308 results on '"Juan Pedro Kusanovic"'
Search Results
2. Characterization of Visceral and Subcutaneous Adipose Tissue Transcriptome and Biological Pathways in Pregnant and Non-Pregnant Women: Evidence for Pregnancy-Related Regional-Specific Differences in Adipose Tissue.
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Shali Mazaki-Tovi, Edi Vaisbuch, Adi L Tarca, Juan Pedro Kusanovic, Nandor Gabor Than, Tinnakorn Chaiworapongsa, Zhong Dong, Sonia S Hassan, and Roberto Romero
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Medicine ,Science - Abstract
The purpose of this study was to compare the transcriptome of visceral and subcutaneous adipose tissues between pregnant and non-pregnant women.The transcriptome of paired visceral and abdominal subcutaneous adipose tissues from pregnant women at term and matched non-pregnant women (n = 11) was profiled with the Affymetrix Human Exon 1.0 ST array. Differential expression of selected genes was validated with the use of quantitative reverse transcription-polymerase chain reaction.Six hundred forty-four transcripts from 633 known genes were differentially expressed (false discovery rate (FDR) 1.5), while 42 exons from 36 genes showed differential usage (difference in FIRMA scores >2 and FDR
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- 2015
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3. A signature of maternal anti-fetal rejection in spontaneous preterm birth: chronic chorioamnionitis, anti-human leukocyte antigen antibodies, and C4d.
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JoonHo Lee, Roberto Romero, Yi Xu, Jung-Sun Kim, Vanessa Topping, Wonsuk Yoo, Juan Pedro Kusanovic, Tinnakorn Chaiworapongsa, Sonia S Hassan, Bo Hyun Yoon, and Chong Jai Kim
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Medicine ,Science - Abstract
Chronic chorioamnionitis is found in more than one-third of spontaneous preterm births. Chronic chorioamnionitis and villitis of unknown etiology represent maternal anti-fetal cellular rejection. Antibody-mediated rejection is another type of transplantation rejection. We investigated whether there was evidence for antibody-mediated rejection against the fetus in spontaneous preterm birth.This cross-sectional study included women with (1) normal pregnancy and term delivery (n = 140) and (2) spontaneous preterm delivery (n = 140). We analyzed maternal and fetal sera for panel-reactive anti-HLA class I and class II antibodies, and determined C4d deposition on umbilical vein endothelium by immunohistochemistry. Maternal anti-HLA class I seropositivity in spontaneous preterm births was higher than in normal term births (48.6% vs. 32.1%, p = 0.005). Chronic chorioamnionitis was associated with a higher maternal anti-HLA class I seropositivity (p
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- 2011
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4. Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: a molecular and culture-based investigation.
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Daniel B DiGiulio, Roberto Romero, Harold P Amogan, Juan Pedro Kusanovic, Elisabeth M Bik, Francesca Gotsch, Chong Jai Kim, Offer Erez, Sam Edwin, and David A Relman
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Medicine ,Science - Abstract
Preterm delivery causes substantial neonatal mortality and morbidity. Unrecognized intra-amniotic infections caused by cultivation-resistant microbes may play a role. Molecular methods can detect, characterize and quantify microbes independently of traditional culture techniques. However, molecular studies that define the diversity and abundance of microbes invading the amniotic cavity, and evaluate their clinical significance within a causal framework, are lacking.In parallel with culture, we used broad-range end-point and real-time PCR assays to amplify, identify and quantify ribosomal DNA (rDNA) of bacteria, fungi and archaea from amniotic fluid of 166 women in preterm labor with intact membranes. We sequenced up to 24 rRNA clones per positive specimen and assigned taxonomic designations to approximately the species level. Microbial prevalence, diversity and abundance were correlated with host inflammation and with gestational and neonatal outcomes. Study subjects who delivered at term served as controls. The combined use of molecular and culture methods revealed a greater prevalence (15% of subjects) and diversity (18 taxa) of microbes in amniotic fluid than did culture alone (9.6% of subjects; 11 taxa). The taxa detected only by PCR included a related group of fastidious bacteria, comprised of Sneathia sanguinegens, Leptotrichia amnionii and an unassigned, uncultivated, and previously-uncharacterized bacterium; one or more members of this group were detected in 25% of positive specimens. A positive PCR was associated with histologic chorioamnionitis (adjusted odds ratio [OR] 20; 95% CI, 2.4 to 172), and funisitis (adjusted OR 18; 95% CI, 3.1 to 99). The positive predictive value of PCR for preterm delivery was 100 percent. A temporal association between a positive PCR and delivery was supported by a shortened amniocentesis-to-delivery interval (adjusted hazard ratio 4.6; 95% CI, 2.2 to 9.5). A dose-response association was demonstrated between bacterial rDNA abundance and gestational age at delivery (r(2) = 0.42; P
