RESUMEN
Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and endoglin levels and decreased placental growth factor levels. Proton pump inhibitors (PPIs) decrease trophoblast sFlt-1 and endoglin secretion in vitro. PPIs are used during pregnancy to combat reflux disease. Here, we investigated whether PPIs affect sFlt-1 in women with confirmed/suspected preeclampsia, making use of a prospective cohort study involving 430 women. Of these women, 40 took PPIs (6 esomeprazole, 32 omeprazole, and 2 pantoprazole) for 8 to 45 (median 29) days before sFlt-1 measurement. Measurements were only made once, at study entry between weeks 20 and 41 (median 33 weeks). PPI use was associated with lower sFlt-1 levels, with no change in placental growth factor levels, both when compared with all non-PPI users and with 80 gestational age-matched controls selected from the non-PPI users. No sFlt-1/placental growth factor alterations were observed in women using ferrous fumarate or macrogol while, as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower placental growth factor levels. The PPI use-associated decrease in sFlt-1 was independent of the application of antihypertensive drugs and also occurred when restricting our analysis to patients with hypertensive disease of pregnancy at study entry. PPI users displayed more cases with preexisting proteinuria, less gestational hypertension, and a lower number of neonatal sepsis cases. Finally, their plasma endoglin and endothelin-1 levels were lower while sFlt-1 levels correlated positively with both. In conclusion, PPI use associates with low sFlt-1, endoglin, and endothelin-1 levels, warranting prospective trials to investigate the therapeutic potential of PPIs in preeclampsia.
Asunto(s)
Endoglina/metabolismo , Endotelina-1/metabolismo , Preeclampsia , Inhibidores de la Bomba de Protones , Receptor 1 de Factores de Crecimiento Endotelial Vascular , Adulto , Determinación de la Presión Sanguínea/métodos , Estudios de Cohortes , Femenino , Reflujo Gastroesofágico/prevención & control , Edad Gestacional , Humanos , Países Bajos/epidemiología , Pruebas de Función Placentaria/métodos , Preeclampsia/tratamiento farmacológico , Preeclampsia/epidemiología , Preeclampsia/metabolismo , Preeclampsia/fisiopatología , Embarazo , Estudios Prospectivos , Inhibidores de la Bomba de Protones/administración & dosificación , Inhibidores de la Bomba de Protones/efectos adversos , Receptor 1 de Factores de Crecimiento Endotelial Vascular/análisis , Receptor 1 de Factores de Crecimiento Endotelial Vascular/metabolismoRESUMEN
BACKGROUND: The placenta has an essential role in determining the outcome of pregnancy. Consequently, biochemical measurement of placentally-derived factors has been suggested as a means to improve fetal and maternal outcome of pregnancy. OBJECTIVES: To assess whether clinicians' knowledge of the results of biochemical tests of placental function is associated with improvement in fetal or maternal outcome of pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised, cluster-randomised or quasi-randomised controlled trials assessing the merits of the use of biochemical tests of placental function to improve pregnancy outcome.Studies were eligible if they compared women who had placental function tests and the results were available to their clinicians with women who either did not have the tests, or the tests were done but the results were not available to the clinicians. The placental function tests were any biochemical test of placental function carried out using the woman's maternal biofluid, either alone or in combination with other placental function test/s. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, extracted data and assessed trial quality. Authors of published trials were contacted for further information. MAIN RESULTS: Three trials were included, two quasi-randomised controlled trials and one randomised controlled trial. One trial was deemed to be at low risk of bias while the other two were at high risk of bias. Different biochemical analytes were measured - oestrogen was measured in one trial and the other two measured human placental lactogen (hPL). One trial did not contribute outcome data, therefore, the results of this review are based on two trials with 740 participants.There was no evidence of a difference in the incidence of death of a baby (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.36 to 2.13, two trials, 740 participants (very low quality evidence)) or the frequency of a