Academic literature on the topic 'ARTERIE UTERINE'
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Journal articles on the topic "ARTERIE UTERINE"
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Bufalino, L., G. Rizzo, D. Rinaldo, E. Romanini, H. Valensise, D. Arduini, and C. Romanini. "Previsione della Preeclampsia nella Gravidanza Gemellare Mediante Velocimetria Doppler Uterina." Acta geneticae medicae et gemellologiae: twin research 43, no. 1-2 (April 1994): 115. http://dx.doi.org/10.1017/s0001566000003056.
Full textAbstract:
AbstractL'incidenza di pre-eclampsia nella gravidanza gemellare è aumentata di circa 5 volte rispetto alle gravidanze singole. La velocimetria Doppler a livello uterino si è dimostrato in popolazioni a rischio, un metodo efficace per identificare precocemente le pazienti a rischio di pre-eclampsia. Non sono disponibili dati a questo riguardo nella gravidanza gemellare.Obiettivi: 1) valutare le differenze negli indici di resistenza delle arterie uterine tra gravidanze singole e gemellari, 2) valutare eventuali differenze in gravidanze gemellari complicate da pre-eclampsia, 3) valutare il valore predittivo della velocimetria Doppler uterina sulla pre-eclampsia in gravidanze gemellari esaminate a 20-24 settimane di gestazione e poi seguite prospettivamente.Disegno dello studio: l'indice di resistenza RI a livello di entrambe le arterie uterine è stato calcolato mediante Doppler colore-pulsato (Ansaldo Hitachi AU590A) nelle seguenti popolazioni: a) 315 gravidanze singole non complicate, b) 96 gravidanze gemellari non complicate, c) 53 gravidanze gemellari complicate da pre-eclampsia, d) 63 gravidanze gemellari valutate a 20-24 settimane di gestazione e non complicate al momento della osservazione.Risultati: 1) sia nelle gravidanze singole che in quelle gemellari i valori di RI decrescono nel corso della gravidanza e i valori presenti nelle gravidanze gemellari a decorso normale sono significativamente inferiori (Anova p < 0.001). 2) le gravidanze gemellari complicate da preeclampsia dimostrano valori di RI lievemente superiori alle gravidanze gemellari non complicate (p <0.05). 3) il valore predittivo sulla preeclampsia delle arterie uterine a 20-24 settimane è risultato inadeguato (k = 0.24).Conclusioni: la velocimetria Doppler delle arterie uterine è risultata di scarsa utilità clinica nel prevedere la preeclampsia nelle gravidanze gemellari.
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Winata, I. Gede Sastra, and Nicholas Renata Lazarosony. "Procedures to Reduce Haemorrhage during Myomectomy for Fibroids." Cermin Dunia Kedokteran 49, no. 10 (October 3, 2022): 589. http://dx.doi.org/10.55175/cdk.v49i10.2076.
Full textAbstract:
<p>Uterine fibroids are the most common solid tumors in the female pelvis. Myomectomy is the first choice of treatment for woman who want to keep their uterus. Haemorrhage, uterine perforation, cervical injury, and metabolic problems from excessive absorption of the distension medium, such as glycine, are risks of hysteroscopic myomectomy. There are several procedures and techniques to reduce haemorrhage during myomectomy for fibroids. Some research demonstrated excellent outcomes with uterine artery ligation.</p><p>Mioma uteri adalah tumor jinak yang paling sering dijumpai pada wanita. Tindakan miomektomi adalah salah satu pilihan terapi pada wanita yang tetap ingin mempertahankan rahim. Perdarahan, perforasi uterus, cedera serviks dan masalah metabolisme akibat penyerapan berlebihan media distensi, seperti glisin, adalah risiko prosedur histeroskopi miomektomi. Beberapa prosedur dan teknik dapat mengurangi perdarahan saat miomektomi pada kasus mioma uteri. Beberapa penelitian menunjukkan hasil yang sangat baik dengan ligasi arteri uterina.</p>
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Intriago Cedeño, Carlos Fabricio, Andrea Monserrate Murillo Mera, and Nelson Efren Campoverde Mejia. "Embarazo ectópico cervical: Reporte de caso clínico." QhaliKay. Revista de Ciencias de la Salud ISSN: 2588-0608 3, no. 1 (January 20, 2019): 1. http://dx.doi.org/10.33936/qkrcs.v3i1.2049.
Full textAbstract:
Los embarazos ectópicos constituyen la emergencia más peligrosa de la gestación en sus primeras etapas. Las presentaciones cervicales comprenden una subcategoría del embarazo ectópico, de naturaleza sumamente infrecuente, con una incidencia del 0,1% de casos, la implantación ocurre en el cérvix en lugar del útero y al ser un sitio de proximidad con las arterias uterinas, la invasión del trofoblasto al cérvix lo convierte en un embarazo ectópico de alto riesgo de compromiso hemodinámico. Se describe el caso de una paciente de 40 años de edad que debuta con cuadro clínico caracterizado por dolor en hipogastrio y fosas iliacas derecha e izquierda, acompañado por amenorrea y sangrado transvaginal, se realizó ecografía transvaginal que muestra la cavidad uterina vacía y una implantación anómala en el cérvix. Se comprobaron los criterios ecográficos de Ushakov, se ratificó la importancia clínica y diagnóstica urgente en esta patología y se instauró el tratamiento conservador quirúrgico de carácter controversial mediante el legrado uterino.
Palabras clave: cérvix, implantación, extrauterino, hemorragia, Ushakov
Abstract
Ectopic pregnancies constitute the most dangerous gestation emergency in its early stages. The cervical presentations include a subcategory of ectopic pregnancy, of a very rare nature, with an incidence of 0.1% of cases, implantation occurs in the cervix instead of the uterus and being a site of proximity to the uterine arteries, the invasion of the trophoblast to the cervix makes it an ectopic pregnancy with a high risk of hemodynamic compromise. We describe the case of a 40 years old patient who debuts with a clinical characterized by pain in hypogastrium and right and left iliac fossae, accompanied by amenorrhea and transvaginal bleeding, transvaginal ultrasound was performed showing the empty uterine cavity and an abnormal implantation in the cervix. The ultrasound criteria of Ushakov were checked, the clinical importance and urgent diagnosis in this pathology were ratified, and conservative surgical treatment of controversial character was established through uterine curettage.
Keywords: cervix, implantation, extrauterine, hemorrhage, Ushakov
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Kokov, L. S., M. M. Damirov, G. E. Belozerov, and O. N. Oleynikova. "Modern approaches to endovascular treatment of uterine leiomyoma." Gynecology 20, no. 5 (October 15, 2018): 63–67. http://dx.doi.org/10.26442/2079-5696_2018.5.63-67.
Full textAbstract:
Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.
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Cúneo, Nicasio, Alejandro Soderini, Lucía Rodich, Carlos Reyes, Claudia Arias, Alejandro Aragona, and Evangelina Bonavía. "Traquelectomía radical abdominal con preservación de la arteria uterina (TRAPAU ): presentación de la técnica quirúrgica y evaluación de resultados iniciales." Revista Peruana de Ginecología y Obstetricia 55, no. 4 (April 28, 2015): 273–80. http://dx.doi.org/10.31403/rpgo.v55i304.
Full textAbstract:
Objetivos: Presentar una variante técnica de la traquelectomía radical abdominal, preservando la integridad de ambas arterias uterinas (TRAPAU); su factibilidad y resultados iniciales. Diseño: Estudio clínico quirúrgico. Institución: Hospital Oncológico de Buenos Aires Marie Curie, Argentina. Participantes: Mujeres con cáncer de cérvix uterino estadios Ia2 – Ib1. Intervenciones: Se presenta una técnica diseñada para el tratamiento conservador de la fertilidad, para pacientes con cáncer de cérvix uterino estadios Ia2 – Ib1. Nueve pacientes con edad promedio 28,5 años (20 a 32 años) y tumor central clínico <2 cm fueron tratadas entre octubre 2004 y octubre 2008. Las pacientes fueron estatificadas según criterios FIGO, previo consentimiento informado. La técnica quirúrgica consistió en: 1) laparotomía exploradora con disección de fosas, espacios y linfadenectomía pélvica bilateral, con biopsia por congelación de los ganglios; 2) disección de la arteria uterina desde su nacimiento; 3) disección del uréter en todo su trayecto; 4) sección de parametrios anteriores, posteriores y laterales, preservando el nervio y plexo hipogástricos; 5) diéresis de mango vaginal en 2 colgajos, anterior y posterior; 6) sección del cérvix a nivel ístmicocervical, con biopsia introperatoria del margen superior del cuello uterino; 7) síntesis vaginal al istmo. Principales medidas de resultados: Factibilidad quirúrgica, pérdida sanguínea, tiempo operatorio, complicaciones, duración de internación, radicalidad quirúrgica por estudio anatomopatológico de la pieza operatoria, gestaciones y recidivas. Resultados: La técnica pudo realizarse satisfactoriamente en todos los casos. En dos, se completó con la histerectomía, debido a márgenes cervicales comprometidos. Duración 180 minutos. Débito sanguíneo 600 mL. Fueron complicaciones un caso de dispareunia más poliposis cervical y un caso de dismenorrea. En el seguimiento de 2 a 50 meses, se verificó una gestación y una recidiva central. Conclusiones: La TRAPAU ha demostrado ser quirúrgicamente factible, con óptima radicalidad quirúrgica, manteniendo la integridad de la irrigación uterina, lo que preserva mejor la funcionalidad del aparato reproductor.
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Kabine, M., H. Chraibi-Kaadoud, A. Bassir, H. Jalal, H. Asmouki, A. Aboulfalah, and A. Soummani. "FAUX ANEVRYSME DE L ARTERE UTERINE : ETIOLOGIE INHABITUELLE DES HEMORRAGIES DU POST-PARTUM." International Journal of Advanced Research 10, no. 04 (April 30, 2022): 979–84. http://dx.doi.org/10.21474/ijar01/14633.
