Natalia Camacho - Academia.edu (original) (raw)
Papers by Natalia Camacho
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery.... more OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the midtrimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intraamniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.
Ultrasound in Obstetrics & Gynecology, 2007
to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (... more to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (36.1 (2.9) mm) and PPROM (36.6 (16.6) mm) groups, but shorter in the TPTL group (20.4 (9.2) mm; P = 0.01). Mean (SD) FMBV was lower in controls (9.4 (6.4)%) than in the PPROM (21.2 (10.0)%) and TPTL (18.9 (6.9)%) groups (P = 0.01). The median time between the first examination and delivery was 2 (range, 1-4) weeks in the PPROM group and 4 (range, 1-14) weeks in the TPTL group. In PPROM, 7/10 cases delivered within the 2 weeks after the first examination, and 6/7 had a FMBV above 18% in spite of a cervical length within normal values. In TPTL, there was a significant association between the cervical length and the time to delivery (r = 51, P = 0.001), but in most cases FMBV was similarly increased. Conclusions: In TPTL the cervical length correlated well with the time to delivery and FMBV did not improve this information. However, in PPROM an increment in FMBV appears to be independently associated with an earlier delivery.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory and angiogenic adi... more Objective-Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory and angiogenic adipokine that circulates in oligomeric complexes including: low-molecular-weight (LMW) trimers, medium-molecular-weight (MMW) hexamers and high-molecular-weight (HMW) isoforms. The aim of this study was to determine whether there are changes in adiponectin multimers in pregnancy and as a function of maternal weight.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produc... more Objective-Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produced in almost all cell types in response to a wide range of stressful stimuli and their production has a survival value. Evidence suggests that extra-cellular HSP70 is involved in the activation of the innate and adaptive immune response. Furthermore, increased mRNA expression of HSP 70 was observed in human fetal membranes following endotoxin stimulation. This study was conducted to determine the changes in amniotic fluid HSP70 concentrations during pregnancy, term and preterm parturition, intra-amniotic infection (IAI), and histologic chorioamnionitis.
Journal of Perinatal Medicine, 2006
OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery.... more OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the midtrimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intraamniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Intra-amniotic infection/inflammation (IAI) is one of the most important mechanisms of ... more Objective-Intra-amniotic infection/inflammation (IAI) is one of the most important mechanisms of disease in preterm birth. Resistin is an adipocytokine that has been linked to insulin resistance, diabetes, obesity and inflammation. The objective of this study was to determine if resistin is present in amniotic fluid (AF) and if its concentration changes with gestational age, in the presence of labor, and in IAI in patients with spontaneous preterm labor (PTL) and intact membranes, preterm prelabor rupture of membranes (PPROM), and clinical chorioamnionitis.
American Journal of Obstetrics and Gynecology, 2008
Objective-An imbalanced chronic blood flow between the donor and recipient twin through placental... more Objective-An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS.
Ultrasound in Obstetrics & Gynecology, 2003
Objective: In threatened preterm labour less than 15% of the women will progress to active labour... more Objective: In threatened preterm labour less than 15% of the women will progress to active labour and delivery. This study investigates if cervical length measurements by transvaginal ultrasound can discriminate between true and false labour in women presenting with preterm contractions. Methods: Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at 24-36 (median 30.5) weeks of gestation. Women presenting in active labour defined by cervical dilatation, with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within seven days of presentation. Results: Delivery within seven days of presentation occurred in 21 of the 253 (8.2%) pregnancies and this was inversely related to cervical length. In 209 cases the cervical length was 15 mm or more and only two of these (1%) delivered within seven days. In the 44 with cervical length less than 15 mm delivery within seven days of presentation occurred in 19 (43.2%). Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within seven days was provided by cervical length (p < 0.0001), previous contraction frequency at presentation (p < 0.009), history of preterm delivery (p < 0.01) and vaginal bleeding (p < 0.019) with no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Conclusions: Sonographic measurement of cervical length helps to avoid over-diagnosis of preterm labour in women with preterm contractions and intact membranes and may be helpful to avoid unnecessary intervention.
