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Gajić Bojić M, Đukanović Đ, Marinković S, Jovičić S, Stojiljković MP, Djuric DM, Škrbić R. Methodological challenges in using human umbilical artery as a model for in vitro studies. Exp Physiol 2023; 108:1569-1578. [PMID: 37837634 PMCID: PMC10988505 DOI: 10.1113/ep091374] [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: 06/27/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
NEW FINDINGS What is the central question of this study? What are the biggest challenges in performing in vitro studies on isolated human umbilical arteries? What is the main finding and its importance? The protocols presented in this study indicate some potential outcomes important for interpretation of the vascular responsivities of human umbilical arteries and could be useful for planning future in vitro studies with human umbilical arteries. ABSTRACT Human umbilical artery (HUA) preparations are of particular importance for in vitro studies on isolated blood vessels because their sampling is not risky for the patient, and they can provide the closest possible impression of changes related to the uteroplacental circulation during pre-eclampsia. Using organ bath techniques, useful experimental protocols are provided for measuring some pathophysiological phenomena in the vascular responses of HUAs. Several vasoconstrictors (serotonin, prostaglandin F and phenylephrine) and vasodilators (acetylcholine and minoxidil) were seleted for determination of their vasoactivity in HUAs. The role of L-type voltage-operated calcium channels and different types of potassium channels (KATP , BKCa and KV ) were assessed, as was the impact of homocysteine. Serotonin was confirmed to be the most potent vasoconstrictor, while acetylcholine and phenylephrine caused variability in the relaxation and contraction response of HUA, respectively. The observed increase in serotonin-induced contraction and a decrease in minoxidil-induced relaxation in the presence of homocysteine suggested its procontractile effect on HUA preparations. Using selective blockers, it was determined that KATP and KV channels participate in the minoxidil-induced relaxation, while L-type voltage-dependent Ca2+ channels play an important role in the serotonin-induced contraction. The presented protocols reveal some of the methodological challenges related to HUA preparations and indicate potential outcomes in interpreting the vascular effects of the investigated substances, both in physiological conditions and in the homocysteine-induced pre-eclampsia model.
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Affiliation(s)
- Milica Gajić Bojić
- Centre for Biomedical Research, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
| | - Đorđe Đukanović
- Centre for Biomedical Research, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
| | - Sonja Marinković
- Department of PaediatricsUniversity Clinical Centre of the Republic of SrpskaBanja Luka The Republic of SrpskaBosnia and Herzegovina
| | - Sanja Jovičić
- Department of Histology and Embryology, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
| | - Miloš P. Stojiljković
- Centre for Biomedical Research, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
| | - Dragan M. Djuric
- Centre for Biomedical Research, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
- Faculty of Medicine, Institute of Medical Physiology ‘Richard Burian’University of BelgradeBelgradeSerbia
| | - Ranko Škrbić
- Centre for Biomedical Research, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of MedicineUniversity of Banja LukaBanja Luka The Republic of SrpskaBosnia and Herzegovina
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Lorigo M, Mangana C, Cairrao E. Disrupting effects of the emerging contaminant octylmethoxycinnamate (OMC) on human umbilical artery relaxation. Environ Pollut 2023; 335:122302. [PMID: 37536478 DOI: 10.1016/j.envpol.2023.122302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/05/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
Cardiovascular diseases (CVD) represent the number one cause of death worldwide. The vascular endothelium may play a role in the pathophysiology of CVD diseases. Octylmethoxycinnamate (OMC) is a UV-B filter (CAS number: 5466-77-3) widely used worldwide in numerous personal care products, including sunscreens, daily creams, and makeup. This UV-B filter is considered an endocrine disruptor. Therefore, this investigation aimed to evaluate the direct effects of OMC in human umbilical arteries (HUAs) with endothelium and the possible mechanisms involved in the response. The results demonstrated that OMC exerts a rapid (non-genomic) and endothelium-dependent arterial relaxant effect on HUAs previously contracted with serotonin (5-HT) and Histamine (His). On the other hand, when HUAs were contracted with potassium chloride (KCl), the relaxing effect was only observed in HUAs without endothelium, and it appeared to be inhibited in HUAs with endothelium. Thus, the vasorelaxant effect of OMC depends on the endothelium and depends on the contractile agent used, suggesting that OMC may act through different signaling pathways. Furthermore, computational modulation studies, corroborated the binding of OMC to all the proteins under investigation (eNOS, COX-2, ET-1, and TxA2), with higher affinity for COX-2. In summary, the vascular effect of OMC may involve activating different pathways, i.e., acting through the NO pathway, COX pathway, or activating the endothelin-1 pathway.
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Affiliation(s)
- Margarida Lorigo
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilhã, Portugal; FCS - UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal; C4-UBI, Cloud Computing Competence Centre, University of Beira Interior, 6200-501, Covilhã, Portugal.
| | - Carolina Mangana
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilhã, Portugal; FCS - UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal.
| | - Elisa Cairrao
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilhã, Portugal; FCS - UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal; C4-UBI, Cloud Computing Competence Centre, University of Beira Interior, 6200-501, Covilhã, Portugal.
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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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Abdelnaby EA, Emam IA, El-Sherbiny HR, Fadl AM. The effects of aging and gestational month on uteroplacental vascular perfusion, and umbilical artery hemodynamics in pregnant jennies. BMC Vet Res 2022; 18:404. [PMID: 36380376 PMCID: PMC9664605 DOI: 10.1186/s12917-022-03499-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to correlate the pulsed wave spectral indices of the middle uterine artery at both sides with placental development in jenny within mid-late pregnancies, and establish umbilical Doppler values for different ages and different gestational months. Twenty Equus Asinus pregnant jennies 260-450 kg (average, 320 ± 10 kg) were examined from 5 to 9 months of pregnancy with different ages (4-14 years). Monthly B-mode ultrasound examination was performed on both the combined thickness of the uterus and placenta (CTUP; mm) and umbilical artery cross-sectional diameter, and Doppler mode examination was performed on both the middle uterine (MUA at right [R] and left [L] sides) and umbilical arteries to measure both Doppler indices that expressed by resistance (RI) and pulsatility indices (PI), and blood flow rate. CTUP was elevated within pregnancy time at different ages (P < 0.05). L. PI was significantly declined throughout different ages (P < 0.05), but this declining trend was not observed in L. RI. The L. blood flow rate (R; bpm) was elevated among different ages and different months (P < 0.05). Both RI and PI were significantly decreased from 5 to 9 month of gestation period in jennies (P < 0.05).. The umbilical arteries cross-sectional diameter (Umb A; mm), was elevated among different ages and different months, while both Doppler indices were declined. A positive correlation was found (between both Doppler indices of both umbilical and uterine arteries P < 0.001). There was elevated vascular perfusion in uterine and umbilical arteries associated with reduced both Doppler indices along the course of pregnancy at different ages.
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Affiliation(s)
- Elshymaa A Abdelnaby
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt.
| | - Ibrahim A Emam
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Hossam R El-Sherbiny
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt
| | - Aya M Fadl
- Theriogenology Department, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, 12211, Egypt
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Zahid SM, Opheim GL, Henriksen T, Michelsen TM, Haugen G. Effect of a standardized maternal meal on fetal middle cerebral artery Doppler indices: A single-blinded crossover study. PLoS One 2022; 17:e0272062. [PMID: 35925970 PMCID: PMC9352093 DOI: 10.1371/journal.pone.0272062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Measures of Doppler blood flow velocity profiles are an integral part of monitoring fetal well-being during pregnancy. These examinations are performed at different times of the day and at different maternal meal states. In uncomplicated pregnancies, we assessed the effect of a standardized maternal meal on middle cerebral artery (MCA) and umbilical artery (UA) Doppler blood flow velocity pulsatility indices (PIs) and MCA peak systolic velocity (PSV). Methods In this prospective single-blinded crossover study 25 healthy women were examined at 36 weeks of pregnancy. The first examination was performed in the morning following overnight fast, and repeated after extended fast (state A), and after a standard breakfast meal (state B). Results Irrespective of maternal prandial status, the MCA-PI values were lower in the 2nd compared to the 1st examination (-0.187; p = 0.071, and -0.113; p = 0.099, state A and B, respectively). Compared to the values in the 1st examination, the UA-PI values, were higher after extended fast (0.014; p = 0.436), and lower post-prandially (-0.036; p = 0.070). The difference (state B minus state A) between the meal states were not significant (0.074; p = 0.487 and -0.050; p = 0.058, for MCA-PI and UA-PI, respectively). Adjusting for the possible influence of fetal heart rate on MCA-PI and UA-PI, the differences between meal states remained non-significant (p = 0.179, p = 0.064, respectively). The MCA-PSV values increased after the meal (6.812; p = 0.035), whereas no increase was observed following extended fast (0.140; p = 0.951). The difference in MCA-PSV values between the two meal states was not significant (6.672; p = 0.055). Conclusion Our results demonstrate possible diurnal variations in MCA-PI and UA-PI, with and without adjustment for fetal heart rate, that seem to be unaffected by maternal meal intake in healthy pregnancies.
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Affiliation(s)
- Saba Muneer Zahid
- Division of Obstetrics and Gynaecology, Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Gun Lisbet Opheim
- Division of Obstetrics and Gynaecology, Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
| | - Tore Henriksen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Trond Melbye Michelsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Tica OS, Tica AA, Cojocaru D, Gheonea M, Tica I, Alexandru DO, Cojocaru V, Petcu LC, Tica VI. Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome. Ann Med 2021; 53:1455-1463. [PMID: 34463170 PMCID: PMC8409927 DOI: 10.1080/07853890.2021.1968030] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/07/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Absent end-diastolic flow (AEDF) in the umbilical artery (UA) worsens the already poor prognosis of growth-restricted fetuses (GRFs) in pregnancies complicated by early-onset preeclampsia with severe features (ESP). METHOD We assessed the correlation between the effect of maternal dexamethasone (Dex) on AEDF in the UA and perinatal outcomes, in 59 GRFs from EPS-complicated pregnancies. The maternal outcome was also evaluated. RESULTS The mean maternal age at inclusion was 22.4 ± 5.9 years. Dex transiently restored EDF in the UA in 38 (64.4%) cases (trAEDF group), but in 21 (35.6%) patients, the flow was persistently absent (prAEDF group). The effect lasted up to the 4th day.The gestational age at diagnosis, number of days from admission until delivery, and fetal weight were significantly lower in the prAEDF group than in the trAEDF group (p < .05). The same group had a significantly increased rate of fetal proximal deterioration, low APGAR scores, neonatal hypoxia, assisted ventilation, mild intraventricular haemorrhage (I/II), and respiratory distress syndrome, as well as maternal deterioration, especially in cases of resistant hypertension (p < .05). Although the rates of fetal acidemia and perinatal mortality in the prAEDF group were respectively three times and two times higher, the differences were not significant (p > .05). CONCLUSIONS The Dex no-effect on UA Doppler in GRFs with AEDF in the UA, in EPS-complicated pregnancies, can be a useful marker for a higher risk of proximal fetal deterioration, poor state at delivery, neonatal hypoxic complications, and worsening maternal condition, but not for perinatal mortality. The findings also highlight the alarmingly younger age of patients with EPS. Finally, all these pregnancies should be monitored in a complex multidisciplinary manner in tertiary referral units.Key messageThe effect of dexamethasone on absent end-diastolic flow in the umbilical artery in growth-restricted fetuses from pregnancies complicated by early-onset preeclampsia with severe features can be a useful prognostic factor for perinatal outcomes.
