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Objective
In a proportion of patients with preeclampsia, unremodeled spiral arteries develop additional pathological changes, termed decidual vasculopathy (DV), or acute atherosis. DV has been correlated to adverse clinical outcome and increased placental pathology. However, it was unclear whether these effects pertained to individual features of DV.Methods
We performed a reanalysis of placental samples from preeclamptic pregnancies (n = 76), recording the number of vessels with DV, their location in the decidua and their morphological features. Results were correlated with clinical and placental parameters, using Spearman's rho test. P-value < 0.05 was considered significant.Results
Total number of vessels with DV (totalDV) correlated with higher diastolic blood pressure, higher urine protein-to-creatinine ratio, shorter gestational age, lower birth weight, 5 min APGAR score and umbilical artery pH, and with increased accelerated villous maturity, infarction and hematoma formation, but not with HELLP syndrome markers. Additionally, there was a striking correlation of increased perinatal mortality with the number of vessels located in the decidua basalis (DVbas), and with vessels showing DV with thrombosis (DVthrom). Other morphological features, such as foam cell infiltration, did not increase correlation strength.Discussion
In our study of preeclamptic placental samples, totalDV related to worse clinical outcome and increased placental pathology. Moreover, DVbas and DVthrom related to perinatal death. DV could be a manifestation of an underlying (vascular) pathology, increasing the risk of adverse pregnancy outcome.Conclusions
In preeclampsia, totalDV, DVbas and DVthrom correlated with increased placental pathology and adverse maternal and fetal outcome, most relevantly with perinatal mortality. 相似文献3.
R. Villar Jiménez L. BelmonteE. González Mirasol G. González De Merlo 《Clínica e investigación en ginecología y obstetricia》2013
Introduction
To evaluate whether there are adverse pregnancy outcomes in pregnant women with a risk index above the cut-off point in first-trimester screening for fetal chromosomal abnormalities and an amniocentesis result of normal fetal karyotype in a sample of pregnant women attending our clinic at the beginning of pregnancy.Subjects and methods
We performed a case-control study. A series of patients who underwent first-trimester combined screening as part of antenatal care between January 2009 and January 2010 were selected.Results
Of the maternal complications registered during the pregnancy, gestational diabetes was more frequent among cases.Conclusions
The incidence of the remaining complications analyzed (intrauterine restricted growth, preeclampsia, oligoamnios) was similar in the two groups. In most of the pregnant women, delivery occurred after 37 weeks through the vaginal route. 相似文献4.
Pluvio Jesús Coronado Martín Juana Brenes SánchezMaría Fasero Laiz Fernando Bullón SopelanaJosé Antonio Vidart Aragón 《Progresos de Obstetricia y Ginecología》2006
Objective
To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia.Material and methods
We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated.Results
The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients.Conclusions
Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia. 相似文献5.
Eduardo Reyna-Villasmil Jorly Mejia-MontillaNadia Reyna-Villasmil Duly Torres-CepedaJoel Santos-Bolívar Jhoan Aragón-CharryIsmael Suárez-Torres 《Progresos de Obstetricia y Ginecología》2014
Objective
To compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women.Materials and method
We included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis.Results
Plasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05).Conclusion
The findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women. 相似文献6.
Objective
Our primary aim was to investigate if women with early or late preeclampsia have different placental perfusion compared with normal pregnancies. A secondary aim was to investigate if placental perfusion changes with increasing gestational age in normal pregnancy.Methods
The study population included thirteen women with preeclampsia (five with early and eight with late preeclampsia) and nineteen women with normal pregnancy (ten with early and nine with late pregnancy). Early was defined as <34 weeks and late as ≥34 weeks gestation. All women underwent a magnetic resonance imaging (MRI) examination including a diffusion weighted sequence at 1.5 T. The perfusion fraction was calculated.Results
Women with early preeclampsia had a smaller placental perfusion fraction (p = 0.001) and women with late preeclampsia had a larger placental perfusion fraction (p = 0.011), compared to women with normal pregnancies at the corresponding gestational age. The placental perfusion fraction decreased with increasing gestational age in normal pregnancies (p = 0.001).Conclusion
Both early and late preeclampsia differ in placental perfusion from normal pregnant women. Observed differences are however in the opposite direction, suggesting differences in pathophysiology. Placental perfusion decreases with increasing gestational age in normal pregnancy. 相似文献7.