Objective-To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' ... more Objective-To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' among asymptomatic patients at high-risk for spontaneous preterm delivery.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Objective: The role of intra-amniotic infection in the etiology of fetal death has been proposed.... more Objective: The role of intra-amniotic infection in the etiology of fetal death has been proposed. This study was conducted to determine the prevalence of microbial invasion of the amniotic cavity (MIAC) and the frequency of maternal and/or fetal inflammation in patients presenting with a fetal death. Methods: A prospective study was conducted in patients with a fetal death. Amniocenteses were performed for clinical indications (karyotype), as well as to assess the microbiological and cytological state of the amniotic cavity. Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. An amniotic fluid white blood cell count and glucose determinations were also performed. Histological examination of the placenta was conducted to identify a maternal inflammatory response (acute chorioamnionitis) or a fetal inflammatory response (funisitis). Results: This study included 44 patients with intrauterine fetal death. The median gestational age at diagnosis was 30.1 weeks (range 16.3-40.4 weeks). One patient had documented MIAC (1/44). Acute histological chorioamnionitis was found in 20.9% (9/43), but a fetal inflammatory response was observed in only 2.3% (1/43) of cases. One patient had a positive amniotic fluid culture for Streptococcus agalactiae (group B streptococcus). Conclusion: Histological chorioamnionitis was present in 20.9% of cases, but MIAC could be demonstrated with conventional microbiological techniques in only one case. A fetal inflammatory response was nine times less frequent than a maternal inflammatory response (maternal 20.9% vs. fetal 2.3%, p = 0.008) in cases of fetal death.
American Journal of Obstetrics and Gynecology, 2007
This study aimed to discover “signature pathways” that characterize biologic processes, based on ... more This study aimed to discover “signature pathways” that characterize biologic processes, based on genes differentially expressed in the uterine cervix before and after spontaneous labor.The cervical transcriptome was characterized previously from biopsy specimens taken before and after term labor. Pathway analysis was used to study the differentially expressed genes, based on 2 gene-to-pathway annotation databases (Kyoto Encyclopedia of Genes and Genomes [Kanehisa Laboratories, Kyoto University, Kyoto, Japan] and Metacore software [GeneGo, Inc, St. Joseph, MI]). Overrepresented and highly impacted pathways and connectivity nodes were identified.Fifty-two pathways in the Metacore database were enriched significantly in differentially expressed genes. Three of the top 5 pathways were known to be involved in cervical remodeling. Two novel pathways were plasmin signaling and plasminogen activator urokinase signaling. The same analysis with the Kyoto Encyclopedia of Genes and Genomes database identified 4 significant pathways that the impact analysis confirmed. Multiple nodes that provide connectivity within the plasmin and plasminogen activator urokinase signaling pathways were identified.Three strategies for pathway analysis were consistent in their identification of novel, unexpected, and expected pathways, which suggests that this approach is both valid and effective for the elucidation of biologic mechanisms that are involved in cervical dilation and remodeling.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Background/objective: Fetal inflammatory response has been implicated as a mechanism of multi-sys... more Background/objective: Fetal inflammatory response has been implicated as a mechanism of multi-system organ injury in preterm and term neonates. Microbial invasion of the amniotic cavity (MIAC) is frequently associated with a fetal inflammatory response. However, there are no studies comparing the fetal response to MIAC in term and preterm gestations. The purpose of this study was to compare the umbilical cord plasma interleukin-6 (IL-6) concentrations in term and preterm neonates in the presence or absence of MIAC. Study design: Umbilical cord blood was obtained at birth from 252 neonates whose mothers had an amniocentesis within 48 h of delivery (preterm delivery, n = 62; term delivery, n = 190). MIAC was defined as a positive amniotic fluid culture for bacteria or genital mycoplasmas. IL-6 was measured by a sensitive and specific immunoassay. Results: The median IL-6 concentration in umbilical cord plasma was significantly higher in preterm neonates than in term neonates (median 13.4 pg/ml, range 0.1-676 pg/ml vs. median 3.2 pg/ml, range 0.1-408 pg/ml; p < 0.0001). In the context of MIAC, the median umbilical cord plasma IL-6 concentration was significantly higher in preterm than in term neonates (median 31.6 pg/ml, range 1.4-676 pg/ml vs. median 11.7 pg/ml, range 1.3-82 pg/ml, respectively; p < 0.05). Neonates born to mothers with a positive amniotic fluid culture had a significantly higher median IL-6 concentration than neonates born to mothers with a negative amniotic fluid culture (preterm: median 31.6, range 1.4-676 pg/ml vs. median 8.0, range 0.1-656 pg/ml; p < 0.05 and term: median 11.7, range 1.3-82 pg/ml vs. median 3.1, range 0.1-408 pg/ml; p < 0.01, respectively). Conclusions: The preterm fetus is capable of mounting a systemic cytokine response as measured by IL-6 in its peripheral blood. In the setting of MIAC, a fetal IL-6 response is higher in preterm than in term gestation. J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. 