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Affiliation(s)
- Oana Sorina Tica
- Department of “Mother and Child”, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- Emergency Clinical County Hospital of Craiova, Craiova, Romania
| | - Andrei Adrian Tica
- Emergency Clinical County Hospital of Craiova, Craiova, Romania
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Doriana Cojocaru
- Department of Anesthesiology and Intensive Care, Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau, Chisinau, Moldova
- Timofei Mosneaga Republican Clinical Hospital, Chisinau, Moldova
| | - Mihaela Gheonea
- Emergency Clinical County Hospital of Craiova, Craiova, Romania
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Irina Tica
- Department of Internal Medicine, Faculty of Medicine, University “Ovidius” Constanta, Constanta, Romania
- University Regional Emergency Hospital of Constanta, Constanta, Romania
| | - Dragos Ovidiu Alexandru
- Department of Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Victor Cojocaru
- Department of Anesthesiology and Intensive Care, Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau, Chisinau, Moldova
- Timofei Mosneaga Republican Clinical Hospital, Chisinau, Moldova
| | - Lucian Cristian Petcu
- Department of Biophysics, Faculty of Dental Medicine, University “Ovidius” Constanta, Constanta, Romania
| | - Vlad Iustin Tica
- University Regional Emergency Hospital of Constanta, Constanta, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, University “Ovidius” Constanta, Constanta, Romania
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Nandadasa S, Szafron JM, Pathak V, Murtada SI, Kraft CM, O'Donnell A, Norvik C, Hughes C, Caterson B, Domowicz MS, Schwartz NB, Tran-Lundmark K, Veigl M, Sedwick D, Philipson EH, Humphrey JD, Apte SS. Vascular dimorphism ensured by regulated proteoglycan dynamics favors rapid umbilical artery closure at birth. eLife 2020; 9:e60683. [PMID: 32909945 PMCID: PMC7529456 DOI: 10.7554/elife.60683] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/09/2020] [Indexed: 01/29/2023] Open
Abstract
The umbilical artery lumen closes rapidly at birth, preventing neonatal blood loss, whereas the umbilical vein remains patent longer. Here, analysis of umbilical cords from humans and other mammals identified differential arterial-venous proteoglycan dynamics as a determinant of these contrasting vascular responses. The umbilical artery, but not the vein, has an inner layer enriched in the hydrated proteoglycan aggrecan, external to which lie contraction-primed smooth muscle cells (SMC). At birth, SMC contraction drives inner layer buckling and centripetal displacement to occlude the arterial lumen, a mechanism revealed by biomechanical observations and confirmed by computational analyses. This vascular dimorphism arises from spatially regulated proteoglycan expression and breakdown. Mice lacking aggrecan or the metalloprotease ADAMTS1, which degrades proteoglycans, demonstrate their opposing roles in umbilical vascular dimorphism, including effects on SMC differentiation. Umbilical vessel dimorphism is conserved in mammals, suggesting that differential proteoglycan dynamics and inner layer buckling were positively selected during evolution.
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Affiliation(s)
- Sumeda Nandadasa
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research InstituteClevelandUnited States
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale UniversityNew HavenUnited States
| | - Vai Pathak
- Case Comprehensive Cancer Center, Case Western Reserve UniversityClevelandUnited States
| | - Sae-Il Murtada
- Department of Biomedical Engineering, Yale UniversityNew HavenUnited States
| | - Caroline M Kraft
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research InstituteClevelandUnited States
| | - Anna O'Donnell
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research InstituteClevelandUnited States
| | - Christian Norvik
- Department of Experimental Medical Science and Wallenberg Center for Molecular Medicine, Lund UniversityLundSweden
| | - Clare Hughes
- The Sir Martin Evans Building, School of Biosciences, Cardiff UniversityCardiffUnited Kingdom
| | - Bruce Caterson
- The Sir Martin Evans Building, School of Biosciences, Cardiff UniversityCardiffUnited Kingdom
| | | | - Nancy B Schwartz
- Department of Pediatrics, University of ChicagoChicagoUnited States
| | - Karin Tran-Lundmark
- Department of Experimental Medical Science and Wallenberg Center for Molecular Medicine, Lund UniversityLundSweden
| | - Martina Veigl
- Case Comprehensive Cancer Center, Case Western Reserve UniversityClevelandUnited States
- Department of Medicine, Case Western Reserve UniversityClevelandUnited States
| | - David Sedwick
- Department of Medicine, Case Western Reserve UniversityClevelandUnited States
| | - Elliot H Philipson
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research InstituteClevelandUnited States
- The Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland ClinicClevelandUnited States
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale UniversityNew HavenUnited States
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research InstituteClevelandUnited States
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Pels A, Derks J, Elvan-Taspinar A, van Drongelen J, de Boer M, Duvekot H, van Laar J, van Eyck J, Al-Nasiry S, Sueters M, Post M, Onland W, van Wassenaer-Leemhuis A, Naaktgeboren C, Jakobsen JC, Gluud C, Duijnhoven RG, Lely T, Gordijn S, Ganzevoort W. Maternal Sildenafil vs Placebo in Pregnant Women With Severe Early-Onset Fetal Growth Restriction: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e205323. [PMID: 32585017 PMCID: PMC7301225 DOI: 10.1001/jamanetworkopen.2020.5323] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe early onset fetal growth restriction caused by placental dysfunction leads to high rates of perinatal mortality and neonatal morbidity. The phosphodiesterase 5 inhibitor, sildenafil, inhibits cyclic guanosine monophosphate hydrolysis, thereby activating the effects of nitric oxide, and might improve uteroplacental function and subsequent perinatal outcomes. OBJECTIVE To determine whether sildenafil reduces perinatal mortality or major morbidity. DESIGN, SETTING, AND PARTICIPANTS This placebo-controlled randomized clinical trial was conducted at 10 tertiary referral centers and 1 general hospital in the Netherlands from January 20, 2015, to July 16, 2018. Participants included pregnant women between 20 and 30 weeks of gestation with severe fetal growth restriction, defined as fetal abdominal circumference below the third percentile or estimated fetal weight below the fifth percentile combined with Dopplers measurements outside reference ranges or a maternal hypertensive disorder. The trial was stopped early owing to safety concerns on July 19, 2018, whereas benefit on the primary outcome was unlikely. Data were analyzed from January 20, 2015, to January 18, 2019. The prespecified primary analysis was an intention-to-treat analysis including all randomized participants. INTERVENTIONS Participants were randomized to sildenafil, 25 mg, 3 times a day vs placebo. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of perinatal mortality or major neonatal morbidity until hospital discharge. RESULTS Out of 360 planned participants, a total of 216 pregnant women were included, with 108 women randomized to sildenafil (median gestational age at randomization, 24 weeks 5 days [interquartile range, 23 weeks 3 days to 25 weeks 5 days]; mean [SD] estimated fetal weight, 458 [160] g) and 108 women randomized to placebo (median gestational age, 25 weeks 0 days [interquartile range, 22 weeks 5 days to 26 weeks 3 days]; mean [SD] estimated fetal weight, 464 [186] g). In July 2018, the trial was halted owing to concerns that sildenafil may cause neonatal pulmonary hypertension, whereas benefit on the primary outcome was unlikely. The primary outcome, perinatal mortality or major neonatal morbidity, occurred in the offspring of 65 participants (60.2%) allocated to sildenafil vs 58 participants (54.2%) allocated to placebo (relative risk, 1.11; 95% CI, 0.88-1.40; P = .38). Pulmonary hypertension, a predefined outcome important for monitoring safety, occurred in 16 neonates (18.8%) in the sildenafil group vs 4 neonates (5.1%) in the placebo group (relative risk, 3.67; 95% CI, 1.28-10.51; P = .008). CONCLUSIONS AND RELEVANCE These findings suggest that antenatal maternal sildenafil administration for severe early onset fetal growth restriction did not reduce the risk of perinatal mortality or major neonatal morbidity. The results suggest that sildenafil may increase the risk of neonatal pulmonary hypertension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02277132.
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Affiliation(s)
- Anouk Pels
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Derks
- Wilhelmina Children’s Hospital, Department of Obstetrics, University Medical Center Utrecht, Gynecology and Neonatology, Utrecht, the Netherlands
| | - Ayten Elvan-Taspinar
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjon de Boer
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hans Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Judith van Laar
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands
| | - Jim van Eyck
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marieke Sueters
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marinka Post
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Wes Onland
- Emma Children’s Hospital, Amsterdam UMC, Department of Neonatology, University of Amsterdam, Amsterdam, the Netherlands
| | - Aleid van Wassenaer-Leemhuis
- Emma Children’s Hospital, Amsterdam UMC, Department of Neonatology, University of Amsterdam, Amsterdam, the Netherlands
| | - Christiana Naaktgeboren
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Janus C. Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruben G. Duijnhoven
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Titia Lely
- Wilhelmina Children’s Hospital, Department of Obstetrics, University Medical Center Utrecht, Gynecology and Neonatology, Utrecht, the Netherlands
| | - Sanne Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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9
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Drukker L, Staines-Urias E, Villar J, Barros FC, Carvalho M, Munim S, McGready R, Nosten F, Berkley JA, Norris SA, Uauy R, Kennedy SH, Papageorghiou AT. International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21 st Project. Am J Obstet Gynecol 2020; 222:602.e1-602.e15. [PMID: 31954701 PMCID: PMC7287403 DOI: 10.1016/j.ajog.2020.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges. OBJECTIVES To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. STUDY DESIGN In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks' gestation, confirmed by ultrasound measurement of crown-rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed. RESULTS Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%-6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)-2 - 0.000004455*gestational age3. CONCLUSION We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.
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Affiliation(s)
- Lior Drukker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Eleonora Staines-Urias
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil; Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Shama Munim
- Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - James A Berkley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom; KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shane A Norris
- SAMRC Development Pathway for Health Research Unit, Department of Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ricardo Uauy
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Division of Paediatrics, Pontifical Universidad de Chile, Santiago, Chile
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom.
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10
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Park J, Anderson CW, Sewanan LR, Kural MH, Huang Y, Luo J, Gui L, Riaz M, Lopez CA, Ng R, Das SK, Wang J, Niklason L, Campbell SG, Qyang Y. Modular design of a tissue engineered pulsatile conduit using human induced pluripotent stem cell-derived cardiomyocytes. Acta Biomater 2020; 102:220-230. [PMID: 31634626 PMCID: PMC7227659 DOI: 10.1016/j.actbio.2019.10.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/06/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Abstract
Single ventricle heart defects (SVDs) are congenital disorders that result in a variety of complications, including increased ventricular mechanical strain and mixing of oxygenated and deoxygenated blood, leading to heart failure without surgical intervention. Corrective surgery for SVDs are traditionally handled by the Fontan procedure, requiring a vascular conduit for completion. Although effective, current conduits are limited by their inability to aid in pumping blood into the pulmonary circulation. In this report, we propose an innovative and versatile design strategy for a tissue engineered pulsatile conduit (TEPC) to aid circulation through the pulmonary system by producing contractile force. Several design strategies were tested for production of a functional TEPC. Ultimately, we found that porcine extracellular matrix (ECM)-based engineered heart tissue (EHT) composed of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and primary cardiac fibroblasts (HCF) wrapped around decellularized human umbilical artery (HUA) made an efficacious basal TEPC. Importantly, the TEPCs showed effective electrical and mechanical function. Initial pressure readings from our TEPC in vitro (0.68 mmHg) displayed efficient electrical conductivity enabling them to follow electrical pacing up to a 2 Hz frequency. This work represents a proof of principle study for our current TEPC design strategy. Refinement and optimization of this promising TEPC design will lay the groundwork for testing the construct's therapeutic potential in the future. Together this work represents a progressive step toward developing an improved treatment for SVD patients. STATEMENT OF SIGNIFICANCE: Single Ventricle Cardiac defects (SVD) are a form of congenital disorder with a morbid prognosis without surgical intervention. These patients are treated through the Fontan procedure which requires vascular conduits to complete. Fontan conduits have been traditionally made from stable or biodegradable materials with no pumping activity. Here, we propose a tissue engineered pulsatile conduit (TEPC) for use in Fontan circulation to alleviate excess strain in SVD patients. In contrast to previous strategies for making a pulsatile Fontan conduit, we employ a modular design strategy that allows for the optimization of each component individually to make a standalone tissue. This work sets the foundation for an in vitro, trainable human induced pluripotent stem cell based TEPC.
