RESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of permanent placental injury due to a severe acute respiratory syndrome coronavirus 2 infection during pregnancy on feto-placental circulation. METHODS: In this cross-sectional study, 83 pregnant women with planned deliveries were divided into two groups according to their severe acute respiratory syndrome coronavirus 2 infection statuses during pregnancy. Their demographic parameters, obstetric histories, and prenatal risks were evaluated. A prenatal fetal Doppler ultrasound examination was performed for all participants, and umbilical artery and middle cerebral artery Doppler parameters were obtained. Postpartum placentas were examined for pathological findings under appropriate conditions. All placentas were evaluated according to the Amsterdam consensus criteria. Mann-Whitney U test, Student's t-test, and chi-square test were used for comparisons. RESULTS: Demographic parameters were statistically similar, except that they were borderline significant for gestational weeks at delivery (p=0.044). In the pathological examination of the placenta, regardless of the trimester of exposure to viral infection, perivillous fibrin deposition and villus dystrophic calcification were more common in group 2 (p=0.016 and p=0.048, respectively) than in group 1. In the prenatal Doppler examination between the groups, no statistically significant difference was found for all of the umbilical artery pulsatile index, middle cerebral artery pulsatile index, and cerebro-placental ratio values. CONCLUSION: Severe acute respiratory syndrome coronavirus 2 infection during pregnancy causes an increase in perivillous fibrin deposition and villus dystrophic calcification in the placenta. Placental injury caused by the severe acute respiratory syndrome coronavirus 2 virus does not affect fetal Doppler parameters.
Assuntos
COVID-19 , Circulação Placentária , Gravidez , Feminino , Humanos , Placenta/diagnóstico por imagem , Estudos Transversais , COVID-19/complicações , FibrinaRESUMO
A perfusão arterial reversa gemelar é uma anormalidade rara que pode ocorrer em gestações gemelares monocoriônicas. Consiste em uma alteração na circulação fetoplacentária, com desvio de sangue de um dos gemelares para o outro, por meio de anastomoses arterioarteriais e venovenosas na superfície placentária e anastomoses arteriovenosas em áreas de circulação placentária compartilhada. O feto bombeador pode desenvolver insuficiência cardíaca devido ao aumento do débito cardíaco, e o feto receptor, perfundido por sangue pobre em oxigênio por meio do fluxo reverso, é severamente malformado, incompatível com a vida extrauterina. Este artigo apresenta o caso de uma gestação gemelar monocoriônica diamniótica, com manejo clínico conservador. O objetivo é relatar um caso de complicação rara de gestações monozigóticas e revisar condutas para diagnóstico e manejo adequado.(AU)
Twin reverse arterial perfusion is a rare abnormality that can occur in monochorionic twin pregnancies. It consists of an alteration in the fetal-placental circulation, with blood diversion from one of the twins to the other, through arterio-arterial and veno- venous anastomosis on the placental surface and arterio-venous anastomosis in areas of shared placental circulation. The pumping fetus may develop heart failure due to increased cardiac output, and the recipient fetus, perfused by oxygen-poor blood through reverse flow, is severely malformed, incompatible with extrauterine life. This article presents the case of a monochorionic diamniotic twin pregnancy, with conservative clinical management. The objective is to report a case of rare complication of monozygotic pregnancies and review procedures for diagnosis and adequate management.(AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Complicações na Gravidez/fisiopatologia , Anastomose Arteriovenosa/anormalidades , Artérias Umbilicais/anormalidades , Anormalidades Congênitas/diagnóstico por imagem , Gravidez de Alto Risco , Gemelaridade Monozigótica , Transfusão Feto-Fetal/complicações , Brasil , Circulação Placentária , Morte Fetal , Monitorização Fetal , Clampeamento do Cordão Umbilical , Trabalho de Parto PrematuroRESUMO