33 Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Mater nal-Fetal and Neonatal Medicin e J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Maternal-Fetal and Neonatal Medicin e 36 J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Mater nal-Fetal and Neonatal Medicin e J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14
American Journal of Reproductive Immunology, 2008
Problem Mannose-binding lectin (MBL) is a pattern-recognition receptor that activates complement ... more Problem Mannose-binding lectin (MBL) is a pattern-recognition receptor that activates complement and modulates inflammation. Homozygosity for the most common allele of the MBL2 gene that is associated with high MBL serum concentrations is more prevalent among patients with pre-eclampsia. The objective of this study was to determine maternal plasma MBL concentrations in normal pregnant women and patients with pre-eclampsia.Method of study This cross-sectional study included normal pregnant women (n = 187) and patients with pre-eclampsia (n = 99). Maternal plasma MBL concentrations were determined by ELISA.Results Women with pre-eclampsia had a higher median maternal plasma MBL concentration than normal pregnant women. MBL concentration distribution curves were three-modal, the subintervals in normal pregnancy were low (<143.7), intermediate (143.7–1898.9) and high (>1898.9 ng/mL). The proportion of normal pregnant women was larger in the low subinterval, while the proportion of patients with pre-eclampsia was larger in the high subinterval (P = 0.02). Normal pregnant women in the high subinterval had a larger rate of placental underperfusion than those in the low and intermediate subintervals (P = 0.02).Conclusions The median maternal plasma MBL concentration is elevated in patients with pre-eclampsia and a larger proportion of these patients are in the high subinterval than normal pregnant women, suggesting that this component of the innate immune system is involved in the mechanisms of disease in pre-eclampsia.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Objective: Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and... more Objective: Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and calprotectin (MRP8/14) are antimicrobial peptides stored in leukocytes that act as effector molecules of the innate immune response. The purpose of this study was to determine whether parturition, premature rupture of the membranes (PROM) and microbial invasion of the amniotic cavity (MIAC) are associated with changes in amniotic fluid concentrations of these antimicrobial peptides. Study design: Amniotic fluid was retrieved by amniocentesis from 333 patients in the following groups: group 1, mid-trimester with a subsequent normal pregnancy outcome (n = 84); group 2, preterm labor and intact membranes without MIAC who delivered at term (n = 36), or prematurely (n = 52) and preterm labor with MIAC (n = 26); group 3, preterm PROM with (n = 26) and without (n = 26) MIAC; and group 4, term with intact membranes in the absence of MIAC, in labor (n = 52) and not in labor (n = 31). The concentrations of HNP 1-3, BPI and calprotectin in amniotic fluid were determined by specific and sensitive immunoassays. Placentae of patients in both preterm labor with intact membranes and preterm PROM groups who delivered within 72 h of amniocentesis were examined. Non-parametric statistics, receiver-operating characteristic (ROC) curves and Cox regression models were used for analysis. A p value of < 0.05 was considered statistically significant. Results: Intra-amniotic infection was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin in both women with preterm labor and intact membranes, and women with preterm PROM. Preterm PROM was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Preterm parturition was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin, while parturition at term was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3. Among patients with preterm labor and intact membranes, elevation of amniotic fluid HNP 1-3, BPI and calprotectin concentrations was associated with intra-amniotic inflammation, histological chorioamnionitis and a shorter interval to delivery. Conclusion: MIAC, preterm parturition and preterm PROM are associated with increased amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Moreover, elevated amniotic fluid concentrations of BPI, immunoreactive HNP 1-3 and calprotectin are associated with intra-amniotic inflammation, histological chorioamnionitis and shorter amniocentesisto-delivery interval in patients presenting with preterm labor with intact membranes.
