicine, Southwest Medical University, No. 319, Section 3, Zhongshan Road, Luzhou, Sichuan, China
| | - Xiaodong Fu
- Department of Obstetrics, The Affiliated Hospital of Southwest Medical University, No.8, Kangcheng Road, Luzhou, 646000, Sichuan, China
| | - Xiyuan Liu
- Department of Clinical Medicine, Southwest Medical University, No. 319, Section 3, Zhongshan Road, Luzhou, Sichuan, China
| | - Jing Xiao
- Department of Clinical Medicine, Southwest Medical University, No. 319, Section 3, Zhongshan Road, Luzhou, Sichuan, China
| | - Linli Yu
- Department of Clinical Medicine, Southwest Medical University, No. 319, Section 3, Zhongshan Road, Luzhou, Sichuan, China
| | - Yunying Nie
- Department of Clinical Medicine, Southwest Medical University, No. 319, Section 3, Zhongshan Road, Luzhou, Sichuan, China
| | - Yujiao Zhang
- Department of Obstetrics, The Affiliated Hospital of Southwest Medical University, No.8, Kangcheng Road, Luzhou, 646000, Sichuan, China.
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Luo Y, Li Y, Zhang L. The combined use of ultrasound examination of hemodynamics in the umbilical artery and urine microalbumin levels can predict adverse pregnancy outcomes in patients with severe preeclampsia. J OBSTET GYNAECOL 2023; 43:2208674. [PMID: 37227086 DOI: 10.1080/01443615.2023.2208674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of this study was to elucidate the application of ultrasound examination of umbilical artery (UA) hemodynamics with urine microalbumin (UmA) determination in evaluating the outcomes of sPE patients. Altogether 80 sPE patients and 75 healthy pregnant women were recruited. UmA, RI (resistance index) and PI (pulsatility index) were separately measured by ELISA and the ultrasonic Doppler flow detector. The correlation between parameters was analysed using Pearson's coefficient method. The independent risk factors of sPE were identified using the Logistic regression model. sPE patients had increased UmA, RI and PI (all p < 0.05). UmA level was positively correlated with RI and PI in sPE patients. RI, PI and UmA were independent risk factors of sPE (all p < 0.05). sPE can predict adverse pregnancy outcomes. High UmA levels may increase the risk of poor prognosis. Overall, ultrasound examination of UA hemodynamics with UmA determination can predict the adverse pregnancy outcomes of sPE patients.IMPACT STATEMENTWhat is already known on this subject? Doppler ultrasound and urine microalbumin (UmA) measurement are important tools in assessing the clinical severity of severe preeclampsia (sPE).What do the results of this study add? This study aims to unravel the application of ultrasound examination of hemodynamics in the umbilical artery (UA) combined with the determination of UmA in evaluating the outcomes of sPE patients.What are the implications of these findings for clinical practice and/or further research? Ultrasound examination of hemodynamics in UA combined with the determination of UmA can predict the adverse pregnancy outcomes of sPE patients.
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Affiliation(s)
- Yan Luo
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P.R. China
| | - Yulin Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P.R. China
| | - Li Zhang
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P.R. China
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Azman SS, Yazid MD, Abdul Ghani NA, Raja Sabudin RZA, Abdul Rahman MR, Sulaiman N. Generation of a novel ex-vivo model to study re-endothelialization. Artif Cells Nanomed Biotechnol 2023; 51:408-416. [PMID: 37584645 DOI: 10.1080/21691401.2023.2245456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
Endothelial dysfunction initiates the pathogenesis of a myriad of cardiovascular diseases, yet the precise underlying mechanisms remain unclear. Current model utilises mechanical denudation of arteries resulting in an arterial-injury model with onset of intimal hyperplasia (IH). Our study shows that 5 min enzymatic denudation of human umbilical artery (hUA) lumen at 37 °C efficiently denudes hUA while maintaining vessel integrity without significantly increase intima-media thickness after 7 days in culture. This ex-vivo model will be a valuable tool in understanding the mechanism of re-endothelialization prior to smooth muscle cells (SMC) activation thus placating IH at an early stage.
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Affiliation(s)
- Siti Sarah Azman
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Faculty of Applied Sciences, Universiti Teknologi MARA, Perak Branch, Tapah Campus, Perak, Malaysia
| | - Muhammad Dain Yazid
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Nur Azurah Abdul Ghani
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
- Hospital Canselor Tuanku Mukhriz, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Raja Zahratul Azma Raja Sabudin
- Hospital Canselor Tuanku Mukhriz, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- Hospital Canselor Tuanku Mukhriz, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Nadiah Sulaiman
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
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Tokalioglu EO, Tanacan A, Ayhan ŞG, Serbetci H, Agaoglu MO, Kara O, Sahin D. Umbilical artery half peak systolic velocity deceleration time: a novel Doppler parameter for prediction of neonatal outcomes in pregnant women with preeclampsia. Arch Gynecol Obstet 2023:10.1007/s00404-023-07248-6. [PMID: 37865627 DOI: 10.1007/s00404-023-07248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. METHODS A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28-41 weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. RESULTS Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34 weeks, and birth weight < 2500 g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06-0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). CONCLUSION UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery.
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Affiliation(s)
- Eda Ozden Tokalioglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Şule Goncu Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hakkı Serbetci
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Merve Ozturk Agaoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Madbouly H, El-Shahat KH, Fathi M, Abdelnaby EA. Hemodynamic changes in late advanced pregnant Zaraibi goats during the peripartum period. BMC Vet Res 2023; 19:194. [PMID: 37803319 PMCID: PMC10559465 DOI: 10.1186/s12917-023-03745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
The objective of the present study was to demonstrate the blood flow velocities, blood flow rate (BFR; bpm) with the accurate ratio of both systolic and diastolic velocities points (S/D) in addition to Doppler indices (resistive and pulsatility index [RI and PI]) in both fetal [fetal heart (FH), fetal abdominal aorta (Ab. A), and umbilical artery (UM.A)] and maternal [Middle uterine artery (MU.A)] sides during the last month of gestation. Ten Zaraibi (Egyptian Nubian) goats weighing 40-50kg and aged from 5-7 years were examined twice per month till reached the last month of pregnancy. Then all females were examined every 5 days starting from day -35 till day -1 before kidding.The pregnant goats were examined by ultrasonic and Doppler indices were recorded with Doppler scanning (7.5 -12 MHz, with colored and spectral graph to form the perfect wave to assess Doppler measurements). The obtained data were analyzed using analysis of variance. Results indicated that on the fetal side; the maximum point of velocity (MSV; cm/sec) in the FH and BFRwere elevated from day -35 till day -10 with a slight decline at days -5 and -1 at the peripartum period (P < 0.05), while FH.PI and S/D ratio declined till day -1(P < 0.05). In addition, the fetal Ab. A, and UM.A PI, RI, and S/D ratio declined from day -35 till day -1 at the peripartum period with a significant increase in the peak systolic velocity (PSV) and BFR(P < 0.05). However, non-significant changes in the end diastolic velocity (EDV) were detected. On the maternal side, the MU.A PI and S/D declined from day -35 till day -1 with an elevation of both PSV and BFRat the same time points (P < 0.05). In conclusion, the Doppler evaluation of fetal and maternal blood flow vessels is important to give complete information that directly affects the health status of the mother and fetus.
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Affiliation(s)
- Hager Madbouly
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt.
| | - K H El-Shahat
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
| | - Mohamed Fathi
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
| | - Elshymaa A Abdelnaby
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
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Jonker D, Melly B, Brink LT, Odendaal HJ, Stein DJ, Donald KA. Associations between prenatal alcohol and tobacco exposure on Doppler flow velocity waveforms in pregnancy: a South African study. BMC Pregnancy Childbirth 2023; 23:601. [PMID: 37612623 PMCID: PMC10464169 DOI: 10.1186/s12884-023-05881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The negative impact of prenatal alcohol and tobacco exposure (PAE and PTE) on fetal development and birth outcomes are well described, yet pathophysiologic mechanisms are less clear. Our aim was to investigate (1) the associations between quantity, frequency and timing (QFT) of PAE and PTE with blood flow velocities in arteries of the fetal-placental-maternal circulation and (2) the extent to which combined effect of QFT of PAE and/or PTE and Doppler flow velocity waveforms (FWV) predict infant birth weight. METHODS The Safe Passage Study is a cohort based in urban Cape Town, South Africa. Recruitment occurred between 2007 and 2015. Information on QFT of PAE and PTE was collected prospectively at up to 4 occasions during pregnancy using a modified Timeline Follow-Back approach. Ultrasound examinations consisted of Doppler flow velocity waveforms of the uterine, umbilical (UA) and fetal middle cerebral arteries for the pulsatility index (PI) at 20-24 and 34-38 weeks. Exclusion criteria included: twin pregnancies, stillbirths, participants exposed to other drugs. The sample was divided into three groups (controls, PAE and PTE) and included 1396 maternal-fetal-dyads assessed during the second trimester; 1398 assessed during the third trimester. RESULTS PTE was associated with higher UA PI values in second and third trimesters (p < 0.001), compared to the PAE and control group. The total amount of cigarettes smoked during pregnancy was positively correlated with UA PI values (r = 0.087, p < 0.001). There was a positive correlation between cigarettes smoked per day in trimester one (r = 0.091, p < 0.01), and trimester two (r = 0.075, p < 0.01) and UA PI (in trimester two), as well as cigarettes smoked per day in trimester two (r = 0.058, p < 0.05) and trimester three (r = 0.069, p < 0.05) and the UA PI in trimester three. Generalized additive models indicated that PAE in trimester two, PTE in trimester one and Doppler FWV in trimester three were significant predictors of birth weight in this sample. CONCLUSION In our study, PTE in trimesters two and three resulted in increased vascular resistance of the placenta. These findings highlight nuance in associations between PAE, PTE and blood flow velocities in arteries of the fetal-placental-maternal circulation and birth weight, suggesting that quantity and timing are important factors in these relationships.