Full textAbstract:
Le faux anevrysme de lartere uterine est une complication rare, encore mal connue de la cesarienne, il est responsable dune hemorragie du post-partum secondaire, le plus souvent severe. Nous rapportons une observation dun faux anevrysme de lartere uterine gauche survenu 1 mois apres accouchement par cesarienne et revele par des metrorragies. Le diagnostic repose sur les donnees echographiques couple au Doppler vasculaire.Langiographie des arteres uterines constitue lexamen de reference. Son rôle est double, diagnostique et therapeutique par embolisation arterielle selective permettant lexclusion definitive de la lesion, tout en preservant la fertilite des patientes. Summary: The false aneurysm of the uterine artery is a rare, still poorly understood complication of caesarean section, it is an uncommun cause of secondary postpartum hemorrhage, most often severe. We report a case of a false aneurysm of the left uterine artery which occurred 1 month after caesarean delivery, revealed by metrorrhagia. Diagnosis is based on ultrasound data coupled with vascular Doppler. Angiography of the uterine arteries is the reference examination. Its role is twofold: diagnostic and therapeutic by selective arterial embolization allowing the definitive exclusion of the lesion, while preserving the fertility of the patients.
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Lin, Chen, Hong He, Ning Cui, Zongli Ren, Minglin Zhu, and Raouf A. Khalil. "Decreased uterine vascularization and uterine arterial expansive remodeling with reduced matrix metalloproteinase-2 and -9 in hypertensive pregnancy." American Journal of Physiology-Heart and Circulatory Physiology 318, no. 1 (January 1, 2020): H165—H180. http://dx.doi.org/10.1152/ajpheart.00602.2019.
Full textAbstract:
Normal pregnancy involves extensive remodeling of uterine and spiral arteries and matrix metalloproteinases (MMPs)-mediated proteolysis of extracellular matrix (ECM). Preeclampsia is characterized by hypertension in pregnancy (HTN-Preg) and intrauterine growth restriction (IUGR) with unclear mechanisms. Initial faulty placentation and reduced uterine perfusion pressure (RUPP) could release cytoactive factors and trigger an incessant cycle of suppressed trophoblast invasion of spiral arteries, further RUPP, and progressive placental ischemia leading to HTN-Preg and IUGR; however, the extent and depth of uterine vascularization and the proteolytic enzymes and ECM proteins involved are unclear. We hypothesized that HTN-Preg involves decreased uterine vascularization and arterial remodeling by MMPs and accumulation of ECM collagen. Blood pressure (BP) and fetal parameters were measured in normal Preg rats and RUPP rat model, and the uteri were assessed for vascularity, MMP levels, and collagen deposition. On gestational day 19, BP was higher, and the uterus weight, litter size, and pup weight were reduced in RUPP vs. Preg rats. Histology of uterine tissue sections showed reduced number (5.75 ± 0.95 vs. 11.50 ± 0.87) and size (0.05 ± 0.01 vs. 0.12 ± 0.02 mm2) of uterine spiral arterioles in RUPP vs. Preg rats. Immunohistochemistry showed localization of endothelial cell marker cluster of differentiation 31 (CD31) and smooth muscle marker α-actin in uterine arteriolar wall and confirmed decreased number/size of uterine arterioles in RUPP rats. The cytotrophoblast marker cytokeratin-7 showed less staining and invasion of spiral arteries in the deep decidua of RUPP vs. Preg rats. Uterine arteries showed less expansion in response to increases in intraluminal pressure in RUPP vs. Preg rats. Western blot analysis, gelatin zymography, and immunohistochemistry showed decreases in MMP-2 and MMP-9 and increases in the MMP substrate collagen-IV in uterus and uterine arteries of RUPP vs. those in Preg rats. The results suggest decreased number, size and expansiveness of spiral and uterine arteries with decreased MMP-2 and MMP-9 and increased collagen-IV in HTN-Preg. Decreased uterine vascularization and uterine arterial expansive remodeling by MMPs could be contributing mechanisms to uteroplacental ischemia in HTN-Preg and preeclampsia. NEW & NOTEWORTHY Preeclampsia is a pregnancy-related disorder in which initial inadequate placentation and RUPP cause the release of cytoactive factors and trigger a ceaseless cycle of suppressed trophoblast invasion of spiral arteries, further RUPP, and progressive placental ischemia leading to HTN-Preg and IUGR; however, the extent/depth of uterine vascularization and the driving proteolytic enzymes and ECM proteins are unclear. This study shows decreased number, size, and expansiveness of uterine spiral arteries, with decreased MMP-2 and MMP-9 and increased collagen-IV in HTN-Preg rats. The decreased uterine vascularization and uterine arterial expansive remodeling by MMPs could contribute to progressive uteroplacental ischemia in HTN-Preg and preeclampsia.
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Weiner, C., K. Z. Liu, L. Thompson, J. Herrig, and D. Chestnut. "Effect of pregnancy on endothelium and smooth muscle: their role in reduced adrenergic sensitivity." American Journal of Physiology-Heart and Circulatory Physiology 261, no. 4 (October 1, 1991): H1275—H1283. http://dx.doi.org/10.1152/ajpheart.1991.261.4.h1275.
Full textAbstract:
During pregnancy, vascular reactivity of the uterine artery is characterized by decreased contraction to norepinephrine and increased relaxation to acetylcholine. We investigated whether 1) relaxation to A23187 is increased during pregnancy and 2) endothelium-derived relaxing factor (EDRF) and/or prostaglandins are responsible for the decreased uterine artery sensitivity to norepinephrine during pregnancy. Isolated rings of uterine and carotid arteries were obtained from pregnant and nonpregnant guinea pigs. Relaxation to sodium nitroprusside in uterine but not carotid artery was reduced during pregnancy. Relaxation of both uterine and carotid arteries to the calcium ionophore A23187 was unaffected by pregnancy. During pregnancy, contractions to norepinephrine were reduced in the uterine artery compared with arteries from nonpregnant animals. Indomethacin slightly enhanced the contractions of uterine artery to norepinephrine during pregnancy. However, indomethacin-treated uterine arteries from pregnant animals were still less responsive to norepinephrine than control uterine arteries from nonpregnant animals. Methylene blue enhanced the efficacy of norepinephrine in uterine arteries of nonpregnant animals as well as carotid arteries of pregnant and nonpregnant animals but not in uterine arteries of pregnant animals. In contrast, N-monomethyl-L-arginine, a specific inhibitor of EDRF synthesis, not only enhanced uterine and carotid artery responses to norepinephrine in both pregnant and nonpregnant animals but fully reversed the blunted potency of norepinephrine on uterine arteries of pregnant to that of nonpregnant animals.(ABSTRACT TRUNCATED AT 250 WORDS)
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Xiao, DaLiao, XiaoHui Huang, Soochan Bae, Charles A. Ducsay, Lawrence D. Longo, and Lubo Zhang. "Cortisol-mediated regulation of uterine artery contractility: effect of chronic hypoxia." American Journal of Physiology-Heart and Circulatory Physiology 286, no. 2 (February 2004): H716—H722. http://dx.doi.org/10.1152/ajpheart.00805.2003.
Full textAbstract:
We previously demonstrated that cortisol regulated α1-adrenoceptor-mediated contractions differentially in nonpregnant and pregnant uterine arteries. Given that chronic hypoxia during pregnancy has profound effects on maternal uterine artery reactivity, the present study investigated the effects of chronic hypoxia on cortisol-mediated regulation of uterine artery contractions. Pregnant ( day 30) and nonpregnant ewes were divided between normoxic control and chronically hypoxic [maintained at high altitude (3,820 m), arterial Po2: 60 mmHg for 110 days] groups. Uterine arteries were isolated and contractions measured. In hypoxic animals, cortisol (10 ng/ml for 24 h) increased norepinephrine-induced contractions in pregnant, but not in nonpregnant, uterine arteries. The 11β-hydroxysteroid dehydrogenase inhibitor carbenoxolone did not change cortisol effects in nonpregnant uterine arteries, but abolished it in pregnant uterine arteries by increasing norepinephrine pD2 (–log EC50) in control tissues. The dissociation constant of norepinephrine-α1-adrenoceptors was not changed by cortisol in nonpregnant, but decreased in pregnant uterine arteries. There were no differences in the density of glucocorticoid receptors between normoxic and hypoxic tissues. Cortisol inhibited the norepinephrine-induced increase in Ca2+ concentrations in nonpregnant arteries, but potentiated it in pregnant arteries. In addition, cortisol attenuated phorbol 12,13-dibutyrate-induced contractions in normoxic nonpregnant and pregnant uterine arteries, but had no effect on the contractions in hypoxic arteries. The results suggest that cortisol differentially regulates α1-adrenoceptor- and PKC-mediated contractions in uterine arteries. Chronic hypoxia suppresses uterine artery sensitivity to cortisol, which may play an important role in the adaptation of uterine vascular tone and blood flow in response to chronic stress of hypoxia during pregnancy.
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Idowu, Bukunmi, Bolanle Ibitoye, and Victor Adetiloye. "Uterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 39, no. 09 (August 7, 2017): 464–70. http://dx.doi.org/10.1055/s-0037-1604489.
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Objective To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography. Methods This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests. Results The median uterine volume of the subjects was 556 cm3, while that of the controls was 90.5 cm3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values. Conclusion There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.
Dissertations / Theses on the topic "ARTERIE UTERINE"
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Quadrifoglio, M. "FIRST TRIMESTER SCREENING FOR HYPERTENSIVE DISORDER OF PLACENTAL AND MATERNOGENIC ORIGIN." Doctoral thesis, Università degli Studi di Milano, 2015. http://hdl.handle.net/2434/263870.
Full textAbstract:
FIRST TRIMESTER SCREENING OF HYPERTENSIVE DISORDERS OF PLACENTAL AND MATERNOGENIC ORIGIN
Background:
Hypertensive disorders (HD) constitute a heterogeneous group of conditions. They complicate around 10% of pregnancies, and are a major cause of maternal and perinatal morbidity and mortality. The most used classification is based on temporal criteria: diagnosis (or delivery) before/after 34 weeks’ of gestation. Early-onset HD (before 34 weeks) is commonly associated with abnormal uterine artery Doppler, fetal growth restriction, evidence of ischemic lesions on placental examination and adverse maternal and neonatal outcomes. In contrast, late-onset HD (after 34 weeks) is mostly associated with normal or slightly increased uterine resistance index, a low rate of fetal involvement, and more favourable perinatal outcomes. Nevertheless, the phenotypes of HD do not fit entirely into the temporal classification. Thus, it has been hypothesized that phenotypes of HD, rather than temporal classification, reflect the underlying aetiology of HD: 1) HD of placental origin, when the defect in placentation causes an altered remodelling of the spiral arteries leading to reduced placental flow, activation of coagulation cascade, organ damage and intrauterine fetal growth restriction (IUGR); and 2) HD of maternogenic origin, associated with normal feto-placental perfusion and normal fetal growth, probably related to chronic inflammation and insuline resistance, typical aspects of metabolic syndrome.