Raquel Carrillo-Vadillo Juan Carlos García-Lozano Ana Peciña López Lucas Cerrillos-González Rafael Torrejón Cardoso 《Progresos de Obstetricia y Ginecología》2010
Objectives
To report a case of partial hydatidiform mole presenting as preeclampsia at 17 weeks of gestation and to review the data on the diagnosis and management of this entity.Case Rrport
The patient was admitted for severe preeclampsia. Ultrasound and cytogenetic studies revealed a partial hydatiform mole. Abdominal uterine evacuation was performed and the patient was monitored until the process resolved.Discussion
Partial hydatiform mole usually manifests as first-trimester metrorrhagia. This entity is not generally associated with specific fetal anomalies, but retarded fetal growth is almost always present. These moles rarely present with a picture of early-onset preeclampsia, as in the present case. Diagnosis is based on ultrasound, human chorionic gonadotropin (HCG) measurements and fetal karyotype, although the definitive diagnosis is histological. Partial hydatiform mole is considered a localized disease that usually resolves with uterine evacuation. However, in some patients, there can be persistent trophoblastic disease.Conclusion
Diagnosis of partial hydatiform mole should be taken into account in patients with early onset preeclampsia. 相似文献8.
Eduardo Reyna-Villasmil Jorly Mejia-MontillaNadia Reyna-Villasmil Duly Torres-CepedaJoel Santos-Bolívar 《Progresos de Obstetricia y Ginecología》2012
Objective
To establish the usefulness of neurokinin B concentrations as a risk marker in patients with preeclampsia.Method
A total of 100 patients were selected. Fifty patients with preeclampsia were selected as cases (group A) and 50 healthy normotensive pregnant women with a similar age and body mass index to the study group were selected as controls (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine neurokinin B concentrations.Results
Statistically significant differences in neurokinin B concentrations were found between group A (16.3 ± 9.6 ng/L) and group B (3.5 ± 2.0 ng/L; P<.05). There was a positive and significant correlation with values of systolic and diastolic blood pressure (P<.05). A cut-off value of 5 pg/ml had a value under the curve of 0.93, sensitivity of 75.0%, specificity of 87.5%, a positive predictive value of 90.0%, a negative predictive value of 70.0%, and a diagnostic accuracy of 81.2%.Conclusions
Concentrations of neurokinin B were significantly higher in patients with preeclampsia than in healthy normotensive pregnant women. This peptide is useful as a risk marker in patients with preeclampsia. 相似文献9.
María José Miranda Lucas Marta Jane Serra Ramón María Miralles Pi Miriam de la Flor Lopez 《Progresos de Obstetricia y Ginecología》2014
Background
Postpartum hemorrhage is a potentially serious complication and includes bruising of the birth canal. It is vitally important that the diagnosis and treatment take place at an early stage.Case
We report a serious case of bruising of the birth canal that required selective embolization after unsuccessful local surgical treatment, with hypovolemic shock and disseminated intravascular coagulation.Conclusion
Embolization requires an infrastructure and technology that are available in tertiary care hospitals. Early diagnosis allows embolization to be performed in hemodynamically stable patients. Uterine artery embolization in expert hands enables future fertility to be preserved with few complications. 相似文献10.
Rita Vidal Hernández M. Rut Aguiar CoutoMarta Vázquez Rodríguez Ángel Zoido PérezAlfonso Otero Valenzuela 《Progresos de Obstetricia y Ginecología》2007
Objective
To evaluate didelphic uterus as a cause of abdominal pain.Material and method
We reviewed 2 cases in adolescents managed by our service from 2002 to 2006.Results
In both patients, we confirmed the existence of didelphic uterus and septate vagina associated with renal agenesis. Outcome was favorable in both patients after surgery.Conclusions
The 2 cases described illustrate the need to include congenital abnormalities in the differential diagnosis of lower abdominal pain and vaginal mass in adolescents. 相似文献11.