small-for-gestational-age infant (RR 0.44, 95% CI 0.16 to 1.19, one trial, 118 participants (low quality evidence)).In terms of this review's secondary outcomes, there was no evidence of a clear difference between women who had biochemical tests of placental function compared with standard antenatal care for the incidence of stillbirth (RR 0.56, 95% CI 0.16 to 1.88, two trials, 740 participants (very low quality evidence)) or neonatal death (RR 1.62, 95% CI 0.39 to 6.74, two trials, 740 participants, very low quality evidence)) although the directions of any potential effect were in opposing directions. There was no evidence of a difference between groups in elective delivery (RR 0.98, 95% CI 0.84 to 1.14, two trials, 740 participants (low quality evidence)), caesarean section (one trial, RR 0.48, 95% CI 0.15 to 1.52, one trial, 118 participants (low quality evidence)), change in anxiety score (mean difference -2.40, 95% CI -4.78 to -0.02, one trial, 118 participants), admissions to neonatal intensive care (RR 0.32, 95% CI 0.03 to 3.01, one trial, 118 participants), and preterm birth before 37 weeks' gestation (RR 2.90, 95% CI 0.12 to 69.81, one trial, 118 participants). One trial (118 participants) reported that there were no cases of serious neonatal morbidity. Maternal death was not reported.A number of this review's secondary outcomes relating to the baby were not reported in the included studies, namely: umbilical artery pH < 7.0, neonatal intensive care for more than seven days, very preterm birth (< 32 weeks' gestation), need for ventilation, organ failure, fetal abnormality, neurodevelopment in childhood (cerebral palsy, neurodevelopmental delay). Similarly, a number of this review's maternal secondary outcomes were not reported in the included studies (admission to intensive care, high dependency unit admission, hospital admission for > seven days, pre-eclampsia, eclampsia, and women's perception of care). AUTHORS' CONCLUSIONS: There is insufficient evidence to support the use of biochemical tests of placental function to reduce perinatal mortality or increase identification of small-for-gestational-age infants. However, we were only able to include data from two studies that measured oestrogens and hPL. The quality of the evidence was low or very low.Two of the trials were performed in the 1970s on women with a variety of antenatal complications and this evidence cannot be generalised to women at low-risk of complications or groups of women with specific pregnancy complications (e.g. fetal growth restriction). Furthermore, outcomes described in the 1970s may not reflect what would be expected at present. For example, neonatal mortality rates have fallen substantially, such that an infant delivered at 28 weeks would have a greater chance of survival were those studies repeated; this may affect the primary outcome of the meta-analysis.With data from just two studies (740 women), this review is underpowered to detect a difference in the incidence of death of a baby or the frequency of a small-for-gestational-age infant as these have a background incidence of approximately 0.75% and 10% of pregnancies respectively. Similarly, this review is underpowered to detect differences between serious and/or rare adverse events such as severe neonatal morbidity. Two of the three included studies were quasi-randomised, with significant risk of bias from group allocation. Additionally, there may be performance bias as in one of the two studies contributing data, participants receiving standard care did not have venepuncture, so clinicians treating participants could identify which arm of the study they were in. Future studies should consider more robust randomisation methods and concealment of group allocation and should be adequately powered to detect differences in rare adverse events.The studies identified in this review examined two different analytes: oestrogens and hPL. There are many other placental products that could be employed as surrogates of placental function, including: placental growth factor (PlGF), human chorionic gonadotrophin (hCG), plasma protein A (PAPP-A), placental protein 13 (PP-13), pregnancy-specific glycoproteins and progesterone metabolites and further studies should be encouraged to investigate these other placental products. Future randomised controlled trials should test analytes identified as having the best predictive reliability for placental dysfunction leading to small-for-gestational-age infants and perinatal mortality.