The early identification of pregnancies at risk of HD is a major challenge. Extensive research has identified a series of 1st trimester biophysical and biochemical markers of impaired placentation. The combination of these markers and maternal history have been used by clinicians as a 1st trimester screening for the recognition of pregnancies at risk of early/late onset HD.
The aim of the study is to evaluate a new classification of hypertensive disease based on physiopathology, and not on temporary factors and to evaluate the effectiveness of 1st trimester screening for HD of placental and maternal origin by Doppler velocimetry of uterine arteries (UtA).
Material and Methods:
This is a prospective longitudinal cohort study of pregnant women followed in two hospital: prenatal diagnosis and gynaecologic Unit of the Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” in Trieste and Obstetrics and Gynecologic Unit of Children’s Hospital – ICP “Vittore Buzzi” in Milan, Italy. This study was offered to pregnant women at the time of first trimester ultrasound aneuploidy screening. All women were recruited consecutively from October 2007 to April 2009 in Triest and from October 2009 to December 2012 in Milan. We enrolled singleton pregnancies between 11+0 and 13+6 weeks of gestation. The inclusion criteria were: single pregnancy, gestational age between 11+0 and 13+6 weeks confirmed by scan measurements, and signed informed consent. Multiple pregnancies or pregnancies complicated by fetal malformation or aneuploidy, spontaneous abortion, intrauterine fetal death, maternal neurodevelopment delay or psychiatric disorders were excluded.
The following data were collected at the time of the scan: maternal history, previous disease, age, body mass index (BMI), parity, mode of conception (spontaneous or IVF), and gestational age. Doppler velocimetry of both UtA was added to routine ultrasound measurements. Doppler study was performed trans-abdominally, after identifying with the Color Doppler each uterine artery along the side of the cervix and uterus at the level of the internal os. Pulsed wave Doppler was used with the sampling gate set at 2 mm to cover the whole vessel ensuring the angle of insonation <30°. When three similar consecutive waveforms were obtained the pulsatility index (PI) was measured, and the mean PI of the left and right arteries was calculated. The measurements were performed by sonographers qualified by Fetal Medicine Foundation. Once the ultrasound examination was performed and the gestational age confirmed, a blood sample (around 5 cc) was taken from each woman. Maternal serum PAPP-A and B-hCG were measured and converted in multiple of the median (MoM).
Definitions: Placental HD was defined as gestational hypertension, with or without proteinuria, associated to IUGR (defined as the AC <5th centile or reduction in AC >40 centiles). Maternal HD was defined as gestational hypertension, with or without proteinuria, associated to appropriate for gestational age fetal growth. Chronic hypertension was defined as history of known hypertension or blood pressure ≥140/90 mmHg in two or more occasions with a distance at least of 4 hours before 20 weeks of gestation. The HD were also distinguished into early-onset, diagnosed <34 weeks’ gestation, and late-onset, with diagnosis ≥ 34 weeks. Intra-uterine growth restriction (IUGR) was defined as ultrasound abdominal circumference below the 10th percentile according to standards references based on gestational age. Other causes of IUGR such as infection, anomalies and abnormal chromosomes were excluded in all cases.
Pregnancy outcome data were collected as follows: fetal and maternal outcomes were obtained either directly from the clinical record if the delivery occurred in “Vittore Buzzi” Hospital or in “Burlo Garofolo” hospital or by a telephone questionnaires to the women after delivery.
Statistical analysis: The distribution of data was evaluated with Kruskall-Wallis test. In case of non-uniformely distributed data a log transformation was applied. The results are represented as mean value and standard deviation (SD). Logistic regression models were computed to evaluate the significance of the variables considered. The following variables were included: UtA mean PI, BMI, parity, gestational age at time of recruitment and fetal sex. The receiver operating curves (ROC) constructed on regression models were computed and area under the ROC (AUC) calculated to evaluate the performance of the model. We evaluated the 1st trimester model to identify: firstly, women at risk of developing placental or maternogenic HD, and, secondly, the early and late-onset HD. Each disease was evaluated against the whole cohort. The analysis was performed with the program Stata/IC 11.2 for Windows (Stata Corp LP, College Station, USA).
Results:
4218 women were enrolled in the study. 712 patients were lost to follow up or excluded because incomplete data acquisition. Overall 34 women were excluded because of: spontaneous abortion, aneuploidies or fetal malformations, and intrauterine fetal death. Among 3472 pregnancies included in the study, 122 women (3,5%) developed some hypertensive gestational disease, 56 fetuses were IUGR (1,6%), 10 women had chronic hypertension (0.3%) and 3284 women were unaffected (94.6%).
If we considered classification based on the aetiology, 16 women (0.5%) developed placental HD, 106 (3.0%) presented maternal HD. If we considered classification based on time of delivery, 11 women (0.3%) developed early-HD, 111 women (3.2%) presented late-HD.
The mean uterine artery PI was significantly higher in placental HD (2.36 p<0.01) when compared with the unaffected group (1.60). If we consider the early-late group, the mean uterine artery PI was significantly higher in early HD group (2.30, p<0.01) respect control group and in late HD group (1.71, p< 0.05). PAPP-A was significant lower in maternal-HD, late-HD and IUGR group (p< 0.01) and in CH group (p<0.05). There was no significant difference in BhCG levels through study group.
Concerning prediction of the logistic regression, the validity of the uterine arteries Doppler velocimetry has been confirmed for early identification of women at risk of developing a hypertensive disease, especially of placental origin. In effect the area under the ROC curve for placental hypertensive diseases was 0.879, whereas for early diseases was 0.858.
Conclusions:
The main findings of the study are: 1) the UtA mean PI is altered in placental HD, while there were no differences in maternogenic HD; 2) the UtA mean PI is altered in early-onset HD and late-onset HD; 3) the predictive value of UtA mean PI is higher for placental HD than for early-onset HD; and 4) the performance of the model based on UtA PI in the 1st trimester performs best in the prediction of the placental HD compared to all other groups.
Our study has some limitations: we acknowledge that the number of cases in the study is too small (the prevalence of HD in our cohort is low) to draw firm conclusions, and confirmation from larger studies will be required. Smoking habit was not considered. Diagnosis of early and late preeclampsia is based on time at delivery and not at time of diagnosis. Despite these limitations, the study shows that the classification based on phenotypes of HD is more appropriate than that based on temporal criteria. Indeed, our findings underline the importance of the “etiology” based classification in order to use, in the most appropriate way, the biophysical or biochemical marker screening tools. Thus, the usefulness of Doppler velocimetry of the uterine arteries to identify HD not associated with IUGR or simply based on temporal criteria appears to be of limited value. This finding is important when evaluating the performance of the screening programs or preventive policies.
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Teixidor, i. Viñas Mireia. "Rol de la inserció profilàctica de catèters balons oclusius percutanis a pacients amb anomalia placentària adherent." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/399505.
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Objectiu: La malaltia adherent placentària (MAP) és una causa d’hemorràgia postpart severa, amb una pèrdua sanguínia esperada de 3-5L. Ha estat tractada amb cesària i histerectomia peri- part de forma tradicional. S’exposa la nostra experiència amb la inserció profilàctica de catèters balons oclusius percutanis (CBOP) a ambdues artèries ilíaques internes, amb o sense necessitat d’embolització arterial uterina per tal de preservar l’úter de la pacient. Durant el treball de recerca s’ha desenvolupat un nou protocol de tractament conservador multidisciplinar anomenat Triple P procedure. S’avalua els resultats obtinguts des de la implantació d’aquest protocol, així com la necessitat de intervencions futures a dones amb MAP.
Material i Mètode: Dos articles han estat publicats a la literatura. El primer va ser publicat al Clinical radiology i inclou vint- i- set pacients diagnosticats perinatalment de MAP amb sospita de placenta percreta que varen ser tractades amb CBOP immediatament abans de realitzar un part per cesària. El segon article és un estudi de cohorts publicat al Ultrasound in Obstetrics and Gynecology on es compara 19 dones amb MAP tractades amb el Triple-P protocol (Grup estudi) i 11 tractades amb CBOP i part per cesària (Grup Control). El nombre i volum de transfusions sanguínies, pèrdua sanguínia estimada, la necessitat d’embolització arterial uterina (EAU) i/o la necessitat d’histerectomia han estat recopilades a ambdós articles.
Resultats: Placenta percreta va ser confirmada en 19 pacients [sis (54.5%) pacients del Grup Control i 13 (68.4%) del Grup Estudi]. La pèrdua sanguínia mitja estimada va ser menor al Grup Estudi que en el Grup Control (1.70 L vs 2.17 L, respectivament), però la diferència no va ser estadísticament significativa (P=0.445). El risc d’hemorràgia postpart (HPP) i la necessitat d’histerectomia van disminuir de forma estadísticament significativa en el Grup Estudi (HPP, 54.5% vs 15.8%; P=0.035; histerectomia, 27.3% vs 0.0%; P=0.045). Com a conseqüència, es va observar una disminució estadísticament significativa en l’estada hospitalària de les pacients del Grup estudi (P=0.044).