Introducción: La placenta sintetiza y secreta varias hormonas que permiten la regulación del embarazo, el trabajo de parto y la adaptación metabólica materno-fetal. Su comportamiento asociado al tipo de parto puede dar información relevante sobre efectos epigenéticos. Objetivo: Describir el tipo de parto con los niveles de oxitocina, cortisol y hormonas tiroideas en plasma de cordón umbilical al nacer. Método: A 50 mujeres con embarazos principalmente normales se les cuantificaron los niveles neurohormonales en plasma de cordón umbilical, obtenido inmediatamente tras el periodo expulsivo. Los resultados se incorporaron a la base de datos clínicos de cada participante y se analizaron con Stata v.14.0. El protocolo fue aprobado por el comité de ética. Resultados: Hubo 33 partos vaginales (12 espontáneos, 13 acelerados y 8 inducidos) y 17 cesáreas (7 electivas y 10 de urgencia). Se observaron mayores niveles de cortisol en los partos vaginales acelerados; las cesáreas tuvieron menores niveles de cortisol y hormona estimulante de la tiroides. Las intervenciones clínicas, con altos o bajos niveles hormonales, están en directa relación con el tipo de parto. Conclusiones: El cortisol y la hormona estimulante de la tiroides medidos en plasma de cordón umbilical variaron según el tipo de parto. Esto es una primera cuantificación de hormonas en plasma de cordón umbilical y su posible regulación placentaria a propósito del tipo de parto.
Introduction: The placenta synthesizes and secretes several hormones allowing the regulation of pregnancy, labor and maternal-fetal metabolic adaptation. Their behavior associated with the type of delivery, may provide relevant information on epigenetic effects. Objective: To describe the type of delivery with the levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma at birth. Method: Neurohormonal levels from umbilical cord plasma obtained immediately post expulsion, were quantified in 50 women with mainly normal pregnancies. Results incorporated into the clinical database of each participant, statistically analyzed in Stata v.14.0. Protocol approved by ethics committee. Results: 33 were vaginal deliveries (12 spontaneous, 13 accelerated, 8 induced) and 17 cesarean sections (7 elective and 10 emergency). Higher cortisol levels were observed in accelerated vaginal deliveries, cesarean sections had lower cortisol and thyroid stimulating hormone levels. While clinical interventions, with high or low hormone levels, were related to the type of delivery. Conclusions: Cortisol and thyroid stimulating hormone measured in umbilical cord plasma varied according to the type of delivery. This is a first quantification of hormones in umbilical cord plasma and their possible placental regulation in relation to the type of delivery.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Hormônios Placentários/metabolismo , Parto Obstétrico , Sangue Fetal/química , Hormônios Tireóideos/análise , Cordão Umbilical/química , Hidrocortisona/análise , Ocitocina/análise , Cesárea , Estudos Transversais , Circulação PlacentáriaRESUMO
Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...(AU)
Assuntos
Animais , Feminino , Gravidez , Cães , Monitorização Hemodinâmica/métodos , Monitorização Hemodinâmica/veterinária , Circulação Placentária , Artérias Umbilicais/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artérias Cerebrais/embriologia , Ultrassonografia Doppler/veterináriaRESUMO
Background: Doppler ultrasonography enables the investigation of vascular blood flow indexes in gestational assessment,being able to detect vascular resistances that can affect fetal and maternal circulation, such as cases of placental insufficiency, associated with fetal cerebral oxygenation deficit and fetal distress. The study aims to assume hemodynamicallynormal values in the final third of gestation in bitches, of the umbilical, uteroplacental, middle cerebral and internal carotidarteries, correlating the obtained Doppler velocimetric indexes, for the assessment of the feto-placental circulation, andprediction of fetal viability indexes, fetal centralization and probable date of delivery.Materials, Methods & Results: Thirty healthy bitches were examined in the final third of gestation (40-60 days). Thesewere evaluated by Doppler ultrasonography at 2 times (T): T1: between 40-50 days; T2: between 51-60 of gestation.At each time point, the peak systolic velocities (PSV) and end-diastolic velocities (EDV) used to obtain the pulsatility(IP) and resistivity (IR) indexes of the umbilical, uteroplacental, middle cerebral and internal carotid arteries of fetuseswere evaluated. Also, the systole/diastole (S/D) ratio of these vessels was evaluated. The data obtained were subjected toanalysis of variance and Tukey test, using a P value equal to 5%. A significant difference was observed between velocitiesand Doppler velocimetric indexes between the 2 phases of the gestational final third in all studied vessels. There was anincrease in the values of PSV and EDV and a decrease in the indexes, as the probable date of delivery approached. Theanalysis of the umbilical cord IR showed an increase from P1 to P2 (P < 0.05), while the IP decreased at the same time.For all studied variables there was a statistically significant difference (P < 0.05). In the uteroplacental...