Asunto(s)
Placenta/fisiología , Pruebas de Función Placentaria/métodos , Resultado del Embarazo , Biomarcadores/sangre , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Muerte Perinatal , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Mortinato/epidemiologíaRESUMEN
NEW FINDINGS: What is the topic of this review? This review focuses on the effects of insulin therapy on fetoplacental vasculature in gestational diabetes mellitus and the potentiating effects of adenosine on this therapy. What advances does it highlight? This review highlights recent studies exploring a potential functional link between insulin receptors and their dependence on adenosine receptor activation (insulin-adenosine axis) to restore placental endothelial function in gestational diabetes mellitus. Gestational diabetes mellitus (GDM) is a disease that occurs during pregnancy and is associated with maternal and fetal hyperglycaemia. Women with GDM are treated via diet to control their glycaemia; however, a proportion of these patients do not achieve the recommended values of glycaemia and are subjected to insulin therapy until delivery. Even if a diet-treated GDM pregnancy leads to normal maternal and newborn glucose levels, fetoplacental vascular dysfunction remains evident. Thus, control of glycaemia via diet does not prevent GDM-associated fetoplacental vascular and metabolic alterations. We review the available information regarding insulin therapy in the context of its potential consequences for fetoplacental vascular function in GDM. We propose the possibility that insulin therapy to produce normoglycaemia in the mother and newborn may require additional therapeutic measures to restore the normal metabolic condition of the vascular network in GDM. A role for A1 and A2A adenosine receptors and insulin receptors A and B as well as a potential functional link in the cell signalling associated with the activation of these receptors is proposed. This possibility could be helpful for the planning of strategies, including adenosine receptor-improved insulin therapy, for the treatment of GDM patients, thereby promoting the wellbeing of the growing fetus, newborn and mother.
Asunto(s)
Diabetes Gestacional/tratamiento farmacológico , Diabetes Gestacional/fisiopatología , Insulina/uso terapéutico , Circulación Placentaria/fisiología , Femenino , Humanos , Recién Nacido , Pruebas de Función Placentaria/métodos , EmbarazoRESUMEN
Blood platelets are highly specialized cells that drive hemostatic events and tissue repair mechanisms at the site of vascular injury. Their peculiar morphology and certain functional characteristics can be analyzed by flow cytometry (FCM). Specifically, platelet activation, a hallmark of prothrombotic states and inflammatory conditions, is associated with changes in expression of both surface and intracellular antigens that are recognized by specific monoclonal antibodies. Assessment of platelet activation status as ex vivo or in vitro reactivity to specific agonists has become relevant in particular conditions (namely, cardiovascular diseases, hematological malignancies, monitoring of pharmacological antiaggregation). In addition, aberrant surface marker expression that characterizes inherited and acquired platelet function disorders is also detected by FCM. This review discusses the main applications of FCM in platelet analyses, which are relevant for both research and clinical settings.
Asunto(s)
Plaquetas/metabolismo , Plaquetas/patología , Citometría de Flujo/métodos , Animales , Anticuerpos Monoclonales/química , Antígenos de Plaqueta Humana/biosíntesis , Regulación de la Expresión Génica , Humanos , Pruebas de Función Placentaria/métodosAsunto(s)
Errores Diagnósticos/prevención & control , Enfermedades Placentarias/diagnóstico , Placenta/patología , Pruebas de Función Placentaria , Femenino , Humanos , Servicio de Ginecología y Obstetricia en Hospital/normas , Pruebas de Función Placentaria/métodos , Pruebas de Función Placentaria/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , EmbarazoRESUMEN
BACKGROUND: Biochemical tests of placental or feto-placental function were widely used in the 1960s and 1970s in high-risk pregnancies to try to predict, and thus try to avoid, adverse fetal outcome. OBJECTIVES: To assess the effects of performing biochemical tests of placental function in high-risk, low-risk, or unselected pregnancies. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 May 2012). SELECTION CRITERIA: Controlled trials (randomized or 'quasi-randomized') that compare the use of biochemical tests of placental function in pregnancy with non-use. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by the review author. MAIN RESULTS: A single eligible trial of poor quality was identified. It involved 622 women with high-risk pregnancies who had had plasma (o)estriol estimations. Women were allocated to have their (o)estriol results revealed or concealed on the basis of hospital record number (with attendant risk of selection bias). There were no obvious differences in perinatal mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.36 to 2.13) or planned delivery (RR 0.97, 95% CI 0.81 to 1.15) between the two groups. AUTHORS' CONCLUSIONS: The available trial data do not support the use of (o)estriol estimation in high-risk pregnancies. The single small trial available does not have the power to exclude a beneficial effect but this is probably of historical interest since biochemical testing has been superseded by biophysical testing in antepartum fetal assessment.