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Affiliation(s)
- Deborah Jonker
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Brigitte Melly
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lucy T Brink
- Department of Obstetrics and Gynaecology, Stellenbosch University, Parow, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Parow, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Murtada SI, Ramachandra AB, Humphrey JD. Ex vivo biomechanical characterization of umbilical vessels: Possible shunts in congenital heart palliation. J Biomech 2023; 151:111518. [PMID: 36906968 DOI: 10.1016/j.jbiomech.2023.111518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
Children born with congenital heart defects typically undergo staged palliative surgeries to reconstruct the circulation to improve transport of deoxygenated blood to the lungs. As part of the first surgery, a temporary shunt (Blalock-Thomas-Taussig) is often created in neonates to connect a systemic and a pulmonary artery. Standard-of-care shunts are synthetic, which can lead to thrombosis, and much stiffer than the two host vessels, which can cause adverse mechanobiological responses. Moreover, the neonatal vasculature can undergo significant changes in size and structure over a short period, thus constraining the use of a non-growing synthetic shunt. Recent studies suggest that autologous umbilical vessels could serve as improved shunts, but there has not been a detailed biomechanical characterization of the four primary vessels - subclavian artery, pulmonary artery, umbilical vein, and umbilical artery. Herein, we biomechanically phenotype umbilical veins and arteries from prenatal mice (E18.5) and compare them to subclavian and pulmonary arteries harvested at two critical postnatal developmental ages (P10, P21). Comparisons include age-specific physiological conditions and simulated 'surgical-like' shunt conditions. Results suggest that the intact umbilical vein is a better choice as a shunt than the umbilical artery due to concerns with lumen closure and constriction related intramural damage in the latter. Yet, decellularization of umbilical arteries may be a viable alternative, with the possibility of host cellular infiltration and subsequent remodeling. Given recent efforts using autologous umbilical vessels as Blalock-Thomas-Taussig shunts in a clinical trial, our findings highlight aspects of the associated biomechanics that deserve further investigation.
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Affiliation(s)
- S-I Murtada
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - A B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA.
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Lecoq FA, Barnouin L, Ardouin L, Hartmann D, Obert L. Inverted human umbilical artery as a 3D scaffold for sciatic nerve regeneration in rats. Cell Tissue Bank 2022; 23:909-922. [PMID: 35503142 PMCID: PMC9675695 DOI: 10.1007/s10561-022-10006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/03/2022] [Indexed: 11/02/2022]
Abstract
Treatment of peripheral nerve injuries (PNIs) remains a challenge. Interposing a graft delivers better regenerative outcomes. Autografts present major drawbacks which have given rise to the development of alternatives such as artificial scaffolds, some of which are very promising. This study was designed to investigate the potential use of an inverted human umbilical cord artery (iHUA) as a 3D scaffold nerve chamber, for nerve regeneration after transection of the sciatic nerve (SN) in rats. Rats underwent surgical SN transection in their right hindlimb, followed by suture of the device at the resected stumps. Local tolerance, insert biodegradability and nerve reconstruction over time were thoroughly studied by histopathological and morphometric analysis, completed by functional test assessment of sensitivity and motricity recovery. We have demonstrated that nerve reconstruction in the presence of an iHUA insert is effective. The device is well tolerated and highly biodegraded. Although the regenerated nerve is still immature at the end of our study, signs of sensitivity and partial functional recovery were witnessed, confirming our histological findings. Our results support the potential clinical use of iHUA as a 3D scaffold to bridge nerve discontinuity and guide axonal regrowth in selected cases of PNIs.
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Affiliation(s)
- Flore-Anne Lecoq
- Institut de la Main Nantes Atlantique, Elsan Santé Atlantique, Saint Herblain, France
| | | | - Ludovic Ardouin
- Institut de la Main Nantes Atlantique, Elsan Santé Atlantique, Saint Herblain, France
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Huang J, Wang C, Li X, Jing Y. Application of CEEMD noise reduction algorithm in ultrasound imaging in evaluating fetuses with abnormal glucose metabolism in late pregnancy. Pak J Med Sci 2021; 37:1590-1594. [PMID: 34712288 PMCID: PMC8520375 DOI: 10.12669/pjms.37.6-wit.4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To explore the predictive effect of abnormal glucose metabolism and fetal hemodynamic parameters on adverse pregnancy outcome. Methods: One hundred and nine pregnant women with abnormal glucose metabolism during pregnancy from June 2016 to October 2018 were selected and divided into poor prognosis group (34 cases) and good prognosis group (75 cases). The hemodynamic parameters of fetal cerebral artery (MCA), umbilical artery (UA) and uterine artery of pregnancy (UT-A), including peak systolic velocity (s / D), resistance index (RI) and plasticity index (PI), were measured by color Doppler ultrasound. The receiver operating characteristic (ROC) curve of adverse pregnancy outcomes was drawn and the best threshold index was determined. Results: MCA-PI poor prognosis group, MCA-RI, RI ratio (MCA/UA) are lower than the good prognosis group, Ut-A-PI is higher than the good prognosis group (P<0.05,). ROC curve analysis results show that when the MCA-PI 1.56, the sensitivity of the predicted adverse outcomes of pregnancy, the highest specificity<, was 91.18%, 80.00%, respectively. Logistic regression analysis of risk factors shows poor pregnancy outcomes include: pregnant women, older age, body mass index ≥24.0kg/m2 and a family history of diabetes. Protective factors include exercise during pregnancy, MCA-PI≥1.56, MCA-RI≥0.63 and RI The ratio (MCA/UA) ≥0.84. Conclusion: Color Doppler ultrasound measured MCA-PI<1.56 the most important indicators of poor pregnancy outcomes as abnormal glucose metabolism during pregnancy and predict the exact cutoff. Pregnant women, older age, body mass index ≥24.0kg/m2 and a family history of diabetes and abnormal glucose metabolism during pregnancy risk factors for adverse outcomes of pregnancy.
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Affiliation(s)
- Junfeng Huang
- Junfeng Huang, Deputy Chief Nurse. Department of Nursing, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Cuiting Wang
- Cuiting Wang, Bachelor's Degrees. Department of Obstetrical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Xianxia Li
- Xianxia Li, Supervisor nurse. Department of Obstetrical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
| | - Yuqin Jing
- Yuqin Jing, Supervisor nurse. Department of Surgical, Maternal and Child Health Hospital of Jinan City, Jinan City 250001, Shandong Province, China
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Liu H, Liu J. Improved support vector machine algorithm based on the influence of Gestational Diabetes Mellitus on the outcome of perinatal outcome by ultrasound imaging. Pak J Med Sci 2021; 37:1625-1629. [PMID: 34712295 PMCID: PMC8520353 DOI: 10.12669/pjms.37.6-wit.4855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 07/07/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives: In order to understand the incidence and epidemiological characteristics of gestational diabetes mellitus, the ultrasound imaging of support vector machine processing algorithm was used to clarify the outcome of maternal and neonatal gestational diabetes mellitus. Methods: This study selected clinical data of 12,190 pregnant women who were hospitalized for delivery, and were divided into diabetic group (1268 cases) and control group (10922 cases) according to the diagnosis of gestational diabetes. The study was conducted from January 1, 2012 to December 31, 2019. Colour Doppler ultrasound was performed to record fatal umbilical artery and brain the middle arteries and uterine arteries which are effective indicators of measuring fatal intrauterine conditions. Chi-square test was used to compare the rates between groups, and multivariate logistic regression was used for labour outcomes. Results: The incidence of diabetes during pregnancy is about 10.4% (1268/12190). Senior citizens and women suffering from obesity increase the risk of gestational diabetes, maternal hypertension disorders in pregnancy, premature rupture of membranes, oligohydramnios, fatal distress, multiple births, malpresentation risk increased significantly (P <0.05) than the control group. In gestational diabetes caesarean section rate was significantly higher (61.0% vs46.4%). Caesarean new born 5-minute Apgar score was significantly lower than the control group (P <0.05). Conclusion: In maternal gestational diabetes in high risk pregnancies, complications of pregnancy significantly increase the importance of enhancing weight management and blood glucose monitoring to reduce complications.
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Affiliation(s)
- Hehua Liu
- Hehua Liu, Attending Physician. Department of Obstetrics, East Hospital of The Fourth Hospital, Shijiazhuang City, 050011, China
| | - Jie Liu
- Jie Liu, Attending Physician. Department of Emergency Medicine, East Hospital of The Fourth Hospital, Shijiazhuang City, 050011, China
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Adanaş Aydın G, Özdemir Akdur P, Özgen G. The effect of glucose tolerance test on fetoplacental circulation. Taiwan J Obstet Gynecol 2021; 60:723-727. [PMID: 34247814 DOI: 10.1016/j.tjog.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Acute hyperglycemia affects the fetoplacental circulation. This study aims to investigate the possible effect of acute hyperglycemia induced by 50 g oral glucose tolerance test (OGTT) on fetoplacental circulation in women between 24 and 28 weeks of gestation. MATERIALS AND METHODS Between January 2019 and April 2019, a total of 29 women who were between 24 and 28 weeks of gestation with a singleton gestation and were in low-risk group were included in this prospective study. All patients underwent fetal biometric measurements using ultrasonography (USG) and were administered 50 g OGTT. Before and 1 h after the test, Doppler USG was used to measure uterine artery, umbilical artery (UA), middle cerebral artery (MCA), pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio. The cerebroplacental ratio (CPR) was calculated as the ratio of the MCA-PI/UA-PI. RESULTS There was a decline in the MCA-RI (p = 0.008) and UA-PI (p = 0.021) at 1 h after the administration of 50 g OGTT. Z-scores of the mean UA-PI, MCA-PI, and CPR were calculated and a statistically significant increase in the Z-scores of the mean UA-PI was observed (p = 0.028). CONCLUSION Our study results show that acute hyperglycemia induced by OGTT significantly increases the Z-scores of the UA-PI, affecting the fetoplacental circulation.