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Affiliation(s)
- Jinkyu Park
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Christopher W Anderson
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Pathology, Yale University, New Haven, CT 06510, United States
| | - Lorenzo R Sewanan
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, United States
| | - Mehmet H Kural
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT 06511, United States
| | - Yan Huang
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Jiesi Luo
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Liqiong Gui
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT 06511, United States
| | - Muhammad Riaz
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Colleen A Lopez
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Ronald Ng
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, United States
| | - Subhash K Das
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States
| | - Juan Wang
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT 06511, United States
| | - Laura Niklason
- Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Biomedical Engineering, Yale University, New Haven, CT 06510, United States; Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT 06511, United States
| | - Stuart G Campbell
- Department of Biomedical Engineering, Yale University, New Haven, CT 06510, United States
| | - Yibing Qyang
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, 300 George Street, New Haven, CT 06511, United States; Yale Stem Cell Center, 10 Amistad street, New Haven, CT 06511, United States; Vascular Biology and Therapeutics Program, Yale University, New Haven, CT 06510, United States; Department of Pathology, Yale University, New Haven, CT 06510, United States.
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11
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Casati D, Pellegrino M, Cortinovis I, Spada E, Lanna M, Faiola S, Cetin I, Rustico MA. Longitudinal Doppler references for monochorionic twins and comparison with singletons. PLoS One 2019; 14:e0226090. [PMID: 31809530 PMCID: PMC6897428 DOI: 10.1371/journal.pone.0226090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To construct monochorionic (MC) twin-specific longitudinal Doppler references for umbilical artery pulsatility index (UA-PI), middle cerebral artery (MCA) PI and peak systolic velocity (PSV) and ductus venosus (DV) PI derived from a strictly selected cohort of uncomplicated MC twins. The secondary aim of the study was to compare our findings with singleton reference charts. METHODS A retrospective evaluation was made of all consecutive uncomplicated MC twin pregnancies referred to our Unit from 2010 to 2018. Fortnightly serial examinations were performed of UA-PI, MCA-PI, MCA-PSV and DV-PI, according with the clinical protocol, from 20 to 37 weeks of gestation. We included cases with at least four ultrasound examinations, delivery at our hospital and complete neonatal follow up. A two-step method was used to trace the estimated centile curves: estimation of the median was performed with appropriate fractional polynomials by a multilevel model and estimation of the external centiles through the residuals (quantile regression). The comparison with singletons was made by plotting the references derived from the present study on the referred charts commonly used for singletons. RESULTS The study group comprised 150 uncomplicated MC twin pairs. Estimated centiles (3rd, 5th, 10th, 50th, 90th, 95th, 97th) of UA-PI, MCA-PI, MCA-PSV and DV-PI in function of the gestational age are presented. The comparison with singletons showed substantial differences, with higher UA-PI and lower MCA-PI and PSV median values in MC twins. Median DV PI values were similar to the values for singletons, while the upper centiles were higher in MC twins. CONCLUSIONS This study sets out MC twin-specific longitudinal references for UA-PI, MCA-PI, MCA-PSV and DV-PI derived from the largest series of uncomplicated MC twin pregnancies presently available. The comparison with singleton reference values underscores the deviation from physiology that is intrinsic to these unique pregnancies and supports the need for MC twin-specific charts.
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Affiliation(s)
- Daniela Casati
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Marcella Pellegrino
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory G.A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan Milan, Italy
| | - Elena Spada
- Neonatal Unit, University of Turin, City of Health and Science of Turin, Turin, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Maria Angela Rustico
- Fetal Therapy Unit 'Umberto Nicolini', Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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12
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Di Martino DD, Ferrazzi E, Garbin M, Fusè F, Izzo T, Duvekot J, Farina A. Multivariable evaluation of maternal hemodynamic profile in pregnancy complicated by fetal growth restriction: prospective study. Ultrasound Obstet Gynecol 2019; 54:732-739. [PMID: 30207002 DOI: 10.1002/uog.20118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/20/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the association between fetal growth restriction (FGR) and maternal hemodynamic parameters using multivariable analysis, adjusting for major confounding factors, such as hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension). METHODS A prospective cohort study was conducted between January 2013 and April 2016. Two cohorts of patients were recruited, between 24 and 39 weeks of gestation, in a high-risk outpatient setting. These cohorts comprised 49 appropriate-for-gestational-age singleton fetuses and 93 that were FGR (abdominal circumference (AC) at recruitment in the second half of pregnancy ≤ 10th percentile with a previous normal AC at 20-22 weeks). Maternal echocardiography was performed at the time of enrolment and included hemodynamic parameters of systolic and diastolic function and cardiac remodeling indices. Data were analyzed using a multivariable generalized linear model to estimate the association of FGR with maternal hemodynamic parameters after adjusting for significant confounding factors. RESULTS In the multivariable analysis, after adjustment for hypertensive disorders of pregnancy and smoking, FGR was associated with a 14% increase in maternal total vascular resistance, 16% reduction in cardiac output, 13% reduction in left ventricular mass and 11% reduction in heart rate; similar results were observed for the corresponding indexed parameters. Hypertensive disorders of pregnancy in the absence of FGR were associated with a 25% increase in total vascular resistance, 16% increase in left ventricular mass and 14% reduction in diastolic function; similar results were observed for the corresponding indexed parameters. CONCLUSION FGR is significantly and independently associated with several maternal hemodynamic parameters, even after adjustment for major confounding factors, such as hypertensive disorders of pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D D Di Martino
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Health Sciences, University of Milan, Milan, Italy
| | - M Garbin
- Unit of Cardiology, Buzzi Children's Hospital, Milan, Italy
| | - F Fusè
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - T Izzo
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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13
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DeVore GR, Gumina DL, Hobbins JC. Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile. Am J Obstet Gynecol 2019; 221:498.e1-498.e22. [PMID: 31153929 DOI: 10.1016/j.ajog.2019.05.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/18/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether abnormal global, transverse, and longitudinal ventricular contractility of the heart in fetuses with an estimated fetal weight <10th centile is present, irrespective of Doppler studies of the umbilical artery and cerebroplacental ratio. STUDY DESIGN This was a retrospective study of 50 fetuses with an estimated fetal weight <10th centile that were classified based on Doppler results from the pulsatility indices of the umbilical artery and middle cerebral artery, and the calculated cerebroplacental ratio (pulsatility indices of the umbilical artery/middle cerebral artery). Right and left ventricular measurements were categorized into 3 groups: (1) global ventricular contractility (fractional area change), (2) transverse ventricular contractility (24-segment transverse fractional shortening), and (3) basal-apical longitudinal contractility (longitudinal strain, longitudinal displacement fractional shortening, and basal lateral and septal wall annular plane systolic excursion). Z scores for the above measurements were computed for fetuses with an estimated fetal weight <10th centile using the mean and standard deviation derived from normal controls. Ventricular contractility measurements were considered abnormal if their Z score values were <5th centile (z score <-1.65) or >95th centile (Z score >1.65), depending on the specific ventricular measurement. RESULTS The average gestational age at the time of the examination was 32 weeks 4 days (standard deviation 3 weeks 4 days). None of the 50 study fetuses demonstrated absent or reverse flow of the umbilical artery Doppler waveform. Eighty-eight percent (44/50) of fetuses had one or more abnormal measurements of cardiac contractility of 1 or both ventricles. Analysis of right ventricular contractility demonstrated 78% (39/50) to have 1 or more abnormal measurements, which were grouped as follows: global contractility 38% (19/50), transverse contractility 66% (33/50); and longitudinal contractility 48% (24/50). Analysis of left ventricular contractility demonstrated 1 or more abnormal measurements in 58% (29/50) that were grouped as follows: global contractility 38% (19/50); transverse contractility 40% (20/50); and longitudinal contractility 40% (20/50). Of the 50 study fetuses, 25 had normal pulsatility index of the umbilical artery and cerebroplacental ratios, 80% of whom had 1 or more abnormalities of right ventricular contractility and 56% of whom had 1 or more abnormalities of left ventricular contractility. Abnormal ventricular contractility for these fetuses was present in all 3 groups of measurements; global, transverse, and longitudinal. Those with an isolated abnormal pulsatility index of the umbilical artery (n=11) had abnormalities of transverse contractility of the right ventricular and global contractility in the left ventricle. When an isolated cerebroplacental ratio abnormality was present, the right ventricle demonstrated abnormal global, transverse, and longitudinal contractility, with the left ventricle only demonstrating abnormalities in transverse contractility. When both the pulsatility index of the umbilical artery and cerebroplacental ratio were abnormal (3/50), transverse and longitudinal contractility measurements were abnormal for both ventricles, as well as abnormal global contractility of the left ventricle. CONCLUSIONS High rates of abnormal ventricular contractility were present in fetuses with an estimated fetal weight <10th centile, irrespective of the Doppler findings of the pulsatility index of the umbilical artery, and/or cerebroplacental ratio. Abnormalities of ventricular contractility were more prevalent in transverse measurements than global or longitudinal measurements. Abnormal transverse contractility was more common in the right than the left ventricle. Fetuses with estimated fetal weight less than the 10th centile may be considered to undergo assessment of ventricular contractility, even when Doppler measurements of the pulsatility index of the umbilical artery, and cerebroplacental ratio are normal.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, CA.
| | - Diane L Gumina
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
| | - John C Hobbins
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
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Ferreira RDDS, Negrini R, Bernardo WM, Simões R, Piato S. The effects of sildenafil in maternal and fetal outcomes in pregnancy: A systematic review and meta-analysis. PLoS One 2019; 14:e0219732. [PMID: 31339910 PMCID: PMC6655684 DOI: 10.1371/journal.pone.0219732] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/02/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The number of studies associating the use of sildenafil in gestation is increasing. This drug inhibits phosphodiesterase type 5 (PDE5), an enzyme responsible for degradation of nitric oxide, and its efficacy is greater in the placental territory, as the maternal side of the placenta have more PDE5 than other sites. For this reason, promising results have been observed related to the prevention of preeclampsia and intrauterine growth restriction and to improvement of maternal-fetal morbidity in cases of placental insufficiency. OBJECTIVE To evaluate the benefits of using sildenafil in pregnancy. SEARCHED STRATEGY MEDLINE, ClinicalTrials.gov, Embase, LILACS and Cochrane databases were searched through September 2018. There was no restriction in language or year of publication. This study was registered in PROSPERO (CRD42017060288). SELECTION CRITERIA Randomized clinical trials which used sildenafil for treatment or prevention of obstetric diseases compared with placebo were selected. DATA COLLECTION AND ANALYSIS The results were obtained using the inverse variance method for continuous variables and Man-Whitney for categorical variables. MAIN RESULTS Among a population of 598 pregnant women from the seven clinical trials included, 139 had pre-eclampsia, 275 had intrauterine growth restriction, and 184 had oligohydramnios. A significant increase of 222.58 grams [27.75 to 417.41] was observed in the fetal weight at birth of patients taking sildenafil. The other outcomes did not show any statistical significance. This may be due to the small number of patients used in each study and the great heterogeneity between the groups. CONCLUSIONS Sildenafil could be associated with increasing fetal weight at birth in placental insufficiency despite the limitations of this meta-analysis, even though more studies in this field are needed to introduce this drug into obstetric clinical practice.