Asunto(s)
Estriol/sangre , Enfermedades Fetales/diagnóstico , Embarazo de Alto Riesgo/sangre , Biomarcadores/sangre , Femenino , Humanos , Pruebas de Función Placentaria/métodos , Embarazo , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Identification of outpatients with high platelet reactivity (HPR) on antiplatelet treatment is an unmet need. The present study was conducted in healthy individuals (n = 50) and in outpatients with coronary artery disease (CAD) at a distance from the acute ischemic episode (aspirin group, n = 71; aspirin/clopidogrel group, n = 106). We studied the feasibility and the precision of whole blood multiple electrode aggregometry (MEA) after triggering platelet aggregation by arachidonic acid or adenosine diphospate (ADP). The MEA can be performed on whole blood within 2 hours after sample venipuncture. The threshold for the diagnosis of HPR is situated at 55 and 50 U for the arachidonic acid and ADP test, respectively. Frequency of HPR was 7% and 20% in aspirin and aspirin/clopidogrel groups, respectively. In 3.8% of patients in aspirin/clopidogrel group, combined HPR on aspirin and clopidogrel was found. In outpatients with CAD, use of MEA is feasible for the diagnosis of HPR.
Asunto(s)
Aspirina/administración & dosificación , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Agregación Plaquetaria/efectos de los fármacos , Ticlopidina/análogos & derivados , Adulto , Anciano , Clopidogrel , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función Placentaria/métodos , Ticlopidina/administración & dosificaciónRESUMEN
OBJECTIVE: To explore the clinical values in detecting the placental elastic modulus using real-time quantitative shear wave elasticity imaging. METHODS: A total of 30 women in the late pregnancy stage without complications and having normal, single pregnancies, as well as normal fetal growth, amniotic fluid index, and anterior placenta were selected. A real-time elasticity imaging shear wave ultrasonic diagnostic apparatus was used to randomly select regions of interest at the central and edge of the placenta. The elastography imaging mode was launched to measure the elasticity of the elastic modulus of these placental parts. A total of 15 measured values were obtained at the placental center and edge for each pregnancy case. Umbilical artery and uterine artery pulsatility index (PI) values for 18 cases were also randomly measured. RESULTS: The average value of 30 placental edges of the elastic modulus (n = 15) was (7.60 +/- 1.71) kPa. The average value of the 30 placental central elastic modulus (n = 15 ) was (7.84 +/- 1.68) kPa. No significant difference was observed between placenta central and edge elastic modulus. The PI mean value of umbilical artery in 18 cases was 0.94, whereas the average PI values of the uterine artery was 0.83. No linear correlation was found among the elastic modulus, the placental uterine artery PI values, and the umbilical artery PI values (p > 0.05). CONCLUSION: No difference between the placental center of normal pregnancies and the edge of the elastic modulus was detected. The elastic modulus of the placenta could be obtained in the best position. The placenta varied greatly between elastic modulus. No correlation was found between the placental elastic modulus, the uterine artery, and umbilical artery PI values. Real-time shear wave elasticity imaging technology can provide morphological evidence of placental function, which may emerge as a new clinical assessment approach.
Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Placenta/fisiopatología , Pruebas de Función Placentaria/métodos , Ultrasonografía Prenatal/métodos , Adulto , Femenino , Humanos , Embarazo , Flujo Pulsátil , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiologíaRESUMEN
BACKGROUND: To examine if different pathogen-reduction technologies (PRTs) induce different degrees of platelet (PLT) storage lesion. DESIGN: Twenty-seven split triple-dose apheresis PLTs were PRT treated using ultraviolet light with either riboflavin (M) or psoralen (I) or remained untreated (C). Samples taken on days (d) 0 to 8 were analysed for PLT count, blood gas (pH, pO(2) and pCO(2)), metabolism (lactate, glucose, ATP content), in vitro function [swirling, hypotonic shock response (HSR) and aggregation], activation (p-selectin expression) and cellular integrity (JC-1 signal, annexin A5 release). RESULTS: Platelet counts of all study groups remained unchanged during storage indicating that PRT treatment did not induce relevant cell lysis. Although M units demonstrated the highest values for HSR until d5, PRT treatment lowered all parameters examined with significant differences to untreated controls by d7 of storage. During final storage, M was significantly superior over I for HSR, aggregation with TRAP-6 as agonist (collagen was similar), annexin A5 release and JC-1 signal. Regarding blood gas and metabolic analysis, the most evident effect of PRT was an elevated glycolytic flux combined with higher acidity due to increased lactate accumulation. Most likely due to impaired O(2) consumption, pH and ATP decreased more rapidly in I relative to C and M. CONCLUSION: Pathogen reduction technology-treated PLTs remained comparable to untreated units throughout 7 days of storage. Mitochondria-based oxidative respiration appeared up-regulated after the riboflavin-based PRT. Compared to the psoralen-based PRT, this resulted in significantly better ATP maintenance and in vitro function during the last storage period (d7, d8).