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- 2008
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5. Impact of the change of the Atalah standard cut-off point to classify underweight nutritional status during pregnancy
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Marcela Araya B, María Luisa Garmendia, Camila Corvalán, and Juan Pedro Kusanovic
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Nutritional status assessment ,Pregnancy ,Nutrition and Dietetics ,business.industry ,Gestational weight gain ,Nutritional status ,medicine.disease ,Cut off point ,Environmental health ,Medicine ,IOM ,Underweight ,medicine.symptom ,Pre-pregnancy underweight ,business ,Food Science - Abstract
Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)
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- 2021
6. Damage-control resuscitation in obstetrics
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María Fernanda Escobar, Javier Andrés Carvajal, Juan Pedro Kusanovic, and Isabella Ramos
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Pregnancy ,medicine.medical_specialty ,business.industry ,Resuscitation ,Event (relativity) ,Mortality rate ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,Hemorrhage ,Maternal morbidity ,Damage control resuscitation ,macromolecular substances ,Blood Coagulation Disorders ,medicine.disease ,Obstetrics ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Humans ,Medicine ,Female ,business - Abstract
Severe obstetric hemorrhage is a catastrophic event and represents the main cause of maternal morbidity and mortality worldwide. The elevated mortality rate due to hemorrhage is associated with metabolic complications and organ hypoperfusion that may trigger a state of irreversible coagulopathy. Thus, the use of conventional measures to control bleeding frequently generates a vicious cycle in which the patient continues bleeding (prolonging surgical times). Damage-control surgery has proven to be feasible and effective in the context of obstetric hemorrhage. It combines surgical and resuscitative measures that generate successful results in the control of refractory bleeding, ultimately decreasing mortality in patients being in critical condition.
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- 2020
7. Trends and predictors of gestational diabetes mellitus in Chile
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Susana Mondschein, María Luisa Garmendia, Braulio Montiel, and Juan Pedro Kusanovic
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Adult ,Blood Glucose ,medicine.medical_specialty ,endocrine system diseases ,Type 2 diabetes ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Chile ,Family history ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Obesity ,Confidence interval ,Gestational diabetes ,Diabetes, Gestational ,Socioeconomic Factors ,Cohort ,Marital status ,Female ,business - Abstract
Objective To examine the temporal trends in gestational diabetes mellitus (GDM) prevalence in Chile, and to determine the main predictors of GDM. Methods A secondary analysis was conducted of all birth records at Hospital Dr. Sotero del Rio, Chile, from January 1, 2002, to December 31, 2015. We excluded those women with pre-existing type 2 diabetes, those with missing data, and those with unlikely data. GDM was defined as fasting glucose levels >5.55 mmol/L [>100 mg/dL] or >7.77 mmol/L [>140 mg/dL] 2 hours after glucose load in the oral glucose tolerance test. Potential predictors were selected based on prior research and ease of evaluation. Results From the original database of 100 758 records, 86 362 women were included in the final cohort. The mean GDM prevalence was 7.6% (95% CI [confidence interval] 7.5%-7.8%), increasing from 4.4% (95% CI 4.0%-4.9%) in 2002 to 13.0% (95% CI 12.0%-13.9%) in 2015. Age, education, marital status, parity, family history of type 2 diabetes, personal history of GDM, hypertension and pre-eclampsia, alcohol consumption, smoking, and pre-gestational nutritional status performed well in the prediction of GDM. Conclusion One out of eight Chilean pregnant women of medium- to low socio-economic status were found to develop GDM. We identified a set of easy-to-capture predictors in the primary health care system that may allow for the early identification of women at high-risk for the development of GDM.
