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[Expression of vascular endothelial growth factor in placenta from pregnancy complicated with pregnancy induced hypertension].

OBJECTIVE: To study the expression of vascular endothelial growth factor (VEGF) in placenta from normal pregnancy and pregnancy complicated with pregnancy induced hypertension (PIH) and the effect of VEGF on the etiology of PIH. METHOD: Use the immunohistochemistry to determine the location and intensity of VEGF staining in placenta from 21 cases of normal pregnancy and 62 cases of mild, moderate and severe group of pregnancies complicated with PIH. RESULT: Immunolocalization of VEGF in all cases was observed mainly in syncytiotrophoblast. Intensity of VEGF immunostaining in syncytiotrophoblast was significantly reduced in the moderate PIH group (P < 0.05) and the severe PIH group (P < 0.01) compared with both the mild PIH group and the normal group, while there was no qualitative differences between the mild PIH group and the normal group. Intensity of staining in decidual cells was also similar in all the groups. CONCLUSION: These results suggest that VEGF is secreted mainly by syncytiotrophoblast in human placenta and the reduced VEGF may be responsible, at least in part, for the impaired vascular development in PIH.

Adult↗

Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses.

This study was conducted to investigate the association between uterine artery Doppler flow patterns and uteroplacental vascular pathology in normal and complicated pregnancies in view of the recently described concept of heterogeneous causes of hypertensive pregnancy complications. Forty-three women whose pregnancies were complicated by pre-eclampsia, the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and/or small for gestational age (SGA) fetuses and 27 women with normal pregnancies undergoing elective caesarean section were included. We obtained uterine artery Doppler waveforms at a mean of 4 days before delivery. Placental bed biopsies were obtained at caesarean section and analysed for physiological changes and pathological changes. We found that abnormal uterine artery Doppler flow was strongly associated with pregnancy complications. Absence of physiological changes was seen in 58 per cent of complicated pregnancies and 40 per cent of normal pregnancies. Pathological changes were seen in 58 per cent of complicated pregnancies and 53 per cent of normal pregnancies; they occurred in spiral arteries with and without physiological changes, and there was no significant correlation to Doppler results. In conclusion, absence of physiological changes is associated with abnormal uterine artery Doppler flow and pregnancy complications. However, there is a gradient in the severity of uteroplacental vascular pathology and the correlation with pregnancy complications is not as strong as previously thought. There is also a significant degree of uteroplacental vascular pathology in normal pregnancies with normal uterine artery Doppler flow. This variation may be partly due to sampling error, as a typical biopsy contains only one or two spiral arteries. We hypothesize that additional factors might be necessary to induce the clinical syndrome of pre-eclampsia.

Arteries↗

Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome.

OBJECTIVE: To investigate the relation between gestational weight gain in women of normal prepregnant weight and complications during pregnancy and delivery in a population with high gestational weight gain and birth weight. METHODS: Healthy women (n = 615) of normal weight before pregnancy (body mass index 19.5-25.5 kg/m(2)) were randomly selected. Maternity records gave information on age, height, prepregnant weight, gestational weight gain, parity, smoking, gestational hypertension and diabetes, preeclampsia, delivery complications, and infants' birth size and health. RESULTS: The mean weight gain in pregnancy was 16.8 +/- 4.9 kg (mean +/- standard deviation). A total of 26.4% of the women had complications, either in pregnancy (9.1%) or delivery (17.3%). Women gaining weight according to the recommendation of the Institute of Medicine (11.5-16.0 kg) had lower frequency of pregnancy-delivery complications than women gaining more than 20.0 kg (P =.017), but did not differ significantly from those gaining 16-20 kg (P >.05). When dividing weight gain in pregnancy into quintiles, a relative risk of 2.69 (95% confidence interval 1.01, 7.18, P =.048) was found for complications in pregnancy in the fourth quintile (17.9-20.8 kg), using the second quintile as reference (12.5-15.5 kg). The mean birth weight was 3778 +/- 496 g. A low weight gain in pregnancy (less than 11.5 kg) was associated with an increased frequency of infants weighing less than 3500 g at birth (P <.01). CONCLUSION: A gestational weight gain of 11.5-16.0 kg (Institute of Medicine recommendation) for women of normal prepregnant weight is related to the lowest risk for pregnancy-delivery complications. In the population studied, the upper limit might be higher (up to 18 kg), and low weight gain should be avoided to optimize birth outcome.

Adult↗

[Pregnancy complications and pregnancy outcome in women under 18 and above 35 years old in highly industrialized urban complex of Upper Silesia].