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Affiliation(s)
- Gültekin Adanaş Aydın
- Bursa Yüksekİhtisas Training and Research Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey.
| | - Pınar Özdemir Akdur
- Bursa Yüksekİhtisas Training and Research Hospital, Department of Radiology, Bursa, Turkey
| | - Gülten Özgen
- Bursa Yüksekİhtisas Training and Research Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
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Yin Q, Zhang Y, Ma Q, Gao L, Li P, Chen X. The clinical value of blood flow parameters of the umbilical artery and middle cerebral artery for assessing fetal distress. Am J Transl Res 2021; 13:5280-5286. [PMID: 34150119 PMCID: PMC8205796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the clinical value of blood flow parameters of the umbilical artery (UA) and middle cerebral artery (MCA) for gauging fetal distress. METHODS This study was conducted among 256 pregnant women who presented for routine prenatal checkups and successfully gave birth in our hospital from January 2018 to February 2020. These pregnant women were examined with the Color Doppler Ultrasound, and the color Doppler flow imaging (CDFI) showed the blood flow of the UA and MCA. In accordance with the diagnostic criteria of fetal distress, they were divided into a fetal distress group (n=67) and a control group (n=189). The receiver operator characteristic (ROC) curve analysis was performed on the diagnostic value of the flow in the UA and MCA. According to their pregnancy outcomes, they were divided into a good pregnancy outcome group (n=209) and an adverse pregnancy outcome group (n=47), and their blood flow parameters of the UA and MCA were compared. RESULTS The S/D, PI, and RI values of the UA in the fetal distress group exceeded those in the control group, and the S/D, PI, and RI values of the MCA were lower than those in the control group (P<0.05). The good pregnancy outcome group had lower S/D, PI, and RI values of the UA. The good pregnancy outcome group had higher S/D, PI, and RI values of the MCA (P<0.05). ROC curves revealed that the areas under curve of S/D, PI, and RI of the UA were 0.81, 0.76 and 0.74, respectively; the areas under curve of S/D, PI, and RI of the MCA were 0.82, 0.78 and 0.71, respectively. CONCLUSION The hemodynamic indexes of the UA and MCA can be used as a basis for evaluating fetal distress, which shows important clinical indications for gauging pregnancy outcome.
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Affiliation(s)
- Qiuping Yin
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
| | - Yuying Zhang
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
| | - Qinfeng Ma
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
| | - Li Gao
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
| | - Ping Li
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
| | - Xianxia Chen
- Department of Ultrasound, Qinghai Provincial People's Hospital Xining, Qinghai, P. R. China
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Cahill LS, Stortz G, Ravi Chandran A, Milligan N, Shinar S, Whitehead CL, Hobson SR, Ayyathurai V, Rahman A, Saghian R, Jobst KJ, McShane C, Block-Abraham D, Seravalli V, Laurie M, Millard S, Delp C, Wolfson D, Baschat AA, Murphy KE, Serghides L, Morgen E, Macgowan CK, Parks WT, Kingdom JC, Sled JG. Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology. EBioMedicine 2021; 67:103326. [PMID: 33965347 DOI: 10.1016/j.ebiom.2021.103326] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Methods Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Findings Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. Interpretation The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique.
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Liu Q, Li B. The diagnostic value of ultrasound detection of the fetal middle cerebral artery, umbilical artery blood flow and fetal movement reduction in fetal distress. Am J Transl Res 2021; 13:3529-3535. [PMID: 34017532 PMCID: PMC8129210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of ultrasound detection of the fetal middle cerebral artery, umbilical artery blood flow and fetal movement reduction in fetal distress. METHODS A total of 30 cases of pregnant women with fetal distress (FIUD) in our hospital were selected as the observation group, and 60 cases of normal pregnant women in the same period were selected as the control group. The fetal umbilical artery, middle cerebral artery resistance index (RI), pulsatility index (PI), the ratio of peak systolic blood flow velocity to end-diastolic blood flow velocity (S/D) and fetal movement reduction were detected. The diagnostic value of the above indicators alone and in combination for fetal distress was observed. RESULTS The RI, PI and S/D of umbilical artery in the observation group were higher than those in the control group (P<0.001). The S/D, RI and PI of the middle cerebral artery in the observation group were lower than those in the control group (P<0.01). The number of cases with decreased fetal heart rate in the observation group was significantly higher than that in the control group (P<0.001). The area under the curve (AUC) of umbilical artery S/D, umbilical artery RI, umbilical artery PI, middle cerebral artery S/D, middle cerebral artery PI, middle cerebral artery RI, fetal movement reduction and combined above indexes were 0.788, 0.870, 0.847, 0.852, 0.802, 0.658, 0.750 and 1.000 respectively (all P<0.05). The combined diagnosis has a higher diagnostic value for fetal distress. CONCLUSION Umbilical artery, middle cerebral artery hemodynamics combined with fetal movement has a specific value in diagnosing fetal distress, which is worth of clinical application.
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Affiliation(s)
- Qingfeng Liu
- Department of Obstetrics, Linyi Women's and Children's Hospital Linyi, Shandong Province, China
| | - Bingxing Li
- Department of Obstetrics, Linyi Women's and Children's Hospital Linyi, Shandong Province, China
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Di Mascio D, Herraiz I, Villalain C, Buca D, Morales-Rosello J, Loscalzo G, Sileo FG, Finarelli A, Bertucci E, Facchinetti F, Rizzo G, Brunelli R, Giancotti A, Muzii L, Maruotti GM, Carbone L, D'Amico A, Tinari S, Morelli R, Cerra C, Nappi L, Greco P, Liberati M, Galindo A, D'Antonio F. Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study. Fetal Diagn Ther 2021; 48:448-456. [PMID: 34130275 DOI: 10.1159/000516443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/01/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The role of cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) to predict adverse intrapartum and perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR) remains controversial. METHODS This was a multicenter, retrospective cohort study involving 5 referral centers in Italy and Spain, including singleton pregnancies complicated by late FGR, as defined by Delphi consensus criteria, with a scan 1 week prior to delivery. The primary objective was to compare the diagnostic accuracy of the CPR and UCR for the prediction of a composite adverse outcome, defined as the presence of either an adverse intrapartum outcome (need for operative delivery/cesarean section for suspected fetal distress) or an adverse perinatal outcome (intrauterine death, Apgar score <7 at 5 min, arterial pH <7.1, base excess of >-11 mEq/mL, or neonatal intensive care unit admission). RESULTS Median CPR absolute values (1.11 vs. 1.22, p = 0.018) and centiles (3 vs. 4, p = 0.028) were lower in pregnancies with a composite adverse outcome than in those without it. Median UCR absolute values (0.89 vs. 0.82, p = 0.018) and centiles (97 vs. 96, p = 0.028) were higher. However, the area under the curve, 95% confidence interval for predicting the composite adverse outcome showed a poor predictive value: 0.580 (0.512-0.646) for the raw absolute values of CPR and UCR, and 0.575 (0.507-0.642) for CPR and UCR centiles adjusted for gestational age. The use of dichotomized values (CPR <1, UCR >1 or CPR <5th centile, UCR >95th centile) did not improve the diagnostic accuracy. CONCLUSION The CPR and UCR measured in the week prior delivery are of low predictive value to assess adverse intrapartum and perinatal outcomes in pregnancies with late FGR.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Danilo Buca
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Jose Morales-Rosello
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Filomena Giulia Sileo
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Finarelli
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alice D'Amico
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Sara Tinari
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Roberta Morelli
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Chiara Cerra
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery and Experimental Medicine, Institute of Obstetrics and Gynaecology, University of Ferrara, Ferrara, Italy
| | - Marco Liberati
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Francesco D'Antonio
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Odendaal HJ, Crockart IC, Du Plessis C, Brink L, Groenewald CA. Accelerations of the Fetal Heart Rate in the Screening for Fetal Growth Restriction at 34-38 Week's Gestation. Glob J Pediatr Neonatal Care 2021; 3:573. [PMID: 34816253 PMCID: PMC8607280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To use machine learning to determine what information on Doppler velocimetry and maternal and fetal heart rates, collected at 20-24 weeks gestation, correlates best with fetal growth restriction according to the estimated fetal weight at 34-38 weeks. STUDY DESIGN Data of 4496 pregnant women, collected prospectively for the Safe Passage Study, from August 2007 to August 2016, were used for the present analysis. Doppler flow velocity of the uterine, umbilical, and middle cerebral arteries and transabdominally recorded maternal and fetal ECGs were collected at 20-24 weeks gestation and fetal biometry collected at 34-38 weeks from which the estimated fetal weight was calculated. Fetal growth restriction was defined as an estimated fetal weight below the 10th centile. Accelerations and decelerations of the fetal and maternal heart rates were quantified as gained or lost beats per hour of recording respectively. Machine learning with receiver operative characteristic curves were then used to determine which model gives the best performance. RESULTS The final model performed exceptionally well across all evaluation metrics, particularly so for the Stochastic Gradient Descent method: achieving a 93% average for Classification Accuracy, Recall, Precision and F1-Score to identify the fetus with an estimated weight below the 10th percentile at 34-38 weeks. Ranking determined that the most important standard feature was the umbilical artery pulsatility index. However, the excellent overall accuracy is likely due to the value added by the pre-processed features regarding fetal gained beats and accelerations. CONCLUSION Fetal movements, as characterized by gained beats as early as 20-24 weeks gestation, contribute to the value of the flow velocimetry of the umbilical artery at 34-38 weeks in identifying the growth restricted fetus.
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Affiliation(s)
- HJ Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa,Corresponding author: Odendaal HJ, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Tygerberg, PO Box 241, Cape Town 8000, South Africa
| | - IC Crockart
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, South Africa
| | - C Du Plessis
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa
| | - L Brink
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa
| | - CA Groenewald
- Department of Obstetrics and Gynaecology, Stellenbosch University, South Africa
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Gude P, Kaci CSB, Sieker M, Vogelsang H, Bellgardt M, Herzog-Niescery J, Weber TP, Weber J, Teubner S, Kern P. The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study. Int J Obstet Anesth 2020; 45:83-89. [PMID: 33298344 DOI: 10.1016/j.ijoa.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. METHODS We included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor. RESULTS Ultrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ± 15.9 mmHg to 123.1 ± 14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups. CONCLUSIONS Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.