Assuntos
Feminino , Animais , Gravidez , Cães , Artéria Carótida Interna/diagnóstico por imagem , Artérias Cerebrais/embriologia , Artérias Umbilicais/diagnóstico por imagem , Circulação Placentária , Monitorização Hemodinâmica/métodos , Monitorização Hemodinâmica/veterinária , Ultrassonografia Doppler/veterináriaRESUMO
The objective was to evaluate the blood flow of the uterine artery (UA) and umbilical artery (UMB) in the physiological pregnancy of goats by means of Doppler throughout the gestational period. Twenty-five Saanen goats weighing 55 ± 10 kg and aged between 2 and 5 were evaluated weekly, from the 21st until the 143rd day of gestation, and daily from that period until parturition. Values for peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance (RI) and pulsatility (PI) indices of the uterine and umbilical arteries were determined. The values obtained were correlated with gestational age by Spearman's test, tested for adjustment to regression models and compared with the number of fetuses by ANOVA. The umbilical cord was first visualized at 28 days. Of the variables evaluated, RIUMB and PIUMB correlated with gestational age (p<0.001; and 0.046; respectively) and RIUMB had a low negative correlation with the number of fetuses per pregnancy (p = 0.003; r- Spearman = - 0.218). PSVUMB and EDVUMB values did not correlate with gestational age (p=0.737 and 0.768, respectively), but there was a decrease in the mean values throughout pregnancy (PSVUMB= 0.07; 0.31 and EDVUMB= 0.01; 0.06) as well as the change in the flow pattern of the spectral trace. The mean values of the uterine artery dopplervelocimetric variables PSVUT, EDVUT, PIUT and RIUT did not correlate with gestational age (p= 0.324; 0.372, 0.143; 0.13; respectively). It is expected that the results obtained will contribute to a broader understanding of the hemodynamic changes resulting from pregnancy in goats.(AU)
Assuntos
Animais , Feminino , Gravidez , Artérias Umbilicais/diagnóstico por imagem , Cabras/anatomia & histologia , Ultrassonografia Doppler/veterinária , Artéria Uterina/diagnóstico por imagem , Circulação Placentária/fisiologiaRESUMO
La prematiridad fue aumentando la supervivencia desde hace varios años, y eso produce, sobre todo, una preocupación en los prematuros nacidos antes de las 28 semanas de gestación. El tiempo del clampeo del cordón umbilical puede generar diversos trastornos, principalmente, cuando se realiza temprano (10-15 segundos). Ya desde hace 20 años, a través de varias investigaciones, se pudieron demostrar los notorios beneficios del clampeo demorado del cordón (de 2 a 3 minutos). Esta práctica fue instalada en la asistencia obstétrica y neonatal por las recomendaciones de sociedades científicas y de las revisiones sistemáticas, que señalaron las sólidas evidencias que apoyaban esta conducta para prematuros. En esta revisión, se describen los artículos más relevantes en los últimos años, que sustentan notoriamente la aplicación del clampeo demorado del cordón versus el clampeo temprano. Asimismo, esta práctica genera una disminución de los trastornos graves en prematuros.