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- 2019
8. Comparison of two identification and susceptibility test kits for Ureaplasma spp and Mycoplasma hominis in amniotic fluid of patients at high risk for intra-amniotic infection
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Jhon García, Alejandra Rosas, Pablo Silva, María Elena Nilo, Daniela Luna, María Fernanda Escobar, Carolina Martinovic, Luis Gabriel Parra-Lara, Paula Vargas, Eduardo Espejo, Fernando Ferrer, Rafael Valdés, Karla Silva, Víctor Córdova, Francisco Díaz, Maria Andrea Zambrano, M.J. Silva, and Juan Pedro Kusanovic
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Amniotic fluid ,biology ,business.industry ,Obstetrics and Gynecology ,Mycoplasma hominis ,bacterial infections and mycoses ,urologic and male genital diseases ,Chorioamnionitis ,medicine.disease ,biology.organism_classification ,medicine.disease_cause ,female genital diseases and pregnancy complications ,Microbiology ,Ureaplasma ,fluids and secretions ,Intra-amniotic infection ,Pediatrics, Perinatology and Child Health ,medicine ,bacteria ,business ,Preterm delivery ,Ureaplasma urealyticum - Abstract
Objective: Ureaplasma urealyticum and Mycoplasma hominis are the most common microorganisms found in the amniotic fluid of patients at risk for preterm delivery. However, culture techniques for gen...
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- 2019
9. Gingival Crevicular Placental Alkaline Phosphatase Is an Early Pregnancy Biomarker for Pre-Eclampsia
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Roberto Romero, Maximiliano Monckeberg, Daniela Albers, Valeria Ramírez, Juan Pedro Kusanovic, Sebastian E. Illanes, Marcela Hernández, Ornella Realini, Fernanda Param, Alejandra Chaparro, and Gregory E. Rice
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medicine.medical_specialty ,pre-eclampsia ,Clinical Biochemistry ,Article ,03 medical and health sciences ,0302 clinical medicine ,gestation ,medicine ,cohort study ,lcsh:R5-920 ,030219 obstetrics & reproductive medicine ,Eclampsia ,Receiver operating characteristic ,Obstetrics ,business.industry ,030206 dentistry ,medicine.disease ,Blood pressure ,Placental alkaline phosphatase ,Cohort ,embryonic structures ,Biomarker (medicine) ,Gestation ,placental biomarkers ,lcsh:Medicine (General) ,business ,risk prediction model ,Cohort study - Abstract
Early and innovative diagnostic strategies are required to predict the risk of developing pre-eclampsia (PE). The purpose of this study was to evaluate the performance of gingival crevicular fluid (GCF) placental alkaline phosphatase (PLAP) concentrations to correctly classify women at risk of PE. A prospectively collected, retrospectively stratified cohort study was conducted, with 412 pregnant women recruited at 11–14 weeks of gestation. Physical, obstetrical, and periodontal data were recorded. GCF and blood samples were collected for PLAP determination by ELISA assay. A multiple logistic regression classification model was developed, and the classification efficiency of the model was established. Within the study cohort, 4.3% of pregnancies developed PE. GCF-PLAP concentration was 3- to 6-fold higher than in plasma samples. GCF-PLAP concentrations and systolic blood pressure were greater in women who developed PE (p = 0.015 and p <, 0.001, respectively). The performance of the multiparametric model that combines GCF-PLAP concentration and the levels of systolic blood pressure (at 11–14 weeks gestation) showed an association of systolic blood pressure and GCF-PLAP concentrations with the likelihood of developing PE (OR:1.07, 95% CI 1.01–1.11, p = 0.004 and OR:1.008, 95% CI 1.000–1.015, p = 0.034, respectively). The model had a sensitivity of 83%, a specificity of 72%, and positive and negative predictive values of 12% and 99%, respectively. The area under the receiver operating characteristic (AUC-ROC) curve was 0.77 and correctly classified 72% of PE pregnancies. In conclusion, the multivariate classification model developed may be of utility as an aid in identifying pre-symptomatic women who subsequently develop PE.