OBJECTIVES: There is a considerable effort done by many researchers towards identification factors that are responsible for increase in risk of adverse perinatal outcome. Maternal age is one of the most obvious but also one of the most difficult to proper interpretation. MATERIAL AND METHODS: The authors analyzed major complications in pregnancy and labour in women under 18 above 35 years old in highly industrialized urban complex of Upper Silesia. RESULTS: Extremes of reproductive age, adolescence and age above 35 years have an impact on biological, social, cultural and economic conditions that significantly affects obstetrical results. CONCLUSIONS: Teenage mothers and the mothers above 35 years old are regarded to be in increased risk of instrumental delivery and caesarean section. These factors are also associated with augmented incidence of complication such as preterm labour, intrauterine growth restriction etc.

Adolescent↗

Acute atherosis in pregnancies complicated by hypertension, small-for-gestational-age infants, and diabetes mellitus.

A clinicohistologic study of acute atherosis in late complicated pregnancy was undertaken. Maternal vessels in the placental basal plate, underlying the amniochorial membranes and in placental bed biopsy specimens, were examined histologically. The earliest histologically convincing lesion acceptable as acute atherosis was fibrinoid necrosis with a perivascular mononuclear cell infiltrate, while lipophages were a late phenomenon. Any maternal uterine vessel that had not undergone physiologic vascular changes could be affected by acute atherosis. Acute atherosis was not seen in normal pregnancies or in pregnancies of diabetic women but was seen in pregnancies complicated by preeclampsia, small-for-gestational-age infants, or both. In pregnancies complicated by small-for-gestational-age infants, acute atherosis was not seen in the vessels in the decidua parietalis.

Acute Disease↗

[Application of laparoscopy in ectopic pregnancy complicated with intrauterine pregnancy: reports of 5 cases].

OBJECTIVE: To investigate the effects of laparoscopy in treating ectopic pregnancy complicated with intrauterine pregnancy. METHOD: Laparoscopy was performed in 5 patients with ectopic pregnancy complicated with intrauterine pregnancy. RESULTS: The ectopic pregnancy tissue or the damaged fallopian tube was successfully excised laparoscopically. CONCLUSION: Laparoscopy is safe for treating ectopic pregnancy complicated with intrauterine pregnancy, causing minimal injuries and less disturbance to intrauterine pregnancy and ensuring rapid recovery.

Adult↗

The art and science of maintenance of normoglycemia in pregnancies complicated by insulin-dependent diabetes mellitus.

OBJECTIVE: To provide a "how-to" manual for achieving and maintaining normoglycemia in pregnant women with insulin-dependent diabetes. METHODS: We describe a detailed program that has successfully maintained normoglycemia before, during, and after diabetes-complicated pregnancies. Insulin and glucose requirements throughout pregnancy, during labor, and in the postpartum period are outlined. RESULTS: With preconception planning and careful dietary and blood glucose management during pregnancy, complications can be minimized and an optimal outcome of pregnancy can be achieved in women with diabetes. CONCLUSION: Women with type I, insulin-dependent diabetes can now have the same chances as women without diabetes to have a healthy infant. The reduction of risks associated with pregnancies complicated by diabetes can be ensured if normoglycemia is achieved before and during the pregnancy.

Journal Article↗

Kyphoscoliosis complicating pregnancy.

OBJECTIVE: To assess whether the outcome of pregnancies complicated by kyphoscoliosis has improved with modern obstetric and orthopedic care. METHODS: A total of 17 patients with 27 pregnancies complicated by kyphoscoliosis were identified from 91,498 pregnancies between 1980 and 1994 from the obstetric audit database. Their obstetric records and associated orthopedic records were carefully studied. RESULTS: The incidence of kyphoscoliosis complicating pregnancy in the study period was 0.029%. The mean age of these patients in their index pregnancy was 32.7 years (range 23-40), mean height 140.7 cm (range 126-163). The cause of the kyphoscoliosis included traumatic injury, spinal tuberculosis, infantile poliomyelitis and idiopathic kyphoscoliosis. Eight of the patients had previous spinal surgery. The vaginal delivery rate was high and none suffered any cardiorespiratory embarrassment. There was no maternal or perinatal mortality. CONCLUSIONS: The high maternal and perinatal risks associated with kyphoscoliosis reported in earlier literature is no longer valid. The high proportion of patients who had previous spinal surgery before pregnancy might be conducive to the avoidance of harassment and thus a favorable pregnancy outcome.

Adult↗

[Complicated pregnancy with lithiasis and resectable gallbladder cancer. A case report and literature review].

Pregnancy complicated with gallbladder disease stone has an incidence of 2-14%, and more than 30% of patients do not respond to medical treatment; therefore, in order to reduce the morbidity and mortality in fetus and mother, surgical management would be required. The current use of ultrasound of high resolution has facilitated the diagnosis and also, in the present clinical case, this imaging modality allowed us to suspect the unusual diagnosis reported, that corresponds to a female of 34 years old with 33 weeks of pregnancy, complicated with symptomatic gallbladder disease stone, whose pain was intractable at the expectant management. The clinical diagnosis was corroborated by ultrasound and the report was: lithiasis, biliary sludge and an intragallbladder image of bilobular polypoid. The patient was submitted to cholecystectomy by laparotomy, whose histopathologic findings were: cholelithiasis and in situ gallbladder adenocarcinoma with an exophytic growing variety. The purposes of this article are to report a case and to review the literature.