Asunto(s)
Plaquetas/metabolismo , Desinfección/métodos , Fármacos Fotosensibilizantes/farmacología , Agregación Plaquetaria/efectos de los fármacos , Agregación Plaquetaria/efectos de la radiación , Plaquetoferesis/métodos , Riboflavina/farmacología , Rayos Ultravioleta , Plaquetas/citología , Conservación de la Sangre , Furocumarinas/farmacología , Humanos , Pruebas de Función Placentaria/métodos , Recuento de PlaquetasRESUMEN
1. PBF 8 o 10 /10 es signo de bienestar fetal. 2. PBF 6/10 es considerado equívoco en la predicción de asfixia fetal. 3. PBF 0 a 4/10 sugiere alto riesgo de asfixia fetal severa si no se interviene en una semana. 4. PBF se indica en embarazo con riesgos de compromiso fetal hipóxico-isquémico. 5. Se puede realizar una o más veces a la semana si la condición clínica lo requiere. 6.- El PBF es no invasivo; es fácil de aprender y de realizar. Bien indicado tiene un alto rendimiento. 7. Debe efectuarse siempre en período post prandial. Al completar esta actualización, hemos podido reenfocar nuestro estudio de la Unidad Feto-placentaria y con ello definir las indicaciones del perfil biofísico fetal en nuestra Unidad de Perinatología.
1. BFP 8 or 10/10 means fetal wellbeing. 2. BFP 6/10 is considered ambiguous for prediction of fetal asphyxia. 3. BFP 0 to 4/10 suggests high risk of fetal asphyxia if there's no intervention in a week. 4. BFP is indicated in pregnancies in risk for hypoxic-ischemic fetal damage. 5. BFP may be performed one time or more in a week depending on demand of the clinical condition. 6. BFP is non invasive; is easy to learn and to perform. If properly indicated its performance is high. 7. BFP must be performed always during post prandial periods. When finishing this update, we're able to re-focuse our studies of the feto-placental unit, and through this, to define the indications for biophysical fetal profile in our Perinatology Unit.
Asunto(s)
Humanos , Femenino , Embarazo , Feto/fisiología , Monitoreo Fetal/métodos , Pruebas de Función Placentaria/métodosAsunto(s)
Estetrol/sangre , Estradiol/sangre , Estriol/sangre , Estrona/sangre , Biomarcadores/sangre , Biomarcadores/orina , Climaterio , Colorimetría , Estetrol/orina , Estradiol/fisiología , Estradiol/orina , Estriol/fisiología , Estriol/orina , Estrona/fisiología , Estrona/orina , Femenino , Enfermedades Fetales/diagnóstico , Monitoreo Fetal , Cromatografía de Gases y Espectrometría de Masas , Enfermedades de los Genitales Femeninos/diagnóstico , Humanos , Pruebas de Función Ovárica , Pruebas de Función Placentaria/métodos , Embarazo , Complicaciones del Embarazo/diagnóstico , Diagnóstico Prenatal , RadioinmunoensayoRESUMEN
Estudiamos la actividad somática durante el registro de la frecuencia cardíaca fetal en condiciones basales (test basal), comparando los resultados obtenidos en función de la reactividad fetal.Analizamos los movimientos fetales, registrados mediante un cinetocardiotocógrafo, durante el test basal realizado a 100 gestantes, y se comparó el perfil de movimientos de los registros reactivos (51 casos) con los no reactivos (47 casos). Se utilizó un modelo informático experimental para el análisis de los movimientos, tanto de forma cuantitativa (número y porcentaje) como cualitativa (pequeña, mediana y larga duración). El número de movimientos fue mayor en los registros reactivos (55,3) que en los no reactivos (35,5) (p < 0,0001). Idéntica significación estadística se obtuvo al comparar el porcentaje de movimientos entre los registros reactivos (15,7 por ciento) y los no reactivos (9,2 por ciento). La comparación por tipos de movimientos fue igualmente significativa.La actividad somática es significativamente mayor cuando el test basal de la frecuencia cardíaca fetal es clasificado como reactivo (AU)
Asunto(s)