Conclusió: Els CBOP amb o sense EAU contribueixen a la disminució de la pèrdua sanguínia i del risc d’histerectomia peripart a les pacients amb MAP. La introducció del Triple-P procedure disminueix de forma significativa el risc d’histerectomia, HPP i estada hospitalària a aquestes pacients.Aim: Morbidly adherent placenta (MAP) is a cause of severe postpartum haemorrhage (PPH) with expected blood loss of 3-5L. Traditionally, this has been treated by caesarean hysterectomy. We report our experience of prophylactic occlusion balloon catheters (POBC) in both internal iliac arteries before caesarean section, with or without embolisation to preserve the uterus and reduce haemorrhage. During our research we developed a new multidisciplinary conservative protocol of treatment involving POBC and placental non-separation, myometrial excision and reconstruction of the uterine wall called Triple P procedure. We also evaluate patient outcomes and need for further interventions in women with MAP, before and after introduction of the Triple-P procedure. Methods and Materials: Two articles have published in the literature. The first one was publish at Clinical radiology and includes twenty-seven women diagnosed with MAP and with suspected placenta percreta underwent POBCs before caesarean section. The second article is a cohort study published at Ultrasound in Obstetrics and Gynecology and compares 19 women with MAP treated with the Triple-P protocol (study group) and 11 treated with POBC and caesarean (control group). The quantity of blood replacement products, estimated blood loss, and necessity for uterine arterial embolization and/or hysterectomy were recorded retrospectively in both articles. Results: Placenta percreta was confirmed in 19 patients [six (54.5%) patients in the control group and 13 (68.4%) in the study group]. Estimated mean blood loss during the procedure was lower in the study group than in the control group (1.70 L vs 2.17 L, respectively), but the difference was not statistically significant (P=0.445). The risks of postpartum hemorrhage (PPH) and hysterectomy were statistically significantly lower in the study group (PPH, 54.5% vs 15.8%; P=0.035; hysterectomy, 27.3% vs 0.0%; P=0.045). As a consequence, there was a significant decrease in duration of inpatient stay in the study group (P=0.044). Conclusion: POBC with or without UAE, contributes to reduction in blood loss and preservation of the uterus in women with MAP Introduction of the Triple-P procedure conveyed a significantly reduced rate of hysterectomy, PPH and duration of hospital stay in patients with MAP.
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Franco, Glaucimeire Marquez. "Centralização cerebral materna na doença hipertensiva específica da gestação." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/4729.
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Introduction: Preeclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality worldwide Objectives: To evaluate the maternal brain centralization in pregnant women with specific gestational hypertension. Produce a systematic review article on the ophthalmic artery Doppler and uterine artery and the flow-mediated dilation. Develop an original article in order to assess the possible occurrence of maternal brain centralization in pregnant women with specific gestational hypertension. Establish normal values of the ratio of uterine artery to the ophthalmic artery (mean and standard deviation). Compare the ratio of uterine with the ophthalmic artery in normal and pathological group. Set the cut-off point, using the ROC curve for specific diagnosis of patients with hypertensive disease of pregnancy. Methods: A systematic literature review involved 260 indexed articles from Medline via PubMed and Virtual Health Library (VHL), published between 1989 and 2014. For the original article, we performed a case-control study of 178 pregnant women divided into two groups: a control group of normal patients (PN), a total of 83 normotensive pregnant women; and one case group of 95 patients with specific gestational hypertension. The analyzed parameters which formed part of the variables studied were: systolic velocity (VS), diastolic velocity (RV), the resistance index, systole-diastole relationship. In addition to these variables were also studied epidemiological variables of pregnancy, parity, abortion, weight, height, BMI, maternal age, gestational age. Results: Through the search strategy, were located 260 articles, of which 33 articles were eligible, with fifteen articles on the ophthalmic artery, eight articles on the brachial artery and eight articles on uterine artery. A total of 178 patients took part in study. The average age of normal pregnant women group of patients was 29.8 ± 4.7 and patients with specific gestational hypertension, of 26.14 ± 6.17. The mean gestational age of normal pregnant patients was 34.3 ± 3.5 weeks and the patients with specific gestational hypertension, of 32.40 ± 3.37. The mean body mass index (BMI) of healthy patients was 26.8 ± 5.6 and patients with specific gestational hypertension, of 30.55 ± 5.12. A normality curve systole-diastole compared with the respective cutoff was performed. A ROC curve was developed, with the cutoff point, considering the systolic velocity, diastolic velocity, systolic-diastolic ratio and the resistance index of the ophthalmic artery, respectively. Conclusion: The Doppler uterine artery and ophthalmic artery flow-mediated dilatation can be useful to identify patients at risk for allowing the monitoring of disease progression and perform effective interventions. It is observed that the possibility of maternal centralization in high-risk pregnancy as the PE is real, whereas in the average normal values and the standard deviation of the Doppler AU / AO-systole-diastole ratio were 0.43 ± 0 16. The cutoff point more sensitive, verified by the ROC curve, which defines maternal brain centralization in patients with hypertensive disorders of pregnancy, is 0.57 for the S / D for UD / AO, with 78% sensitivity and 13 % false positive and 77% specificity.
Introdução: A pré-eclâmpsia é um importante problema em obstetrícia, com altos índices de morbidade perinatal e mortalidade em todo o mundo, principalmente nos países em desenvolvimento. Objetivos: Avaliar a ocorrência de centralização cerebral materna em gestantes portadoras de doença hipertensiva específica da gestação. Produzir um artigo de revisão sistemática sobre Doppler da artéria oftálmica e da artéria uterina e sobre a dilatação fluxo-mediada da artéria braquial. Elaborar um artigo original para avaliar a ocorrência da centralização cerebral materna em gestantes portadoras de doença hipertensiva específica da gestação. Estabelecer a curva de normalidade da relação do Doppler da artéria uterina com o Doppler da artéria oftálmica. Comparar a relação do Doppler da uterina com o Doppler da artéria oftálmica no grupo normal e patológico. Definir o ponto de corte, através da curva ROC, para diagnóstico de pacientes com doença hipertensiva específica da gestação. Métodos: A revisão sistemática da literatura envolveu 260 artigos indexados das bases de dados Medline via PubMed e Biblioteca Virtual em Saúde (BVS), publicados entre 1989 e 2014. Para o artigo original, foi realizado um estudo caso controle com 178 gestantes distribuídas em dois grupos: um grupo-controle de pacientes normais (PN), num total de 83 gestantes normotensas; e um grupo casos de 95 pacientes com doença hipertensiva específica da gestação. As variáveis estudadas foram: a velocidade sistólica (VS), a velocidade diastólica (VD), o índice de resistência, a relação sístole-diástole. Além dessas variáveis foram estudadas paridade, aborto, peso, altura, IMC, idade materna, idade gestacional. Resultados: Por meio da estratégia de busca, localizaram-se 260 artigos, dos quais foram elegíveis 32 artigos, sendo dezesseis artigos sobre a artéria oftálmica, oito artigos sobre a artéria braquial e oito artigos sobre a artéria uterina. Um total de 178 pacientes fez parte do estudo. A média de idade das pacientes do grupo de gestantes normais foi de 29,8±4,7 e das pacientes com doença hipertensiva específica da gestação, de 26,14±6,17. A média da idade gestacional das pacientes gestantes normais foi de 34,3±3,5 semanas e das pacientes com doença hipertensiva específica da gestação, de 32,40±3,37. A média do índice de massa corporal (IMC) das gestantes normais foi de 26,8±5,6 e das pacientes com doença hipertensiva específica da gestação, de 30,55±5,12. Foi realizada uma curva de normalidade da relação sístole-diástole com o respectivo ponto de corte. Desenvolveu-se uma curva ROC com o ponto de corte, considerando a velocidade sistólica, a velocidade diastólica, a relação sístole-diástole e o índice de resistência da artéria oftálmica, respectivamente. Conclusão: O Doppler da artéria oftálmica e da artéria uterina e a dilatação fluxo mediada podem ser úteis para identificar pacientes em risco. Observou-se que a ocorrência de centralização materna em gravidez de alto risco como a pré-eclâmpsia (PE) é real, visto que na curva de normalidade a média e o desvio padrão do Doppler da AU/AO da relação sístole-diástole foram de 0,43 ± 0,16. O ponto de corte mais sensível, verificado por meio da curva ROC, que define centralização cerebral materna nas pacientes com doença hipertensiva específica da gestação, é de 0,57 para a S/D da UD/AO, com 78% de sensibilidade e 13% de falso positivo e 77% de especificidade.
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Chaves, Francisco Nogueira. "Technical ligation of ascending branches of the arteries uterna vaginal and its effect in the treatment of symptomatic uterine fibroids." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4792.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorA miomatose uterina à um problema de saÃde pÃblica em todo o mundo, sendo responsÃvel por 30 a 40% das indicaÃÃes de histerectomia. Necessita-se de alternativas terapÃuticas eficazes, seguras, minimamente invasivas e de baixo custo. Alguns pesquisadores observaram resultados satisfatÃrios ao promover a diminuiÃÃo do fluxo sanguineo para o Ãtero, atravÃs da oclusÃo dos vasos uterinos por via laparoscÃpica. Neste estudo, com 16 pacientes com volume uterino aumentado, sangramento uterino anormal e dor de origem miomatosa; afastando outras causas concomitantes como cÃncer de colo ou endomÃtrio, adenomiose, e pÃlipos uterinos. Realizou-se uma tÃcnica simplificada de ligadura das artÃrias uterinas ascendentes, por via vaginal (LAUAV), e avaliou-se suas repercussÃes sobre sinais e sintomas mencionados, como tambÃm, sobre as alteraÃÃes do FSH, das imagens uterinas e o grau de satisfaÃÃo geral com o procedimento. A oclusÃo destes vasos foi executada pelo fundo de saco anterior, atravÃs de incisÃo da mucosa vaginal ao nÃvel da prega vÃsico cervical, das 10h Ãs 14h, seguida de secÃÃo dos ligamentos supra-cervical e vÃsico uterino para afastar a bexiga e o ureter. A LAUAV foi realizada sob visÃo direta com material especÃfico para trabalhar neste espaÃo exÃguo. As pacientes foram acompanhadas por 6 meses e reavaliadas em relaÃÃo aos parÃmetros comentados. O sangramento, a dor, o volume uterino, o diÃmetro do maior mioma apresentaram diminuiÃÃo significante e o FSH nÃo apresentou diferenÃas significantes, refletindo preservaÃÃo da funÃÃo ovariana. NÃo ocorreram complicaÃÃes. O grau de satisfaÃÃo das pacientes atingiu 90%. A LAUAV apresentou-se como uma opÃÃo segura, barata e eficaz no tratamento da miomatose sintomÃtica.