Introduction
Preeclampsia is a pregnancy-specific disorder and placental factor(s) contribute to the pathogenesis of preeclampsia. Turnover of villous trophoblast is affected by impaired placental perfusion in preeclampsia. Expression and localisation of cadherins and cytokeratins are involved in the pathogenesis of preeclampsia. However, studies describing the associations between cadherins and cytokeratins in preeclampsia are limited. The aim of this study was to investigate the expression of E-cadherin, N-cadherin, cytokeratin 18 and cytokeratin 19 in placentae from women with preeclampsia in order to determine whether their expression differs with disease severity.Methods
29 preeclamptic placentae and 25 normotensive placentae were included in this study. The expression of E-cadherin, cytokeratin 18, cytokeratin 19 andN-cadherin was quantified by immunohistochemistry and western blotting.Results
E-cadherin, cytokeratin 18 and cytokeratin 19 were expressed predominantly in the syncytiotrophoblast of the placenta and the expression of E-cadherin, cytokeratin 18 and cytokeratin 19 was significantly increased in preeclampsia compared to normotensive pregnancies. However, there was no significant difference in expression between severe preeclampsia and mild preeclampsia. In addition, there was no difference in the expression of N-cadherin between preeclampsic and normotensive pregnancies.Discussion
Our data demonstrated increased expression of E-cadherin, cytokeratin 18 and cytokeratin 19 in the syncytiotrophoblast of preeclamptic placentae, but this increase was not correlated with disease severity.Conclusion
Our data suggests that E-cadherin and cytokeratins are involved in the pathogenesis of preeclampsia. 相似文献12.
Eduardo Reyna-Villasmil Jorly Mejia-MontillaDuly Torres-Cepeda Joel Santos-BolívarJhoan Aragon-Charrys Nadia Reyna-VillasmilAlfonso Bravo-Henríquez 《Progresos de Obstetricia y Ginecología》2014
Objective
To compare plasma homocysteine concentrations in preeclamptic, eclamptic and normotensive pregnant patients before and after delivery.Methods
We included 30 patients with mild preeclampsia (group A), 30 patients with severe pre-eclampsia (group B), and 30 patients with eclampsia (group C). A control group of 35 normotensive women (group D) was selected with a similar age and body mass index as the study groups. In all groups, blood samples were collected in all patients before delivery, and post-partum follow-up samples were collected at 7 days and 6 weeks.Results
Statically significant differences were found between controls and the three study groups in birthweight (P<.05). Before delivery, the highest concentrations were seen in eclamptic patients followed by those with severe preeclampsia. Concentrations were significantly higher in the three study groups than in controls (P<.05). At 7 days and 6 weeks, mean homocysteine concentrations were significantly higher in groups A, B and C than in group D (P<.05).Conclusions
Homocysteine concentrations were significantly higher in pre-eclamptic and eclamptic patients than in normotensive pregnant women and remained higher at 6 weeks after delivery. 相似文献13.
Resultados perinatales de un protocolo de atención para gestantes con riesgo de prematuridad extrema
A. Corrales Gutiérrez J.A. Suarez GonzalezM.R. Cabrera Delgado M.E. Benavides Casal 《Clínica e investigación en ginecología y obstetricia》2014
Introduction
Gestational age and birthweight are the most important variables that influence perinatal outcomes and future quality of life.Method
An intervention project was applied following a protocol for the perinatal care of women admitted to the Mariana Grajales Perinatal Care Unit in Santa Clara at risk of extremely preterm delivery (26 to 32 weeks).Objective
To evaluate perinatal results and neonatal survival in this high-risk group.Results
The causes of extreme prematurity were, in order of frequency, aggravated preeclampsia, premature rupture of membranes, spontaneous delivery, and gastorrhagia in the second half of pregnancy. The most common route of delivery was cesarean section. Birthweight was less than 1 500 g in 52% of the neonates, mainly due to preeclampsia and preterm delivery. Low Apgar scores of 4-6 were found in 12.3% of the neonates with 100% recovery at 5 minutes. Delivery occurred at less than 30 weeks in 30.1%. Pregnancy was prolonged by 8.6 days in preeclampsia, by 6 days in premature rupture of membranes and by 322 days in preterm delivery. The most frequent complications were hyaline membrane disease (15%) and sepsis (36.9%), which provoked one death.Conclusions
Survival in this group of high-risk neonates was high, decisively influencing the low infant mortality rate in this unit in 2009-2010. 相似文献14.