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- 2021
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10. Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, neonatal bacteremia, and implications for clinical care
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M. T. Gervasi, Sonia S. Hassan, Ramiro Diaz-Primera, Roberto Romero, Juan Pedro Kusanovic, Ali Alhousseini, Ángel García-Sánchez, Eli Maymon, Offer Erez, Gaurav Bhatti, Lami Yeo, David Bryant, Eun Jung Jung, Chong Jai Kim, Bo Hyun Yoon, Kevin R. Theis, Hunter Gomez-Roberts, Percy Pacora, Bogdan Panaitescu, Kia Lannaman, Susan Berman, Julio Marin-Concha, Nardhy Gomez-Lopez, Chaur-Dong Hsu, and Aneesha Varrey
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Adult ,Amniotic fluid ,Placenta ,Bacteremia ,medicine.disease_cause ,Chorioamnionitis ,Ureaplasma ,Article ,Microbiology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Funisitis ,medicine ,Gardnerella vaginalis ,Humans ,030212 general & internal medicine ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Interleukin-6 ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Amniotic Fluid ,Systemic Inflammatory Response Syndrome ,Fetal Diseases ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Female ,Anaerobic bacteria ,Neonatal Sepsis ,business ,Biomarkers - Abstract
Objectives Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5–12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intra-amniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia. Methods This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration ≥2.6 ng/mL. Results (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra-amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40–58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases. Conclusions Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood.
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- 2021
11. The effects of a combined intervention (docosahexaenoic acid supplementation and home-based dietary counseling) on metabolic control in obese and overweight pregnant women: the MIGHT study
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Paola Casanello, Ricardo Uauy, María Luisa Garmendia, Juan Pedro Kusanovic, and Marcela Flores
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Adult ,Blood Glucose ,medicine.medical_specialty ,Docosahexaenoic Acids ,Offspring ,Dietary Sugars ,Directive Counseling ,Overweight ,law.invention ,Fetal Macrosomia ,Young Adult ,Insulin resistance ,Randomized controlled trial ,law ,Interquartile range ,Pregnancy ,Internal medicine ,medicine ,Birth Weight ,Humans ,Obesity ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Fetal Blood ,Combined Modality Therapy ,Gestational diabetes ,Diabetes, Gestational ,Dietary Supplements ,Female ,medicine.symptom ,Insulin Resistance ,business - Abstract
Background Lifestyle interventions have shown limited effectiveness in the prevention of gestational diabetes mellitus. The combination of lifestyle interventions with omega-3 polyunsaturated fatty acid supplementation could have a synergetic effect on maternal and offspring outcomes. Objective We evaluated the effects of docosahexaenoic acid supplementation among obese and overweight pregnant women (independently or combined with a dietary counseling intervention) on metabolic control in mothers and their offspring. Study Design This study was a randomized controlled trial with a 2×2 factorial design. The following inclusion criteria were used: 4000 g); and neonatal insulin resistance (cord blood Homeostasis Model Assessment for Insulin Resistance ≥2.60), which was assessed in a subsample of 226 newborns. The analysis was by intention to treat and by efficacy. The trial was registered on ClinicalTrials.gov ( NCT02574767 ). Results The overall incidence of gestational diabetes mellitus was 20.2% (Group 1, 21.0%; Group 2, 20.1%; Group 3, 18.9%; and Group 4, 20.9%). Mean birthweight was 3403.0 g (standard deviation, 575.3), and the incidence of macrosomia was 11.9% (Group 1, 13.2%; Group 2, 10.8%; Group 3, 11.5%; and Group 4, 12.1%). Median cord blood Homeostasis Model Assessment for Insulin Resistance was 0.9 (interquartile range, 0.6–1.7), and 10.2% showed cord blood insulin resistance (Group 1, 12.0%; Group 2, 12.0%; Group 3, 9.7%; and Group 4, 5.1%). No significant differences were found among groups regarding primary outcomes (P Conclusion For women who were overweight or obese at the beginning of pregnancy, this combined intervention did not reduce the risk of gestational diabetes in mothers or macrosomia and insulin resistance in neonates.