Uterine Myomatosis is a worldwide Public Health problem, responsible for 30 to 40% of indications for hysterectomy. Efficient, safe, minimally invasive alternative and low costs therapeutics are needed. Some researchers have observed satisfactory results at promoting the reduction of blood flow to uterus, through the occlusion of uterus blood vessels via laparoscopy. 16 patients who presented uterine increased volume, uterine abnormal bleeding and pain, originated by myomatosis participated in this study. Patients who presented other concurrent causes such as uterine bleeding, pain or uterine volume increase such as cervix cancer or uterus endometrial cancer, adenomyosis and uterine polyps were excluded from this study. It was carried out a ligature technique of ascendant branches of uterine arteries via vaginal (LAUAV) and the repercussion on signals and symptoms above mentioned, as well as alterations of follicle stimulating hormone (FSH), of uterine images, and the level of general satisfaction with such medical proceeding have been evaluated. Occlusion of such vessels was carried out by the bottom of the anterior saccus, through incision of vaginal mucosa, at the level of vesico-cervical plica, from 10a.m. to 2 p.m., followed by section of supra-cervical and vesicouterine ligaments to deviate the bladder and the ureter. LAUAV was carried out under direct vision with specific material to work in such a small space. Patients have been accompanied during 6 months and the re-evaluated in relation to the commented parameters. Bleeding, pain and uterine volume, and the diameter of the dominant myoma has presented significant reduction and FSH has not presented statistically considerable difference, reflecting the preservation of ovarian reserve. No Complications have occurred. Patientsâ satisfaction level attained 90%. LAUAV represents a secure, low-cost and efficient treatment of symptomatic myomatosis.
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RABEARIVELO, HAJANIRINA. "Le doppler uterin : interet predictif pour les complications gravidiques sur 45 grossesses suivies au pme du chu de nantes." Nantes, 1993. http://www.theses.fr/1993NANT044M.
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García, García Belén. "UTOPIA:Eficacia del Doppler de las arterias uterinas en el segundo trimestre y control exhaustivo de la gestación para la prevención de malos resultados perinatales. Estudio randomizado." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/325417.
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La preeclampsia (PE) y el retraso de crecimiento intrauterino (RCIU) afectan a un 4-10% de todas las gestaciones. A pesar de ser las causas principales de parto prematuro yatrogéno y morbilidad materna en países desarrollados, su fisiopatología multifactorial no está del todo aclarada. La única medida terapéutica eficaz continúa siendo la finalización de la gestación. Por lo tanto, predicción y prevención de PE y RCIU siguen siendo objetivos prioritarios en la medicina materno-fetal.
Objetivo: Valorar la capacidad del Doppler de arterias uterinas en segundo trimestre para la detección de pacientes con riesgo incrementado de PE y RCIU y, si su seguimiento exhaustivo durante la gestación mejoraría los resultados maternofetales en una población no seleccionada.
Métodos: Estudio multicéntrico aleatorizado. Desde junio de 2006 a mayo de 2010, se llevó a cabo este estudio en cuatro centros en España: Hospital Universitario Vall d'Hebron, Hospital Universistario de Sant Joan de Déu, Hospital Universitario de Las Palmas de Gran Canaria y el Hospital de Son Llatzer.
En la ecografía morfólogica rutinaria de segundo trimestre, las gestantes fueron asignadas aleatoriamente al grupo de estudio Doppler o no Doppler. Las pacientes que presentaban un aumento de resistencia a nivel de las arterias uterinas eran sometidas a control exhaustivo en la Unidad de Alto Riesgo Obstétrico. El control exhaustivo consistía en visitas mensuales para la toma de constantes , proteinuria cualitativa, analítica sanguínea y control ecográfico de crecimiento fetal y Doppler útero-placentario.
Resultados: Se incluyeron los 11667 mujeres. En general, PE se presentó en 350 casos (2,58%), PE de instauración precoz (<34s) en 48 casos (0.41%), retraso del crecimiento intrauterino en 722 casos (6,18%), retraso del crecimiento intrauterino de instauración precoz en 93 casos (0,79) y PE del instauración tardía con retraso del crecimiento intrauterino en 32 casos (0,27%). El aumento de resitencia a nivel de las arterias uterinas, considerado como aquel IP por encima del p90, fue capaz de detectar el 59% de los casos de PE de instauración precoz y el 60% de los casos de RCIU de instauración precoz con una tasa de falsos positivos de 11.1%. Cuando se compararon los resultados perinatales y maternos según grupo al que hubiesen sido asignadas (UT-Doppler vs no - UT Doppler), no se encontraron diferencias estadísticamente significativas. Sin embargo, si se observó un mayor número de intervenciones médicas, tales como inducción al trabajo de parto y tratamiento con corticoesteroides.
Conclusión: El estudio ecográfico rutinario de la resistencia a nivel de las arterias uterinas en segundo trimestre, en población no seleccionada identifica a aquellas pacientes con riesgo de complicaciones placentarias, pero la anticipación en el diagnóstico no mejora la morbi-mortalidad materno-fetal.Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are estimated to affect 4-10% of all pregnancies. Despite being the leading causes of premature iatrogenic deliveries and maternal morbidity in developed countries, their aetiologies remain elusive and the only definitive therapeutic measure is delivery. Therefore, prediction and prevention of PE and IUGR remain major goals in fetal-maternal medicine. Aims: To ascertain whether uterine artery Doppler screening for PE and IUGR risk in the second trimester and targeted surveillance improve maternal and perinatal outcomes in an unselected population Methods: Multi-center randomised open-label controlled trial. From June 2006 to May 2010, this randomised trial was conducted at four centres in Spain: Vall d’Hebron University Hospital, Sant Joan de Déu University Hospital, Las Palmas de Gran Canaria University Hospital and Son Llatzer Hospital. In the second trimester rutine anomaly scan, women were randomly assigned to the uterine or non-uterine Doppler groups. Women with abnormal uterine artery Doppler were offered intensive surveillance in high-risk clinics of the participating centres with 4-weekly visits that included measurement of maternal blood pressure, proteinuria in dipsticks, blood test, foetal growth and Doppler scan. Results: 11667 women were included. Overall, PE occurred in 350 cases (2,58%), early-onset PE in 48 cases (0,41%), IUGR in 722 cases (6,18%), early-onset IUGR in 93 cases (0,79%) and early-onset PE with IUGR in 32 cases (0,27%). Uterine artery mPI >90th percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UT-Doppler vs non-UT Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had a increase in medical interventions, such as corticosteroid administration and labour induction. Conclusion: Routine second trimester uterine artery Doppler ultrasound in unselected populations identifies women at risk for placental complications, however anticipation of the diagnosis failed to improve maternal or neonatal morbi-mortality.
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Zlotnik, Eduardo. "Parâmetros de ressonância magnética da pelve como fatores preditivos de resposta de leiomioma uterino à embolização arterial." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-11092012-095441/.
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Os métodos minimamente invasivos têm sido cada vez mais utilizados para o tratamento do leiomioma e, a embolização da artéria uterina, tem se destacado como método seguro e efetivo. O objetivo deste estudo foi avaliar, pela ressonância magnética da pelve, os fatores preditores da diminuição dos leiomiomas de pacientes submetidos a embolização da artéria uterina. Métodos: Estudaram-se 50 mulheres sintomáticas com leiomioma uterino, na menacme, que foram submetidas a embolização da artéria uterina. Acompanhou-se, por meio da ressonância magnética o volume do útero e dos leiomiomas. Foram examinados 179 leiomiomas nestas pacientes, um mês antes e seis meses depois do procedimento. Resultados: Seis meses após o tratamento, a redução média do volume uterino foi de 38,91%, enquanto os leiomiomas tiveram redução de 55,23%. Nos leiomiomas submucosos e/ou com a relação nódulo/músculo em T2 mais elevada, a redução do volume foi ainda maior (maior que 50,00%). Conclusões: As pacientes portadoras de leiomiomas e submetidas à embolização da artéria uterina apresentaram redução de volume dos nódulos superior a 50,00%, à ressonância magnética, quando eram submucosos e/ou tinham uma relação nódulo/músculo em T2 mais elevadaObjective : Minimally invasive methods are being an alternative to treat leiomyomas, including the uterine artery embolization that has emerged as a safe and effective method. The aim of this study was to evaluate the magnetic resonance imaging predictors of decrease in leiomyomas of patients who underwent uterine artery embolization. Methods: This study followed 50 symptomatic premenopausal women with uterine leiomyoma who underwent uterine artery embolization. Treatment was accompanied by magnetic resonance imaging of both the volume of the uterus and the leiomyomas. We examined 179 leiomyomas in that 50 patients, one month before and six months after of the procedure. Results: Six months after treatment, the mean reduction in uterine was 38.91%, while leiomyomas decreased by 55.23%. In submucosal leiomyomas and/or with a higher node/muscle ratio in T2, the volume reduction was even higher (greater than 50.00%). Conclusions: The patients with leiomyomas and underwent uterine artery embolization, showed reductions in the volume of nodes greater than 50,00%, on the magnetic resonance imaging, when they were submucosal and / or had a higher node-to-muscle ratio in T2
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Toro, Mayorga Ana G. "UTERINE ARTERY RUPTURE, AN ANGIOPATHY OF THE REPRODUCTIVE SYSTEM OF THE MARE: OCCURRENCE AND POTENTIAL EFFECTS." UKnowledge, 2015. http://uknowledge.uky.edu/gluck_etds/24.
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The intent of this research was to identify if the degenerative changes within arteries in the endometrium (endometrial angiopathies) correlate with degenerative changes in the uterine arteries and can be used as a predictor of increased risk for uterine artery rupture (UAR). With this objective specimens from 20 mares that died from uterine artery rupture and 21 control mares that died from unrelated causes were obtained from cases submitted to the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) over a two-year period. Postmortem specimens of each mare were collected from the left and right uterine arteries at the origin, bifurcation, and distal to the bifurcation as well as full thickness uterine wall sections at five different sites. An additional sample was taken from the uterine artery at the site of rupture in the affected mares. Tissue samples were immersed in 10% neutral buffered formalin, routinely processed, and stained with hematoxylin and eosin, Masson’s Trichrome, and Verhoeff´s Van Gieson histochemical stains as well as a smooth muscle-actin immunohistochemical marker. Elastosis, fibrosis, and vascular smooth muscle cell degeneration were identified in this study as potential contributors of vascular degeneration and a scoring system was developed to differentiate the degrees of severity of these specific degenerative changes within the intima and media of the vascular wall. Based on the scoring system, sections of uterine arteries and endometrial arterioles were blindly examined and the scored changes recorded for statistical analysis. Although the degenerative changes in endometrial and uterine arteries were similar within each group, the results could not not be used to predict an increased risk for UAR. Furthermore, we determined the major changes in vascular pathology of the affected uterine arteries and show there is a significant difference in degenerative changes between specific layers of the vascular wall.