Ultrasound in Obstetrics & Gynecology, 2007
ObjectivesTo determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ ... more ObjectivesTo determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ among asymptomatic patients at high risk for spontaneous preterm delivery.To determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ among asymptomatic patients at high risk for spontaneous preterm delivery.MethodsThis retrospective case–control study included 281 patients with (n = 66) or without (n = 215) AF ‘sludge’, who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded.This retrospective case–control study included 281 patients with (n = 66) or without (n = 215) AF ‘sludge’, who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded.ResultsThe prevalence of AF ‘sludge’ in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with ‘sludge’ had: (1) a higher rate of spontaneous preterm delivery at < 28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3–28.1) weeks vs. 32.3 (IQR, 27.7–34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval (‘sludge’ positive 127 days (95% CI, 120–134 days) vs. ‘sludge’ negative 161 days (95% CI, 153–169 days); P < 0.001) and ultrasound-to-preterm PROM interval (‘sludge’ positive 23 days (95% CI, 7–39 days) vs. ‘sludge’ negative 57 days (95% CI, 38–77 days); P = 0.003) than those without ‘sludge’. AF ‘sludge’ was an independent explanatory variable for the occurrence of spontaneous preterm delivery at < 28 weeks, < 32 weeks and < 35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length < 25 mm and ‘sludge’ conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at < 28 weeks and < 32 weeks, respectively.The prevalence of AF ‘sludge’ in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with ‘sludge’ had: (1) a higher rate of spontaneous preterm delivery at < 28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3–28.1) weeks vs. 32.3 (IQR, 27.7–34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval (‘sludge’ positive 127 days (95% CI, 120–134 days) vs. ‘sludge’ negative 161 days (95% CI, 153–169 days); P < 0.001) and ultrasound-to-preterm PROM interval (‘sludge’ positive 23 days (95% CI, 7–39 days) vs. ‘sludge’ negative 57 days (95% CI, 38–77 days); P = 0.003) than those without ‘sludge’. AF ‘sludge’ was an independent explanatory variable for the occurrence of spontaneous preterm delivery at < 28 weeks, < 32 weeks and < 35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length < 25 mm and ‘sludge’ conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at < 28 weeks and < 32 weeks, respectively.ConclusionsAF ‘sludge’ is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of ‘sludge’ and a short cervix confers a higher risk for spontaneous preterm delivery at < 28 weeks and < 32 weeks than a short cervix alone. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.AF ‘sludge’ is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of ‘sludge’ and a short cervix confers a higher risk for spontaneous preterm delivery at < 28 weeks and < 32 weeks than a short cervix alone. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
American Journal of Obstetrics and Gynecology, 2007
Dimensión 1 Actitudes y percepciones positivas acerca del aprendizaje.
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery.... more OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the midtrimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intraamniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.