Adulto , Embarazo , Femenino , Humanos , Desarrollo Fetal/fisiología , Movimiento Fetal/fisiología , Monitoreo Fetal/métodos , Feto/anomalías , Feto/fisiopatología , Frecuencia Cardíaca/fisiología , Pruebas de Función Placentaria/métodos , Selección de Paciente , Movimiento Fetal/genética , Movimiento Fetal/inmunologíaRESUMEN
Muchos autores han informado del uso de la estimulación vibroacústica fetal como un método para mejorar la eficacia de la monitorización fetal no estresante sin modificar el valor predictivo de la prueba. Este estímulo altera el comportamiento fetal y la frecuencia cardíaca. La información disponible sugiere que la exposición del feto a la estimulación vibroacústica es clínicamente segura. Desde el punto de vista experimental, la estimulación vibroacústica ofrece la oportunidad de evaluar cómo responde el feto al ambiente externo. Serán precisas nuevas investigaciones para determinar la frecuencia optima, duración, intensidad y tipo de estímulo más útil (AU)
Asunto(s)
Frecuencia Cardíaca Fetal/fisiología , Edad Gestacional , Monitoreo Fetal , Sufrimiento Fetal , Pruebas de Función Placentaria/métodosRESUMEN
Nuestro objetivo fue evaluar el beneficio y el momento de inicio del test no estresante en los embarazos de bajo riesgo obstétrico de nuestro medio. Estudio retrospectivo de 100 gestaciones sin enfermedad asociada procedentes de nuestras consultas externas. Se evaluaron los siguientes parámetros: edad materna, paridad, test no estresante (TNS) semanal desde la semana 38 hasta el momento del parto, recuento de movimientos fetales, prueba de Pose cuando fue necesaria, monitorización intraparto, estudio bioquímico fetal cuando fue preciso, tipo de parto, peso del recién nacido (RN) y test de Apgar al primer y quinto minutos. Se realizó un estudio descriptivo de todas las variables y se compararon los resultados del último TNS con el test de Apgar del RN. Se consideraron significativos los valores de p < 0,05. Sólo se registró un 1 por ciento de TNS patológicos y se trataba de una gestación de 41 semanas. Ningún test de Apgar fue inferior a 8 a los 5 min. En nuestro medio, la monitorización fetal no estresante resulta innecesaria en embarazos de bajo riesgo obstétrico antes de la 40 semana de gestación, ya que no aporta beneficios en la valoración del estado del bienestar fetal (AU)
Asunto(s)
Embarazo , Femenino , Masculino , Humanos , Recién Nacido , Gestión de Riesgos/métodos , Indicadores de Salud , Frecuencia Cardíaca/fisiología , Protocolos Clínicos , Puntaje de Apgar , Indicadores de Morbimortalidad , Feto/fisiología , Monitoreo Fetal/métodos , Pruebas de Función Placentaria/métodos , Estudios Retrospectivos , Paridad , Oxitocina/análisis , Monitoreo Fetal/tendencias , Monitoreo Fetal , Monitoreo Fetal/clasificaciónRESUMEN
Objetivo: Evaluar la relación entre los niveles de hormona de crecimiento al nacimiento y a la edad de 9 años con la presión arterial del niño Material y métodos: Estudio prospectivo de seguimiento longitudinal (desde nacimiento hasta los 9 años de edad). Setenta y seis niños que nacieron en el Hospital Universitario Príncipe de Asturias durante 1990-1991 con mediciones funiculares de GH, IGF-I y glucosa, de estos 76, un niño falleció al año de vida por meningitis y 51 niños aceptaron participar. Se midió la presión arterial, antropometria del niño de 9 años y niveles séricos de GH, IGF-I y glucosa. Resultados: La presión arterial sistólica del niño de 9 años se asocia inversamente a los niveles fetales de GH (p = 0,002) y directamente con los parámetros antropométricos a la edad de 9 años (p = 0,004). Conclusiones: Estos resultados apoyan la hipótesis de que los desórdenes de la presión arterial pueden comenzar en el feto, en donde los niveles fetales de hormona de crecimiento tienen una relevancia fundamental (AU)
Asunto(s)
Femenino , Masculino , Humanos , Recién Nacido , Desarrollo Fetal/fisiología , Monitoreo Fetal/métodos , Presión Sanguínea/fisiología , Antropometría/métodos , Biomarcadores/análisis , Feto/fisiopatología , Feto/patología , Análisis de Regresión , Hormona de Crecimiento Humana/análisis , Hormona de Crecimiento Humana/fisiología , Pruebas de Función Placentaria/métodos , Estudios Prospectivos , Edad Gestacional , Índice de Masa Corporal , Radioinmunoensayo/métodosRESUMEN