Pedro Luis Martínez Castro M. Dolores Atero CigalatJosé Manuel Bosch Martí Amparo Covisa PerisEsther Estellés Chapa Ana García GarcíaCristina Zorrero Martínez Enrique García García 《Progresos de Obstetricia y Ginecología》2008
Objective
To determine the prevalence of endometrial adenocarcinoma in patients with a diagnosis of atypical endometrial hyperplasia after endometrial biopsy.Patients and methods
Twenty patients with a diagnosis of atypical endometrial hyperplasia after endometrial biopsy by means of office hysteroscopy and/or after endometrial resection by means of operative hysteroscopy.Results
Hysterectomy was performed in 15 patients and eight cases of endometrial adenocarcinoma were found. Reintervention was required in two patients, who underwent laparoscopic lymphadenectomy. 相似文献15.
A. Nankali Sh. Malek-khosravi M. Zangeneh M. Rezaei Z. Hemati M. Kohzadi 《Journal of obstetrics and gynaecology of India》2013,63(2):112-115
Objective
Hypertension disorders are associated with higher rates of maternal, fetal, and infant mortality, and severe morbidity, especially in cases of severe preeclampsia, eclampsia, and HELLP syndrome. The aim of the study was to determine maternal outcomes in pregnant women with severe preeclampsia.Data Source
The data source consisted of 349 cases with severe preeclampsia.Design
A cross-sectional study was undertaken on 349 cases of severe preeclampsia in pregnancy.Setting/Period
The patients selected for this study were from those who presented at Kermanshah University of Medical Sciences, Department of Obstetrics and Gynecology during 2007–2009.Materials and Methods
Statistical analysis was performed using SPSS 16 software and conducting Chi square and independent sample t tests. Demographic data involving age, parity, gestational age, clinical, and laboratory findings were recorded from the medical files. In addition, delivery route, indications of cesarean delivery, and maternal complications were determined.Results
Of the 349 severely preeclampsia cases, among the 22 cases (6.3 %) who had suffered from eclamptic seizers, 17 cases (77.3 %) were in the age group of 18–35 years (P = 0.351) and 13 cases (59.1 %) in the gestational age group of 28–37 weeks (P = 0.112). One case (0.3 %) was demonstrated to have HELLP syndrome. Placental abruption was obstetric complication in 7.7 % (27 cases). Delivery route was vaginal in 120 cases (34.4 %), while 229 cases (65.6 %) underwent cesarean delivery. The most frequent maternal complication (37 cases) reported was coagulopathy (10.6 %).Conclusions
We concluded that severe preeclampsia and eclampsia are associated with higher rates of maternal severe morbidity and that these two factors still remain the major contributors to maternal morbidity in Iran. 相似文献16.
Introduction
Preeclampsia is a serious pregnancy complication. Soluble endoglin (sEng) is released from the placenta and contributes to the maternal endothelial dysfunction seen in preeclampsia. Recently oxysterols, which activate the Liver X Receptor (LXR), have been implicated in producing sEng, by upregulating matrix metalloproteinase-14 (MMP14; cleaves endoglin to produce sEng) and down-regulating tissue inhibitor of metalloproteinase-3 (TIMP-3; inhibitor of MMP14). The functional experiments in that study were performed on JAR cells (human choriocarcinoma cell line) and placental explants.Methods
We characterized LXR in severe preeclamptic placentas, and assessed whether oxysterols increase release of sEng from primary human umbilical vein endothelial cells (HUVECs), primary trophoblasts and placental explants. Given pravastatin is thought to block oxysterol production and inhibit the LXR, we examined whether pravastatin reduces sEng release.Results
LXRα and β were localized to the syncytiotrophoblast and villous tips and were significantly up-regulated in preeclamptic placenta. Oxysterols upregulated sEng production in HUVECs and placental explants although the increases were far more modest than that recently reported. Oxysterols did not upregulate sEng in primary trophoblasts. Furthermore, mRNA expression of MMP14 and TIMP-3 were not altered by oxysterols in any tissue. Surprisingly, pravastatin did not decrease oxysterol-induced upregulation of sEng.Discussion
LXR is up-regulated in preeclamptic placenta. Oxysterols upregulate sEng production from human tissues, but the increase is modest, suggesting this may not be the main mechanism for the very significant elevations in sEng seen in preeclampsia. Pravastatin does not decrease sEng production.Conclusion
Oxysterols modestly up-regulate sEng production which is not quenched by pravastatin. 相似文献17.