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Mandia, L. "PLACENTATION IN OOCYTE DONATION PREGNANCIES: EVALUATION OF UTERINE ARTERIES DOPPLER AND PLACENTAL HORMONES." Doctoral thesis, Università degli Studi di Milano, 2015. http://hdl.handle.net/2434/333994.
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Introduction and objective: The aim of our study was to investigate the hypothesis that placentation in oocyte donation pregnancies (OD) presents differences compared to pregnancies conceived naturally or through in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) technique using autologous oocytes, as a result of alteration in normal placental and fetal-maternal interaction responsible of physiological placentation, due to genetic or hormonal factor and abnormal uterine and placental perfusion.
Methods: To verify this issue we performed 2 study concurrently. We first performed a longitudinal study to measure uterine artery doppler pulsatility index (PI) at first (11-13+6 weeks), second (19-21 weeks) and third trimester (30-32 weeks) and maternal serum levels of and 17-β estradiol at 11-13+6 weeks in 55 OD pregnancies, in 48 (IVF/ICSI) pregnancies with autologous oocytes and 122 spontaneous pregnancies.
The second was a retrospective study performed in order to analyze free β-human chorionic gonadotropin (hCG), pregnancy-associated plasma protein-A (PAPP-A) and nuchal translucency in 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI).
Results: Mean uterine artery PI was significantly lower in OD in all trimester of pregnancy. First trimester: Controls 1,679 (DS 0,456), Autologous IVF/ICSI 1,706 (DS 0,481) and OD IVF/ICSI - oocyte recipients 1,415 (DS 0,486), showing the latter a reduced value [IC95% - p 0.001 (OD vs. Spontaneous conceived pregnancies) and p 0.007 (OD vs. Autologous IVF/ICSI)]; II trimester: Controls 0,96 (0,294), Autologous IVF/ICSI 1,15 (0,407), OD IVF/ICSI - oocyte recipients 0,80 (0,292) (p < 0.05). III trimester, only the analysis between OD and spontaneous conceived pregnancies showed the same trend (p 0.018). Free β-hCG levels were significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p<0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p<0.05). PAPP-A levels did not significantly differ among the four groups. Significantly lower nuchal translucency was detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p<0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p<0.05) and Age-matched Controls (1.44 ± 0.42 mm; p<0.05).
Conclusion: Oocyte donation has a significant impact either on biophysical and biochemical markers.
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Patel, Trusher. "Uterine Arterial Embolization: Classification of Leiomyomas to Determine Predictors of Response." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-134426/.
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The purpose of this study is to determine features of uterine leiomyoma on Magnetic Resonance Imaging (MRI) that identify predictors of response to Uterine Arterial Embolization (UAE). MRI images were obtained before and after UAE in 35 women. These images were analyzed for uterine and fibroid size changes along with fibroid border characteristics and location for a total of 73 fibroids. Fibroids were classified as either smooth or lobulated based on border appearance on MR imaging to determine any differences in mean fibroid volume reduction post-embolization. The mean decrease in fibroid volume from pre-embolization to post-embolization was 48.1% ± 28.6 % (SD) (P < 0.001). No statistical difference was detected in the mean volume reduction between lobulated and smooth fibroids, 40.6% ± 23.1% (SD) and 50.9% ± 30.2% (SD) respectively, with a confidence interval [-25.1, 4.6, SEM 7.5, Df 71], single factor ANOVA (F[1,71]=1.88, Fcrit=3.98, p=0.17). However, some difference was detected in the failure rate of lobulated versus smooth fibroids to embolization, 5% and 9.4% respectively, ANOVA (F [1, 71]= 0.37, Fcrit= 3.98, p > 0.1), albeit at low statistical power. Also no difference was detected in mean fibroid volume reduction between intramural, submucosal, and subserosal fibroids. Thus, we introduced a novel characteristic by which to classify uterine fibroids based upon border appearance on MR imaging.
Books on the topic "ARTERIE UTERINE"
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Lee, Christoph I. Uterine Artery Embolization for Fibroids. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0028.
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This chapter, found in the abdominal and pelvic pain section of the book, provides a succinct synopsis of a key study examining the use of uterine artery embolization for patients with fibroids. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Women with symptomatic uterine fibroids undergoing uterine artery embolization were found to have similar quality of life measures 1 year posttreatment and faster recovery after uterine artery embolization versus surgery. However, benefits of noninvasive uterine artery embolization must be weighed against the need for reinterventions among a minority of patients with treatment failure. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Sapkal, Rekha. Surgical Skills on Internal Iliac Artery Ligation for Controlling Postpartum and Pelvic Hemorrhage. Jaypee Brothers Medical Publishers, 2015.
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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Obstetric emergencies. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0031.
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Pre-eclampsia 518Eclampsia 520HELLP syndrome 522Postpartum haemorrhage 524Amniotic fluid embolism 526Pre-eclampsia is a common complication of pregnancy, UK incidence is 3–5%, with a complex hereditary, immunological and environmental aetiology.Abnormal placentation is characterized by impaired myometrial spiral artery relaxation, failure of trophoblastic invasion of these arterial walls and blockage of some vessels with fibrin, platelets and lipid-laden macrophages. There is a 30–40%, reduction in placental perfusion by the uterine arcuate arteries as seen by Doppler studies at 18–24 weeks gestation. Ultimately the shrunken, calcified, and microembolized placenta typical of the disease is seen. The placental lesion is responsible for fetal growth retardation and increased risks of premature labour, abruption and fetal demise. Maternal systemic features of this condition are characterized by widespread endothelial damage, affecting the peripheral, renal, hepatic, cerebral, and pulmonary vasculatures. These manifest clinically as hypertension, proteinuria and peripheral oedema, and in severe cases as eclamptic convulsions, cerebral haemorrhage (the most common cause of death due to pre-eclampsia in the UK), pulmonary oedema, hepatic infarcts and haemorrhage, coagulopathy and renal dysfunction....
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Hawkins, Joy L. Severe Peripartum Hemorrhage. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0049.
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Peripartum hemorrhage remains an important cause of maternal morbidity and mortality. Antepartum factors contributing to hemorrhage risk include abnormal placentation, while in the postpartum period uterine atony is the most common cause. Regardless of etiology, early recognition and timely treatment of peripartum hemorrhage is necessary to prevent massive blood loss and to improve outcomes for the mother and neonate. Massive transfusion protocols are crucial to successful resuscitation, and during situations of significant hemorrhage providers should also consider use of cell salvage, uterine artery embolization, antifibrinolytics, and clotting factor concentrates. Appropriate teamwork can lead to favorable outcomes even in cases of massive hemorrhage.
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Bonnet, Marie-Pierre, and Anne Alice Chantry. Placenta and uteroplacental perfusion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0003.
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The placenta is a complex and changing organ necessary for normal fetal growth and development and for maintenance of a healthy pregnancy. It has three major functions: a protective function of the fetus, an endocrine function, and a metabolic function. The main functional unit of the placenta is the chorionic villous, responsible for the majority of the fetal–maternal exchanges. Migration of trophoblastic cells induces a remodelling of the uterine arteries, with vasodilatated and compliant vessels, unresponsive to maternal vasomotor control. Therefore, any significant change in maternal blood pressure, in particular in the context of general or regional anaesthesia, can directly impact on uteroplacental perfusion. Most anaesthetic drugs cross the placental barrier, but without significant consequences on the fetal well-being.
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Robinson, Byron. Arteria Uterina Ovarica: The Utero-Ovarian Artery, or, the Genital Vascular Circle, Anatomy and Physiology, with Their Application in Diagnosis and Surgical Intervention. Creative Media Partners, LLC, 2018.
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Jacquemyn, Yves, and Anneke Kwee. Antenatal and intrapartum fetal evaluation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0006.
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Antenatal and intrapartum fetal monitoring aim to identify the beginning of the process of fetal hypoxia before irreversible fetal damage has taken place. Fetal movement counting by the mother has not been reported to be of any benefit. The biophysical profile score, incorporating ultrasound and fetal heart rate monitoring, has not been proven to reduce perinatal mortality in randomized trials. Doppler ultrasound allows the exploration of the perfusion of different fetal organ systems and provides data on possible hypoxia and fetal anaemia. Maternal uterine artery Doppler can be used to select women with a high risk for intrauterine growth restriction and pre-eclampsia but does not directly provide information on fetal status. Umbilical artery Doppler has been shown to reduce perinatal mortality significantly in high-risk pregnancies (but not in low-risk women). Adding middle cerebral artery Doppler to umbilical artery Doppler does not increase accuracy for detecting adverse perinatal outcome. Ductus venosus Doppler demonstrates moderate value in diagnosing fetal compromise; it is not known whether its use adds any value to umbilical artery Doppler alone. Cardiotocography (CTG) reflects the interaction between the fetal brain and peripheral cardiovascular system. Prelabour routine use of CTG in low-risk pregnancies has not been proven to improve outcome; computerized CTG significantly reduces perinatal mortality in high-risk pregnancies. Monitoring the fetus during labour with intermittent auscultation has not been compared to no monitoring at all; when compared with CTG no difference in perinatal mortality or cerebral palsy has been noted. CTG does lower neonatal seizures and is accompanied by a statistically non-significant rise in caesarean delivery. Fetal blood sampling to detect fetal pH and base deficit lowers caesarean delivery rate and neonatal convulsions when used in adjunct to CTG. Determination of fetal scalp lactate has not been shown to have an effect on neonatal outcome or on the rate of instrumental deliveries but is less often hampered by technical failure than fetal scalp pH. Analysis of the ST segment of the fetal ECG (STAN®) in combination with CTG during labour results in fewer vaginal operative deliveries, less need for neonatal intensive care, and less use of fetal blood sampling during labour, without a change in fetal metabolic acidosis when compared to CTG alone.
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Hakim, Alan J., and Rodney Grahame. Hypermobility syndromes. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0159.