Adenocarcinoma↗

Pregnancy complicated with Bartter's syndrome: a case report.

Bartter's syndrome is a rare renal disorder, and since there are few case reports of Bartter's syndrome complicating pregnancy are few, the changes of electrolytes and hormonal metabolism during pregnancy are unknown. We describe and discuss the course of pregnancy complicated with Bartter's syndrome.

Adult↗

[Cesarean section in pregnancy complicated by severe hepatitis and heart disease].

In this article, we reported the analysis of two severe diseases complicating pregnancy: 1,918 cases of heart disease in last 36 years and 22 cases of severe hepatitis in last 16 years. The conclusion was that on active therapy and close cooperation with cardiologist, pregnancy complicated with heart disease of grade III-IV cardiac function can be taken as an indication of Cesarean section. This operation performed at a proper time is good for the mother and also the baby. The traditional idea that Cesarean section could only be done for an obstetrical reason is not quite adequate. For primiparas with severe hepatitis, a supportive therapy with fresh blood transfusion, albumin and Cesarean section under local anesthesia might be the method of choice, its mortality rate being much lower than a vaginal delivery.

Cesarean Section↗

Flow-velocity profiles of the fetal aorta and umbilical artery in pregnancies complicated by pregnancy-induced hypertension and fetal growth retardation.

Sixty-seven women undergoing ultrasonographic evaluation in the high-risk clinic were randomly recruited to be examined by a newly developed computerized method that presents flow-velocity profiles derived from pulsed Doppler-generated flow-velocity waveforms. Each woman had pulsed Doppler flow velocimetry of the fetal aorta and umbilical arteries done. Subjects were either normal controls (N = 20) or had pregnancies complicated by pregnancy-induced hypertension (N = 29), fetal growth retardation (N = 11), or both (N = 7). Distinct patterns of flow-velocity distribution across the fetal aorta and proximal umbilical arteries were identified in the pregnancies characterized by increased placental resistance. At peak systole, normal velocity was maintained only at a narrow area around the center of the vessel, whereas velocity in the rest of the vessel area was markedly reduced. These changes were present in 40 of 47 subjects (85.1%) with complicated pregnancies, whereas 27 of 47 (57.4%) had umbilical artery systolic-diastolic ratios above the 95th percentile. No significant differences between normal and complicated pregnancies were seen during diastole. Our findings suggest that increased placental resistance results in a redistribution of velocities within fetal blood vessels, often before maximal end-diastolic velocity is decreased.

Adult↗

Plasma total cysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study.

BACKGROUND: Total homocysteine (tHcy) is associated with pregnancy complications and adverse pregnancy outcomes. The associations of plasma total cysteine (tCys) with such outcomes have not been investigated in large populations. OBJECTIVE: We investigated the association between plasma tCys and pregnancy complications, congenital malformations, and other adverse pregnancy outcomes. DESIGN: The plasma tCys concentrations of 5883 women aged 40-42 y that were measured in 1992-1993 during a cardiovascular health screening were compared with the outcomes and complications of 14492 pregnancies in the same women that were registered in the Medical Birth Registry of Norway from 1967 to 1996. RESULTS: After adjustment for parity, mother's age, tHcy, total cholesterol, body mass index, smoking, and coffee drinking, high plasma tCys concentrations (above the 95th percentile) were associated with significantly higher risks of preeclampsia [n = 342; odds ratio (OR): 1.6; 95% CI: 1.1, 2.4; P = 0.03], premature delivery (n = 774; OR: 1.8; 95% CI: 1.3, 2.5; P = 0.001), and very low birth weight (n = 175; OR: 2.0; 95% CI: 1.1, 3.9; P = 0.03) than were lower plasma tCys concentrations. tCys was not associated with the risk of placental abruption. High tCys concentrations showed a weak association with congenital malformations and stillbirths with birth weight <1500 g. The associations were independent of the tHcy concentrations. CONCLUSION: High tCys concentrations were associated with risks of preeclampsia, premature delivery, and low birth weight.

Abruptio Placentae↗

Duplex Doppler ultrasound in the evaluation of pregnancies complicated by pregnancy-induced hypertension.

Umbilical artery velocimetry using pulsed Doppler technique was carried out in 49 pregnancies complicated by pregnancy-induced hypertension (PIH). Outcome of the pregnancies was evaluated after delivery. We found the systolic to diastolic ratio of the umbilical artery to be highly sensitive and specific in predicting abnormal outcome in pregnancies complicated by PIH. In our opinion, the pulsed Doppler technique can be a useful adjunct to other methods for evaluation of fetal well-being in patients with PIH.