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Affiliation(s)
- P Gude
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany.
| | - C S B Kaci
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - M Sieker
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - H Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - M Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - J Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - T P Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - J Weber
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - S Teubner
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - P Kern
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
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Wen J, Tang J, Ran S, Ho H. Computational modelling for the spiral flow in umbilical arteries with different systole/diastole flow velocity ratios. Med Eng Phys 2020; 84:96-102. [PMID: 32977927 DOI: 10.1016/j.medengphy.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/16/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
The systole/diastole (S/D) flow velocity ratios in umbilical arteries (UAs) have been used to assess the health status of the feto-placental circulation, yet its connection to the morphology of UAs, specifically its coiling pattern remains unclear. Spiral flow induces unbalanced wall shear stress (WSS) distribution in UAs, and may contribute to the uneven arterial wall thickness, and the chirality. In this paper, we use a 3D computational fluid dynamics (CFD) technique to quantify the wall shear stress (WSS) in UA models of two configurations, i.e. at 0.17 and 0.50 spirals per centimeter, to represent normo- and hyper-coiling, respectively. For CFD simulations we use two different S/D ratios (3.02 and 5.70) revealed from the ultrasonography waveforms of a normal and an intrauterine growth restriction (IUGR) case. We found that more coils in the UA model enhanced WSS throughout a cardiac cycle (up to 24%) with the same inflow condition. In addition, time-averaged WSS are generally increased and more uneven in the hyper-coiling model. We suggest that the large WSS difference between the peak systole and end diastole (62% higher in the IURG case than the normal case) may induce uneven stenosis distribution at UAs, and contribute to UA chirality.
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Affiliation(s)
- J Wen
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, Sichuan, China
| | - J Tang
- Ultrasound Department, Chongqing Health Center for Women and Children, Chongqing, China
| | - S Ran
- Ultrasound Department, Chongqing Health Center for Women and Children, Chongqing, China.
| | - H Ho
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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Turner J, Dunn L, Kumar S. Changes in fetoplacental Doppler indices following intrapartum maternal sildenafil citrate treatment. Eur J Obstet Gynecol Reprod Biol 2020; 254:302-307. [PMID: 33045501 DOI: 10.1016/j.ejogrb.2020.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Uterine contractions during labour can result in a 60 % decline in fetoplacental perfusion, predisposing the fetus to hypoxic brain injury. Sildenafil citrate (SC) has shown promise in increasing uteroplacental perfusion as well as reducing the risk of operative birth for intrapartum fetal compromise (IFC). The aim of this study was to investigate the effect of intrapartum SC administration on fetoplacental blood flow indices. METHODS This was a subgroup analysis from an earlier Phase II double blind randomized controlled trial; assessing the effect of intrapartum SC administration (50 mg orally 8 -hly in labour) compared to placebo for the reduction of operative birth for IFC. An ultrasound scan measuring fetoplacental Doppler indices was performed prior to and 1-4 h after the administration of the first treatment dose. RESULTS Of the 300 women randomized to the main study, pre-treatment ultrasound scans were performed in 261 participants who received the study medication; paired pre- and post-treatment scans were performed in 70 (26.8 %). SC resulted in an increase in the middle cerebral artery pulsatility index (PI) z-score [+0.08 (1.35) vs.-0.12 (1.15)], a decline in the umbilical artery-PI z-score [-0.07 (0.96) vs. + 0.04 (1.25)] and an increase in the cerebroplacental ratio [MCA-PI/UA-PI] (CPR) z-score [+0.10 (1.13) vs.-0.26 (1.14)] although these failed to reach statistical significance. Amongst those with a pre-treatment CPR above the 5th centile, SC significantly reduced the risk of operative birth for IFC compared to placebo [logrank p = 0.02; hazards ratio 0.48, 95 % CI 0.29-0.77, p = 0.003]. CONCLUSION Although the differences in Doppler indices pre- and post- SC treatment were non-significant, there was a clear trend towards a reduction in the UA PI, a corresponding increase in the MCA PI and a rise in post treatment CPR values suggesting potential improvement in fetoplacental Dopplers with intrapartum SC treatment. However this study was limited by the small sample size. The results of this hypothesis generating study suggest that it may be possible to stratify women that would most benefit from this intervention based upon their pre-labour CPR.
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Affiliation(s)
- Jessica Turner
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; Faculty of Medicine, University of Queensland, Whitty Building, Annerley Road, South Brisbane, Queensland, 4101, Australia
| | - Liam Dunn
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; Faculty of Medicine, University of Queensland, Whitty Building, Annerley Road, South Brisbane, Queensland, 4101, Australia.
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Di Mascio D, Rizzo G, Buca D, D'Amico A, Leombroni M, Tinari S, Giancotti A, Muzii L, Nappi L, Liberati M, D'Antonio F. Comparison between cerebroplacental ratio and umbilicocerebral ratio in predicting adverse perinatal outcome at term. Eur J Obstet Gynecol Reprod Biol 2020; 252:439-443. [PMID: 32763648 DOI: 10.1016/j.ejogrb.2020.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cerebroplacental ratio (CPR) has been associated with adverse perinatal outcome irrespective of fetal weight. More recently, it has been proposed that the ratio between umbilical and middle cerebral artery pulsatility index, the umbilicocerebral ratio (UCR) had a higher diagnostic accuracy compared to CPR in predicting adverse outcome. The aim of the study was to compare the diagnostic accuracy of CPR and UCR in predicting adverse perinatal outcome in the third trimester of pregnancy. STUDY DESIGN Secondary analysis of prospective study carried out in a dedicated research ultrasound clinic in a single tertiary referral center over a one-year period. Inclusion criteria were consecutive singleton pregnancies between 36 + 0 and 37 + 6 weeks of gestation. Exclusion criteria were multiple gestations, pregnancies affected by structural or chromosomal anomalies, maternal medical complications or drugs intake and abnormal Doppler waveform in the UA, defined as PI>95th or absent/end diastolic flow. All women were pre-screened at 28-32 weeks of gestation in order to rule out signs of early fetal growth restriction. The primary outcome was to compare the diagnostic performance of CPR and UCR in detecting the presence of fetuses affected by a composite adverse outcome. RESULTS Mean CPR (1.35 ± 0.39 vs 1.85 ± 0.58, p < 0.001) was significantly lower while mean UCR (0.78 ± 0.25 vs 0.58 ± 0.20, p = 0.001) was significantly higher in pregnancies experiencing compared to those not experiencing composite adverse outcome. There was no difference between CPR and UCR in predicting adverse perinatal outcome in the third trimester of pregnancy and both showed a very low diagnostic accuracy. CPR had an AUC of 0.51 (95 % CI 0.43-0.58) while UCR had an AUC of 0.51 (95 % CI 0.43-0.58) in predicting composite adverse outcome. Likewise, there was no difference in the diagnostic accuracy of CRP (AUC: 0.600, 95 % CI 0.36-0.83) and UCR (AUC: 0.589, 95 % CI 0.35-0.83) when considering only SGA fetuses. CONCLUSIONS A low CPR and a high UCR are significantly associated with adverse perinatal outcome in singleton pregnancies at term. There was no difference between CPR and UCR in predicting perinatal outcome. Despite this, the diagnostic accuracy of both these parameters is too poor to advocate for their use as a screening tool of perinatal impairment at term, unless specific indications, such as SGA or FGR, have been identified.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - Danilo Buca
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Alice D'Amico
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Martina Leombroni
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Tinari
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynecology, University of Foggia, Italy
| | - Marco Liberati
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Francesco D'Antonio
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Italy.
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Mowad HH, Abougabal KM, Fahim AS, Shehata NAA, Ali HAA, Nasser MZ. Vascular endothelial growth factor C/A 2578 gene polymorphism and umbilical artery Doppler in preeclamptic women. Pregnancy Hypertens 2019; 18:173-178. [PMID: 31678758 DOI: 10.1016/j.preghy.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/18/2019] [Accepted: 09/22/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Preeclampsia is strongly associated with placental hypoperfusion. Genetic factors have an impact on the pathogenesis of preeclampsia. The aim is to assess the association of Vascular Endothelial Growth Factor (C2578A) gene polymorphism with the occurrence and severity of preeclampsia and the umbilical artery Doppler changes among preeclamptic women. MATERIALS AND METHODS This case-control study was conducted in clinical and Chemical pathology and Obstetrics departments in Beni- Suef University, Egypt. Two hundred and ninety pregnant women above 20 weeks gestational age until delivery were divided into 2 main groups. The patient group included 145 preeclamptic women who were further sub grouped according to the severity of preeclampsia into 82 severe and 63 mild cases. Control group included 145 normotensive pregnant women. Our primary outcome was detection of VEGF C 2578 A gene mutations by a polymerase chain reaction. A secondary outcome was Doppler changes in the pulsatility index of the umbilical artery compared with VEGF genotypes. RESULTS Our study showed that VEGF C 2578 A genotype and alleles frequencies were not related to the occurrence of preeclampsia (p-value 0.513 and 0.549, respectively), odds ratio (95%CI) 1.154 (0.724-1.848). Mild preeclamptic cases showed no significance comparing VEGF genotypes studied and pulsatility index of the umbilical artery. However, severe cases showed p-value < 0.0001. CONCLUSION We concluded that VEGF 2578C/A polymorphism had no association with the occurrence of preeclampsia in studied groups, whereas there was a significant relationship among severe cases between CA and CC genotypes and pulsatility index of the umbilical artery.