Ultrasound in Obstetrics & Gynecology, 2007
to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (... more to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (36.1 (2.9) mm) and PPROM (36.6 (16.6) mm) groups, but shorter in the TPTL group (20.4 (9.2) mm; P = 0.01). Mean (SD) FMBV was lower in controls (9.4 (6.4)%) than in the PPROM (21.2 (10.0)%) and TPTL (18.9 (6.9)%) groups (P = 0.01). The median time between the first examination and delivery was 2 (range, 1-4) weeks in the PPROM group and 4 (range, 1-14) weeks in the TPTL group. In PPROM, 7/10 cases delivered within the 2 weeks after the first examination, and 6/7 had a FMBV above 18% in spite of a cervical length within normal values. In TPTL, there was a significant association between the cervical length and the time to delivery (r = 51, P = 0.001), but in most cases FMBV was similarly increased. Conclusions: In TPTL the cervical length correlated well with the time to delivery and FMBV did not improve this information. However, in PPROM an increment in FMBV appears to be independently associated with an earlier delivery.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory and angiogenic adi... more Objective-Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory and angiogenic adipokine that circulates in oligomeric complexes including: low-molecular-weight (LMW) trimers, medium-molecular-weight (MMW) hexamers and high-molecular-weight (HMW) isoforms. The aim of this study was to determine whether there are changes in adiponectin multimers in pregnancy and as a function of maternal weight.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produc... more Objective-Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produced in almost all cell types in response to a wide range of stressful stimuli and their production has a survival value. Evidence suggests that extra-cellular HSP70 is involved in the activation of the innate and adaptive immune response. Furthermore, increased mRNA expression of HSP 70 was observed in human fetal membranes following endotoxin stimulation. This study was conducted to determine the changes in amniotic fluid HSP70 concentrations during pregnancy, term and preterm parturition, intra-amniotic infection (IAI), and histologic chorioamnionitis.
Journal of Perinatal Medicine, 2006
OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery.... more OBJECTIVE-A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the midtrimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intraamniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.
Journal of Maternal-fetal & Neonatal Medicine, 2008
Objective-Intra-amniotic infection/inflammation (IAI) is one of the most important mechanisms of ... more Objective-Intra-amniotic infection/inflammation (IAI) is one of the most important mechanisms of disease in preterm birth. Resistin is an adipocytokine that has been linked to insulin resistance, diabetes, obesity and inflammation. The objective of this study was to determine if resistin is present in amniotic fluid (AF) and if its concentration changes with gestational age, in the presence of labor, and in IAI in patients with spontaneous preterm labor (PTL) and intact membranes, preterm prelabor rupture of membranes (PPROM), and clinical chorioamnionitis.
American Journal of Obstetrics and Gynecology, 2008
Objective-An imbalanced chronic blood flow between the donor and recipient twin through placental... more Objective-An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS.
Ultrasound in Obstetrics & Gynecology, 2003
Objective: In threatened preterm labour less than 15% of the women will progress to active labour... more Objective: In threatened preterm labour less than 15% of the women will progress to active labour and delivery. This study investigates if cervical length measurements by transvaginal ultrasound can discriminate between true and false labour in women presenting with preterm contractions. Methods: Cervical length was measured by transvaginal ultrasound in 253 women with singleton pregnancies presenting with painful uterine contractions at 24-36 (median 30.5) weeks of gestation. Women presenting in active labour defined by cervical dilatation, with ruptured membranes and those that underwent prior or subsequent cervical cerclage were excluded from the study. The clinical management was determined by the attending obstetrician without taking into account the cervical length. Primary outcome of the study was delivery within seven days of presentation. Results: Delivery within seven days of presentation occurred in 21 of the 253 (8.2%) pregnancies and this was inversely related to cervical length. In 209 cases the cervical length was 15 mm or more and only two of these (1%) delivered within seven days. In the 44 with cervical length less than 15 mm delivery within seven days of presentation occurred in 19 (43.2%). Logistic regression analysis demonstrated that significant independent contribution in the prediction of delivery within seven days was provided by cervical length (p < 0.0001), previous contraction frequency at presentation (p < 0.009), history of preterm delivery (p < 0.01) and vaginal bleeding (p < 0.019) with no significant contribution from gestation at presentation, ethnic origin, maternal age, parity, cigarette smoking or the administration of tocolysis, antibiotics or steroids. Conclusions: Sonographic measurement of cervical length helps to avoid over-diagnosis of preterm labour in women with preterm contractions and intact membranes and may be helpful to avoid unnecessary intervention.