Objetivo: La actividad pupilar depende del sistema nervioso autónomo y su regulación llega a alcanzar el córtex cerebral. En este artículo se estudia la evolución funcional del iris fetal en condiciones basales.Sujetos y métodos: Se examinaron mediante ultrasonidos 192 pupilas de fetos humanos desde las semanas 15 hasta la 42. Las imágenes eran digitalizadas para la medición informática de los perímetros de la pupila y del iris.Resultados: El perímetro del iris presenta un progreso lineal durante la gestación. El perímetro de la pupila muestra una evolución variable. A partir de la semana 23, el perímetro pupilar con relación al del iris es menor al 30 por 100. Esta relación, perímetro pupilar/iris, presenta una variación estadísticamente significativa a lo largo de la gestación (test de Kruskal-Wallis).Conclusiones: La actividad pupilar manifiesta una integridad de determinadas vías neurológicas y puede permitir un nuevo control neurológico de los fetos humanos (AU)
Asunto(s)
Adulto , Embarazo , Femenino , Masculino , Humanos , Pruebas del Campo Visual/métodos , Iris/anatomía & histología , Iris/fisiología , Pupila , Embriología/clasificación , Embriología/métodos , Neurología/métodos , Feto/anomalías , Feto/fisiología , Desarrollo Fetal , Monitoreo Fetal/métodos , Salud Ocular , Movimientos Oculares/fisiología , Ultrasonido/clasificación , Diagnóstico Prenatal/métodos , Movimiento Fetal/fisiología , Fotogrametría/métodos , Antropometría/métodos , Edad Gestacional , Diagnóstico por Imagen/métodos , Circunferencia del Brazo , Sistema Nervioso Autónomo/anomalías , Sistema Nervioso Autónomo/fisiología , Tálamo/fisiología , Corteza Cerebral/fisiología , Miosis/complicaciones , Miosis/diagnóstico , Fetoscopía/métodos , Feto/embriología , Feto/patología , Feto , Pruebas de Función Placentaria/métodosRESUMEN
The objective of this presentation is to describe noninvasive techniques of antepartum fetal assessment which allow the differentiation of fetuses who will benefit from remaining in-utero versus those who are at risk for intraamniotic infection and will benefit from your prompt delivery. The literature is reviewed in regard to the fetal biophysical profile, the effect of premature rupture of membranes (PROM), the usefulness of individual biophysical component in predicting intraamniotic infection (amniotic fluid volume, non-stress testing), the use of the fetal biophysical profile in improving pregnancy outcome, the relationships among umbilical artery velocimetry, fetal biophysical profile and intraamniotic infection and the mechanisms by which infection diminishes fetal biophysical activities in PROM. After reviewing our own as well as the published experience with the use of fetal biophysical assessment in patients with PROM, the following conclusions are suggested: a) most studies have shown strong correlation between abnormal biophysical assessment and infection outcome (maternal and/or neonatal infection) as well as intraamniotic infection, if there is frequent (i.e. daily) testing; and b) fetal biophysical tests (profiles, NSTs, amniotic fluid volume determinations) are quite reliable in predicting the well fetus who can safely remain in-utero and also the fetus who is at high risk for developing neonatal sepsis. A protocol for management of preterm PROM will be outlined based upon frequent (daily) fetal biophysical assessment. Although there are no controlled randomized trials to support that pregnancy outcome is improved by the use of frequent biophysical assessment, non-randomized studies as well as studies with historic controls suggest that the use of frequent biophysical assessment is beneficial in managing patients with PROM.
