1,721,082 research outputs found
Is It Time to Redefine Fetal Decelerations in Cardiotocography?
No full textHistorically, fetal heart rate (FHR) decelerations were classified into “early”, “late”, and “variable” based on their relationship with uterine contractions. So far, three different putative etiologies were taken for granted. Recently, this belief, passed down through generations of birth attendants, has been questioned by physiologists. This narrative review aimed to assess the evidence on pathophysiology behind intrapartum FHR decelerations. This narrative review is based on information sourced from online peer-reviewed articles databases and recommendations from the major scientific societies in the field of obstetrics. Searches were performed in MEDLINE/PubMed, EMBASE, and Scopus and selection criteria included studies in animals and humans, where the physiology behind FHR decelerations was explored. The greater affinity for oxygen of fetal hemoglobin than the maternal, the unicity of fetal circulation, and the high anaerobic reserve of the myocardium, ensure adequate oxygenation to the fetus, under basal conditions. During acute hypoxic stress the efficiency of these mechanisms are increased because of the peripheral chemoreflex. This reflex, activated at each uterine contraction, is characterized by the simultaneous activation of two neural arms: the parasympathetic arm, which reduces the myocardial consumption of oxygen by decreasing the FHR and the sympathetic component, which promotes an intense peripheric vasoconstriction, thus centralizing the fetal blood volume. This review summarizes the evidence supporting the hypoxic origin of FHR decelerations, therefore archiving the historical belief that FHR decelerations have different etiologies, according to their shape and relationship with uterine contractions. The present review suggests that it is time to welcome the new scientific evidence and to update the CTG classification systems
Invecchiamento placentare e danno da stress ossidativo nella patologia materno-fetale
No full textObiettivo. L'obiettivo di questo studio è di studiare invecchiamento placentare e stress ossidativo analizzando l'espressione proteica di p21, p53 ed APE1 inoltre abbiamo analizzato anche un marcatore indicativo di danno da stress ossidativo alla doppia elica del DNA.
Materaili e metodi. Studio retrospettivo con realizzazione di un tissue micro array di placenta contenete 92 controlli da diverse epoche gestazionali e 158 casi patologici tra cui pre-eclampsia, HELLP e IUGR occorsi in diverse epoche gestazionali.
Risultati. In questo studio abbiamo evidenziato una influenza significativa dell'epoca gestazionale sull'espressione nel trofoblasto di p21, APE1 ed 8-OHdg. Nelle placente dei casi affetti da pre-eclampsia, HELLP o IUGR vi è un aumentata espressione di p53, 8-OHdg ed APE1 rispetto ai contrilli. Sia nei gruppi di patologia tra la 22a e la 34a settimana gestazionale che dopo la 34a settimana gestazionale APE1 è più espressa nel trofoblasto di pazienti con disordini ipertensivi della gravidanza piuttosto che di pazienti con IUGR. L'espressione di 8-OHdg citoplasmatica è aumentata nel trofoblasto delle placente degli IUGR rispetto a pre-eclampsia o HELLP. Nei casi dopo la 34a settimana p21 è aumentata negli SGA e negli IUGR rispetto a controlli e pre-eclampsia. Anche p53 dopo la 34a settimana gestazionale è aumetata negli IUGR.