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Affiliation(s)
- Raquel Domingues da Silva Ferreira
- Department of Obstetrics & Gynaecology, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil, São Paulo
- Department of Obstetrics & Gynaecology, Hospital Israelita Albert Einstein, São Paulo, Brazil, São Paulo
- * E-mail:
| | - Romulo Negrini
- Department of Obstetrics & Gynaecology, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil, São Paulo
- Department of Obstetrics & Gynaecology, Hospital Israelita Albert Einstein, São Paulo, Brazil, São Paulo
| | | | - Ricardo Simões
- Medicine Department, Universidade de São Paulo, São Paulo, Brazil, São Paulo
| | - Sebastião Piato
- Department of Obstetrics & Gynaecology, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil, São Paulo
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Alsolai AA, Bligh LN, Greer RM, Kumar S. Correlation between fetoplacental Doppler indices and measurements of cardiac function in term fetuses. Ultrasound Obstet Gynecol 2019; 53:358-366. [PMID: 29573498 DOI: 10.1002/uog.19056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/13/2017] [Revised: 03/07/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Redistribution of cardiac output (CO) is responsible for the brain-sparing effect seen during periods of fetal stress. Our aim was to investigate prospectively the correlation between fetoplacental Doppler indices and measurements of cardiac function in uncomplicated term singleton pregnancy. METHODS This was a prospective observational study of normotensive women with appropriately grown, non-anomalous singleton pregnancy. Participants underwent fortnightly ultrasound examinations from 36 weeks' gestation until delivery, and intrapartum and neonatal outcomes were recorded. The correlation between fetoplacental Doppler indices and various measurements of cardiac function was evaluated. RESULTS The study cohort comprised 273 singleton pregnancies. The cerebroplacental ratio (CPR) was correlated positively with left ventricular CO (LVCO) (P < 0.001, rho = 0.29), left-to-right ventricular CO ratio (LVCO/RVCO; P < 0.001, rho = 0.41), global left ventricular strain (P < 0.01, rho = 0.17) and global right ventricular strain (P < 0.001, rho = 0.22). The CPR was correlated inversely with the left ventricular myocardial performance index (P < 0.01, rho = -0.18) and the RVCO (P < 0.001, rho = -0.28). The LVCO and global left ventricular strain were correlated positively with umbilical venous flow (P = 0.04, rho = 0.18 and P < 0.001, rho = 0.25, respectively). There was minimal or no correlation between either the mean uterine artery pulsatility index (PI) or umbilical artery PI with any cardiac indices. CONCLUSION The fetal CPR, middle cerebral artery PI and umbilical venous flow are correlated positively with LVCO, LVCO/RVCO and global left ventricular strain in low-risk term pregnancies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Alsolai
- College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - L N Bligh
- School of Biomedical Science, The University of Queensland, St Lucia, Queensland, Australia
| | - R M Greer
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - S Kumar
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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Wei JF, Wang S, Lu C. Umbilical artery flow monitoring with transesophageal echocardiography during maternal cardiac surgery. Int J Obstet Anesth 2019; 37:131-135. [PMID: 30274712 DOI: 10.1016/j.ijoa.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J F Wei
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China; Shantou University Medical College, Shantou, Guangdong Province, China
| | - S Wang
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
| | - C Lu
- Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
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Pang Y, Thomas P. Progesterone induces relaxation of human umbilical cord vascular smooth muscle cells through mPRα (PAQR7). Mol Cell Endocrinol 2018; 474:20-34. [PMID: 29428395 DOI: 10.1016/j.mce.2018.02.003] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
Progesterone effects on vascular smooth muscle cell (VSMC) relaxation and the mechanism were investigated in cultured human umbilical vein VSMCs. Membrane progesterone receptors mPRα, mPRβ, and mPRγ were highly expressed in VSMCs, whereas nuclear progesterone receptor (nPR) had low expression. Progesterone (20 nM) and 02-0 (mPR-selective agonist), but not R5020 (nPR agonist), induced muscle relaxation in both a VSMC collagen gel disk contraction assay and an endothelium-denuded human umbilical artery ring tension assay. Progesterone and 02-0 increased ERK and Akt phosphorylation and decreased cAMP levels. These effects were blocked by preincubation with pertussis toxin. Progestin-induced muscle relaxation was blocked by pretreatment with mPRα, but not nPR, siRNAs, and by co-treatment with 8-Br-cAMP, AZD6244 (MAP kinase inhibitor), and wortmannin (PI3K inhibitor). Progestins reduced myosin light chain phosphorylation which was blocked with AZD6244 and wortmannin. These results demonstrate progesterone directly relaxes human VSMCs through mPRα/Gi and MAP kinase/ERK-, Akt/PI3K-, and cAMP-dependent pathways.
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Affiliation(s)
- Yefei Pang
- Marine Science Institute, University of Texas at Austin, 750 Channel View Drive, Port Aransas, TX, 78373, USA.
| | - Peter Thomas
- Marine Science Institute, University of Texas at Austin, 750 Channel View Drive, Port Aransas, TX, 78373, USA.
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Hornick MA, Davey MG, Partridge EA, Mejaddam AY, McGovern PE, Olive AM, Hwang G, Kim J, Castillo O, Young K, Han J, Zhao S, Connelly JT, Dysart KC, Rychik J, Peranteau WH, Flake AW. Umbilical cannulation optimizes circuit flows in premature lambs supported by the EXTra-uterine Environment for Neonatal Development (EXTEND). J Physiol 2018; 596:1575-1585. [PMID: 29392729 PMCID: PMC5924826 DOI: 10.1113/jp275367] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 10/04/2017] [Accepted: 01/22/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Bronchopulmonary dysplasia is a disease of extreme prematurity that occurs when the immature lung is exposed to gas ventilation. We designed a novel 'artificial womb' system for supporting extreme premature lambs (called EXTEND) that obviates gas ventilation by providing oxygen via a pumpless arteriovenous circuit with the lamb submerged in sterile artificial amniotic fluid. In the present study, we compare different arteriovenous cannulation strategies on EXTEND, including carotid artery/jugular vein (CA/JV), carotid artery/umbilical vein (CA/UV) and umbilical artery/umbilical vein (UA/UV). Compared to CA/JV and CA/UV cannulation, UA/UV cannulation provided significantly higher, physiological blood flows to the oxygenator, minimized flow interruptions and supported significantly longer circuit runs (up to 4 weeks). Physiological circuit blood flow in UA/UV lambs made possible normal levels of oxygen delivery, which is a critical step toward the clinical application of artificial womb technology. ABSTRACT EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system that promotes physiological development by maintaining the premature lamb in a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit. During the development of EXTEND, different cannulation strategies evolved with the aim of improving circuit flow. The present study examines how different cannulation strategies affect EXTEND circuit haemodynamics in extreme premature lambs. Seventeen premature lambs were cannulated at gestational ages 105-117 days (term 145-150 days) and supported on EXTEND for up to 4 weeks. Experimental groups were distinguished by cannulation strategy: carotid artery outflow and jugular vein inflow (CA/JV; n = 4), carotid artery outflow and umbilical vein inflow (CA/UV; n = 5) and double umbilical artery outflow and umbilical vein inflow (UA/UV; n = 8). Circuit flows and pressures were measured continuously. As we transitioned from CA/JV to CA/UV to UA/UV cannulation, mean duration of circuit run and weight-adjusted circuit flows increased (P < 0.001) and the frequency of flow interruptions declined (P < 0.05). Umbilical vessels generally accommodated larger-bore cannulas, and cannula calibre was directly correlated with circuit pressures and indirectly correlated with flow:pressure ratio (a measure of post-membrane resistance). We conclude that UA/UV cannulation in fetal lambs on EXTEND optimizes circuit flow dynamics and flow stability and also supports circuit flows that closely approximate normal placental flow.
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Affiliation(s)
| | | | | | | | | | | | - Grace Hwang
- Center for Fetal ResearchDepartment of Surgery
| | - Jenny Kim
- Center for Fetal ResearchDepartment of Surgery
| | | | | | | | - Sheng Zhao
- Center for Fetal ResearchDepartment of Surgery
| | | | | | - Jack Rychik
- Division of Cardiology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
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Avitan T, Sanders A, Brain U, Rurak D, Oberlander TF, Lim K. Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus. J Clin Ultrasound 2018; 46:235-240. [PMID: 29235099 DOI: 10.1002/jcu.22569] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/08/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine if there are changes in maternal uterine blood flow, fetal brain blood flow, fetal heart rate variability, and umbilical blood flow between morning (AM) and afternoon (PM) in healthy, uncomplicated pregnancies. STUDY DESIGN In this prospective study, 68 uncomplicated singleton pregnancies (mean 35 + 0.7 weeks gestation) underwent a standard observational protocol at both 08:00 (AM) and 13:30 (PM) of the same day. This protocol included Doppler measurements of uterine, umbilical, and fetal middle cerebral artery (MCA) volume flow parameters (flow, HR, peak systolic velocity [PSV], PI, and RI) followed by computerized cardiotocography. Standard descriptive statistics, χ2 and t tests were used where appropriate. P < .05 was considered significant. RESULTS A significant increase in MCA flow and MCA PSV was observed in the PM compared to the AM. This was accompanied by a fall in MCA resistance. Higher umbilical artery resistance indices were also observed in the PM compared to AM. In contrast, fetal heart rate characteristics, maternal uterine artery Doppler flow and resistance indices did not vary significantly between the AM and PM. CONCLUSION In normal pregnancies, variations in fetal cerebral and umbilical blood flow parameters were observed between AM and PM independent of other fetal movements or baseline fetal heart rate. In contrast, uterine flow parameters remained stable across the day. These findings may have implications for the use of serial Doppler parameters used to guide clinical management in high-risk pregnancies.
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Affiliation(s)
- Tehila Avitan
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
| | - Ari Sanders
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
| | - Ursula Brain
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Dan Rurak
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Tim F Oberlander
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Ken Lim
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
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Mohammed R, Provitera L, Cavallaro G, Lattuada D, Ercoli G, Mosca F, Villamor E. Vasomotor effects of hydrogen sulfide in human umbilical vessels. J Physiol Pharmacol 2017; 68:737-747. [PMID: 29375049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
Hydrogen sulfide (H2S) has recently emerged as a biologically active gas with multiple effects on the cardiovascular system. We aimed to investigate the vasomotor actions of sodium sulfide (Na2S), which forms H2S and HS- in solution, in human umbilical artery (HUA) and vein (HUV) rings. In addition, we examined by immunocytochemistry the expression and localization of cystathionine β-synthase (CBS), cystathionine lyase (CSE), and 3-mercaptopyruvate sulphurtransferase (MPST), the enzymes responsible for endogenous H2S production. Human umbilical vessels were compared with chicken embryo umbilical vessels. HUA and HUV expressed a robust signal for CSE, CBS, and 3-MPST in both endothelial and smooth muscle cells. However, HUA rings did not respond to Na2S (10-6M-10-3M) either at resting tone or during contraction evoked by serotonin or KCl. Similarly, the extraembryonic part of chicken allantoic artery did not respond to Na2S. In contrast, Na2S induced a concentration-dependent contraction in HUV rings under resting tone and a concentration-dependent relaxation when the H2UV rings were contracted with serotonin (42 ± 5% relaxation) or KCl (12 ± 5% relaxation). Na2S-induced contraction of HUV was impaired following removal of extracellular Ca2+, endothelial denudation, NO synthase inhibition (L-NAME), or soluble guanylate cyclase (sGC) inhibition (ODQ). Na2S-induced relaxation of HUV was impaired by the KATP channel inhibitor glibenclamide. In conclusion, H2S does not have vasomotor effects on HUA but induced contraction (mediated through inactivation of the NO/sGC axis) and relaxation (mediated through KATP channels) in HUV. Our data suggest a role for H2S in the venous side of human umbilical circulation.