Asunto(s)
Desarrollo Embrionario y Fetal/fisiología , Rotura Prematura de Membranas Fetales/embriología , Diagnóstico Prenatal/métodos , Líquido Amniótico/fisiología , Fenómenos Biofísicos , Biofisica , Femenino , Rotura Prematura de Membranas Fetales/diagnóstico , Rotura Prematura de Membranas Fetales/terapia , Movimiento Fetal/fisiología , Humanos , Pruebas de Función Placentaria/métodos , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Diagnóstico Prenatal/normasRESUMEN
The permeability of the placental barrier to bromosulphophthalein (BSP) is believed to be very low. Whether this property is shared by other cholephilic organic anions, such as fluorescein isothiocyanate (FITC), is not known. When BSP was injected (140 mumol/kg body wt) into the left jugular vein of non-pregnant or pregnant female rats (at the 21st day of pregnancy), a similar and rapid plasma disappearance was observed during the first few minutes; afterwards, a slower disappearance phase was found. This phase was different in these groups, that is, a longer retention of BSP in the maternal bloodstream of pregnant rats was accompanied by a slower BSP output into bile. It was impossible to demonstrate the presence of BSP in fetal blood or the placenta by colorimetric methods. These results are consistent with the modifications occurring in the hepatic handling of BSP during pregnancy together with a marked impermeability of the placenta to the dye, at least in the mother-to-fetus direction. After intravenous FITC (10 mumol/kg body wt) administration to the mother, the compound was rapidly transferred into both the maternal bile and the fetal blood. Thereafter, FITC refluxed back from the fetal-placental compartment to the maternal blood as soon as the maternal liver reduced its plasma concentrations, which were first higher (approximately threefold) and then similar to those found in fetal blood. The reversible retention of FITC by the fetal-placental compartment accounts for a significant delay in both FITC bile output and plasma disappearance as compared with those observed in non-pregnant rats.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Bilis/metabolismo , Fluoresceína-5-Isotiocianato , Pruebas de Función Hepática/métodos , Intercambio Materno-Fetal/fisiología , Pruebas de Función Placentaria/métodos , Sulfobromoftaleína , Animales , Femenino , Fluoresceína-5-Isotiocianato/farmacocinética , Hígado/metabolismo , Placenta/metabolismo , Embarazo , Ratas , Ratas Wistar , Sulfobromoftaleína/farmacocinéticaRESUMEN
Radioimmunoassays of human placental lactogen and estriol levels in the maternal plasma, ultrasound biometry of the abdominal diameter (AD), pulsed Doppler measurements of uteroplacental arteries, the common carotid artery (CCA), and the umbilical artery (UA) and fetal heart rate monitoring were simultaneously performed in 219 risk pregnancies from 26 weeks' onward at regular intervals. The prognostic value of all tests to predict small for gestational age infants (SGA) and fetal distress was evaluated simultaneously. Receiver operator characteristic allowed the simultaneous comparison of all methods: The AD was most predictive for early detection of SGA, even more than uteroplacental blood flow. Fetal blood flow redistribution expressed as a ratio of the resistance index of CCA/UA was the most significant test for detection of fetal distress later in pregnancy, even more than antenatal cardiotocography. Considering cutoff levels used in clinical routine, the sensitivity and specificity of the fetal AD in detecting intrauterine growth retardation more than 28 days before birth, were 71 and 81%, respectively. Pulsed Doppler measurements of CCA/UA less than 7 days before the delivery had a sensitivity and specificity of 83 and 90%, respectively. Our results demonstrate the historical change in fetal surveillance within one study group: If accurate routine ultrasound is available, the use of biochemical placental function tests is not justified, a procedure that is already accepted in nearly all perinatal centers. Fetal cerebral versus umbilical blood flow measurements should be applied as a tool to measure fetal blood flow redistribution in small fetuses to predict most precisely the risk for poor outcome and perinatal hypoxia.