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Affiliation(s)
- Hanan H Mowad
- Department of Clinical and Chemical Pathology, Beni-Suef University, Egypt
| | | | - Ashraf S Fahim
- Department of Gynecology and Obstetrics, Beni-Suef University, Egypt
| | | | - Hamada A A Ali
- Department of Gynecology and Obstetrics, Beni-Suef University, Egypt
| | - Mona Z Nasser
- Department of Clinical and Chemical Pathology, Beni-Suef University, Egypt
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Korkalainen N, Partanen L, Räsänen J, Yliherva A, Mäkikallio K. Fetal hemodynamics and language skills in primary school-aged children with fetal growth restriction: A longitudinal study. Early Hum Dev 2019; 134:34-40. [PMID: 31170674 DOI: 10.1016/j.earlhumdev.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
AIM Long-term follow-up studies on children born with fetal growth restriction (FGR) have revealed a specific profile of neurocognitive difficulties, including problems with speech, language and literacy skills. We hypothesized that problems with communication skills, including language use and literacy skills of FGR children at primary school age are associated with prenatal circulatory changes. METHODS Ultrasonographic assessment of fetoplacental hemodynamics was performed prenatally in 77 fetuses. After a follow-up period of 8-10 years, assessment of reading and spelling skills using standardized tests and the Children's Communication Questionnaire (CCC-2) was performed to measure different language skills in 37 FGR children and 31 appropriately grown (AGA) controls, matched for gestational age. RESULTS Increased blood flow resistance in the umbilical artery (UA PI >2 SD) during fetal life showed odds ratios of 3.5-19.1 for poor literacy and communication skills and need for speech and language therapy. Furthermore, FGR children with prenatal cerebral vasodilatation (cerebroplacental ratio (CPR) < -2 SD) had significantly poorer literacy and communication skills, at primary school age compared to the AGA controls. Abnormal CPR demonstrated odds ratios of 4.2-28.1 for poor literacy and communication skills and need for speech and language therapy. CONCLUSION Increased blood flow resistance in the umbilical artery and cerebral vasodilatation are associated with poor communication, language, and literacy skills at early school age in children born with FGR. These findings indicate the need for continuous follow-up of this group and timely targeted support to ensure optimal academic outcomes.
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Affiliation(s)
- Noora Korkalainen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Lea Partanen
- Child Language Research Center, Logopedics, University of Oulu, Oulu, Finland
| | - Juha Räsänen
- Department of Obstetrics and Gynecology, University Hospital of Helsinki, University of Helsinki, Helsinki, Finland
| | - Anneli Yliherva
- Child Language Research Center, Logopedics, University of Oulu, Oulu, Finland
| | - Kaarin Mäkikallio
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland; Department of Obstetrics and Gynecology, University Hospital of Turku, University of Turku, Turku, Finland
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23
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Akkuş T, Erdoğan G. Ultrasonographic evaluation of feto-placental tissues at different intrauterine locations in rabbit. Theriogenology 2019; 138:16-23. [PMID: 31280181 DOI: 10.1016/j.theriogenology.2019.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
The main purpose of examining multiparous species with real-time ultrasonography is to determine the gestational age and make various fetal measurements for early diagnosis of growth anomalies and sibling mismatches. This study investigated changes in fetometric measurements, obstetric Doppler indices and placental image analysis results based on gestational age and fetal location in fetuses located cranially and caudally between 16 and 24 days gestation in 22 healthy pregnant New Zealand rabbits. The first study group consisted of fetuses positioned at the cranial end (n = 22) while the second group consisted of fetuses positioned at the caudal end (n = 22) in each pregnancy. Fetal biparietal head diameter (BPD) and trunk diameter (TD) were measured, and mean grayness values (MGV) were determined from placental image analysis of each fetus. Using Doppler USG, the pulsatile (PI) and resistance (RI) indices of the uterine artery (UtA) and umbilical artery (UmA) were recorded. By the end of the study, BPD and TD values for cranial and caudal fetuses had significantly increased with gestational age (P < 0.001). The MGV values of caudal fetuses were significantly higher (except for the 16th day) (P < 0.05). The UtA PI value of the caudal fetuses was significantly higher (except for the 18th day) (P < 0.01). The UtA RI values of caudal fetuses were significantly higher than cranial ones on the 16 and 24th days (P < 0.05). The PI of the UmA increased until the 20th day before decreasing significantly in both study groups (P < 0.001). The UmA RI value decreased according to the gestational age in both groups (P < 0.001). It was significantly higher in the caudal fetuses on the 20th day (P < 0.05). The somatic rate of all fetuses peaked at the end of the second trimester, although caudal fetuses had higher fetometric values, and this location difference also affected placental echotexture. In both vessels of caudal fetuses, pulsatility and resistance values were higher. The 20th day of pregnancy was a threshold for the Doppler exam results. In conclusion, growth and metabolic status of fetuses located in different uterine locations in healthy pregnant New Zealand rabbits vary. Based on the these growth curves and hemodynamic data, more comprehensive studies of intrauterine life may be possible.
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Affiliation(s)
- Tuğra Akkuş
- Harran University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey.
| | - Güneş Erdoğan
- Aydin Adnan Menderes University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Aydin, Turkey
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24
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Schou KV, Ekelund CK, Jensen LN, Nørgaard LN, Søgaard K, Rode L, Tabor A, Sundberg K. Short-Term Flow Changes in Monochorionic Survivor Twins after Ultrasound-Guided Umbilical Cord Occlusion. Fetal Diagn Ther 2019; 47:45-53. [PMID: 31195393 DOI: 10.1159/000500021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine hemodynamic changes by Doppler ultrasound of the living fetus during 24 h after umbilical cord occlusion (UCO) in monochorionic diamniotic (MCDA) twin pregnancies. METHOD We conducted a prospective observational study on fetuses undergoing UCO from 2015 to 2017. Doppler parameters peak systolic velocity (PSV) and umbilical pulsatility index (PI) were obtained in the middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus (DV) before and right after UCO, and at 1, 3, 6, 12, and 24 h after. We used multiple of the median (MoM) to adjust for gestational age. Spaghetti plots visualized flow changes over time. Mixed model adjusting for paired longitudinal data compared the values at different time points. RESULTS A total of 16 women were included. MCA-PSV dropped within the first hour after surgery from 0.91 to 0.82 MoM (p = 0.08). MCA-PI and UA-PI increased in the first hour from 0.75 to 0.91 MoM (p = 0.02) and 0.94 to 0.98 MoM (p = 0.22), respectively. The DV-PIV increased to 1.14 MoM 3 h after surgery (p = 0.07). The spaghetti plots illustrated the small changes within the first hours and showed a stabilization of flow measurements near initial values 24 h after UCO. CONCLUSION Within the first hours after UCO the circulation of the survivor twin undergoes small hemodynamic changes.
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Affiliation(s)
- Katrine Vasehus Schou
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, .,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - Charlotte Kvist Ekelund
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa Neerup Jensen
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Søgaard
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sundberg
- Center of Fetal Medicine, Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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25
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Kumari S, Deka D, Dadhwal V, Perumal V. Correlation of fetal blood vessel Doppler measurements with fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions. Int J Gynaecol Obstet 2019; 146:218-222. [PMID: 31004522 DOI: 10.1002/ijgo.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/25/2018] [Accepted: 04/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the correlation between fetal blood vessel Doppler measurements and fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions as a potential guide to therapy. METHODS A prospective observational study was conducted among 30 women who attended a single hospital in India between April 2, 2015 and October 30, 2016. The participants underwent a third intrauterine transfusion based on a middle cerebral artery (MCA) peak systolic velocity (PSV) of greater than 1.50 multiples of the median (MoM). Cordocentesis was performed before the third intrauterine transfusion and hematocrit values correlated with the blood vessel Doppler measurements. RESULTS The MCA PSV MoM and fetal hematocrit MoM had a correlation coefficient of -0.43 (95% confidence interval -0.68 to 0.08; P=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value were 68%, 57%, 83%, and 33%, respectively. The descending aorta PSV δ and fetal hematocrit δ had a correlation coefficient of -0.54 (95% confidence interval -0.75 to -0.23; P=0.001). An area under the curve of 0.80 (standard error 0.085; P=0.017) had 87% sensitivity and 57% specificity for diagnosing fetal anemia. CONCLUSION The descending aorta PSV could offer a useful diagnostic adjunct to MCA PSV after two intrauterine transfusions.
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Affiliation(s)
- Sarita Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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26
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Namazov A, Grin L, Karakus R, Uludogan M, Ayvaci H. An effect of maternal nifedipine therapy on fetoplacental blood flow: a prospective study. Arch Gynecol Obstet 2018; 298:685-688. [PMID: 29971560 DOI: 10.1007/s00404-018-4839-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study is to assess the effects of maternal nifedipine administration on placental and fetal blood flow. METHODS A total of 29 patients with preterm labor diagnosis admitted to the tertiary care center, Zeynep Kamil Hospital, were evaluated. Before and 24-48 h after administration of oral nifedipine, Doppler ultrasound scan was carried out to measure fetal middle cerebral artery, ductus venosus, umbilical artery, and maternal uterine artery blood flow. RESULTS After 24 and 48 h of therapy, there were no changes in mean PI and RI in the umbilical arteries and ductus venosus (p > 0.05). Fetal middle cerebral artery and maternal uterine artery PI and RI values showed a significant reduction 24-48 h after oral nifedipine therapy (p < 0.05). CONCLUSIONS Our study showed that 24 and 48 h after oral nifedipine therapy, there is a significant increase in fetal MCA and maternal uterine artery blood flow, while fetal umbilical artery and ductus venosus Doppler values do not change.
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Affiliation(s)
- Ahmet Namazov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ben-Gurion University of Negev, Faculty of Health Sciences, HaHistadrut street 2, Ashkelon, Israel.
| | - Leonti Grin
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ben-Gurion University of Negev, Faculty of Health Sciences, HaHistadrut street 2, Ashkelon, Israel
| | - Resul Karakus
- Obstetrics and Gynecology Department, Zeynep Kamil Hospital, Istanbul, Turkey
| | - Mehmet Uludogan
- Obstetrics and Gynecology Department, Zeynep Kamil Hospital, Istanbul, Turkey
| | - Habibe Ayvaci
- Obstetrics and Gynecology Department, Zeynep Kamil Hospital, Istanbul, Turkey
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27
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Li H, Shin SE, Seo MS, An JR, Ha KS, Han ET, Hong SH, Kim J, Yim MJ, Lee JM, An TG, Jeon J, Lee SJ, Na SH, Park WS. Alterations of ATP-sensitive K + channels in human umbilical arterial smooth muscle during gestational diabetes mellitus. Pflugers Arch 2018; 470:1325-33. [PMID: 29855712 DOI: 10.1007/s00424-018-2154-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 12/20/2022]
Abstract
We investigated the alterations of ATP-sensitive K+ (KATP) channels in human umbilical arterial smooth muscle cells during gestational diabetes mellitus (GDM). The amplitude of the KATP current induced by application of the KATP channel opener pinacidil (10 μM) was reduced in the GDM group than in the control group. Pinacidil-induced vasorelaxation was also predominant in the normal group compared with the GDM group. Reverse transcription polymerase chain reaction and Western blot analysis suggested that the expression of KATP channel subunits such as Kir6.1, Kir6.2, and SUR2B were decreased in the GDM group relative to the normal group. The application of forskolin and adenosine, which activates protein kinase A (PKA) and thereby KATP channels, elicited KATP current in both the normal and GDM groups. However, the current amplitudes were not different between the normal and GDM groups. In addition, the expression levels of PKA subunits were not altered between the two groups. These results suggest that the reduction of KATP current and KATP channel-induced vasorelaxation are due to the decreased expression of KATP channels, not to the impairment of KATP-related signaling pathways.