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Affiliation(s)
- R Mohammed
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), University of Maastricht, Maastricht, the Netherlands
| | - L Provitera
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Foundation IRCCS CA'Granda Ospedale Maggiore Polyclinic, University of Milan, Milan, Italy
| | - G Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Foundation IRCCS CA'Granda Ospedale Maggiore Polyclinic, University of Milan, Milan, Italy
| | - D Lattuada
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Foundation IRCCS CA'Granda Ospedale Maggiore Polyclinic, University of Milan, Milan, Italy
- Lino Rossi Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - G Ercoli
- Division of Pathology, Foundation IRCCS CA'Granda Ospedale Maggiore Polyclinic, University of Milan, Milan, Italy
| | - F Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Foundation IRCCS CA'Granda Ospedale Maggiore Polyclinic, University of Milan, Milan, Italy
| | - E Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), University of Maastricht, Maastricht, the Netherlands.
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Thuring A, Källén K, Brännström KJ, Jansson T, Maršál K. Doppler Audio Signal Analysis as an Additional Tool in Evaluation of Umbilical Artery Circulation. Ultraschall Med 2017; 38:549-555. [PMID: 26422669 DOI: 10.1055/s-0035-1553302] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose To investigate the predictive capacity of a new method for sound spectrum analysis of Doppler signals recorded from the umbilical artery in high-risk pregnancies. Material and Methods The retrospective study comprised 127 pregnant women with various pregnancy complications between 23 and 39 gestational weeks. Umbilical artery blood flow velocity waveforms were recorded with Doppler ultrasound and characterized by pulsatility index (PI) and blood flow class (BFC). Doppler audio signals were stored on a digital video recorder and the sound frequency at the energy level 15 dB below its peak (MAXpeak-15 dB) was estimated off-line. The prediction of probability for composite adverse pregnancy outcome (operative delivery for fetal distress, admission to neonatal intensive care unit, perinatal death) was evaluated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. Results With increasing umbilical artery BFC, the MAXpeak-15 dB frequencies decreased (p < 0.0001) and the PI increased (p < 0.0001). The ROC AUCs for adverse outcome for MAXpeak-15 dB and for PI were 0.842 and 0.836 (p = 0.88), respectively. For the combination of MAXpeak-15 dB and PI, the corresponding AUC was 0.894, significantly higher than that of PI (p < 0.03) and of MAXpeak-15 dB (p < 0.05). Conclusion Umbilical artery Doppler sound spectrum analysis might be a useful supplement to PI in the clinical evaluation of fetoplacental circulation.
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Affiliation(s)
- Ann Thuring
- Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Karin Källén
- Reproduction and epidemiology, Lund University, Lund, Sweden
| | | | - Tomas Jansson
- Biomedical engineering, Lund University, Lund, Sweden
| | - Karel Maršál
- Obstetrics and Gynecology, Lund University, Lund, Sweden
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Gibbons A, Flatley C, Kumar S. Cerebroplacental ratio in pregnancies complicated by gestational diabetes mellitus. Ultrasound Obstet Gynecol 2017; 50:200-206. [PMID: 27549587 DOI: 10.1002/uog.17242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/30/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). METHODS This was a retrospective cohort study of women with a non-anomalous singleton pregnancy diagnosed with GDM who delivered at Mater Mothers' Hospital between 2007 and 2015. CPR was measured in 1089 cases between 34 + 0 and 36 + 6 weeks' gestation. CPR values were compared between groups categorized according to GDM treatment (by diet, oral hypoglycemic agent (OHA) or insulin). The association between CPR and intrapartum and perinatal outcomes was evaluated. RESULTS No difference in CPR was observed between treatment groups. Fetuses with CPR < 10th centile were significantly more likely to have adverse composite perinatal outcome (odds ratio (OR) = 2.93 (95% CI, 1.95-4.40)), preterm delivery and low birth weight than fetuses with CPR ≥ 10th centile (all P < 0.001). These associations were present regardless of the type of GDM treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than did fetuses of women treated with OHA or dietary control alone. The risk of adverse outcome was significantly increased in the insulin-treated group (OR = 1.75 (95% CI, 1.34-2.28); P < 0.001), which also had higher rates of preterm delivery and higher birth weight. CONCLUSION Regardless of the type of treatment, a low CPR is associated with poorer neonatal outcome in women with GDM. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Gibbons
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - C Flatley
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Abstract
The authors investigate the effect of bumetan ide, an inhibitor of NKCC1 and a loop diuretic, on the tone of human umbilical artery (HUA). Rings of HUA (n = 35) from vaginal deliveries were suspended for isometric tension recordings in organ baths. Cumulative concentration-response curves to serotonin, histamine, and KCl were performed in the absence (control) or in the presence of bumetanide. The relaxant effect of bumetanide was also evaluated in serotonin- and histamine-induced contractions. Bumetanide inhibited HUA tone in serotonin- and histamine-induced contractions with significant changes in the potency (pD(2)) and maximum contractile response (E(max)) values. However, only pD( 2) values for KCl-induced contraction significantly changed in the presence of bumetanide. Bumetanide caused concentration-dependent and sustained relaxations in serotonin-induced contraction; however, there was refractoriness in histamine-induced contraction. These findings raise the possibility that NKCC1 may play a role in the regulation of the umbilical artery tone.
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Affiliation(s)
- Emel Dayioglu
- Department of Pharmacology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
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Abstract
OBJECTIVE Polyamines act as endogenous modulators of cell function and excitability. There are no data in relation to their effects on the human fetoplacental circulation. The aim of this study was to investigate the effects of the polyamines, spermine, and spermidine on human umbilical artery resistance in vitro. METHODS Isometric tension recordings were performed under physiologic conditions on human umbilical arterial rings (n = 12). The in vitro effects of spermine and spermidine (at concentrations ranging between 10(-9) M to 10(-3) M) were measured, and compared with those measured in vehicle control experiments. The maximal inhibition (MMI) at the highest concentration and the pD2 (-log EC50) values for each compound were calculated and compared. RESULTS Spermine and spermidine exerted a potent relaxant effect on human umbilical arterial tone in comparison to vehicle control experiments. The MMI +/- SEM for spermine was 18.41 +/- 1.437% (n = 6; P <.001) and for spermidine was 38.31 +/- 3.572% (n = 6; P <.001). There was no difference observed between the pD2 +/- SEM values for spermine (5.78 +/- 1.54; n = 6) and spermidine (6.27 +/-0.85; n = 6) (P = .517). CONCLUSION The polyamines spermine and spermidine exert a potent relaxant effect on human umbilical artery tone suggestive of an endogenous role for these compounds in vasomotor regulation of the fetoplacental circulation.
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Affiliation(s)
- Nandini Ravikumar
- Department of Obstetrics and Gynaecology, Clinical Science Institute, National University of Ireland Galway, University College Hospital, Galway, Ireland
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Blanco PG, Vercellini R, Rube A, Rodríguez R, Arias DO, Gobello C. Evaluation of feline uterine and umbilical arteries blood flow in a pharmacologically induced abnormal gestation model. Theriogenology 2016; 86:2323-2327. [PMID: 27576196 DOI: 10.1016/j.theriogenology.2016.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 05/19/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/19/2022]
Abstract
The aim of this study was to describe resistance index (RI) and systolic/diastolic ratio (S/D ratio) of uterine and umbilical arteries in an experimental model of abnormal pregnancy in felids. On days 30 to 35 (32 ± 2.9) after mating, 20 domestic short-hair pregnant queens were randomly assigned to one of the following treatment groups: a treated group (TG; n = 8), which received 10 mg/kg of aglepristone subcutaneously twice, 24 hours apart, and a control nontreated group (CG; n = 12). M-mode and Doppler ultrasonographic evaluations were performed at the initiation of the treatment (Day 0) and then every other day during 8 days. In both groups, uterine and umbilical arteries were evaluated by Doppler ultrasound, whereas fetal heart rate was assessed by M-mode ultrasound. Resistance index of uterine artery augmented in TG from Day 2 onward, conversely it decreased in CG (P < 0.01). On Day 8, RI values were 0.64 ± 0.05 vs 0.37 ± 0.01 for TG and CG, respectively. Additionally, S/D ratio of the same artery presented an increase in TG, whereas this ratio diminished in CG (P < 0.01). On Day 8, this parameter showed values of 2.98 ± 0.4 vs 1.62 ± 0.06 for TG and CG, respectively. Resistance index of umbilical artery remained almost unchanged in TG from Day 6 onward, whereas it progressively decreased in CG throughout the course of the study (P < 0.05). On Day 8, RI were 0.89 ± 0.04 and 0.82 ± 0.01, for TG and CG, respectively. Furthermore, on Day 8, S/D ratio of umbilical artery progressively diminished in CG but not in TG (P < 0.01), being 14.7 ± 9.1 vs 5.9 ± 0.3 for TG and CG, respectively. Fetal heart rate was higher in TG than in CG (P < 0.05). Group differences in Doppler parameters appeared on Day 2, when the other clinical or ultrasonographic signs were still absent. It is concluded that blood flow of the uterine and umbilical arteries differed between these normal and abnormal gestations predicting an adverse obstetric outcome.
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Affiliation(s)
- P G Blanco
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), La Plata, Argentina; Laboratory of Reproductive Physiology, FVS-NULP, La Plata, Argentina; National Research Council (CONICET), La Plata, Argentina.
| | - R Vercellini
- National Research Council (CONICET), La Plata, Argentina; Radiology Service, FVS-NULP, La Plata, Argentina
| | - A Rube
- Ultrasonography Service, FVS-NULP, La Plata, Argentina
| | - R Rodríguez
- Radiology Service, FVS-NULP, La Plata, Argentina
| | - D O Arias
- Cardiology Service, Faculty of Veterinary Sciences, National University of La Plata (FVS-NULP), La Plata, Argentina
| | - C Gobello
- Laboratory of Reproductive Physiology, FVS-NULP, La Plata, Argentina; National Research Council (CONICET), La Plata, Argentina
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Rhee CJ, Kaiser JR, Rios DR, Kibler KK, Easley RB, Andropoulos DB, Czosnyka M, Smielewski P, Varsos GV, Rusin CG, Gauss CH, Williams DK, Brady KM. Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants. J Pediatr 2016; 174:52-6. [PMID: 27112042 PMCID: PMC4925245 DOI: 10.1016/j.jpeds.2016.03.066] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/11/2016] [Accepted: 03/24/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). STUDY DESIGN A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. RESULTS Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. CONCLUSION Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants.
