The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
-
J. Matern. Fetal. Neonatal. Med. · Jan 2008
Multicenter StudyA longitudinal study of angiogenic (placental growth factor) and anti-angiogenic (soluble endoglin and soluble vascular endothelial growth factor receptor-1) factors in normal pregnancy and patients destined to develop preeclampsia and deliver a small for gestational age neonate.
Accumulating evidence suggests that an imbalance between pro-angiogenic (i.e., vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)) and anti-angiogenic factors (i.e., soluble VEGF receptor-1 (sVEGFR-1, also referred to as sFlt1)) is involved in the pathophysiology of preeclampsia (PE). Endoglin is a protein that regulates the pro-angiogenic effects of transforming growth factor beta, and its soluble form has recently been implicated in the pathophysiology of PE. The objective of this study was to determine if changes in maternal plasma concentration of these angiogenic and anti-angiogenic factors differ prior to development of disease among patients with normal pregnancies and those destined to develop PE (preterm and term) or to deliver a small for gestational age (SGA) neonate. ⋯ (1) Changes in the maternal plasma concentration of s-Eng, sVEGFR-1, and PlGF precede the clinical presentation of PE, but only changes in s-Eng and PlGF precede the delivery of an SGA neonate; and (2) differences in the profile of angiogenic and anti-angiogenic response to intrauterine insults may determine whether a patient will deliver an SGA neonate, develop PE, or both.
-
J. Matern. Fetal. Neonatal. Med. · Jan 2008
The maternal plasma soluble vascular endothelial growth factor receptor-1 concentration is elevated in SGA and the magnitude of the increase relates to Doppler abnormalities in the maternal and fetal circulation.
The soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1), an antagonist to vascular endothelial growth factor and placental growth factor, has been implicated in the pathophysiology of preeclampsia. Preeclampsia and pregnancy complicated with small for gestational age (SGA) fetuses share some pathophysiologic derangements, such as failure of physiologic transformation of the spiral arteries, endothelial cell dysfunction, and leukocyte activation. The objectives of this study were to: (1) determine whether plasma concentrations of sVEGFR-1 in mothers with SGA fetuses without preeclampsia at the time of diagnosis are different from those in patients with preeclampsia or normal pregnant women, and (2) examine the relationship between plasma concentrations of sVEGFR-1 and Doppler velocimetry in uterine and umbilical arteries in patients with preeclampsia and those with SGA. ⋯ These observations provide support for the participation of the soluble receptor of vascular endothelial growth factor in the pathophysiology of SGA with abnormal uterine artery Doppler velocimetry and preeclampsia. An excess of sVEGFR-1 is released into the maternal circulation of patients with preeclampsia and those with SGA fetuses, as abnormalities of impedance to blood flow involve uterine and umbilical circulation.
-
J. Matern. Fetal. Neonatal. Med. · Dec 2007
Case ReportsIn utero laser treatment of type II vasa previa.
Vasa previa, defined as fetal vessels coursing within the membranes between the presenting part and the cervix, occurs in approximately 1:2500-5000 pregnancies. Type II vasa previa consists of fetal vessels crossing over the internal os connecting a bilobed placenta or a succenturiate lobe with the main placental mass. These vessels are prone to compression during labor or may tear when membranes rupture potentially resulting in fetal exsanguination and neonatal death. ⋯ The purpose of this communication is to report the successful in utero laser ablation of type II vasa previa at 22.5 weeks of gestation. Subsequent ruptured membranes did not result in untoward fetal consequences. Risks and benefits of this novel procedure are discussed.
-
J. Matern. Fetal. Neonatal. Med. · Sep 2007
Randomized Controlled TrialEffect of oxytocics on the blood pressure of normotensive Nigerian parturients.
The single most common direct obstetric disorder accounting for 25% of all maternal deaths globally is severe hemorrhage, generally occurring postpartum. Nearly all these deaths occur in the developing world. The role of oxytocic drugs in the management of the third stage of labor as a strategy to reduce maternal mortality has been emphasized. However, the adverse effects of these oxytocic agents, in particular ergometrine, have not been properly evaluated in our environment. ⋯ These results suggest that ergometrine may be safe in normotensive parturients but hazardous in hypertensive parturients in whom oxytocin would be a safer option.
-
J. Matern. Fetal. Neonatal. Med. · Aug 2007
Case ReportsSevere, early-onset hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome episode with spontaneous remission during pregnancy.
A case of a severe HELLP syndrome episode at 21 + 0 weeks of gestation is reported. Expectant management resulted in rapid improvement of all HELLP parameters. Subsequently preeclampsia developed and uteroplacental dysfunction deteriorated. Intrauterine fetal death occured at 22 + 3 weeks of gestation.