For several years now, the survival of preterm infants has been increasing, which has shifted our concern to preterm infants born before 28 weeks of gestation in particular. The timing of umbilical cord clamping may lead to several disorders, especially when done early (10-15 seconds). In the last two decades, several investigations have shown the considerable benefits of delayed cord clamping (2-3 minutes). Delayed cord clamping has been practiced in obstetrics and neonatal care based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in preterm infants. This review describes the most relevant articles from the last years, which strongly support the use of delayed cord clamping versus early cord clamping. In addition, this practice reduces the rate of severe disorders in preterm infants.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Cordão Umbilical , Circulação Placentária/fisiologia , Ligadura , Fatores de Tempo , Recém-Nascido PrematuroRESUMO
OBJETIVOS: reportar el caso de una paciente con gestación gemelar monocorial-biamniótica complicada por secuencia TRAP que dio lugar al nacimiento de un feto bomba de 1932 gramos sin malformaciones anatómicas y de un feto acardio anceps de 1800 gramos, y realizar una revisión sobre esta patología y la importancia de su diagnóstico y tratamiento precoces. MATERIALES Y MÉTODOS: se presenta el caso de un feto acardio en una gestante con embarazo sin control estricto en el Hospital San Pedro de Logroño en el año 2019, de interés por su diagnóstico tardío y elevado peso al nacimiento del feto acardio. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed, OVID, Embase y SciE-LO con las palabras clave DeCS y términos MeSH. Como criterios de inclusión se consideraron artículos tipo series y reportes de casos y artículos de revisión desde enero de 1950 hasta enero de 2020. RESULTADOS: la búsqueda incluyó 39 referencias bibliográficas sobre las que se repasaron las principales cuestiones teóricas a exponer. El peso del feto acardio de nuestro caso fue muy elevado sin provocar repercusión en el feto sano, en comparación con la bibliografía, lo que aporta singularidad al caso, siendo sólo equiparable la serie de casos de Brassard et al (1999), con pesos de los fetos acardio por encima de 1700 gramos y diferenciándose en 100 gramos del feto bomba. CONCLUSIONES: el feto acardio es una complicación infrecuente de embarazos gemelares monocoriales. Se requiere la presencia de anastomosis vasculares placentarias entre ambas circulaciones. El diagnóstico precoz es importante para disminuir la morbilidad y usar, en la medida de lo posible, técnicas terapéuticas no invasivas.
OBJECTIVES: to report the case of a patient with a monochorionic-biamniotic twin gestation complicated by TRAP sequence that gave rise to the birth of a pump fetus without anatomical malformations (1932 g) and an acardiac anceps fetus (1800 g), and to review this pathology and the importance of its early diagnosis and management. MATERIAL AND METHODS: the case of an acardiac fetus is presented in a pregnant woman without strict control at the Hospital San Pedro de Logroño in 2019, worthwhile because of its late diagnosis and high birth weight. A search of the literature was carried out in the Medline databases via PubMed, OVID, Embase and SciELO with the MeSH terms. As inclusion criteria, we considered series-type articles and case reports, cohorts and review articles from January 1950 to January 2020. RESULTS: 39 bibliographic references were included with the main theoretical questions to be reviewed. Our acardiac fetus weight was very high comparing with the bibiography and without causing repercussion in the healthy fetus, which contributes to the uniqueness of the case, only the series report by Brassard et al (1999) is comparable, with weights of the acardiac fetus above 1700 grams and differing by 100 grams from the pump fetus. CONCLUSIONS: the acardiac fetus is an infrequent complication of monochorionic twin pregnancies. The presence of placental vascular anastomoses between both circulations is required. Early diagnosis is important to decrease morbidity and to use, as far as possible, non-invasive therapeutic techniques.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações na Gravidez/diagnóstico por imagem , Doenças em Gêmeos/diagnóstico por imagem , Transfusão Feto-Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Perfusão , Gravidez Múltipla , Anormalidades Múltiplas/diagnóstico por imagem , Ultrassonografia Pré-Natal , Circulação Placentária , Coração Fetal/diagnóstico por imagem , Gravidez de Gêmeos , Anencefalia/diagnóstico por imagemRESUMO