Objective-To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' ... more Objective-To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' among asymptomatic patients at high-risk for spontaneous preterm delivery.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Objective: The role of intra-amniotic infection in the etiology of fetal death has been proposed.... more Objective: The role of intra-amniotic infection in the etiology of fetal death has been proposed. This study was conducted to determine the prevalence of microbial invasion of the amniotic cavity (MIAC) and the frequency of maternal and/or fetal inflammation in patients presenting with a fetal death. Methods: A prospective study was conducted in patients with a fetal death. Amniocenteses were performed for clinical indications (karyotype), as well as to assess the microbiological and cytological state of the amniotic cavity. Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. An amniotic fluid white blood cell count and glucose determinations were also performed. Histological examination of the placenta was conducted to identify a maternal inflammatory response (acute chorioamnionitis) or a fetal inflammatory response (funisitis). Results: This study included 44 patients with intrauterine fetal death. The median gestational age at diagnosis was 30.1 weeks (range 16.3-40.4 weeks). One patient had documented MIAC (1/44). Acute histological chorioamnionitis was found in 20.9% (9/43), but a fetal inflammatory response was observed in only 2.3% (1/43) of cases. One patient had a positive amniotic fluid culture for Streptococcus agalactiae (group B streptococcus). Conclusion: Histological chorioamnionitis was present in 20.9% of cases, but MIAC could be demonstrated with conventional microbiological techniques in only one case. A fetal inflammatory response was nine times less frequent than a maternal inflammatory response (maternal 20.9% vs. fetal 2.3%, p = 0.008) in cases of fetal death.
American Journal of Obstetrics and Gynecology, 2007
This study aimed to discover “signature pathways” that characterize biologic processes, based on ... more This study aimed to discover “signature pathways” that characterize biologic processes, based on genes differentially expressed in the uterine cervix before and after spontaneous labor.The cervical transcriptome was characterized previously from biopsy specimens taken before and after term labor. Pathway analysis was used to study the differentially expressed genes, based on 2 gene-to-pathway annotation databases (Kyoto Encyclopedia of Genes and Genomes [Kanehisa Laboratories, Kyoto University, Kyoto, Japan] and Metacore software [GeneGo, Inc, St. Joseph, MI]). Overrepresented and highly impacted pathways and connectivity nodes were identified.Fifty-two pathways in the Metacore database were enriched significantly in differentially expressed genes. Three of the top 5 pathways were known to be involved in cervical remodeling. Two novel pathways were plasmin signaling and plasminogen activator urokinase signaling. The same analysis with the Kyoto Encyclopedia of Genes and Genomes database identified 4 significant pathways that the impact analysis confirmed. Multiple nodes that provide connectivity within the plasmin and plasminogen activator urokinase signaling pathways were identified.Three strategies for pathway analysis were consistent in their identification of novel, unexpected, and expected pathways, which suggests that this approach is both valid and effective for the elucidation of biologic mechanisms that are involved in cervical dilation and remodeling.