Etiologija preeklampsije Vulić, Marko
Gynaecologia et perinatologia (Zagreb, Croatia),
01/2019, Letnik:
28, Številka:
1-2
Journal Article
Recenzirano
Odprti dostop
Preeklampsija (PE) je najčešći oblik hipertenzivne bolesti u trudnoći, a javlja se s učestalošću od 2–7% te značajno doprinosi perinatalnom mortalitetu i morbiditetu. Klinički se manifestira kao ...pojava hipertenzije nakon 20. tjedna trudnoće u prethodno normotenzivnih žena, s vrijednostima sistoličkog i dijastoličkog tlaka većim od ≥18,7 kPa (≥140 mmHg) i ≥12 kPa (≥90 mmHg) u dva mjerenja u razmaku većem od 6 sati te proteinurijom. Točna patofiziologija bolesti nije jasna, ali se najčešće smatra da je riječ o poremetnji placentacije koja u konačnici dovodi do disfunkcije endotela. Jedina konačna terapija preeklampsije je porođaj.
Synopsis
Good and meticulous pre‐pregnancy follow up and a multidisciplinary approach is of crucial importance for a successful pregnancy outcome after pancreas and kidney transplantation.
To compare the immunohistochemical expression of IL-6 in placental membranes of late preterm delivery in women with histologically proven chorioamnionitis with and without preterm premature rupture ...of membranes (PPROM).
Fetal membranes were collected from 60 women who had late preterm delivery with histologic chorioamnionitis with and without PPROM (30 in each group). Immunohistochemistry for IL-6 was performed on formalin fixed and paraffin-embedded sections. The two groups were matched for age, body mass index and parity. SPSS Version 17.0 was used for statistical analysis.
There was no difference in immunohistochemical expression of IL-6 in placental membranes of women with histologic chorioamnionitis regardless of the membrane status.
Chorioamnionitis has no impact on immunohistochemical expression of IL-6 in placental membranes of women with late preterm delivery despite the clinical presentation.
The aim was to determine whether discordant twin growth has an impact on preterm birth in dichorionic pregnancies. This retrospective study included dichorionic twin pregnancies in the period from ...January 1, 2013 to December 31, 2015. The following variables were investigated: maternal age (years), parity, body mass index (kg/m2), week (≤366/7 and ≥37) and mode of delivery (vaginal and cesarean section), birth weight (grams) and Apgar score (≤7, 8-10). Discordant twin growth in dichorionic pregnancies was found to be associated with preterm birth (χ2=4.74; p=0.03) but had no impact on the mode of delivery (χ2=0.119; p=0.73). There was a statistically significant difference in the rate of small for gestational age (SGA) neonates (χ2=16.4556; p=0.000267) and Apgar score (χ2=7.9931; p<0.05) between the study groups. Mode of conception in dichorionic pregnancies was not a risk factor for preterm delivery (χ2=1.417; p=0.23). In conclusion, discordant twin growth in dichorionic pregnancies is a risk factor for preterm delivery and has no impact on the mode of delivery but has an impact on the rate of SGA and Apgar score.
Background
Optimal gestational weight gain has not yet been clearly defined and remains one of the most controversial issues in modern perinatology. The role of optimal weight gain during pregnancy ...is critical, as it has a strong effect on perinatal outcomes.
Purpose
In this study, gestational body mass index (BMI) change, accounting for maternal height, was investigated as a new criterion for gestational weight gain determination, in the context of fetal growth assessment. We had focused on underweight women only, and aimed to assess whether the Institute of Medicine (IOM) guidelines could be considered acceptable or additional corrections are required in this subgroup of women.
Methods
The study included 1205 pre-pregnancy underweight mothers and their neonates. Only mothers with singleton term pregnancies (37th–42nd week of gestation) with pre-gestational BMI < 18.5 kg/m
2
were enrolled.
Results
The share of small for gestational age (SGA) infants in the study population was 16.2 %. Our results showed the minimal recommended gestational weight gain of 12–14 kg and BMI change of 4–5 kg/m
2
to be associated with a lower prevalence of SGA newborns. Based on our results, the recommended upper limit of gestational mass change could definitely be substantially higher.
