High Glucose Level Disturbs the Resveratrol-Evoked Curtailment of CX3CL1/CX3CR1 Signaling in Human Placental Circulation

Hyperglycemia-induced hyperactivity of chemokine CX3CL1 (fractalkine) occurs in the human placenta. Anti-inflammatory/antioxidant activities of resveratrol (3,5,4'-trihydroxy-trans-stilbene) are related to the modulation of chemokine CX3CL1 and its receptor, CX3CR1, signaling pathways. We examined the influence of high glucose (25 mmol/L glucose; HG group; N = 36) on resveratrol-mediated effects on CX3CL1 and TNF-α production by the placental lobule, CX3CR1 expression and contents of CX3CR1, TNF-α receptor 1 (TNFR1), and NF-κB proteins in placental tissue. The placental lobules perfused under normoglycemic conditions formed the control NG group (N = 36). Resveratrol (50 and 100 μM; subgroups B and C) administered into the perfusion fluid lowered the production of both CX3CL1 and TNF-α. The reductions in CX3CL1 levels were more evident in the NG group. CX3CR1 expression was significantly higher in the NG subgroups B and C compared to the HG subgroups B and C (385.2 and 426.5% versus 199.3 and 282.4%, resp.). An increase in CX3CR1 protein content in placental lysates was observed in the NG subgroups B and C. Also, resveratrol significantly decreased NF-κBp65 protein content only in the NG group, not affecting hyperglycemia-elicited TNFR1 upregulation. In conclusion, euglycemia assures optimal effects of resveratrol pertaining to CX3CL1/CX3CR1 signaling in the placenta. Future studies on resveratrol are needed, especially those including maternal-fetal risk assessments.

Hemoperitoneum in a patient with spontaneous rupture of the posterior wall of an unscarred uterus in the second trimester of pregnancy

BACKGROUND

Hemoperitoneum resulting from a rupture of an unscarred uterus is a rare condition. Uterine rupture in patients without evident risk factors is associated with non-specific signs and symptoms that can delay the diagnosis. This is a report of spontaneous rupture of posterior wall of the uterus in the second trimester of pregnancy presented as intra-abdominal bleeding.

CASE PRESENTATION

Here, we report the case of a 31-year-old Caucasian multiparous female (gravida 3, para 1) who had a sudden onset of abdominal pain at 28 weeks of gestation. The patient had no history of caesarean section. Exploratory laparotomy was performed due to deterioration of the patient's clinical condition, and ultrasound results were suspicious for hemoperitoneum. Uterine rupture in the posterior wall with active bleeding from the defect was confirmed. A caesarean section was performed, and a live female infant weighing 1000 g, with an Apgar score of three, was delivered. A hysterectomy was performed during the caesarean section.

CONCLUSION

Diagnostic difficulties arise from the rarity of the disease, a nonspecific clinical picture and the absence of the main risk factors. Uterine rupture should be considered in the differential diagnosis of hemoperitoneum in patients with an unscarred uterus.

Placental tumor (chorioangioma) as a cause of polyhydramnios: a case report

Placental chorioangioma is the most common type of placental tumor. It is usually symptomless and may be associated with serious maternal and fetal complication when it reaches a large size. We presented a case of an angiomatous type of placental hemangioma diagnosed in the second trimester of pregnancy in a patient with polyhydramnios. A normal volume of amniotic fluid was successfully achieved by three amnioreductions with conservative management. The size of the placental tumor remained the same from the time of diagnosis to the end of pregnancy. A term labor was uncomplicated and a healthy newborn was delivered. Macroscopic and microscopic examination of the placenta confirmed the diagnosis. Despite the rarity of placental tumors, they should be considered as differential diagnosis in cases of polyhydramnios.