RESUMO
Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.
Assuntos
COVID-19/complicações , Placenta/irrigação sanguínea , Placenta/patologia , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Infecciosas na Gravidez/etiologia , Trombose/etiologia , Adulto , Antígenos CD/análise , COVID-19/patologia , COVID-19/virologia , Caderinas/análise , Claudina-5/análise , Endotélio/irrigação sanguínea , Endotélio/patologia , Endotélio/virologia , Feminino , Humanos , Recém-Nascido , Microvasos/patologia , Microvasos/virologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/virologia , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/virologia , SARS-CoV-2/isolamento & purificação , Trombose/patologia , Trombose/virologia , Adulto Jovem , Fator de von Willebrand/análiseAssuntos
Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral , Complicações Cardiovasculares na Gravidez/patologia , Insuficiência Respiratória/patologia , Choque Cardiogênico/patologia , Trombose/patologia , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Primeiro Trimestre da Gravidez , Falha de Prótese , Edema Pulmonar/patologia , Insuficiência Respiratória/etiologia , Choque Cardiogênico/etiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Trombose/etiologiaAssuntos
Humanos , Feminino , Gravidez , Adulto , Complicações Cardiovasculares na Gravidez/patologia , Insuficiência Respiratória/patologia , Choque Cardiogênico/patologia , Trombose/patologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral , Complicações Cardiovasculares na Gravidez/etiologia , Primeiro Trimestre da Gravidez , Edema Pulmonar/patologia , Insuficiência Respiratória/etiologia , Choque Cardiogênico/etiologia , Trombose/etiologia , Falha de Prótese , Evolução Fatal , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/patologiaAssuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Displasia Arritmogênica Ventricular Direita/patologia , Autopsia , Ecocardiografia/métodos , Feminino , Morte Fetal , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/patologia , Ultrassonografia Pré-Natal/métodosAssuntos
Humanos , Feminino , Gravidez , Adulto , Complicações Cardiovasculares na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Displasia Arritmogênica Ventricular Direita/diagnóstico , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Autopsia , Ecocardiografia/métodos , Ultrassonografia Pré-Natal/métodos , Displasia Arritmogênica Ventricular Direita/patologia , Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Morte FetalRESUMO
BACKGROUND AND AIMS: Pregnancy-related hypertensive disorders are complications in which risk factors are identified such as nulliparity, age, malnutrition, obesity and social issues. Those statements are explained by theories of abnormal placentation, immunological inadequacy, genetics and oxidative stress, but all theories converge in endothelial damage, which is able to mechanically deform and hemolyze erythrocytes as they pass through the capillaries. Given the effects of endothelial damage, the aim of the study was to determine erythrocyte alterations in peripheral blood smear of patients with hypertensive disorders of pregnancy that could be used as prognostic condition. METHODS: We performed a prospective, descriptive and observational study where all patients with hypertensive disorders admitted to the obstetrics and gynecology service of a specialty hospital were recruited. Patients who provided signed informed consent underwent peripheral blood smear. Results were tabulated in percentage graphics and analyzed with Cramer's V based on χ(2). The peripheral blood smear consisted of an extended drop of peripheral blood from the patient with subsequent hematological staining done with Romanowsky stain. RESULTS: A total of 119 samples were analyzed; 74% showed abnormal morphology of erythrocytes and the most frequent abnormality was the presence of schistocytes in up to 39% of samples. Descriptive analysis showed a degree of association to independent variables with Cramer's V = 0.41 value (p <0.05). CONCLUSIONS: A high percentage of patients with hypertensive disorders of pregnancy show some morphologic alterations of erythrocytes in peripheral blood smear.