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Hypermobility-related syndromes constitute a family of heritable disorders of connective tissue (HDCT) that derive from abnormalities affecting genes that encode for the connective tissue matrix proteins such as collagen, fibrillin, and tenascin. They range from such commonplace though poorly recognized conditions such as the joint hypermobility syndrome (JHS) to the better-known, if more rare, eponymous syndromes such as Marfan's syndrome (MFS) and the different types of the Ehlers-Danlos syndrome (EDS). The more common presentations are with skin pathology (bruising, scaring), joint or spinal and/or muscle pain and instability with vulnerability to injury and chronic widespread pain, cardiac valve pathologies, and in MFS and vascular EDS, arterial dilatation with the risk of dissection and rupture. JHS (widely considered synonymous with the EDS hypermobility type) is further complicated by cardiovascular autonomic dysfunction such as orthostatic intolerance, palpitations, and syncope, and the recently described and commonly encountered pangastrointestinal dysmotility. The latter can manifest as gastro-oesophageal reflux, gastroparesis, slow-transit constipation, or rectal evacuatory dysfunction with rectal intussusception. In addition, HDCT are associated with bladder and uterine problems as a consequence of pelvic floor weakness. Such multisystemic conditions need to be managed by a multidisciplinary team able to draw on medical, surgical, physical, and psychological interventions by appropriately experienced specialists and therapists. This chapter introduces the reader to the epidemiology, genetics, classification, and clinical presentation of JHS, EDS, and MFS. It also describes the key investigations required to support a diagnosis and assess complications of an HDCT, as well as the multidisciplinary approach to management.
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Juri Moran, Joulia Marianita, Paulina Elizabeth Durán Mora, Estefania Vanessa Arauz Andrade, Yessenia Isabel Sarchi Guayasamin, Alejandra Elizabeth Vasquez Fuel, Cesar Wladimir Reyes Padilla, Pamela Nathaly Pastrano Coronado, Lucia Paola Rodriguez Paz, Martha Elizabeth Aguilar Villagran, and Oscar Andres Toapanta Proaño. Ginecología Obstetricia: Patologías durante el embarazo. Mawil Publicaciones de Ecuador, 2019, 2020. http://dx.doi.org/10.26820/978-9942-826-07-7.
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En Medicina, el área de aplicación de Ginecología, la ciencia de la mujer condensa el estudio de las enfermedades frecuentes y graves, el diagnóstico, detección de los factores de riesgo y establecer mecanismos de prevención, prescribir los tratamientos médicos y quirúrgicos de las enfermedades del sis- tema reproductor femenino, entiéndase, todo lo relacionado con la vagina, las mamas, el útero y los ovarios. Durante el siglo XX, motivado por el crecimiento acelerado del conocimien- to científico y médico, se acrecienta la toma de conciencia del rol que le co- rresponde desempeñar a la medicina en el sector de la salud y la protección de la mujer embarazada. Los problemas del trato genital femenino cuando se asumen como responsabilidad de los ginecólogos, quienes incluyeron dentro del proceso de auscultación, diagnóstico y tratamiento aspectos fisiológicos y endocrinos. Las barreras de la formación académica se fueron difuminando y los ginecó- logos y obstetras comenzaron a estrechar su campo laboral y como resultante se constituyó la Ginecobstetricia. En el marco de estas reflexiones, surge la idea de la presentación de un tex- to titulado Ginecología – Obstetricia, mediante el cual se pretende hacer una contribución real a nivel teórico que permita apoyar a profesionales y estu- diantes en el área de salud humana, básicamente en algunas de las patologías o complicaciones médicas asociadas al embarazo, y tratadas por la especialidad obstétrica, así mismo, se abordan dos temas (1 y 2) de conocimiento general. Cabe indicar que el texto no pretende abordar la vasta información o literatura que sobre los temas se han tratado. El libro ha sido estructurado bajo el perfil de diez (10) temas que discurren estrictamente sobre contenidos específicos, a sa- ber: 1. El parto y sus fases, 2. Pruebas de Bienestar Fetal, 3. Amenaza de Parto Pretérmino, 4. Ruptura Prematura de Membranas, 5. Amenaza de aborto, 6. Desprendimiento de placenta, 7. Infecciones de vías urinarias en embarazadas, 8. Diabetes Gestacional, 9. Hipertension en las embarazadas y 10. Preeclamp- sia y eclampsia En el primer tema, el Parto y sus fases, se precisan diferentes nociones sobre 26 GINECOLOGIA - OBSTETRICIA el proceso y el resultado de parir (dar a luz). A lo largo de la historia ha evolu- cionado el conocimiento de este tema dando como resultado una terminología precisa sobre los diferentes tipos de parto: parto natural, parto normal, parto ins- trumental, parto pretérmino, parto humanizado, etc. Estas nociones obedecen a determinadas circunstancias específicas que lo circunscribe como el uso o no de instrumentos que ayuden al nacimiento de un feto. De manera general, el parto marca el final del embarazo y el nacimiento de la criatura que se engendraba en el útero de la madre. Este proceso por el que la mujer o la hembra de una especie vivípara expulsa el feto y la placenta al final de la gestación consta de tres fases: la fase de dilatación, la de expulsión y la placentaria o de alumbramiento. En el segundo tema titulado Pruebas de Bienestar Fetal, se destaca el desa- rrollo de diferentes pruebas para el control del bienestar fetal. Éstas constitu- yen las técnicas aplicadas a las madres que permiten predecir el posible riesgo fetal o hacer un pronóstico del estado actual del feto, es decir, que tratan de conseguir a través de una valoración del feto de forma sistemática, la identifi- cación de aquellos que están en peligro dentro del útero materno, para así to- mar las medidas apropiadas y prevenir un daño irreversible. Se abordan en este contexto las indicaciones y los métodos (clínicos, biofísicos y bioquímicos más utilizados para el control de bienestar fetal. En el tema tres (3) denominado Amenaza de Parto Pretérmino, el trabajo se centra, en el desarrollo de los siguientes ítems. La Definición de Parto Pretérmi- no, la Definición de amenaza de Parto Pretérmino, la Evaluación del riesgo, la etiología, la Clínica de la Amenaza de Parto Pretérmino, el Diagnóstico precoz de la Amenaza de Parto Pretérmino, la Evaluación de gestantes que acuden a emergencia por signos y síntomas de Amenaza de Parto Pretérmino y el trata- miento. El trabajo parte de la definición de Parto Pretérmino entendido como aquel que ocurre después de la semana 23 y antes de la semana 37 de gestación, para posteriormente, tratar lo relativo a la Amenaza de Parto Pretérmino (APP) definido como el proceso clínico sintomático (Aparición de dinámica uterina regular acompañado de modificaciones cervicales) que puede conducir a un parto pretérmino. Su etiología es compleja y multifactorial, en la que pueden intervenir de forma simultánea factores inflamatorios, isquémicos, inmunológi- cos, mecánicos y hormonales. 27 GINECOLOGIA - OBSTETRICIA Por otro parte, el tema cuatro (4) expone la Ruptura Prematura de Membra- nas, la cual constituye una complicación usual en la práctica obstétrica, esta puede aumentar la incidencia en la morbilidad y mortalidad materna – fetal. Múltiples estudios se están llevando a cabo para poder dilucidar completamente su fisiopatología, lo cual se hace cada vez más necesario para poder aplicar estos conceptos en la práctica clínica, la evidencia actual indica que la Ruptura Prematura de Membrana es un proceso que puede ser afectado por factores: bioquímicos, fisiológicos, patológicos y ambientales. El capítulo cinco (5) comprende la temática sobre la Amenaza de aborto. (AA) que es la complicación más común durante el embarazo, se define como el sangrado transvaginal antes de las 20 semanas de gestación (SDG) gestación o con un feto menor de 500g, con o sin contracciones uterinas, sin dilatación cervical y sin expulsión de productos de la concepción”. Es decir, se presenta hemorragia de origen intrauterino antes de la vigésima semana completa de ges- tación, con o sin contracciones uterinas, sin dilatación cervical y sin expulsión de los productos de la concepción. Los síntomas abarcan amenorrea secundaria, presencia de vitalidad fetal y cólica abdominales con o sin sangrado vaginal entre otros. Para el diagnóstico se puede hacer una ecografía abdominal o va- ginal, examen pélvico y de laboratorio. En un principio el tratamiento consiste en recomendar reposo en cama y reposo pélvico. La identificación de factores de riesgo, el Ultrasonido obstétrico y la medición de marcadores bioquímicos son de gran importancia para realizar un diagnóstico y establecer un pronóstico oportuno. Estos aspectos y otros relacionados con el tema como son: la clínica, el protocolo a seguir, el tratamiento y la prevención, son tratados en este capí- tulo. El tema Desprendimiento de placenta es desarrollado a lo largo del tema seis (6). Su contenido aborda los aspectos importes como los factores de riesgo, etiología, síntomas y signos, diagnóstico y tratamiento de esta complicación cuyo proceso se caracteriza por el desprendimiento total o parcial, antes del parto, de una placenta que esta insertada en su sitio normal. Este hecho que puede traer grandes consecuencias para el feto y para la madre, puede ocurrir en cualquier momento del embarazo. Los desprendimientos producidos antes de las 20 semanas, por su evolución, deberán ser tratados como abortos. Los que tienen lugar después de la semana 20 de gestación y antes del alumbramiento constituyen el cuadro conocido como desprendimiento prematuro de la placenta normalmente insertada. (abrptio plantae o accidente de Baudelocque). El pro- ceso ha tenido una variedad de denominaciones a lo largo del tiempo y son consecuencia de la diversidad de cuadros clínicos que pueden producirse, sien- do las más empleadas en la actualidad: abruptio placentae, ablatio placentae, desprendimiento prematuro de placenta normalmente inserta (DPPNI), junto con el término abreviado desprendimiento prematuro de placenta (DPP). Para hablar de otra importante complicación que aqueja a la gestante y su bebe por nacer se expone en el tema (7) relacionado con las Infecciones de vías urinarias en embarazadas. Los particulares cambios morfológicos y funcio- nales que se producen en el tracto urinario de la gestante hacen que la infec- ción del tracto urinario (ITU) sea la segunda patología médica más frecuente del embarazo, por detrás de la anemia. Las 3 entidades de mayor repercusión son: Bacteriuria asintomática (BA) (2-11%), cuya detección y tratamiento son fundamentales durante la gestación, pues se asocia a prematuridad, bajo peso y elevado riesgo de progresión a pielonefritis aguda (PA) y sepsis; la Cistitis aguda (CA) (1,5%) y la Pielonefritis aguda (1-2%), principal causa de ingreso no obstétrico en la gestante, que en el 10 al 20% de los casos supone alguna complicación grave que pone en riesgo la vida materna y la fetal. La Diabetes Gestacional se ubica y desarrolla en el tema ocho (8). Este tipo de diabetes que aparece o se diagnostica durante el embarazo ha aumentado su prevalencia y cobrado gran relevancia epidemiológica en los últimos años. La Diabetes Gestacional (DG) o Diabetes Mellitius Gestacional (DMG) se carac- teriza por una secreción de insulina insuficiente para compensar la resistencia a la hormona, propia del embarazo. Después del parto, los niveles de glucosa sanguínea suelen normalizarse; sin embargo, algunas mujeres desarrollan DM tipo 2 y se asocia con complicaciones graves en la madre y el hijo, incluso años después del nacimiento. La Hipertensión en las Embarazadas, tema tan tratado y controvertido en los últimos años por su significación a nivel de que es la complicación médica 29 GINECOLOGIA - OBSTETRICIA más frecuente de la gestación y ocurre según estudios comprobados en el 7% a 10% de los embarazos y constituye una causa importante de morbimortalidad materna y perinatal. De manera clásica, la HTA en el embarazo ha sido definida como el incremento, durante la gestación, de la presión arterial sistólica (PAS) en 30 mmHg o más y/o la presión arterial diastólica (PAD) en 15 mmHg o más comparado con el promedio de valores previos a la 20va. semana de gestación. Cuando no se conocen valores previos, una lectura de 140/90 mmHg o mayor es considerada como anormal. El tema desarrollado abarca una visión general sobre algunos aspectos relativos a la definición y su clasificación, los factores predisponentes, sintomatología, diagnóstico, tratamiento, etc. Por último, el tema 10 aborda dos alteraciones íntimamente ligadas a la hi- pertensión arterial en el embarazo: la preeclampsia y la eclampsia. Éstas son en ocasiones tratadas como componentes de un mismo síndrome ya que la pree- clampsia es la hipertensión de reciente comienzo con proteinuria después de las 20 semanas de gestación y la eclampsia es la presencia de convulsiones genera- lizadas inexplicables en pacientes con preeclampsia.