Conclusioni. Le placente da gravidanze patologiche presentano una alterata espressione di p21, p53, APE1 e 8-OHdg. Le alterazioni delle vie intracellulari che coinvolgono questi elementi possono essere la causa o la conseguenza della disfunzione placentare ma in ogni caso riflettono un cattivo funzionamento placentare
Fetal gender ratio in recurrent miscarriages
No full textAnna Del Fabro1, Lorenza Driul1, Omar Anis1, Ambrogio P Londero1, Serena Bertozzi2, Livio Bortotto3, Diego Marchesoni11Clinic of Obstetrics and Gynecology, 2Clinic of Surgery, 3Unit of Genetics, University Hospital of Udine, Udine, ItalyBackground: The purpose of this study was to evaluate the gender ratio and incidence of chromosomal anomalies in the products of conception (POC) from recurrent miscarriages.Methods: We determined the karyotypes of POC from patients with recurrent spontaneous miscarriages between 1999 and 2009.Results: In total, 313 specimens were successfully karyotyped, with a median gestational age of 10 weeks at miscarriage (interquartile range 8–13); 199 (64%) were females and 114 (36%) were males. In total, 121 (39%) had abnormal karyotypes, the most prevalent of which were chromosome 21 and 16 trisomies, triploidy, and monosomy X.Conclusion: Our findings suggest that female POC might be more susceptible to recurrent miscarriages than male ones during embryogenesis, implantation, and initial fetal development.Keywords: fetal gender, recurrent miscarriages, karyotype anomalie
Acute tocolysis for intrapartum nonreassuring fetal status: how often does it prevent cesarean delivery? A systematic review and meta-analysis of randomized controlled trials
No full textOBJECTIVE: This study aimed to evaluate the effectiveness of intrapartum acute tocolysis for nonreassuring fetal heart rate tracing in decreasing the incidence of cesarean delivery. Secondary outcomes included modes of delivery other than cesarean delivery, successful acute tocolysis, time-to-delivery interval, and short-term perinatal outcomes. DATA SOURCES: Searches were performed in MEDLINE/PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and Reviews, ClinicalTrials.gov, and the International Clinical Trials Registry Platform from the inception of each database until February 2022. STUDY ELIGIBILITY CRITERIA: Selection criteria included randomized controlled trials of laboring patients with singleton gestations randomized to receive intrapartum acute tocolysis for nonreassuring fetal heart rate tracing, as defined by the original trial. METHODS: All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. A frequentist network-meta-analysis was performed. RESULTS: Four randomized clinical trials were eligible, including 605 patients with nonreassuring fetal heart rate tracing and singleton gestations at gestational ages >32 weeks. The cesarean delivery rate was similar among patients managed with different types of acute tocolysis. Acute tocolysis, compared with emergency delivery, was associated with improved neonatal acid-base status (notably decreasing the prevalence of base deficit >12 mmol/L [beta-2 agonists odds ratio, 0.61; 95% confidence interval, 0.37–0.99] and the rate of neonatal intensive care unit admission [beta-2 agonists odds ratio, 0.42; 95% confidence interval, 0.22–0.78]) and with an increase in the time-to-delivery interval (beta-2 agonists mean difference, 17.62 minutes; 95% confidence interval, 15.66–19.58); there was no reduction of cesarean delivery rate, showing an increased rate with atosiban and beta-2 agonists. CONCLUSION: The cesarean delivery rate was not reduced by acute tocolysis when used for nonreassuring fetal heart rate tracing during labor. Acute tocolysis is associated with improved short-term fetal outcomes and safely increases the time-to-delivery interval
What is the success rate of trial of labor in monochorionic diamniotic twins? A systematic review and meta-analysis of observational studies
No full textThis meta-analysis aimed to evaluate the success rate of trial of labor in monochorionic diamniotic pregnancies and the impact of delivery mode on neonatal outcomes
Misoprostol administration prior to intrauterine contraceptive device insertion: a systematic review and meta-analysis of randomised controlled trials
No full textObjectives: Misoprostol has been used before intrauterine contraceptive device (IUCD) insertion to prime the cervical os. As the literature about this topic is controversial, we aimed to evaluate IUCD insertion failure, women's pain perception, use of cervical dilators and prevalence of side effects following the administration of misoprostol. Methods: Trials published in MEDLINE, Scopus, the Cochrane Library and ClinicalTrials.gov were searched (last search on 23 October 2019). The primary outcome was IUCD insertion failure; secondary outcomes were women's pain perception, use of cervical dilators to facilitate insertion, and prevalence of side effects. Results: Fourteen studies were eligible for inclusion. Misoprostol premedication reduced IUCD insertion failure rates and the use of cervical dilators but significantly increased the prevalence of side effects. The risk of IUCD insertion failure with misoprostol premedication was reduced among women who had undergone previous caesarean section and among women who had experienced previous IUCD insertion failure. Nulliparas did not benefit from misoprostol premedication. Buccal misoprostol administration did not seem to be effective in reducing IUCD insertion failure. Visual analogue scale pain scores were increased with both sublingual and buccal misoprostol administration if IUCD insertion was performed <= 2.5 h after misoprostol premedication. Conclusion: Our data demonstrate reduced IUCD insertion failure among women with previous caesarean section and those with previous IUCD insertion failure, suggesting that misoprostol may be a reasonable choice in these groups of women. Although misoprostol premedication reduced insertion failures, it significantly increased side effects and had a heterogeneous pattern of efficacy; thus, its routine use is not supported by the evidence
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