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Background/objective: Fetal inflammatory response has been implicated as a mechanism of multi-sys... more Background/objective: Fetal inflammatory response has been implicated as a mechanism of multi-system organ injury in preterm and term neonates. Microbial invasion of the amniotic cavity (MIAC) is frequently associated with a fetal inflammatory response. However, there are no studies comparing the fetal response to MIAC in term and preterm gestations. The purpose of this study was to compare the umbilical cord plasma interleukin-6 (IL-6) concentrations in term and preterm neonates in the presence or absence of MIAC. Study design: Umbilical cord blood was obtained at birth from 252 neonates whose mothers had an amniocentesis within 48 h of delivery (preterm delivery, n = 62; term delivery, n = 190). MIAC was defined as a positive amniotic fluid culture for bacteria or genital mycoplasmas. IL-6 was measured by a sensitive and specific immunoassay. Results: The median IL-6 concentration in umbilical cord plasma was significantly higher in preterm neonates than in term neonates (median 13.4 pg/ml, range 0.1-676 pg/ml vs. median 3.2 pg/ml, range 0.1-408 pg/ml; p < 0.0001). In the context of MIAC, the median umbilical cord plasma IL-6 concentration was significantly higher in preterm than in term neonates (median 31.6 pg/ml, range 1.4-676 pg/ml vs. median 11.7 pg/ml, range 1.3-82 pg/ml, respectively; p < 0.05). Neonates born to mothers with a positive amniotic fluid culture had a significantly higher median IL-6 concentration than neonates born to mothers with a negative amniotic fluid culture (preterm: median 31.6, range 1.4-676 pg/ml vs. median 8.0, range 0.1-656 pg/ml; p < 0.05 and term: median 11.7, range 1.3-82 pg/ml vs. median 3.1, range 0.1-408 pg/ml; p < 0.01, respectively). Conclusions: The preterm fetus is capable of mounting a systemic cytokine response as measured by IL-6 in its peripheral blood. In the setting of MIAC, a fetal IL-6 response is higher in preterm than in term gestation. J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. 33 Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Mater nal-Fetal and Neonatal Medicin e J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Maternal-Fetal and Neonatal Medicin e 36 J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14 For personal use only. Cord blood IL-6 in preterm and term neonates Yoon et al. J ournal of Mater nal-Fetal and Neonatal Medicin e J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 118.174.28.35 on 05/20/14
American Journal of Reproductive Immunology, 2008
Problem Mannose-binding lectin (MBL) is a pattern-recognition receptor that activates complement ... more Problem Mannose-binding lectin (MBL) is a pattern-recognition receptor that activates complement and modulates inflammation. Homozygosity for the most common allele of the MBL2 gene that is associated with high MBL serum concentrations is more prevalent among patients with pre-eclampsia. The objective of this study was to determine maternal plasma MBL concentrations in normal pregnant women and patients with pre-eclampsia.Method of study This cross-sectional study included normal pregnant women (n = 187) and patients with pre-eclampsia (n = 99). Maternal plasma MBL concentrations were determined by ELISA.Results Women with pre-eclampsia had a higher median maternal plasma MBL concentration than normal pregnant women. MBL concentration distribution curves were three-modal, the subintervals in normal pregnancy were low (<143.7), intermediate (143.7–1898.9) and high (>1898.9 ng/mL). The proportion of normal pregnant women was larger in the low subinterval, while the proportion of patients with pre-eclampsia was larger in the high subinterval (P = 0.02). Normal pregnant women in the high subinterval had a larger rate of placental underperfusion than those in the low and intermediate subintervals (P = 0.02).Conclusions The median maternal plasma MBL concentration is elevated in patients with pre-eclampsia and a larger proportion of these patients are in the high subinterval than normal pregnant women, suggesting that this component of the innate immune system is involved in the mechanisms of disease in pre-eclampsia.