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Affiliation(s)
- Christopher J Rhee
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
| | - Jeffrey R Kaiser
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Danielle R Rios
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Kathleen K Kibler
- Department of Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - R Blaine Easley
- Department of Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Dean B Andropoulos
- Department of Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Marek Czosnyka
- Department of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter Smielewski
- Department of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Georgios V Varsos
- Department of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Craig G Rusin
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - C Heath Gauss
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - D Keith Williams
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ken M Brady
- Department of Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Critical Care Medicine, Texas Children's Hospital/Baylor College of Medicine, Houston, TX; Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
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Trapani A, Gonçalves LF, Trapani TF, Franco MJ, Galluzzo RN, Pires MMS. Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices. Ultrasound Obstet Gynecol 2016; 48:61-65. [PMID: 26279411 DOI: 10.1002/uog.15673] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR). METHODS This was a prospective study of 35 singleton pregnancies (gestational age, 24-31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z-scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples. RESULTS There was a significant decrease in UtA-PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA-PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA- and UA-PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre-eclampsia. CONCLUSION The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA-PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Trapani
- Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - L F Gonçalves
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Radiology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - T F Trapani
- University of Southern Santa Catarina, Medical School, Palhoça, SC, Brazil
| | - M J Franco
- Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - R N Galluzzo
- Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - M M S Pires
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Mone F, McConnell B, Thompson A, Segurado R, Hepper P, Stewart MC, Dornan JC, Ong S, McAuliffe FM, Shields MD. Fetal umbilical artery Doppler pulsatility index and childhood neurocognitive outcome at 12 years. BMJ Open 2016; 6:e008916. [PMID: 27311899 PMCID: PMC4916642 DOI: 10.1136/bmjopen-2015-008916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine whether an elevated fetal umbilical artery Doppler (UAD) pulsatility index (PI) at 28 weeks' gestation, in the absence of fetal growth restriction (FGR) and prematurity, is associated with adverse neurocognitive outcome in children aged 12 years. METHODS Prospective cohort study, comparing children with a normal fetal UAD PI (<90th centile) (n=110) and those with an elevated PI (≥90th centile) (n=40). UAD was performed at 28, 32 and 34 weeks gestation. At 12 years of age, all children were assessed under standardised conditions at Queen's University, Belfast, UK to determine cognitive and behavioural outcomes using the British Ability Score-II and Achenbach Child Behavioural Checklist Parent Rated Version under standardised conditions. Regression analysis was performed, controlling for confounders such as gender, socioeconomic status and age at assessment. RESULTS The mean age of follow-up was 12.4 years (±0.5 SD) with 44% of children male (n=63). When UAD was assessed at 28 weeks, the elevated fetal UAD group had lower scores in cognitive assessments of information processing and memory. Parameters included (1) recall of objects immediate verbal (p=0.002), (2) delayed verbal (p=0.008) and (3) recall of objects immediate spatial (p=0.0016). There were no significant differences between the Doppler groups at 32 or 34 weeks' gestation. CONCLUSIONS An elevated UAD PI at 28 weeks' gestation in the absence of FGR or prematurity is associated with lower scores of declarative memory in children aged 12 years. A potential explanation for this is an element of placental insufficiency in the presence of the appropriately grown fetus, which affects the development of the fetal hippocampus and information processing and memory long-term. These findings, however, had no impact on overall academic ability, mental processing and reasoning or overall behavioural function.
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Affiliation(s)
- Fionnuala Mone
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| | - Barbara McConnell
- Department of Early Childhood Studies, Stranmillis University College, Belfast, UK
| | - Andrew Thompson
- Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK
| | - Ricardo Segurado
- CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Peter Hepper
- Department of Psychology, Queen's University Belfast, Belfast, UK
| | - Moira C Stewart
- Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK
| | - James C Dornan
- Department of Fetal Medicine, Royal Maternity Hospital, Belfast, UK
| | - Stephen Ong
- Department of Fetal Medicine, Royal Maternity Hospital, Belfast, UK
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| | - Michael D Shields
- Royal Belfast Hospital for Sick Children, Belfast Health & Social Care Trust, Belfast, UK
- Centre for Infection & Immunity, Queen's University Belfast, Belfast, UK
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Ekin A, Gezer C, Solmaz U, Taner CE, Ozeren M, Dogan A, Uyar I. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study. J Perinat Med 2016; 44:243-8. [PMID: 26352077 DOI: 10.1515/jpm-2015-0194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation. METHODS Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately. RESULTS Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h. CONCLUSIONS Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.
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Gordon Z, Glaubach L, Elad D, Zaretsky U, Jaffa AJ. Ex Vivo Human Placental Perfusion Model for Analysis of Fetal Circulation in the Chorionic Plate. J Ultrasound Med 2016; 35:553-560. [PMID: 26892818 DOI: 10.7863/ultra.15.04080] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to develop an ex vivo placental perfusion model to assess changes in the umbilical artery systolic-to-diastolic (S/D) ratio due to progressive occlusion of the placental arterial system. METHODS Ex vivo human placentas were connected to a computerized pulse duplicator mimicking pulsatile flow from the fetal heart. Doppler sonographic measurements were conducted on the umbilical and chorionic arteries of 25 mature placentas. Simulation of placental occlusion was performed by progressive ligature of the chorionic arteries, including one umbilical artery. The correlation between the umbilical artery S/D ratio and the severity of simulated placental occlusion was analyzed. RESULTS The normal mean S/D ratio ± SD decreased gradually along the chorionic plate from 2.66 ± 0.47 at the cord insertion to 1.90 ± 0.59 in generation IV of the chorionic vessels. The Doppler index initially increased slowly with simulated placental occlusion. Only when all 4 generations were occluded was the umbilical artery S/D ratio elevated. Complete occlusion of one umbilical artery resulted in a 39% increase in the umbilical artery S/D ratio. CONCLUSIONS This unique model combining Doppler sonography with perfusion of an ex vivo placenta can be used for a better understudying of pathologic placental blood flow circulation.
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Affiliation(s)
- Zoya Gordon
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Z.G., A.J.J.); Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel (L.G.); Department of Biomedical Engineering, Faculty of Engineering (D.E., U.Z.), and Sackler Faculty of Medicine (D.E., A.J.J.), Tel-Aviv University, Tel-Aviv, Israel; and Department of Medical Engineering, Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel (Z.G.).
| | - Lilia Glaubach
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Z.G., A.J.J.); Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel (L.G.); Department of Biomedical Engineering, Faculty of Engineering (D.E., U.Z.), and Sackler Faculty of Medicine (D.E., A.J.J.), Tel-Aviv University, Tel-Aviv, Israel; and Department of Medical Engineering, Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel (Z.G.)
| | - David Elad
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Z.G., A.J.J.); Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel (L.G.); Department of Biomedical Engineering, Faculty of Engineering (D.E., U.Z.), and Sackler Faculty of Medicine (D.E., A.J.J.), Tel-Aviv University, Tel-Aviv, Israel; and Department of Medical Engineering, Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel (Z.G.)
| | - Uri Zaretsky
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Z.G., A.J.J.); Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel (L.G.); Department of Biomedical Engineering, Faculty of Engineering (D.E., U.Z.), and Sackler Faculty of Medicine (D.E., A.J.J.), Tel-Aviv University, Tel-Aviv, Israel; and Department of Medical Engineering, Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel (Z.G.)
| | - Ariel J Jaffa
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Z.G., A.J.J.); Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel (L.G.); Department of Biomedical Engineering, Faculty of Engineering (D.E., U.Z.), and Sackler Faculty of Medicine (D.E., A.J.J.), Tel-Aviv University, Tel-Aviv, Israel; and Department of Medical Engineering, Afeka, Tel-Aviv Academic College of Engineering, Tel Aviv, Israel (Z.G.)
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Anninos P, Anastasiadis P, Adamopoulos A, Kotini A. Biomagnetic activity and non linear analysis in obstetrics and gynecology in a Greek population. CLIN EXP OBSTET GYN 2016; 43:406-408. [PMID: 27328501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article reports the application of non-linear analysis to biomagnetic signals recorded from fetal growth restriction, fetal brain activity, ovarian lesions, breast lesions, umbilical arteries, uterine myomas, and uterine arteries in a Greek population. The results were correlated with clinical findings. The biomagnetic measurements and the application of non-linear analysis are promising procedures in Obstetrics and Gynecology.
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Akolekar R, Sarno L, Wright A, Wright D, Nicolaides KH. Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45:402-408. [PMID: 25689937 DOI: 10.1002/uog.14824] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To define the contribution of maternal variables which influence the measured fetal middle cerebral artery (MCA) and umbilical artery (UA) pulsatility index (PI) in the assessment of fetal wellbeing. METHODS Maternal characteristics and medical history were recorded and fetal MCA-PI and UA-PI (n = 36,818) were measured in women with singleton pregnancies attending a routine hospital visit at 30 + 0 to 37 + 6 weeks' gestation. For pregnancies delivering phenotypically normal live births or stillbirths ≥ 30 weeks' gestation, variables among maternal demographic characteristics and medical history that are important in the prediction of MCA-PI and UA-PI were determined by multiple linear regression analysis. RESULTS Significant independent contributions to MCA-PI were provided by gestational age at assessment, East Asian racial origin, being parous and birth-weight Z-score of the neonate of the previous pregnancy. Significant independent contributions to UA-PI were provided by gestational age at assessment, Afro-Caribbean, East Asian and mixed racial origin, cigarette smoking, being parous and birth-weight Z-score of the neonate of the previous pregnancy. Multiple linear regression analysis was used to define the contribution of maternal variables that influence the measured MCA-PI and UA-PI and express the values as multiples of the median (MoMs). The cerebroplacental ratio (CPR) MoM was calculated by dividing MCA-PI MoM by UA-PI MoM. The model was shown to provide an adequate fit of MoM values for all covariates, both in pregnancies that delivered small-for-gestational-age neonates and in those without this pregnancy complication. CONCLUSIONS A model was fitted to express MCA-PI, UA-PI and CPR as MoMs after adjusting for variables from maternal characteristics and medical history that affect this measurement.
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Affiliation(s)
- R Akolekar
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK; Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, Kent, UK
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Morton JS, Andersson IJ, Cheung PY, Baker P, Davidge ST. The vascular effects of sodium tanshinone IIA sulphonate in rodent and human pregnancy. PLoS One 2015; 10:e0121897. [PMID: 25811628 PMCID: PMC4374693 DOI: 10.1371/journal.pone.0121897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/09/2015] [Indexed: 12/17/2022] Open
Abstract
Danshen, in particular its derivative tanshinone IIA (TS), is a promising compound in the treatment of cardiovascular diseases and has been used for many years in traditional Chinese medicine. Although many actions of TS have been researched, its vasodilator effects in pregnancy remain unknown. There have been a few studies that have shown the ability of TS to reduce blood pressure in women with hypertensive pregnancies; however, there are no studies which have examined the vascular effects of TS in the pregnant state in either normal or complicated pregnancies. Our aim was to determine the vasoactive role of TS in multiple arteries during pregnancy including: rat resistance (mesenteric and uterine) and conduit (carotid) arteries. Further, we aimed to assess the ability of TS to improve uterine blood flow in a rodent model of intrauterine growth restriction. Wire myography was used to assess vascular responses to the water-soluble derivative, sodium tanshinone IIA sulphonate (STS) or to the endothelium-dependent vasodilator, methylcholine. At mid-pregnancy, STS caused direct vasodilation of rat resistance (pEC50 mesenteric: 4.47±0.05 and uterine: 3.65±0.10) but not conduit (carotid) arteries. In late pregnancy, human myometrial arteries responded with a similar sensitivity to STS (pEC50 myometrial: 3.26±0.13). STS treatment for the last third of pregnancy in eNOS-/- mice increased uterine artery responses to methylcholine (Emax eNOS-/-: 55.2±9.2% vs. eNOS-/- treated: 75.7±8.9%, p<0.0001). The promising vascular effects, however, did not lead to improved uterine or umbilical blood flow in vivo, nor to improved fetal biometrics; body weight and crown-rump length. Further, STS treatment increased the uterine artery resistance index and decreased offspring body weight in control mice. Further research would be required to determine the safety and efficacy of use of STS in pregnancy.
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Affiliation(s)
- Jude S. Morton
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, AB, Canada
| | - Irene J. Andersson
- Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Philip Baker
- Gravida, National Research Centre for Growth and Development, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sandra T. Davidge
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- * E-mail:
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Souza PCP, Alves JAG, Maia SM, Araujo Júnior E, Santana EFM, Silva Costa FD. The 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency, which triggers fetal hemodynamic centralization. Ceska Gynekol 2015; 80:74-79. [PMID: 25723084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency. DESIGN Case report. SETTING Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil. CASE REPORT Hereditary hypofibrinolysis, which is mediated by 4G/4G homozygosity for the PAI-1 gene, is an independent risk factor for pregnancy complications, probably acting through thrombotic induction of placental insufficiency. We report a case of a low risk pregnancy, which separately presented placental insufficiency and fetal centralization at the beginning of the third trimester, without any other clinical manifestations during pregnancy. However, immediately after childbirth, the patient had a deep vein thrombosis of a lower limb. The anatomopathological examination of the placenta showed old and recent placental infarcts. Homozygosity for the 4G allele of PAI-1 gene was subsequently diagnosed as the sole probable causal factor.