Assuntos
Eritrócitos/metabolismo , Hipertensão Induzida pela Gravidez/sangue , Pré-Eclâmpsia/sangue , Complicações Cardiovasculares na Gravidez/sangue , Adulto , Eritrócitos/citologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/patologia , Masculino , Estresse Oxidativo , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Estudos Prospectivos , Adulto JovemRESUMO
PURPOSE: Quantify the volume and diameter of veins in the lower limbs of primigravidae and associate the presence of venous signs and symptoms with the vascular measurements. METHODS: A cross-sectional study assessed 64 lower limbs of 32 healthy women of whom 16 were primigravidae between 22 and 36 weeks pregnant, and 16 nulligravidae. The women were submitted to physical assessment, air plethysmography and vascular ultrasound. The volumes and diameters of the main veins in the lower limbs were compared between pregnant and non-pregnant women. In the group of pregnant women, the attempt was also made to associate such measurements to the presence of vascular signs and symptoms. RESULTS: The average venous volume of the lower limbs (110.1 ± 30.2 and 94.7 ± 27.3 mL; p = 0.036), as well as the diameters of the common femoral (12.72 ± 2.27 and 10.14 ± 1.24 mm; p < 0.0001), saphenous (4.81 ± 1.15 and 3.55 ± 0.98 mm; p < 0.0001) and popliteal (6.87 ± 1.68 and 5.36 ± 1.07 mm; p < 0.0001) veins were, respectively, greater in the pregnant women compared with the control group. In pregnant women with venous stasis symptoms, a venous diameter of the saphenous vein compared to those without no symptoms (5.05 ± 1.19 and 4.09 ± 0.70 mm; p = 0.011) was noted. CONCLUSIONS: Anatomical and functional changes in the venous system during pregnancy were detected by the air plethysmography and the vascular ultrasound in primigravidae. In pregnant women, the presence of venous stasis symptoms found an anatomical and functional substrate detected in the differences in diameter of the saphenous vein.
Assuntos
Extremidade Inferior/irrigação sanguínea , Síndrome Pós-Trombótica/patologia , Complicações Cardiovasculares na Gravidez/patologia , Veia Safena/patologia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Veia Femoral/anatomia & histologia , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiologia , Humanos , Extremidade Inferior/diagnóstico por imagem , Pessoa de Meia-Idade , Pletismografia , Veia Poplítea/anatomia & histologia , Veia Poplítea/diagnóstico por imagem , Veia Poplítea/fisiologia , Síndrome Pós-Trombótica/diagnóstico por imagem , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Ultrassonografia , Adulto JovemRESUMO
AIMS: To assess whether contractile reserve during dobutamine stress echocardiography (DSE) can predict left ventricular functional recovery in patients with peripartum cardiomyopathy and to assess myocardial fibrosis by magnetic resonance imaging (MRI) in these patients. METHODS: Nine patients with peripartum cardiomyopathy were enrolled. All patients underwent DSE and were followed for six months, when a rest Doppler echocardiogram was repeated. MRI was also performed at the beginning of follow-up to identify myocardial fibrosis. RESULTS: Mean age was 29±7.9 years and mean left ventricular ejection fraction at baseline was 39.4±8.6% (range 24-49%). Eight of the nine patients showed left ventricular functional recovery with mean ejection fraction at follow-up of 57.1±13.8%. The ejection fraction response to DSE did not predict recovery at follow-up. On the other hand, left ventricular ejection fraction at baseline correlated with ejection fraction at follow-up. Mild fibrosis was detected in only one patient. CONCLUSION: Left ventricular ejection fraction at baseline was a predictor of left ventricular functional recovery in patients with peripartum cardiomyopathy. Dobutamine stress echocardiography at presentation of the disease did not predict recovery at follow-up. Myocardial fibrosis appeared to be uncommon in this cardiomyopathy.
Assuntos
Ecocardiografia sob Estresse , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Contração Miocárdica , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/fisiopatologia , Função Ventricular Esquerda , Adolescente , Adulto , Feminino , Fibrose , Coração/fisiopatologia , Insuficiência Cardíaca/patologia , Humanos , Imageamento por Ressonância Magnética , Miocárdio/patologia , Valor Preditivo dos Testes , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Transtornos Puerperais/patologia , Adulto JovemRESUMO
Endothelial dysfunction is a fundamental characteristic in the physiopathology of preeclampsia. Currently, a series of markers which explain endothelial dysfunction have been identified. The recognition of endothelial dysfunction has been used to realize an early diagnosis of preeclampsia, as soon as the classification of a possible prognosis. Nevertheless the detection of these markers is not accessible to the majority of hospitable centers that treat patients with preeclampsia. One indirect marker of endothelial dysfunction with a greater accessibility is the assessment of peripheral blood smear. Several studies had proved the presence of endothelial dysfunction by identification of red blood cells crenated in peripheral blood smear led us also to measure the impact in the evolution of the disease.