Sushil Chawla Ashish Marwaha Raju Agarwal 《Journal of obstetrics and gynaecology of India》2015,65(3):172-175
Objectives
To ascertain the prevalence, presentation, diagnosis, severity, and complications of HELLP syndrome.Materials and Methods
This is a prospective observational study analyzing the conditions and the data of 24 cases of HELLP syndrome in a tertiary care hospital. The analysis was done for the demographic characteristics, presentation of these patients, complications associated, and the perinatal outcome.Results
0.45 % of the patients admitted for delivery developed HELLP syndrome. Majority of the patients developed the condition in 30–36 weeks period of gestation, while five patients developed it in the postpartum period. The condition led to 12.5 % of maternal and 45.8 % of perinatal mortality.Conclusion
HELLP syndrome is an important cause for maternal and perinatal morbidity and mortality. 相似文献18.
Objectives
The aim of this study was to determine the expression of the anaphylatoxin receptors complement C3a receptor (C3aR) and C5a receptor (C5aR) in the placentas of pregnancies complicated by severe early onset preeclampsia.Study design
We recruited women with pregnancies complicated by severe early-onset preeclampsia (n = 19, 11 of which were further complicated with IUGR) and women with preterm pregnancies not affected by preeclampsia (n = 8). Gene and protein expression of C3aR and C5aR was analysed by quantitative RT-PCR and Western blotting, respectively.Results
C3aR was detected in the Hofbauer cells in the villous stroma of the placenta. C5aR staining was detected in the syncytiotrophoblast and endothelial cells. We found significantly decreased expression of C3aR mRNA and protein expression in placentas with preeclampsia compared to controls. However, C5aR expression was not significantly different between preeclamptic and control placentas at either the mRNA or protein level.Conclusions
Decreased C3aR expression indicates a dysregulation of the complement system in the placentas of preeclamptic women. Further studies would elucidate the exact mechanisms that complement has in preeclampsia. 相似文献19.
Marcus-Braun N Bourret A von Theobald P 《European journal of obstetrics, gynecology, and reproductive biology》2012,162(2):224-228
Objective
Persistent pelvic pain after vaginal mesh surgery is an uncommon but serious complication that greatly affects women's quality of life. Our aim was to evaluate various procedures for mesh removal performed at a tertiary referral center in cases of persistent pelvic pain, and to evaluate the ensuing complications and outcomes.Study design
A retrospective study was conducted at the University Hospital of Caen, France, including all patients treated for removal or section of vaginal mesh due to pelvic pain as a primary cause, between January 2004 and September 2009.Results
Ten patients met the inclusion criteria. Patients were diagnosed between 10 months and 3 years after their primary operation. Eight cases followed suburethral sling procedures and two followed mesh surgery for pelvic organ prolapse. Patients presented with obturator neuralgia (6), pudendal neuralgia (2), dyspareunia (1), and non-specific pain (1). The surgical treatment to release the mesh included: three cases of extra-peritoneal laparoscopy, four cases of complete vaginal mesh removal, one case of partial mesh removal and two cases of section of the suburethral sling. In all patients with obturator neuralgia, symptoms were resolved or improved, whereas in both cases of pudendal neuralgia the symptoms continued. There were no intra-operative complications. Post-operative Retzius hematoma was observed in one patient after laparoscopy.Conclusions
Mesh removal in a tertiary center is a safe procedure, necessary in some cases of persistent pelvic pain. Obturator neuralgia seems to be easier to treat than pudendal neuralgia. Early diagnosis is the key to success in prevention of chronic disease. 相似文献20.
Ana María Rubio Lorente Ana Belén González LópezEsteban González Mirasol Gaspar González de Merlo 《Progresos de Obstetricia y Ginecología》2011,54(1):4-8