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Prior T, Mullins E, Bennett P, Kumar S. Influence of parity on fetal hemodynamics and amniotic fluid volume at term. Ultrasound Obstet Gynecol 2014; 44:688-692. [PMID: 24585483 DOI: 10.1002/uog.13332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 10/31/2013] [Revised: 01/22/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Pregnancy complications, particularly those associated with placental dysfunction, occur more frequently in nulliparous than in parous women. This difference may be a consequence of improved trophoblastic invasion and, as a result, improved placental function following previous pregnancy. Placental dysfunction in cases of fetal growth restriction may be identified by ultrasound assessment of fetoplacental hemodynamics and amniotic fluid volume. In this prospective observational study, we investigated whether differences in these measures of placental function exist between nulliparous and parous women, prior to active labor. METHODS Over a 2-year period, 456 nulliparous and 152 parous women with uncomplicated singleton pregnancies were recruited to this prospective observational study. Each participant underwent an ultrasound assessment prior to active labor, during which fetal biometry, umbilical artery, middle cerebral artery and umbilical venous Dopplers, as well as amniotic fluid volume, were assessed. All cases were followed up within 48 h of delivery. Ultrasound parameters and intrapartum outcomes were then compared between the nulliparous and parous groups. RESULTS Compared with nulliparous women, parous women had significantly higher fetal middle cerebral artery pulsatility index, cerebroplacental ratio and amniotic fluid volume. In nulliparous women, middle cerebral artery flow rate was also significantly higher and represented a greater percentage of umbilical venous flow than was observed in parous women. CONCLUSION Prior to the active phase of labor, ultrasound parameters indicative of placental function differ significantly between nulliparous and parous pregnancy, even amongst an uncomplicated, low-risk cohort.
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Affiliation(s)
- T Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
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Cruz-Martínez R. Re: influence of parity on fetal hemodynamics and amniotic fluid volume at term. T. Prior, E. Mullins, P. Bennett and S. Kumar. Ultrasound Obstet Gynecol 2014; 44: 688-692. Ultrasound Obstet Gynecol 2014; 44:631. [PMID: 25449115 DOI: 10.1002/uog.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- R Cruz-Martínez
- Department of Fetal Medicine and Surgery,Children's and Women's Specialty Hospital of Queretaro, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico.
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Wang Z, Zhu X, Shi J, Li C, Yun Z, He Y, Chen Y, Cao Y. [Study of reconstruction of digital three-dimensional model of normal human placental vascular network based on MRI data in vitro]. Zhonghua Fu Chan Ke Za Zhi 2014; 49:899-902. [PMID: 25608989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the reconstruction of digital three-dimensional (3D) model of normal human placental vascular network based on MRI data in vitro. METHODS Six full term placentas were collected, casted with modified self-curing denture base resin and scanned by T1 e-THRIVE high resolution magnetic resonance imaging. MRI images were imported into Mimics 14.0 software for 3D reconstruction, and the 3D model was compared with placental vascular casting model. RESULTS (1) The placental vascular network could be obtained on MR 2D images. The 3D model were reconstructed successfully, which showed clear, realistic images. The 3D model could be zoomed and revolved from any direction to observe the branches of arteries and veins. (2) The umbilical vein and 2 umbilical arteries could be seen in the 3D model. In the root of the umbilical cord, the umbilical vein divided into 5-7 branches. While the 2 umbilical arteries anatomoses to form blood sinus and then devided into sub-branches. All the peripheral vessels ended in chorionic plate with abundant sub-branches. (3) When compared with the casting of placental arterial-venous vascular network, the morphology, structure, angle and trend of vessels in 3D model was consistent with the casting network. CONCLUSIONS Reconstruction of digital 3D model of normal human placental vascular network based on MRI in vitro is a new and promising method for the study of placental vasculature. It has better vascular exposure, free rotation, radiation-free. It provides a promising base for the study of placental vasculature in vivo in the future.
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Affiliation(s)
- Zhijian Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China.
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Begum T, Khalil M, Rahman MM, Shen S, Sultana SZ, Mannan S, Ara ZG, Chowdhury AI, Haque MA, Ara A. The site of attachment of umbilical cord and branching pattern of umbilical arteries within the placenta. Mymensingh Med J 2014; 23:644-648. [PMID: 25481579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Placenta is the mirror of maternal and fetal status; it reflects the changes due to complication in pregnancy of mother. Numerous common and uncommon findings of the placenta, umbilical cord and membranes are associated with abnormal fetal development and perinatal morbidity. So, the examination of the placenta can yield information that may be important in the immediate and later management of mother and newborn. This information may also be essential for protecting the attending physician in the event of an adverse maternal or fetal outcome. This cross sectional descriptive study was carried out to determine the incidence of different types of placenta depending on attachment site and branching pattern of arteries of umbilical cord in Bangladeshi Women. To achieve this aim sixty placenta with umbilical cord were collected. Placenta was from 28 weeks to 42 weeks gestational age of normal pregnancy during normal labour at gynaecology and obstetric department of Mymensingh Medical College Hospital. After preservation in 10% formol saline, study was done in the Department of Anatomy of Mymensingh Medical College. In the present study, incidence of different types of placenta depending on attachment site of umbilical cord was 50% Central, 46% Paracentral and 18% Marginal in type. In this study it was also observed that 58% placenta were Disperse in type and 42% were Magistral in type depending on the distribution of umbilical arteries. Observed findings of this study were compared with those of Western and Bangladeshi researchers.
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Affiliation(s)
- T Begum
- Dr Taslima Begum, Assistant Professor, Department of Anatomy, Community Based Medical College Bangladesh (CBMCB), Mymensingh, Bangladesh
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Seravalli V, Block-Abraham DM, Turan OM, Doyle LE, Kopelman JN, Atlas RO, Jenkins CB, Blitzer MG, Baschat AA. First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics. Am J Obstet Gynecol 2014; 211:261.e1-8. [PMID: 24631442 DOI: 10.1016/j.ajog.2014.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 01/11/2014] [Revised: 02/16/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction. STUDY DESIGN Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant. RESULTS Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free β-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P < .001) and UA pulsatility index z-scores (P = .03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P < .001), PAPP-A multiple of the median and bilateral notching (P < .05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores. CONCLUSION Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.
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Affiliation(s)
- Viola Seravalli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Dana M Block-Abraham
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Lauren E Doyle
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Jerome N Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Robert O Atlas
- Department of Obstetrics and Gynecology, Mercy Medical Center, Baltimore, MD
| | - Chuka B Jenkins
- Department of Obstetrics and Gynecology, MedStar Harbor Hospital and Franklin Square Hospital Medical Centers, Baltimore, MD
| | - Miriam G Blitzer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Ahmet A Baschat
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
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Gupta S, Misra R, Ghosh UK, Gupta V, Srivastava D. Comparison of foetomaternal circulation in normal pregnancies and pregnancy induced hypertension using color Doppler studies. Indian J Physiol Pharmacol 2014; 58:284-289. [PMID: 25906613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of present study was to assess fetomaternal blood flows in normal and abnormal pregnancies using color Doppler indices. Subjects were divided into two groups as: Group A of 25 subjects of normal pregnancy as controls and group B of 25 subjects of pregnancy induced hypertension. All the subjects were lying in the age-group of 25-35 years and having 28 to 34 weeks of gestation; the patients were evaluated by detailed history and were subjected to complete general examination. Blood pressure was taken on two occasions at least 6 hours apart. Systemic examination and obstetrical examination was done in all subjects. All cases were subjected to pathological tests- Haemogram, Test for proteins in urine. Ultrasound assessment of fetal growth was done by measuring BPD (Biparietal diameter), HC (Head circumference), FL (Femur length) and AC (Abdominal circumference): Average gestational age and effective fetal weight was then calculated by ultrasound machine. Color Doppler was used to assess the various Doppler indices indices: Pulsatility index (PI), Resistive index (RI) and Systolic diastolic ratio (S/D ratio) in bilateral uterine, umbilical and middle cerebral arteries and compared to the standard normograms. Percentage of subjects having abnormal Doppler indices were calculated. Assessment of percentage of SGA (small for gestational age) fetuses was done in all the three groups. Decline in mean values of all Doppler indices was found with advancing gestational age in normal pregnancy suggesting decreased vascular resistance and increased blood flow in fetomaternal circulation. In pregnancy induced hypertensives, the mean values of Doppler indices showed a decline as in normal pregnancy but showed an increase (more than 2 S.D. of the mean) for that gestational age in comparison to the control group suggesting increased impedance to blood flow in uteroplacental and fetomaternal circulation. Umbilical artery Doppler indices were found to be the most sensitive indicator of uteroplacental and fetoplacental insufficiency in pregnancy induced hypertensives (P = 0.001). Thus we concluded that color Doppler can detect changes in fetomaternal circulation which correlate strongly with the fetal growth and therefore associated with pregnancy outcome.
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Lobmaier SM, Cruz-Lemini M, Valenzuela-Alcaraz B, Ortiz JU, Martinez JM, Gratacos E, Crispi F. Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility. Ultrasound Obstet Gynecol 2014; 43:632-639. [PMID: 24639072 DOI: 10.1002/uog.13365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare left myocardial performance index (MPI) values and reproducibility using different settings and ultrasound equipment in order to standardize optimal machine settings. METHODS Left MPI was prospectively evaluated by one observer performing conventional Doppler in 62 fetuses (28-36 weeks of gestational age) using different settings (changing sweep speed, gain and wall motion filter (WMF)) and two different ultrasound devices (Siemens Antares, Siemens; Voluson 730 Expert, GE Medical Systems). Intraclass coefficients of agreement (ICCs) were calculated using Bland-Altman analysis. RESULTS Using baseline settings on the Siemens, mean (SD) MPI was 0.44 (0.05) with an ICC of 0.81. Decreasing the sweep speed resulted in decreasing average MPI values (0.43) and decreasing ICC (0.61). Lowering gain also influenced average MPI values (0.46) and ICC (0.76). Raising gain resulted in similar MPI values (0.45) with better ICC (0.90) compared with baseline settings. Raising wall motion filter (WMF) provided the best ICC (0.94) compared with the other settings. Changing the ultrasound equipment resulted in an ICC of 0.64. The optimal settings to achieve the highest reproducibility in measurement of MPI were sweep speed 8, gain 60 dB and WMF 281 Hz for Siemens Antares and sweep speed 5, gain -10 dB and WMF 210 Hz for Voluson 730 Expert. CONCLUSION Changing ultrasound settings or equipment may affect the calculation and repeatability of measurement of MPI values. Strict standardization of methods decreases the variability of this parameter for fetal cardiac function assessment.