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- 2020
12. Personalized assessment of cervical length improves prediction of spontaneous preterm birth: a standard and a percentile calculator
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Percy Pacora, Roberto Romero, Juan Pedro Kusanovic, Sonia S. Hassan, Edgar Hernandez-Andrade, Offer Erez, Lami Yeo, Doron Kabiri, Stanley M. Berry, Eun Jung Jung, Dereje W. Gudicha, Carmen Paredes, Chaur-Dong Hsu, and Adi L. Tarca
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Pessary ,Adult ,Percentile ,medicine.medical_specialty ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Obstetric Labor, Premature ,Predictive Value of Tests ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Precision Medicine ,Cervix ,Cervical length ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Short cervix ,medicine.anatomical_structure ,Cervical Length Measurement ,Cohort ,Gestation ,Female ,business - Abstract
BACKGROUND: A sonographic short cervix length (
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- 2020
13. Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index and Maternal Risk Factors in Routine Clinical Use
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Jaime Martinez, Victoria Toro, Lara J. Monteiro, Santiago Álvarez, Juan Pedro Kusanovic, Valentina Arias, Jyh K Nien, Manuel Schepeler, Max Monckeberg, Rosario Fuenzalida, Andrés Calvo, and Sebastian E. Illanes
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Gestational hypertension ,medicine.medical_specialty ,aspirin ,Clinical Biochemistry ,routine care ,Prenatal care ,Article ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,medicine ,gestational hypertension ,030212 general & internal medicine ,reproductive and urinary physiology ,early prediction ,Pregnancy ,Aspirin ,lcsh:R5-920 ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,uterine artery Doppler ,ultrasound ,Retrospective cohort study ,medicine.disease ,female genital diseases and pregnancy complications ,predictive algorithm ,Cohort ,embryonic structures ,prenatal care ,business ,lcsh:Medicine (General) ,Cohort study ,medicine.drug - Abstract
Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clí, nica Dá, vila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.
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- 2020
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14. Effectiveness of a normative nutrition intervention in Chilean pregnant women on maternal and neonatal outcomes: the CHiMINCs study
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Ricardo Uauy, Camila Corvalán, María Luisa Garmendia, Paola Casanello, Marcela Araya, and Juan Pedro Kusanovic
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Adult ,Blood Glucose ,medicine.medical_specialty ,Adolescent ,Birth weight ,Primary health care ,Medicine (miscellaneous) ,Nutritional Status ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Intervention (counseling) ,medicine ,Birth Weight ,Humans ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,Nutrition and Dietetics ,Obstetrics ,business.industry ,Infant, Newborn ,Prenatal Care ,Maternal Nutritional Physiological Phenomena ,medicine.disease ,Obesity ,Gestational Weight Gain ,Clinical trial ,Neonatal outcomes ,Normative ,Female ,business - Abstract
Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited.We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile.This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care.At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes.Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.