Blood Flow Velocity↗

Pregnancy complicated by autoimmune polyglandular syndrome type II: a case report.

Autoimmune polyglandular syndrome may complicate pregnancy and be confused with hyperemesis gravidarum as a cause of hypoglycemia and electrolyte imbalance in the first trimester of pregnancy. Autoimmune polyglandular syndromes are uncommon disorders characterized by the development and presentation of multiple endocrine and organ dysfunction. To our knowledge, we present the first case of an autoimmune polyglandular syndrome complicating pregnancy. A 26-year-old woman, gravida 5 para 3 at 12 weeks gestation, presented with hyperemesis and signs and symptoms consistent with adrenal insufficiency and hypothyroidism. Evaluation revealed autoimmune polyglandular syndrome type II. Autoimmune polyglandular syndromes are a myriad group of diseases characterized by polyglandular dysfunction. These syndromes should be kept in mind when dealing with pregnant patients presenting with hyperemesis and an electrolyte imbalance who do not improve with the usual treatment for hyperemesis. An endocrine dysfunction such as polyglandular syndrome may exist.

Addison Disease↗

Amniotic fluid concentrations of iodothyronines and thyrotropin do not reliably predict fetal thyroid status in pregnancies complicated by maternal thyroid disorders or anencephaly.

In this study we report measurements of amniotic fluid (AF) concentrations of iodothyronines and TSH in 69 normal and 16 complicated pregnancies. The latter group included 2 women with untreated hyperthyroidism, 1 patient with untreated hypothyroidism, 5 hyperthyroid patients who received propylthiouracil (3 with Graves' disease, 1 with a multinodular goiter, and 1 with chronic thyroiditis), 3 women with Graves' disease who were hypothyroid after treatment, but who were receiving replacement therapy, and 5 anencephalic pregnancies. AF hormone levels could not be correlated with either maternal or cord serum values, neonatal serum measurements, and/or the clinical status of the infant. AF TSH and T4 levels were markedly elevated in 1 patient with Graves' disease and severe Rh isoimmunization and in 2 pregnancies complicated by anencephaly without identifiable pituitary tissue in the fetus. We conclude that measurements of AF concentrations of thyroid hormones and TSH do not reliably predict fetal or neonatal thyroid status.

Amniotic Fluid↗

Cerebrovascular disorders complicating pregnancy--beyond eclampsia.

OBJECTIVE: Our purpose was to investigate the problems encountered in the diagnosis and management of cerebrovascular disorders associated with pregnancy and the puerperium. STUDY DESIGN: Pregnancies complicated by cerebrovascular disorders were identified by retrospective chart review (1985 to 1995). Events associated with trauma, neoplasm, drug ingestion, and infection were excluded. RESULTS: The study population comprised 24 women with a variety of cerebrovascular disorders: 14 with infarction (5 arterial, 9 venous), 6 with intracranial hemorrhage (3 anatomic malformation, 3 unknown etiology), 3 with hypertensive encephalopathy, and 1 with an unruptured aneurysm. Blood pressure reflected physical condition at presentation and did not predict diagnosis or outcome except in the 3 women with hypertensive encephalopathy. Only 4 of 14 women with infarction and 1 of 6 with intracranial hemorrhage had a diastolic blood pressure > or = 110 mm Hg. Presumption of eclampsia delayed the diagnosis in 10 women (41.7%). In addition, patient delay in seeking medical attention complicated 10 cases. After review, none of the adverse maternal outcomes were deemed preventable by earlier physician intervention. Seven maternal deaths occurred (29.2%). Neonatal outcome was related to the gestational age and the maternal condition at presentation. CONCLUSION: Cerebrovascular disorders are an uncommon and unpredictable complication of pregnancy that are associated with substantial maternal and fetal mortality. Suspected eclampsia unresponsive to magnesium sulfate therapy warrants an immediate neuroimaging study. Interestingly, in women with intracranial hemorrhage, severe hypertension was not an associated predictive factor.

Adolescent↗

Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes.

The prevalence of smoking during pregnancy is decreasing in some, but not all, developed countries, as the prevalence of overweight is increasing rapidly in most countries. During pregnancy, smoking increases the risk of placental abruption, but reduces the risk of preeclampsia, while overweight increases the risks of gestational diabetes, preeclampsia, and cesarean delivery. Both smoking and overweight are associated with dose-dependent increases in risks of stillbirth and very preterm birth (< 32 weeks). From a public health perspective, smoking and overweight today probably represent the most important modifiable risk factors for pregnancy complications and adverse pregnancy outcomes.

Adolescent↗