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Affiliation(s)
- S M Lobmaier
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
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Beneventi F, Locatelli E, Cavagnoli C, Simonetta M, Lovati E, Lucotti P, Aresi P, Decembrino L, Albertini R, Negri B, Cavallo A, Spinillo A. Effects of uncomplicated vaginal delivery and epidural analgesia on fetal arterial acid-base parameters at birth in gestational diabetes. Diabetes Res Clin Pract 2014; 103:444-51. [PMID: 24529563 DOI: 10.1016/j.diabres.2013.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/12/2013] [Revised: 10/07/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022]
Abstract
AIM To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls. METHODS A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables. RESULTS In the GDM group cord base deficit (-2.63 mmol/l, interquartile range [IQR]=4.2 to -0.65 mmol/l vs. -1.9 mmol/l, IQR=-3.3 to -0.2 mmol/l, p=0.009, odds ratio (OR)=1.51, 95% confidence interval (CI)=1.04-2.18) was lower and concentration of calcium higher (1.49 mmol/l, IQR=1.42-1.56 mmol/l vs. 1.47 mmol/l, IQR=1.41-1.51 mmol/l, p=0.009, OR=1.69, 95% CI=1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0mg/dl [4.7 mmol/l], IQR=70-103.3mg/dl vs. 92.5mg/dl [5.1 mmol/l], IQR=76.5-121.8 mg/dl, p=0.004), lactate (2.65 mmol/l (IQR=1.80-4.20) vs. 3.70 mmol/l (IQR=2.90-5.55 mmol/l), p=0.002) and less pronounced base deficit (-2.05 mmol/l, IQR=-3.90 to -0.17 mmol/l vs. -2.8, IQR=-5.57 to -1.05 mmol/l, p=0.01, OR=0.7, 95% CI=0.49-0.99). CONCLUSIONS In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.
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Affiliation(s)
- F Beneventi
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - E Locatelli
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - C Cavagnoli
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
| | - M Simonetta
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - E Lovati
- Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - P Lucotti
- Department of General Medicine Diabetologic Unit, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - P Aresi
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - L Decembrino
- Department of Pediatrics and Neonatology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - R Albertini
- Department of Clinical Laboratory, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - B Negri
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - A Cavallo
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
| | - A Spinillo
- Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy
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Lees C. Reply: To PMID 24078432. Ultrasound Obstet Gynecol 2014; 43:237-238. [PMID: 24497422 DOI: 10.1002/uog.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- C Lees
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Unterscheider J, Daly S, O'Donoghue K, Malone FD. Critical umbilical artery Doppler abnormalities in early fetal growth restriction and the timing of delivery: an overestimated clinical challenge in daily obstetric practice? Ultrasound Obstet Gynecol 2014; 43:236-237. [PMID: 24497421 DOI: 10.1002/uog.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Affiliation(s)
- J Unterscheider
- Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Massaro FC, Brooks PR, Wallace HM, Nsengiyumva V, Narokai L, Russell FD. Effect of Australian propolis from stingless bees (Tetragonula carbonaria) on pre-contracted human and porcine isolated arteries. PLoS One 2013; 8:e81297. [PMID: 24260567 PMCID: PMC3829943 DOI: 10.1371/journal.pone.0081297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/22/2013] [Indexed: 11/18/2022] Open
Abstract
Bee propolis is a mixture of plant resins and bee secretions. While bioactivity of honeybee propolis has been reported previously, information is limited on propolis from Australian stingless bees (Tetragonula carbonaria). The aim of this study was to investigate possible vasomodulatory effects of propolis in KCl-precontracted porcine coronary arteries using an ex vivo tissue bath assay. Polar extracts of propolis produced a dose-dependent relaxant response (EC50=44.7±7.0 μg/ml), which was unaffected by endothelial denudation, suggesting a direct effect on smooth muscle. Propolis markedly attenuated a contractile response to Ca2+ in vessels that were depolarised with 60 mM KCl, in Ca2+-free Krebs solution. Propolis (160 µg/ml) reduced vascular tone in KCl pre-contracted vessels to near-baseline levels over 90 min, and this effect was partially reversible with 6h washout. Some loss in membrane integrity, but no loss in mitochondrial function was detected after 90 min exposure of human cultured umbilical vein endothelial cells to 160 µg/ml propolis. We conclude that Australian stingless bee (T. carbonaria) propolis relaxes porcine coronary artery in an endothelial-independent manner that involves inhibition of voltage-gated Ca2+ channels. This effect is partially and slowly reversible upon washout. Further studies are required to determine the therapeutic potential of Australian stingless bee propolis for conditions in which vascular supply is compromised.
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Affiliation(s)
- Flavia C. Massaro
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Peter R. Brooks
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Helen M. Wallace
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Vianne Nsengiyumva
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Lorraine Narokai
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Fraser D. Russell
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
- * E-mail:
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Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, Duvekot J, Frusca T, Diemert A, Ferrazzi E, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Thilaganathan B, Todros T, van Wassenaer-Leemhuis A, Valcamonico A, Visser GHA, Wolf H. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013; 42:400-408. [PMID: 24078432 DOI: 10.1002/uog.13190] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early-onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early-onset fetal growth restriction based on time of antenatal diagnosis and delivery. METHODS We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26-32 weeks of gestation, with abdominal circumference < 10(th) percentile and umbilical artery Doppler pulsatility index > 95(th) percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis. RESULTS Five-hundred and three of 542 eligible women formed the study group. Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g; 12 (2.4%) babies died in utero. Gestational age at delivery was 30.7 ± 2.3 weeks, and birth weight was 1013 ± 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 ± 251 g) and born earlier (29.6 ± 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre-eclampsia and 3 days for HELLP syndrome. CONCLUSIONS Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions.
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Affiliation(s)
- C Lees
- Department of Obstetrics & Gynaecology, Rosie Hospital, Cambridge, UK; Department of Obstetrics and Gynecology, KU Leuven, Belgium
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Nouri K, Ott J, Stoegbauer L, Pietrowski D, Frantal S, Walch K. Obstetric and perinatal outcomes in IVF versus ICSI-conceived pregnancies at a tertiary care center--a pilot study. Reprod Biol Endocrinol 2013; 11:84. [PMID: 24004836 PMCID: PMC3844416 DOI: 10.1186/1477-7827-11-84] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although most pregnancies after IVF result in normal healthy outcomes, an increased risk for a number of obstetric and neonatal complications, compared to naturally conceived pregnancies, has been reported. While there are many studies that compare pregnancies after assisted reproductive techniques with spontaneously conceived pregnancies, fewer data are available that evaluate the differences between IVF and ICSI-conceived pregnancies. The aim of our present study was, therefore, to compare obstetric and perinatal outcomes in pregnancies conceived after in vitro fertilization (IVF) versus intracytoplasmatic sperm injection (ICSI). METHODS Three-hundred thirty four women who had become pregnant after an IVF or ICSI procedure resulted in a total of 530 children referred between 2003 und 2009 to the Department of Obstetrics and Gynecology of the Medical University of Vienna, a tertiary care center, and were included in this retrospective cohort study. We assessed maternal and fetal parameters in both groups (IVF and ICSI). The main study outcomes were preterm delivery, the need for neonatal intensive care, and congenital malformations. Moreover, we compared the course of pregnancy between both groups and the occurrence of complications that led to maternal hospitalization during pregnancy. RESULTS There were 80 children conceived via ICSI and 450 children conceived via IVF.Mean gestational age was significantly lower in the ICSI group (p = 0.001). After ICSI, the birth weight (p = 0.008) and the mean APGAR values after 1 minute and after 10 minutes were lower compared to that of the IVF group (p = 0.016 and p = 0.047, respectively). Moreover, ICSI-conceived children had to be hospitalized more often at a neonatal intensive care unit (p = 0.004). There was no difference in pH of the umbilical artery or in major congenital malformations between the two groups. Pregnancy complications (i.e., premature rupture of membranes, cervical insufficiency, and premature uterine contractions) and the need for maternal hospitalization during pregnancy were found significantly more often after IVF (p = 0.0016 and p = 0.0095, respectively), compared to the ICSI group. CONCLUSIONS When comparing IVF versus ICSI-conceived pregnancies at a tertiary care center, we found the course of pregnancy to be more complicated after IVF, whereas the primary fetal outcome seemed to be better in this group than after ICSI treatment.
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Affiliation(s)
- Kazem Nouri
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Lucia Stoegbauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Detlef Pietrowski
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Sophie Frantal
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics of the Medical University of Vienna, Vienna, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Bahado-Singh RO. Re: Cerebroplacental ratio in prolonged pregnancy. F. D'Antonio, D. Patel, N. Chandrasekharan, B. Thilaganathan and A. Bhide. Ultrasound Obstet Gynecol 2013; 42: 196-200. Ultrasound Obstet Gynecol 2013; 42:131. [PMID: 23893599 DOI: 10.1002/uog.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- R O Bahado-Singh
- Oakland University-William Beaumont School of Medicine, Medical Office Building, 3535 West 13 Mile Road, Suite 233, Royal Oak, MI 48073, USA.
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D'Antonio F, Patel D, Chandrasekharan N, Thilaganathan B, Bhide A. Role of cerebroplacental ratio for fetal assessment in prolonged pregnancy. Ultrasound Obstet Gynecol 2013; 42:196-200. [PMID: 23239502 DOI: 10.1002/uog.12357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess the role of the cerebroplacental ratio (CPR), i.e. the ratio between the middle cerebral artery and umbilical artery pulsatility indices, in detecting fetal compromise in prolonged pregnancy. METHODS Women attending a dedicated postdates clinic at 41 weeks' gestation were recruited for the study and CPR was calculated at 41+3 weeks. Induction of labor was offered at 42 weeks to those women still undelivered. Unfavorable outcome was defined as cord arterial pH < 7.15 with a base deficit of > 11 mM/L or operative delivery for abnormal intrapartum fetal electrocardiogram ST-segment analysis. The 5(th) centiles of the CPR, obtained from published reference ranges (0.90) and from our population (0.98), were used as lower cut-off values. RESULTS Three hundred and twenty women who reached a gestational age of over 41 weeks were eligible for inclusion in the study. The median gestational age at delivery was 294 (range, 289-300) days. Unfavorable outcome was observed in 58/320 pregnancies. There was no significant difference in the proportion of unfavorable outcomes between the two groups defined using either CPR cut-off value (both P > 0.05). CONCLUSION CPR is not predictive of unfavorable outcome in women with pregnancies lasting more than 41 weeks.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School and St George's Hospital NHS Trust, London, UK
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Savchev S, Sanz-Cortes M, Cruz-Martinez R, Arranz A, Botet F, Gratacos E, Figueras F. Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function. Ultrasound Obstet Gynecol 2013; 42:201-206. [PMID: 23303527 DOI: 10.1002/uog.12391] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the 2-year neurodevelopmental outcome of full-term, small-for-gestational-age (SGA) newborns with normal placental function, according to current criteria based on umbilical artery Doppler findings. METHODS A cohort of consecutive full-term, SGA newborns with normal prenatal umbilical artery Doppler was compared with a group of full-term, appropriate-for-gestational-age (AGA) infants sampled from our general neonatal population. Neurodevelopmental outcome was evaluated at 24 months' corrected age using the Bayley Scales of Infant and Toddler Development, 3(rd) Edition (Bayley-III), which evaluates cognitive, language, motor, social-emotional and adaptive competencies. The effect of the study group on each domain was adjusted with MANCOVA and logistic regression for gestational age at delivery, socioeconomic status, gender, tobacco smoking and breastfeeding. RESULTS A total of 223 infants (112 SGA and 111 AGA) were included. The groups differed significantly with respect to socioeconomic status and gestational age at delivery. All studied neurodevelopmental domains were poorer in the SGA group, reaching significance for the cognitive (92.9 vs 100.2, adjusted P = 0.027), language (94.7 vs 101, adjusted P = 0.025), motor (94.2 vs 100, adjusted P = 0.027) and adaptive (89.2 vs 96.5, adjusted P = 0.012) scores. Likewise, the SGA group had a higher risk of low scores in language (odds ratio (OR) = 2.63; adjusted P = 0.045) and adaptive (OR = 2.72; adjusted P = 0.009) domains. CONCLUSIONS Compared with normal-sized babies, full-term SGA infants, without placental insufficiency defined according to currently used criteria, have lower 2-year neurodevelopmental scores. These data challenge the concept that SGA fetuses with normal umbilical artery Doppler are 'constitutionally small' but otherwise completely normal.
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Affiliation(s)
- S Savchev
- Perinatal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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