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Saw SN, Poh YW, Chia D, Biswas A, Mattar CNZ, Yap CH. Characterization of the hemodynamic wall shear stresses in human umbilical vessels from normal and intrauterine growth restricted pregnancies. Biomech Model Mechanobiol 2018; 17:1107-1117. [PMID: 29691766 DOI: 10.1007/s10237-018-1017-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
Significant reductions in blood flow and umbilical diameters were reported in pregnancies affected by intrauterine growth restriction (IUGR) from placental insufficiency. However, it is not known if IUGR umbilical blood vessels experience different hemodynamic wall shear stresses (WSS) compared to normal umbilical vessels. As WSS is known to influence vasoactivity and vascular growth and remodeling, which can regulate flow rates, it is important to study this parameter. In this study, we aim to characterize umbilical vascular WSS environment in normal and IUGR pregnancies, and evaluate correlation between WSS and vascular diameter, and gestational age. Twenty-two normal and 21 IUGR pregnancies were assessed via ultrasound between the 27th and 39th gestational week. IUGR was defined as estimated fetal weight and/or abdominal circumference below the 10th centile, with no improvement during the remainder of the pregnancy. Vascular diameter was determined by 3D ultrasound scans and image segmentation. Umbilical artery (UA) WSS was computed via computational flow simulations, while umbilical vein (UV) WSS was computed via the Poiseuille equation. Univariate multiple regression analysis was used to test for the differences between normal and IUGR cohort. UV volumetric flow rate, UA and UV diameters were significantly lower in IUGR fetuses, but flow velocities and WSS trends in UA and UV were very similar between normal and IUGR groups. In both groups, UV WSS showed a significant negative correlation with diameter, but UA WSS had no correlation with diameter, suggesting a constancy of WSS environment and the existence of WSS homeostasis in UA, but not in UV. Despite having reduced flow rate and vascular sizes, IUGR UAs had hemodynamic mechanical stress environments and trends that were similar to those in normal pregnancies. This suggested that endothelial dysfunction or abnormal mechanosensing was unlikely to be the cause of small vessels in IUGR umbilical cords.
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Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore
| | - Yu Wei Poh
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore
| | - Dawn Chia
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Citra Nurfarah Zaini Mattar
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore.
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29
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Abstract
Background Sexual dimorphism in placental size and function has been described. Whether this influences the clinically important umbilical artery (UA) waveform remains controversial, although a few cross-sectional studies have shown sex differences in UA pulsatility index (PI). Therefore, we tested whether fetal sex influences the UA Doppler indices during the entire second half of pregnancy and aimed to establish sex-specific reference ranges for UA Doppler indices if needed. Methods Our main objective was to investigate gestational age-associated changes in UA Doppler indices during the second half of pregnancy and compare the values between male and female fetuses. This was a prospective longitudinal study in women with singleton low-risk pregnancies during 19–40 weeks of gestation. UA Doppler indices were serially obtained at a 4-weekly interval from a free loop of the umbilical cord using color-directed pulsed-wave Doppler ultrasonography. Sex-specific reference intervals were calculated for the fetal heart rate (HR), UA PI, resistance index (RI), and systolic/diastolic ratio (S/D) using multilevel modeling. Results Complete data from 294 pregnancies (a total of 1261 observations from 152 male and 142 female fetuses) were available for statistical analysis, and sex-specific reference ranges for the UA Doppler indices and fetal HR were established for the last half of pregnancy. UA Doppler indices were significantly associated with gestational age (P < 0.0001) and fetal HR (P < 0.0001). Female fetuses had 2–8% higher values for UA Doppler indices than male fetuses during gestational weeks 20+0–36+6 (P < 0.05), but not later. Female fetuses had higher HR from gestational week 26+0 until term (P < 0.05). Conclusions We have determined gestational age-dependent sex differences in UA Doppler indices and fetal HR during the second half of pregnancy, and correspondingly established new sex-specific reference ranges intended for refining diagnostics and monitoring individual pregnancies.
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Affiliation(s)
- Christian Widnes
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway. .,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway.
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway
| | - Torvid Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromso, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Sykehusveien 38, PO Box 24, N-9038, Tromso, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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30
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Chantalat E, Vaysse C, Delchier MC, Bordier B, Game X, Chaynes P, Cavaignac E, Roumiguié M. Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women. Surg Radiol Anat 2018; 40:729-734. [PMID: 29589145 DOI: 10.1007/s00276-018-2007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/23/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy. PATIENTS AND METHODS We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries. RESULTS The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin. CONCLUSION The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.
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Affiliation(s)
- E Chantalat
- Department of General and Gynaecological Surgery, Rangueil University Hospital, 1 Av Pr Poulhès, 31059, Toulouse, France.
- Laboratory of Applied Anatomy, Rangueil University Hospital, Toulouse, France.
| | - C Vaysse
- Department of General and Gynaecological Surgery, Rangueil University Hospital, 1 Av Pr Poulhès, 31059, Toulouse, France
| | - M C Delchier
- Department of Radiology, Rangueil University Hospital, Toulouse, France
| | - B Bordier
- Department of Urological Surgery, Clinique Pasteur, Toulouse, France
| | - X Game
- Department of Urological Surgery, Rangueil University Hospital, Toulouse, France
| | - P Chaynes
- Department of Neurosurgery, Pierre Paul Riquet University Hospital, Toulouse, France
- Laboratory of Applied Anatomy, Rangueil University Hospital, Toulouse, France
| | - E Cavaignac
- Department of Orthopedic Surgery, Pierre Paul Riquet University Hospital, Toulouse, France
- Laboratory of Applied Anatomy, Rangueil University Hospital, Toulouse, France
| | - M Roumiguié
- Department of Urological Surgery, Rangueil University Hospital, Toulouse, France
- Laboratory of Applied Anatomy, Rangueil University Hospital, Toulouse, France
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Inan C, Sayin NC, Dolgun ZN, Erzincan SG, Uzun I, Sutcu H, Sut N, Varol FG. Effects of betamethasone on fetoplacental and maternal hemodynamics in preterm pregnancies. Int J Gynaecol Obstet 2018; 141:354-359. [PMID: 29493778 DOI: 10.1002/ijgo.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/18/2017] [Accepted: 02/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the possible effects of prenatal steroid administration on Doppler parameters of the umbilical artery, uterine artery, middle cerebral artery, and ductus venosus, the cerebroplacental ratio, and the amniotic fluid index in preterm fetuses. METHODS The present prospective observational study was performed at the Perinatology Department of Trakya University, Edirne, Turkey, between June 1, 2015, and September 1, 2016. It included patients with healthy singleton pregnancies who had received betamethasone at 24-34 weeks of pregnancy. Doppler parameters were measured before (0 hours) and 24, 48, and 72 hours after the administration of betamethasone (two intramuscular doses of 12 mg each, administered 24 hours apart). RESULTS There were 68 patients included. Pairwise comparisons demonstrated that, at 72 hours after betamethasone administration, the umbilical artery resistance index (P=0.038), the middle cerebral artery systolic/diastolic velocity ratio (P=0.007), and the amniotic fluid index (P=0.017) were reduced, whereas the end-diastolic velocity of the middle cerebral artery was increased (P=0.012), compared with baseline values. CONCLUSION Betamethasone had favorable effects on fetal cerebral circulation, with increased end-diastolic velocity in the middle cerebral artery; this could represent a positive effect on cerebral blood circulation and decreased flow resistance in the umbilical artery.
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Affiliation(s)
- Cihan Inan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - N Cenk Sayin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Zehra N Dolgun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Selen G Erzincan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Isil Uzun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Havva Sutcu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Necdet Sut
- Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Fusun G Varol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Wu J, Zhou W, Li Q, Yuan R, Li H, Cui S. Combined use of serum gamma glutamyl transferase level and ultrasonography improves prediction of perinatal outcomes associated with preeclamptic pregnancy. Clin Chim Acta 2017; 475:97-101. [PMID: 28964834 DOI: 10.1016/j.cca.2017.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Serum gamma glutamyl transferase (GGT), produced and released mostly from the liver and bile duct, is an enzyme involved in response to oxidative stress, and has been used as a maker for prediction of cardiovascular events. Umbilical artery blood flow resistance index, e.g., the systolic/diastolic ratio (S/D ratio) as determined by ultrasound, has been used to assess the fetal intrauterine conditions. While changes of GGT and S/D ratio in preeclampsia are found to be associated with the risk for adverse perinatal outcome, the potential value of combined use of the two measurements for the prediction of adverse perinatal outcome has not been determined. MATERIALS AND METHODS This study included severe preeclampsia patients in late pregnancy and determined their serum GGT levels and ultrasonic flow resistance index of umbilical artery within a week before delivery. Demographic data and perinatal outcomes including perinatal death, five-minute Apgar score, admission to neonatal intensive care unit, respiratory distress syndrome, and intrauterine growth restriction, are documented and analyzed. RESULTS It was found that serum GGT combined with umbilical artery S/D ratio predicted perinatal adverse outcomes in severe preeclampsia patients with a sensitivity of 94.30% and a specificity of 80.00%. Moreover, absent or reversed UA diastolic blood flow was found to be an independent risk factor for intrauterine growth restriction. CONCLUSION GGT in combination with umbilical artery S/D ratio is a potentially useful marker for the prediction of adverse outcome in severe preeclampsia patients. Future studies in a larger cohort of patients should be performed to verify the efficacy of the strategy. Early and accurate prediction of adverse perinatal events can facilitate the efforts to improve the perinatal outcomes of neonates associated with preeclamptic pregnancies.