Conclusion
Optimal weight gain in underweight women could be estimated in the very beginning of pregnancy as recommended BMI change, but recalculated in kilograms according to body height, which modulates the numerical calculation of BMI. Our proposal presents a further step forward towards individualized approach for each pregnant woman.
To investigate the relationship between maternal pre-pregnancy body-mass index (BMI) and neonatal birth weight.
The observational study included 2906 mothers and their neonates born from 2005 to 2011 ...at the Department of Gynecology and Obstetrics, Split University Hospital Center. Mothers with singleton term pregnancies who were overweight before pregnancy (BMI 25-29.9 kg/m2) were compared with those with normal pre-pregnancy weight (BMI 18.5-24.9 kg/m2). BMI change was assessed as a predictor of birth weight, categorized as small (SGA), appropriate (AGA), or large for gestational age (LGA).
The rate of SGA infants was significantly lower (n=199; 6.8% vs n=1548; 9.2%) and the rate of LGA infants significantly greater among pre-pregnancy overweight mothers compared with normal-weight mothers (n=371; 12.8% vs n=1302; 7.8%; P<0.001 both). Overweight mothers had a significant probability of delivering an SGA neonate when they gained less than 6 kg, as compared with 8 kg among normal-weight mothers. They had a significant probability of delivering an LGA neonate when they gained more than 14 kg, compared with more than 20 kg among normal-weight mothers. BMI change was a more consistent indicator, suggesting that the ranges of 3.0-7.9 kg/m2 in overweight and 2-5.9 kg/m2 in normal-weight women were not associated with a significant increase in the rate of SGA or LGA.
Maternal height seems to be an important factor in optimal weight gain definition, suggesting that BMI change should be a preferred measure of pregnancy-related weight.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Small cell neuroendocrine carcinoma of the cervix (SCNCC) is considered to be an extremely rare, highly invasive and aggressive subtype of squamous cell carcinoma. It is particulary rare during ...pregnancy. Here we report a case in which a 32-year-old patient who was admitted to our Department at 27 completed weeks of gestation with intermittent vaginal spotting and a large amount of malodorous vaginal discharge. Gynecological examination revealed a 2 cm exophytic polypoid tumor coming out of the cervix. On rectal examination there was no clinically evident parametrial invasion. Biopsy of the cervix was performed and the diagnosis of small cell neuroendocrine carcinoma was established. We reviewed and discussed the features, diagnosis, treatment and prognosis of SCNCC diagnosed during pregnancy.
Sitnostanični neuroendokrini rak cerviksa je iznimno rijedak, visoko invazivan i agresivan podtip pločastog raka cerviksa. Poglavito je rijedak tijekom trudnoće. U ovom radu prikazujemo slučaj 32- godišnje bolesnice koja je zaprimljena u našu kliniku s navršenih 27 tjedana trudnoće, s oskudnim vaginalnim krvarenjem, te obilnim iscjetkom neugodnog mirisa. Pregledom u spekulima smo pronašli polipoidnu tvorbu veličine 2 cm koja je prominirala iz cerviksa. Rektalnim pregledom nismo pronašli zahvaćenost parametrija. Učinjena je biopsija polipoidne tvorbe i postavljena dijagnoza sitnostaničnog neuroendokrinog raka cerviksa. U prikazu slučaja raspravljamo o značajkama, dijagnozi, liječenju i prognozi ovoga raka dijagnosticiranog tijekom trudnoće
Objective: The aim of the study was to compare immunohistochemical expression of different T type lymphocytes in foci of villitis of placentae with villitis of unknown etiology (VUE) without and with ...preeclampsia (PE).
Methods: Fifty-four placentae were collected from women who had VUE with (N = 27) and without (N = 27) PE. Immunohistochemistry for types of T lymphocytes was performed on formalin fixed and paraffin-embedded sections by use of the CD3, CD4, FOXP3, CD25, CD8 and CD68 antibodies. All data analyses were done by R Development Core Team.
Results: There was higher immunohistochemical CD4 positive T lymphocyte count and CD4 positive/CD8 positive ratio in placentae with VUE complicated with PE compared to control group.
Conclusion: The higher immunohistochemical CD4 positive T lymphocyte count and CD4 positive/CD8 positive ratio in placentae with VUE complicated with PE could point to their role in ethiopathogenesis of PE.
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