Book chapters on the topic "ARTERIE UTERINE"
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Semaan, Sahar. "Uterine Artery Embolization." In Procedural Dictations in Image-Guided Intervention, 525–27. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-40845-3_115.
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Keefe, Nicole A., and Ziv J. Haskal. "Uterine Artery Embolization." In IR Playbook, 313–22. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-71300-7_28.
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Sutphin, Patrick D., and Suvranu Ganguli. "Uterine Artery Embolization." In Endovascular Interventions, 885–95. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-7312-1_72.
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Sarin, Shawn N., Chad Baarson, Sameul Hanif, Yousaf Awan, and Anthony C. Venbrux. "Uterine Artery Embolization." In Women’s Health in Interventional Radiology, 3–36. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4419-5876-1_1.
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Momah-Ukeh, Ifechi, and Marco Ertreo. "Uterine Artery Embolization." In Essential Interventional Radiology Review, 567–77. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-84172-0_41.
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Houston, J. Graeme. "Infertility and Uterine Artery Embolisation." In Reproductive Surgery in Assisted Conception, 127–31. London: Springer London, 2015. http://dx.doi.org/10.1007/978-1-4471-4953-8_13.
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Kansagra, Kartik, and Cuong H. Lam. "Uterine Artery Embolization – Vascular Emergency." In Essential Interventional Radiology Review, 777–84. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-84172-0_52.
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Manivit, P., R. Polo, M. Nabet, M. Polo, B. Rubini, and J. M. Fromaget. "Intra-arterial chemotherapy in uterine cancer." In Proceedings of the 3rd International Congress on Neo-Adjuvant Chemotherapy, 302–4. Paris: Springer Paris, 1991. http://dx.doi.org/10.1007/978-2-8178-0782-9_74.
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Worthington-Kirsch, Robert L. "Uterine Artery Embolization for Fibroid Disease." In Tumor Ablation, 412–21. New York, NY: Springer New York, 2005. http://dx.doi.org/10.1007/0-387-28674-8_34.
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Spies, James B. "Uterine Artery Embolization Indications and Contraindications." In Radiological Interventions in Obstetrics and Gynaecology, 55–64. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/174_2012_627.
Full textConference papers on the topic "ARTERIE UTERINE"
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Gorikov, Igor, and Irina Andrievskaya. "RELATIONSHIP OF IMMUNO-DOPPLEROMETRIC INDICATORS IN WOMEN WITH EXACERBATION OF CYTOMEGALOVIRAL INFECTION IN THE SECOND TRIMESTER OF PREGNANCY." In XIV International Scientific Conference "System Analysis in Medicine". Far Eastern Scientific Center of Physiology and Pathology of Respiration, 2020. http://dx.doi.org/10.12737/conferencearticle_5fe01d9c5b6059.88807373.
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In order to assess the participation of immunoglobulin G (IgG) in changes in the regulation of blood flow in the uterine arteries, an analysis of the relationship between the serum IgG content and the systolic-diastolic ratio in the right and left uterine arteries was carried out in women with the physiological course of pregnancy and with exacerbation of cytomegalovirus infection in the second trimester of gestation, leading to the development of chronic compensated placental insufficiency.
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Aldhawi, Abeer F., Fares Garad, Mohammed Almetlag, Othman Alshehre, Hatim Alobaidi, Faisal Alahmari, and Sultan Alammari. "Uterine Artery Embolization after Internal Iliac Artery Ligation." In Presentation Abstracts. Thieme Medical and Scientific Publishers Pvt. Ltd., 2021. http://dx.doi.org/10.1055/s-0041-1740881.
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Machado, Priscilla, Kathleen Gillmore, Allison Tan, Carin Gonsalves, and Flemming Forsberg. "Quantitative Assessments of Uterine Fibroids pre and post Uterine Artery Embolization." In 2020 IEEE International Ultrasonics Symposium (IUS). IEEE, 2020. http://dx.doi.org/10.1109/ius46767.2020.9251642.
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Abdullah, Essam Tarek Essameldien, and Karim Ahmed Abdultawab. "Uterine Artery Embolization in Postpartum Hemorrhage." In PAIRS Annual Meeting. Thieme Medical and Scientific Publishers Pvt. Ltd., 2018. http://dx.doi.org/10.1055/s-0041-1730731.
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Moqbil, Sara, Eryk Mikos, Marcin Czeczelewski, Krzysztof Pyra, and Maciej Szmygin. "Pregnancy Outcome after Uterine Artery Embolization—Preliminary Study." In PAIRS 2023 Annual Congress. Thieme Medical and Scientific Publishers Pvt. Ltd., 2023. http://dx.doi.org/10.1055/s-0043-1763353.
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Lubis, Muara Panusunan, Sarma N. Lumbanraja, Herman Hariman, and Adang Bachtiar. "The Role of Uterine Artery Diastolic Notch and Uterine Artery Pulsatility Index to Predict the Event of Early Onset Preeclampsia." In The 2nd International Conference on Tropical Medicine and Infectious Disease. SCITEPRESS - Science and Technology Publications, 2019. http://dx.doi.org/10.5220/0009864002430246.
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Serrano, Andreia, Vanessa Cunha, Jorge P. Teixeira, Maria B. Pires, Joao G. OrNeill, and Valentina Vassilenko. "Hemodynamics in human uterine arteries: modeling and computational fluid dynamics calculations*." In 2019 IEEE 6th Portuguese Meeting on Bioengineering (ENBENG). IEEE, 2019. http://dx.doi.org/10.1109/enbeng.2019.8692493.
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Agrawal, Nimisha. "Uterine arterio-venous malformation after gestational trophoblastic neoplasia: a rare presentation." In 10th National Conference of Asia Oceania Research Organisation on Genital Infections and Neoplasia, India. AOGIN 2021, 2021. http://dx.doi.org/10.7869/aogin57.
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Pallavi, V., L. Gupta, S. K. Naik, R. S. Sisodia, and C. Firtion. "Doppler based identification of uterine artery and umbilical artery for monitoring pregnancy." In 2010 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC 2010). IEEE, 2010. http://dx.doi.org/10.1109/iembs.2010.5628089.
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Fielbrand, R., H. Hertel, P. Hillemanns, and R. Klapdor. "Die blutungsarme Myomenukleation – das temporäre Clipping der Arteriae uterinae." In 64. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe e. V. Georg Thieme Verlag, 2022. http://dx.doi.org/10.1055/s-0042-1756805.
Full textReports on the topic "ARTERIE UTERINE"
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Li, Yanhui, and Cuiju Hua. Comparison of the Efficacy and Subsequent Pregnancy Outcomes of High-intensity Focused Ultrasound and Uterine Artery Embolization in the Chinese Population: Meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0053.
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Review question / Objective: The combination of high-intensity focused ultrasound (HIFU), and uterine artery embolization (UAE) with uterine curettage has been proposed as a therapy strategy for cesarean scar pregnancy (CSP), which can provide a high success rate while reducing blood loss, adverse events, hospital time and cost. Therefore, we performed this meta-analysis to assess the effects of this combination therapy on the efficacy, safety, and pregnancy outcomes in patients with CSP. Eligibility criteria: (1) Study design: Cohort, case-control, or randomized controlled trials that compare the efficacy, safety, and recurrence of UAE combined with curettage and HIFU combined with uterine scraping in the treatment of cesarean section scar pregnancy. (2) Outcome: Success rate, blood loss, time of β-hCG normalization, adverse events, length of stay, hospital costs, menstrual recovery, re-pregnancy status, and pain score.
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Ma, Li, bingxin wen, and zhenhua Wen. A systematic-review and meta-analysis of the efficacy of uterine artery embolization in the treatment of endometriosis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, August 2022. http://dx.doi.org/10.37766/inplasy2022.8.0071.
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