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Affiliation(s)
- Juan Wu
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wei Zhou
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing 400013, China
| | - Quanhua Li
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Rui Yuan
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hezhou Li
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Shihong Cui
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Hernandez-Andrade E, Maymon E, Erez O, Saker H, Luewan S, Garcia M, Ahn H, Tarca AL, Done B, Korzeniewski SJ, Hassan SS, Romero R. A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth. Fetal Diagn Ther 2017; 44:112-123. [PMID: 28926826 DOI: 10.1159/000479684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/19/2017] [Indexed: 02/04/2023]
Abstract
AIM To determine whether Doppler evaluation at 20-24 weeks of gestation can predict reduced fetal size later in pregnancy or at birth. METHODS Fetal biometry and Doppler velocimetry were performed in 2,986 women with a singleton pregnancy at 20-24 weeks of gestation. Predictive performances of the umbilical artery pulsatility index (UA-PI) or the mean uterine artery pulsatility index (UtA-PI) >95th percentile, middle cerebral artery pulsatility index, or cerebroplacental ratio (CPR) <5th percentile for early small for gestational age (SGA; <34 weeks of gestation), late SGA (≥34 weeks of gestation), or SGA at birth (birthweight <10th percentile) were analyzed. RESULTS The prevalence of early SGA, late SGA, and SGA at birth was 1.1, 9.6, and 14.7%, respectively. A CPR <5th percentile had a positive likelihood ratio (LR+) of 8.2 (95% confidence interval [CI] 5.7-12.0) for early SGA, a LR+ of 1.6 (95% CI 1.1-1.2) for late SGA, and a LR+ of 1.9 (95% CI 1.4-2.6) for SGA at birth. A UtA-PI >95th percentile was associated with late SGA and SGA at birth, while an UA-PI >95th percentile was associated with early SGA. Associations were higher in fetuses with an estimated fetal weight <10th percentile. CONCLUSION Fetal biometry and Doppler evaluation at 20-24 weeks of gestation can predict early and late SGA as well as SGA at birth.
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Sinskey JL, Rollins MD, Whitlock E, Moon-Grady AJ, Vu L, Feiner JR, Ferschl MB. Incidence and Management of Umbilical Artery Flow Abnormalities during Open Fetal Surgery. Fetal Diagn Ther 2017; 43:274-283. [PMID: 28848121 DOI: 10.1159/000477963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/30/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Umbilical artery (UA) Doppler ultrasound is used to assess uteroplacental insufficiency. Absent or reversed end diastolic flow (AREDF) in the UA is associated with increased perinatal mortality in fetuses with intrauterine growth restriction. We describe the incidence of UA Doppler abnormalities during open fetal surgery. METHODS We conducted a retrospective review of patients undergoing open in utero myelomeningocele (MMC) repair between 2008 and 2015. Intermittent UA Dopplers were performed during key portions of all cases. Our primary outcome was the rate of any AREDF. Secondary outcomes included analysis of absent versus reversed end diastolic flow (EDF), vasopressor use, and volatile anesthetic and clinical outcomes. RESULTS Thirty-four of 47 fetuses developed UA Doppler abnormalities intraoperatively. Nineteen had absent EDF and 15 had reversed EDF. No AREDF was present before induction, and all AREDF resolved by postoperative day 1. Ten of 19 (52.6%) patients who received sevoflurane had reversed EDF, versus 5/28 (17.9%) for desflurane, odds ratio (95% CI) 5.11 (1.36-19.16), p = 0.02. One intraoperative fetal death occurred in the AREDF group. DISCUSSION AREDF is a common phenomenon during open MMC repair. Anesthetic agent choice may influence this risk. Future studies of UA flow during fetal surgery are needed to further evaluate the impact of intraoperative AREDF on fetal well-being.
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Affiliation(s)
- Jina L Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
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de Treigny OM, Roumiguie M, Deudon R, de Bonnecaze G, Carfagna L, Chaynes P, Rimailho J, Chantalat E. Anatomical study of the inferior vesical artery: is it specific to the male sex? Surg Radiol Anat 2017; 39:961-965. [PMID: 28229186 DOI: 10.1007/s00276-017-1828-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of our study was to clarify the origin of the inferior vesical artery and determine its existence in women. METHODS This descriptive study is based on 25 dissections (6 male and 19 female cadavers). We dissected the internal iliac artery and its branches from the iliac bifurcation, bilaterally and comparatively. Each arterial branch supplying the bladder was identified and dissected as far as the bladder. RESULTS In total, 50 topographies of the bladder vascularization were visualised. The inferior vesical artery was observed in 92% of the male subjects and in 47.4% of the female subjects. In the male cadavers, it arose from the internal iliac artery in 72.7% of cases and from the umbilical artery in 27.3% of cases. In the female cadavers, it arose from a common trunk with the umbilical artery and the uterine artery in 33.3% of cases and directly from the umbilical artery in 33.3% with one terminal branch supplying the upper part of the vagina. In two female subjects, the inferior vesical artery arose from the first segment of the uterine artery (22.2%), and in one subject from the obturator artery (11.1%). CONCLUSIONS The inferior vesical artery is not specific to the male sex. The contradictions found in the literature of this artery are due to the variations observed in pelvic vascularization and to the close connections between vaginal and bladder vascularisation in women. However, surgeons should consider these variations, to prevent bladder devascularization by non-selective ligation.
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Affiliation(s)
- O Merigot de Treigny
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Urology, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - M Roumiguie
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Urology, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - R Deudon
- Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - G de Bonnecaze
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Head and Neck Surgery, Larrey Hospital, CHU Toulouse, Toulouse, France
| | - L Carfagna
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Pediatric Surgery, CHU Paule de Viguier, Toulouse, France
| | - P Chaynes
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Neurosurgical Department, Pierre Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - J Rimailho
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France.,Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - E Chantalat
- Laboratory of Applied Anatomy, Faculty of Medicine Toulouse, Toulouse, France. .,Department of Gynecological Surgery, Rangueil Hospital, CHU Toulouse, 1 avenue J Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
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Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India 2017; 73:232-41. [PMID: 28790780 DOI: 10.1016/j.mjafi.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 12/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Doppler indices form an integral component of noninvasive evaluation of fetal well-being. There is paucity of information about normal obstetric Doppler indices, particularly from the Indian subcontinent. The aim of the study was to find the values of pulsatility index (PI), resistive index (RI) of umbilical artery (UA), and fetal middle cerebral artery (MCA) and calculate cerebro-placental ratio (CP ratio) for 18-40 weeks of normal gestation so that a reference range of these Doppler values can be postulated. METHODS 200 patients were enrolled in the study for color Doppler study of UA and MCA and were serially followed up at 4-6 weeks interval for Doppler indices. Angle-independent Doppler indices like PI and RI for MCA and UA were obtained during each examination. CP ratio was calculated in each case. All the cases were followed up till delivery and the perinatal outcome was recorded. RESULTS & CONCLUSION The fetal MCA PI and RI showed a parabolic curve with plateau at 28-30 weeks of gestation. A significant correlation was noted between MCA PI and RI with gestational age. UA PI and RI showed a gradual fall over the gestational age with a strong negative correlation. There was a significant correlation between MCA PI and UA PI with their respective RI values. CP ratio has also shown a parabolic curve with turning point at 31-32 weeks of gestation. A significant correlation was noted between CP ratio and gestational age. CP ratio also showed a minimal positive correlation with MCA PI and a strong negative correlation with UA PI.
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Rafferty AR, D'Arcy C, Cann L, Pyman J, Rogers P, Davis PG, Nowell C, Burgner D. Histological changes in the umbilical artery following severe chorioamnionitis and funisitis may be indicative of early atherosclerosis. Placenta 2016; 50:40-43. [PMID: 28161060 DOI: 10.1016/j.placenta.2016.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 11/24/2022]
Abstract
We investigated whether histological evidence of early atherosclerosis was present in the umbilical artery of 21 pregnancies complicated by severe perinatal inflammation, and 21 controls matched for gestational age, sex and birth weight. Severe chorioamnionitis with funisitis was associated with increased numbers of CD68 and CD45 positive cells (both P < 0.01), indicating accumulation of monocyte-derived macrophages in lesion-susceptible regions. A down-regulation of SMA expression (P = 0.01) was also observed. These preliminary findings suggest that chorioamnionitis with funisitis may promote changes in the intima and media of the umbilical artery similar to that seen in early atherosclerosis.
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Affiliation(s)
- Anthony R Rafferty
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Colleen D'Arcy
- Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Leonie Cann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jan Pyman
- Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter Rogers
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter G Davis
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Cameron Nowell
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - David Burgner
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
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Widnes C, Flo K, Acharya G. Exploring sexual dimorphism in placental circulation at 22-24 weeks of gestation: A cross-sectional observational study. Placenta 2016; 49:16-22. [PMID: 28012450 DOI: 10.1016/j.placenta.2016.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 11/01/2016] [Accepted: 11/11/2016] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Placental blood flow is closely associated with fetal growth and wellbeing. Recent studies suggest that there are differences in blood flow between male and female fetuses. We hypothesized that sexual dimorphism exists in fetal and placental blood flow at 22-24 weeks of gestation. METHODS This was a prospective cross-sectional study of 520 healthy pregnant women. Blood flow velocities of the middle cerebral artery (MCA), umbilical artery (UA), umbilical vein (UV) and the uterine arteries (UtA) were measured using Doppler ultrasonography. UV and UtA diameters were measured using two-dimensional ultrasonography and power Doppler angiography. Volume blood flows (Q) of the UV and UtA were calculated. Maternal haemodynamics was assessed with impedance cardiography. UtA resistance (Ruta) was computed as MAP/Quta. RESULTS UA PI was significantly (p = 0.008) higher in female fetuses (1.19 ± 0.15) compared with male fetuses (1.15 ± 0.14). MCA PI, cerebro-placental ratio (MCA PI/UA PI), Quv, UtA PI, Quta and Ruta were not significantly different between groups. At delivery, the mean birth weight and placental weight of female infants (3504 g and 610 g) were significantly (p = 0.0005 and p = 0.039) lower than that of the male infants (3642 g and 634 g). DISCUSSION We have demonstrated sexual dimorphism in UA PI, a surrogate for placental vascular resistance, at 22-24 weeks of gestation. Therefore, it would be useful to know when this difference emerges and whether it translates into blood flow differences that may impact upon the fetal growth trajectory.