Se realizó una estudio descriptivo transversal de recolección retrospectiva de datos de 102 historias clinicas con el objetivo de describir las características clínicas y epidemiológicas de la sífilis congénita en neonatos registrados en el Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga durante el período enero 2014 a junio 2017. Los resultados evidencian que el 52% de los neonatos eran del sexo masculino, el peso y longitud del neonato osciló entre 2501 a 4000 gramos y 46 a 55 cms, respectivamente; los neonatos pretérmino y a término tenían un tamaño adecuado; el APGAR fue normal al minuto, cinco y diez minutos. Las manifestaciones clínicas y paraclínicas más frecuentes fueron ictericia (41,2%), leucocitosis (16,7%) y periostitis (12,8%). El 78,4% de los casos presentaron VDRL no reactivo en LCR mientras que 72,5% mostraron VDRL reactivo en sangre. En conclusión, es importante aumentar el control prenatal e indicar de forma rutinaria el VDRL en sangre con la finalidad de detectar tempranamente los casos de sífilis materna y de esta manera prevenir la sífilis congénita(AU)
A descriptive, cross-sectional study, of retrospective review of data from 102 medical charts was carried out in order to describe clinical and epidemiological characteristics of congenital syphilis in neonates registered at the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the period January 2014 to June 2017. Male sex was predominant 52%, weight and height of newborns were between 2.501 to 4.000 grams and 46 to 55 cms, respectively; preterm and term neonates were of adequate size; APGAR score was normal at one, five and ten minutes. Most common clinical and paraclinical manifestations of congenital syphilis of the neonate at birth were jaundice (41,2%), leucocitosis (16,7%) and periostitis (12,8%). 78,4% had non-reactive VDRL in cerebrospinal fluid while 72,5% had reactive VDRL in blood. In conclusion, it is important to increase prenatal control and screen for maternal syphilis in order to detect early cases and prevent congenital syphilis(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Sífilis Congênita/etiologia , Sífilis Congênita/epidemiologia , Recém-Nascido , Doenças Transmissíveis , Circulação Placentária , Relações Materno-FetaisRESUMO
BACKGROUND AND OBJECTIVE: Fluoxetine, antidepressant widely-used during pregnancy, is a selective inhibitor for P-glycoprotein (P-gp). Fexofenadine, an in vivo P-gp probe, is an antihistamine drug for seasonal allergic rhinitis and chronic urticaria treatment during pregnancy and it is available as a racemic mixture. This study evaluated the chiral discrimination of P-gp investigating the effect of fluoxetine on maternal-fetal pharmacokinetics of fexofenadine. METHODS: Healthy parturient women received either a single oral dose of 60 mg racemic fexofenadine (Control group; n = 8) or a single oral dose of 40 mg racemic fluoxetine 3 h before a single oral dose of 60 mg racemic fexofenadine (Interaction group; n = 8). Maternal blood and urine samples were collected up to 48 h after fexofenadine administration. At delivery, maternal-placental-fetal blood samples were collected. RESULTS: The maternal pharmacokinetics of fexofenadine was enantioselective (AUC0-∞R-(+)/S-(-) ~ 1.5) in both control and interaction groups. Fluoxetine increased AUC0-∞ (267.7 vs 376.1 ng.h/mL) and decreased oral total clearance (105.1 vs 74.4 L/h) only of S-(-)-fexofenadine, whereas the renal clearance were reduced for both enantiomers, suggesting that the intestinal P-gp-mediated transport of S-(-)-fexofenadine is influenced by fluoxetine to a greater extent that the R-(+)-fexofenadine. However, the transplacental transfer of fexofenadine is low (~16%), non-enantioselective and non-influenced by fluoxetine. CONCLUSIONS: A single oral dose of 40 mg fluoxetine inhibited the intestinal P-gp mediated transport of S-(-)-fexofenadine to a greater extent than R-(+)-fexofenadine in parturient women. However, the placental P-gp did not discriminate fexofenadine enantiomers and was not inhibited by fluoxetine.