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- 2020
15. Gestational weight gain recommendations for Chilean women: a mathematical optimization approach
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Susana Mondschein, María Luisa Garmendia, Juan Pedro Kusanovic, and Omar Matus
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medicine.medical_specialty ,Population ,Guidelines as Topic ,Overweight ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Humans ,Medicine ,Chile ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,030505 public health ,business.industry ,Obstetrics ,Public Health, Environmental and Occupational Health ,Gestational age ,General Medicine ,Models, Theoretical ,medicine.disease ,Gestational Weight Gain ,Gestational diabetes ,Small for gestational age ,Female ,Underweight ,medicine.symptom ,0305 other medical science ,business ,Weight gain - Abstract
Objectives We examined if the guidelines for gestational weight gain (GWG) proposed by the Institute of Medicine (IOM) are the most suitable for Chilean women. Study design Secondary analysis of records of single full-term births at the Dr. Sotero del Rio Hospital, Santiago, Chile, during 2003–2012 (n = 62,579). Methods From clinical records, we obtained data regarding maternal age, height, prepregnancy and at delivery weights, pathologies during pregnancy such as gestational diabetes (GDM) and pre-eclampsia, gestational age at delivery, and number of infants born small for gestational age (SGA) and large for gestational age (LGA). We formulated a mathematical model (MM) to determine the GWG range that maximizes the likelihood of a healthy pregnancy (HP) if the recommendation is followed. We defined an HP as one where the mother has no complications such as pre-eclampsia, GDM, SGA, or LGA. Results Forty-six percent of women had prepregnancy overweight or obesity. The prevalence of GDM, pre-eclampsia, SGA, and LGA were 3%, 1.2%, 9%, and 12%, respectively. An HP was present in 76% of pregnancies, 79% in the underweight group, 79% in normal weight group, 74% in the overweight group, and 67% in obese women. The GWG recommendations given by the MM (14–20 kg for underweight, 6–20 kg for normal weight, 9–11 kg for overweight, and 6–7 kg for obese) led to higher probabilities of achieving an HP than the ones obtained with the IOM recommendations. Conclusion The adoption of GWG recommendations based on characteristics of the Chilean population might lead to better short- and long-term health results for pregnant women.
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- 2018
16. The Cellular Transcriptome in the Maternal Circulation During Normal Pregnancy: A Longitudinal Study
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Nardhy Gomez-Lopez, Roberto Romero, Sonia S. Hassan, Gaurav Bhatti, Stanley M. Berry, Juan Pedro Kusanovic, Percy Pacora, and Adi L. Tarca
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Adult ,lcsh:Immunologic diseases. Allergy ,0301 basic medicine ,Proteome ,erythroid cells ,Immunology ,T cells ,Inflammation ,Biology ,Transcriptome ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Gene expression ,medicine ,Humans ,Immunology and Allergy ,Longitudinal Studies ,RNA, Messenger ,Gene ,Original Research ,B cells ,Pregnancy ,Blood Cells ,Gene Expression Profiling ,medicine.disease ,immunity ,cytokines ,Gene expression profiling ,030104 developmental biology ,biomarker ,Female ,pregnancy ,medicine.symptom ,lcsh:RC581-607 ,030215 immunology - Abstract
Pregnancy represents a unique immunological state in which the mother adapts to tolerate the semi-allogenic conceptus; yet, the cellular dynamics in the maternal circulation are poorly understood. Using exon-level expression profiling of up to six longitudinal whole blood samples from 49 pregnant women, we undertook a systems biology analysis of the cellular transcriptome dynamics and its correlation with the plasma proteome. We found that: (1) chromosome 14 was the most enriched in transcripts differentially expressed throughout normal pregnancy; (2) the strongest expression changes followed three distinct longitudinal patterns, with genes related to host immune response (e.g., MMP8, DEFA1B, DEFA4, and LTF) showing a steady increase in expression from 10 to 40 weeks of gestation; (3) multiple biological processes and pathways related to immunity and inflammation were modulated during gestation; (4) genes changing with gestation were among those specific to T cells, B cells, CD71+ erythroid cells, natural killer cells, and endothelial cells, as defined based on the GNF Gene Expression Atlas; (5) the average expression of mRNA signatures of T cells, B cells, and erythroid cells followed unique patterns during gestation; (6) the correlation between mRNA and protein abundance was higher for mRNAs that were differentially expressed throughout gestation than for those that were not, and significant mRNA-protein correlations were observed for genes part of the T-cell signature. In summary, unique changes in immune-related genes were discovered by longitudinally assessing the cellular transcriptome in the maternal circulation throughout normal pregnancy, and positive correlations were noted between the cellular transcriptome and plasma proteome for specific genes/proteins. These findings provide insights into the immunobiology of normal pregnancy.