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Affiliation(s)
- Christian Widnes
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway and Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway.
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway and Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway and Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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Levine TA, Alderdice FA, Grunau RE, McAuliffe FM. Prenatal stress and hemodynamics in pregnancy: a systematic review. Arch Womens Ment Health 2016; 19:721-39. [PMID: 27329120 DOI: 10.1007/s00737-016-0645-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal-fetal hemodynamics. The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Of 2532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.
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Affiliation(s)
- Terri A Levine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Ruth E Grunau
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Child and Family Research Institute, Vancouver, Canada
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Northern Ireland.
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Seano G, Primo L. Human Arterial Ring Angiogenesis Assay. Methods Mol Biol 2016; 1430:191-203. [PMID: 27172955 DOI: 10.1007/978-1-4939-3628-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
In this chapter we describe a model of human angiogenesis where artery explants from umbilical cords are embedded in gel matrices and subsequently produce capillary-like structures. The human arterial ring (hAR) assay is an innovative system that enables three-dimensional (3D) and live studies of human angiogenesis. This ex vivo model has the advantage of recapitulating several steps of angiogenesis, including endothelial sprouting, migration, and differentiation into capillaries. Furthermore, it can be exploited for (1) identification of new genes regulating sprouting angiogenesis, (2) screening for pro- or anti-angiogenic drugs, (3) identification of biomarkers to monitor the efficacy of anti-angiogenic regimens, and (4) dynamic analysis of tumor microenvironmental effects on vessel formation.
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Yerlikaya G, Pils S, Springer S, Chalubinski K, Ott J. Velamentous cord insertion as a risk factor for obstetric outcome: a retrospective case-control study. Arch Gynecol Obstet 2015; 293:975-81. [PMID: 26498602 DOI: 10.1007/s00404-015-3912-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Velamentous umbilical cord insertion (VCI) is associated with adverse pregnancy outcomes. Literature lacks data on Doppler. We aimed to evaluate obstetric outcomes and results of uterine and umbilical artery Doppler flowmetry associated with VCI. MATERIALS AND METHODS In a retrospective case-control study, 108 singleton pregnancies with VCI were age- and body mass index-matched to 108 singleton pregnancies without VCI. The main outcome parameters were obstetric outcome, pregnancy-related complications, uterine artery flowmetry at the second-trimester screening, and umbilical artery flowmetry before delivery. Statistical analysis was accomplished using Pearson's Chi-square test or Fisher's exact test, and the Mann-Whitney U test, where appropriate. RESULTS Pregnancies with VCI revealed a significantly higher PI in the umbilical artery during the last measurement before delivery (1.00 ± 0.25 vs. 0.90 ± 0.10; p = 0.001). Gestational age at this measurement did not differ between the groups. Fetal malformations and intrauterine fetal death were more common in pregnancies with VCI (12.7 vs. 0 %; p < 0.001, and 6.5 vs. 0 %; p = 0.014, respectively). Patients with VCI delivered significantly earlier (36.2 ± 4.5 vs. 38.4 ± 2.6; p < 0.001). CONCLUSION Higher rates of (early) preterm delivery were found in pregnancies with VCI. Fetuses with VCI also suffered from malformations and IUFD more frequently. The last pulsatility index value in the umbilical artery, before delivery, was significantly higher in pregnancies with VCI, which is of uncertain clinical value.
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Affiliation(s)
- Gülen Yerlikaya
- Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria
| | - Sophie Pils
- Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria
| | - Stephanie Springer
- Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria
| | - Kinga Chalubinski
- Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria
| | - Johannes Ott
- Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria.
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Khoury J, Knutsen M, Stray-Pedersen B, Thaulow E, Tonstad S. A lower reduction in umbilical artery pulsatility in mid-pregnancy predicts higher infant blood pressure six months after birth. Acta Paediatr 2015; 104:796-800. [PMID: 25865616 DOI: 10.1111/apa.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 03/04/2015] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
AIM The Norwegian-based Cardiovascular Risk Reduction Diet in Pregnancy study found that a cholesterol-lowering diet during pregnancy was associated with an accentuated reduction in the umbilical artery pulsatility index. This follow-up study assessed the possible association between the index and the infants' blood pressure at six months of age. METHODS In the original study, pregnant women consumed an anti-atherogenic or usual diet from gestational weeks 17-20 to birth and underwent Doppler velocimetry at 24, 30 and 36 gestational weeks. In this follow-up study, blood pressure was measured in 105 mother-infant pairs in the intervention group and 106 mother-infant pairs in the control group six months after birth. RESULTS Mean systolic and diastolic blood pressures were not significantly different between both groups. When the groups were combined, multivariate linear analyses showed that a lower versus higher reduction (≥-0.17 versus <-0.17) in the umbilical artery pulsatility index between gestational weeks 24 and 30 and maternal diastolic blood pressure at six months postpartum were significant predictors of higher infant systolic blood pressure (p = 0.03, 0.01, respectively). CONCLUSION A lower reduction in umbilical pulsatility index in mid-pregnancy was associated with higher infant blood pressure at six months of age. This suggests that fetoplacental intrauterine factors may influence future cardiovascular risk.
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Affiliation(s)
- J Khoury
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Bryn Medical Center; Oslo Norway
| | - M Knutsen
- Department of Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - B Stray-Pedersen
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - E Thaulow
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section of Congenital Heart Disease; Division of Women and Children; Oslo University Hospital; Oslo Norway
| | - S Tonstad
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section for Preventive Cardiology; Department of Endocrinology, Morbid Obesity and Preventive Medicine; Oslo University Hospital; Oslo Norway
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Blanco PG, Rodríguez R, Olguín S, Rube A, Tórtora M, Gobello C. Doppler ultrasonographic assessment of maternal and fetal arteries during normal feline gestation. Anim Reprod Sci 2014; 146:63-9. [PMID: 24602508 DOI: 10.1016/j.anireprosci.2014.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/27/2014] [Accepted: 02/02/2014] [Indexed: 01/01/2023]
Abstract
The aim of this study was to describe Doppler parameters of uterine, umbilical, fetal abdominal aorta, fetal renal and fetal internal carotid arteries, as well as fetal heart rate (FHR), during normal feline gestation. Fifteen, 1-4 years of age, weighing 2.5-3.9kg, domestic short-hair pregnant queens, which were born in our institutional cat colony were included in this study. Color and pulsed-wave Doppler evaluations of uterine arteries were performed every 10 days (Day 0, 10, 20, 30, 40, 50, 60) from mating. Fetal Doppler and M-mode ultrasonography were performed to assess umbilical, fetal abdominal aorta, fetal renal, fetal internal carotid arteries and FHR. Both peak systolic velocity (PSV) and end diastolic velocity (EDV) of uterine artery increased up to parturition (P<0.01), while resistance index (RI) decreased from Day 10 onwards (P<0.01). From Day 40 onwards, RI of umbilical artery diminished, while PSV and EDV augmented (P<0.01). Fetal abdominal aorta (P<0.01), renal (P<0.01) and internal carotid (P<0.01) arteries diminished their RI from Days 40, 60 and 40 onwards, respectively. Both PSV and EDV of these three arteries increased progressively. Fetal heart rate was first registered on Day 20 when it began to increase up to Day 40 and then diminished to the end of gestation (P<0.01). It is concluded that blood flow of uterine, umbilical, fetal abdominal aorta, fetal renal and fetal internal carotid arteries progressively increased during normal feline pregnancy, while FHR rose to mid gestation and then decreased up to parturition.
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Affiliation(s)
- P G Blanco
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), 60 y 118, La Plata 1900, Argentina.
| | - R Rodríguez
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), 60 y 118, La Plata 1900, Argentina
| | - S Olguín
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), 60 y 118, La Plata 1900, Argentina
| | - A Rube
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), 60 y 118, La Plata 1900, Argentina
| | - M Tórtora
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), 60 y 118, La Plata 1900, Argentina
| | - C Gobello
- Laboratory of Reproductive Physiology, FVS-NULP, La Plata, Argentina
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Hassan WA, Brockelsby J, Alberry M, Fanelli T, Wladimiroff J, Lees CC. Cardiac function in early onset small for gestational age and growth restricted fetuses. Eur J Obstet Gynecol Reprod Biol 2013; 171:262-5. [PMID: 24176539 DOI: 10.1016/j.ejogrb.2013.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/09/2013] [Accepted: 09/19/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine cardiac function in appropriately grown, small for gestational age and intrauterine growth restricted fetuses and investigate the relationship between cardiac function and fetal arterial and venous Doppler parameters. STUDY DESIGN Myocardial performance index, isovolumetric contraction time, isovolumetric relaxation time, ejection time, and umbilical artery, middle cerebral artery and ductus venosus Doppler pulsatility index were measured for women between 24 and 32 weeks with small for gestational age and intrauterine growth restricted fetuses. Forty-eight appropriately grown, 11 small for gestational age and 12 intrauterine growth restricted cases were included. The relationship between cardiovascular parameters and gestation was defined and Doppler values converted to Z-scores in relation to gestational age. RESULTS In small for gestational age fetuses and fetuses with intrauterine growth restriction the myocardial performance index was 0.66 (0.63-0.7) and 0.64 (0.60-0.67), respectively, and compared to appropriately grown fetuses, at 0.45 (0.43-0.47), was significantly increased (p=0.001). No relationship was found between the myocardial performance index and arterial and venous Doppler Z-score. CONCLUSION Small for gestational age and intrauterine growth restricted fetuses demonstrate altered cardiac function in the late second and early third trimester of pregnancy. Importantly, the myocardial performance index is raised in small for gestational age fetuses before the arterial and venous Doppler abnormalities that characterize hypoxia are evident.
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Affiliation(s)
- Wassim A Hassan
- Fetal Medicine Department, Rosie Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 2QQ, United Kingdom
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