Journal of Maternal-fetal & Neonatal Medicine, 2003
Objective: Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and... more Objective: Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and calprotectin (MRP8/14) are antimicrobial peptides stored in leukocytes that act as effector molecules of the innate immune response. The purpose of this study was to determine whether parturition, premature rupture of the membranes (PROM) and microbial invasion of the amniotic cavity (MIAC) are associated with changes in amniotic fluid concentrations of these antimicrobial peptides. Study design: Amniotic fluid was retrieved by amniocentesis from 333 patients in the following groups: group 1, mid-trimester with a subsequent normal pregnancy outcome (n = 84); group 2, preterm labor and intact membranes without MIAC who delivered at term (n = 36), or prematurely (n = 52) and preterm labor with MIAC (n = 26); group 3, preterm PROM with (n = 26) and without (n = 26) MIAC; and group 4, term with intact membranes in the absence of MIAC, in labor (n = 52) and not in labor (n = 31). The concentrations of HNP 1-3, BPI and calprotectin in amniotic fluid were determined by specific and sensitive immunoassays. Placentae of patients in both preterm labor with intact membranes and preterm PROM groups who delivered within 72 h of amniocentesis were examined. Non-parametric statistics, receiver-operating characteristic (ROC) curves and Cox regression models were used for analysis. A p value of < 0.05 was considered statistically significant. Results: Intra-amniotic infection was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin in both women with preterm labor and intact membranes, and women with preterm PROM. Preterm PROM was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Preterm parturition was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin, while parturition at term was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3. Among patients with preterm labor and intact membranes, elevation of amniotic fluid HNP 1-3, BPI and calprotectin concentrations was associated with intra-amniotic inflammation, histological chorioamnionitis and a shorter interval to delivery. Conclusion: MIAC, preterm parturition and preterm PROM are associated with increased amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Moreover, elevated amniotic fluid concentrations of BPI, immunoreactive HNP 1-3 and calprotectin are associated with intra-amniotic inflammation, histological chorioamnionitis and shorter amniocentesisto-delivery interval in patients presenting with preterm labor with intact membranes.
Ultrasound in Obstetrics & Gynecology, 2007
ObjectivesTo determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ ... more ObjectivesTo determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ among asymptomatic patients at high risk for spontaneous preterm delivery.To determine the clinical significance of the presence of amniotic fluid (AF) ‘sludge’ among asymptomatic patients at high risk for spontaneous preterm delivery.MethodsThis retrospective case–control study included 281 patients with (n = 66) or without (n = 215) AF ‘sludge’, who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded.This retrospective case–control study included 281 patients with (n = 66) or without (n = 215) AF ‘sludge’, who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded.ResultsThe prevalence of AF ‘sludge’ in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with ‘sludge’ had: (1) a higher rate of spontaneous preterm delivery at < 28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3–28.1) weeks vs. 32.3 (IQR, 27.7–34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval (‘sludge’ positive 127 days (95% CI, 120–134 days) vs. ‘sludge’ negative 161 days (95% CI, 153–169 days); P < 0.001) and ultrasound-to-preterm PROM interval (‘sludge’ positive 23 days (95% CI, 7–39 days) vs. ‘sludge’ negative 57 days (95% CI, 38–77 days); P = 0.003) than those without ‘sludge’. AF ‘sludge’ was an independent explanatory variable for the occurrence of spontaneous preterm delivery at < 28 weeks, < 32 weeks and < 35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length < 25 mm and ‘sludge’ conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at < 28 weeks and < 32 weeks, respectively.The prevalence of AF ‘sludge’ in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with ‘sludge’ had: (1) a higher rate of spontaneous preterm delivery at < 28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), < 32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and < 35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3–28.1) weeks vs. 32.3 (IQR, 27.7–34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval (‘sludge’ positive 127 days (95% CI, 120–134 days) vs. ‘sludge’ negative 161 days (95% CI, 153–169 days); P < 0.001) and ultrasound-to-preterm PROM interval (‘sludge’ positive 23 days (95% CI, 7–39 days) vs. ‘sludge’ negative 57 days (95% CI, 38–77 days); P = 0.003) than those without ‘sludge’. AF ‘sludge’ was an independent explanatory variable for the occurrence of spontaneous preterm delivery at < 28 weeks, < 32 weeks and < 35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length < 25 mm and ‘sludge’ conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at < 28 weeks and < 32 weeks, respectively.ConclusionsAF ‘sludge’ is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of ‘sludge’ and a short cervix confers a higher risk for spontaneous preterm delivery at < 28 weeks and < 32 weeks than a short cervix alone. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.AF ‘sludge’ is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of ‘sludge’ and a short cervix confers a higher risk for spontaneous preterm delivery at < 28 weeks and < 32 weeks than a short cervix alone. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
American Journal of Obstetrics and Gynecology, 2007
Dimensión 1 Actitudes y percepciones positivas acerca del aprendizaje.