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- 2019
17. Periodontitis and placental growth factor in oral fluids are early pregnancy predictors of gestational diabetes mellitus
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Valeria Ramírez, Marcela Hernández, Stephanie Acuña-Gallardo, Manuel Varas-Godoy, Alejandra Chaparro, Daniela Albers, Gregory E. Rice, Edgardo Zuñiga, Juan Pedro Kusanovic, and Sebastian E. Illanes
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Adult ,medicine.medical_specialty ,Adolescent ,endocrine system diseases ,Bleeding on probing ,030209 endocrinology & metabolism ,Pregnancy Proteins ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Periodontitis ,Prospective cohort study ,Placenta Growth Factor ,Vascular Endothelial Growth Factor Receptor-1 ,business.industry ,Obstetrics ,Area under the curve ,nutritional and metabolic diseases ,030206 dentistry ,medicine.disease ,female genital diseases and pregnancy complications ,Gestational diabetes ,Diabetes, Gestational ,Nested case-control study ,Periodontics ,Gestation ,Female ,medicine.symptom ,business ,Biomarkers - Abstract
Background Gestational diabetes mellitus (GDM) affects around 7% to 10% of all pregnancies. Early detection of predisposition to GDM is the first step in developing efficacious preventive treatment. The objective of the present study was to establish the utility of placental proteins presents in oral fluids (gingival crevicular fluid [GCF] and saliva), and periodontal disease status as early pregnancy predictors of GDM. Methods A nested case control within a prospective cohort was conducted. Pregnant systemically healthy women, aged between 18 and 40 years at 11 to 14 weeks gestation were included. Samples of oral fluids were collected and a complete maternal/obstetric and periodontal history was obtained. The concentration of placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) were measured by enzyme-linked immunosorbent assay in a nested case control sample of the prospective cohort. Multiple logistic regression models assessed the association. The evaluation of the diagnostic accuracy of the biomarkers was performed through receiver operating characteristic (ROC) curves by calculating the area under the curve (AUC). Results There were recruited 212 pregnant women at 11 to 14 weeks of pregnancy, of these, 14 women (i.e., 6.6%) developed GDM, and displayed significant greater bleeding on probing (BOP) [P = 0.0003]; periodontal probing depth (PD) [P = 0.0028]; clinical attachment level (AL) [P = 0.0008] and periodontal inflamed surface area (PISA) [P = 0.0001]. Similarly, initial glycemia and GCF-PlGF concentrations were significantly greater in women with GDM [P = 0.0012, and P = 0.0019, respectively]. When data were subjected to ROC curve analysis, the combination of initial glycemia and GCF-PlGF concentration delivered an area under the ROC curve of 0.897. Multiple logistic regression analyses demonstrate an association between glycemia (OR 1.21, 95% confidence interval [CI] 1.06 to 1.38; P = 0.005) and GCF-PlGF concentrations in women who developed GDM (OR 1.68, CI 1.05 to 2.68 P = 0.03). Conclusions Within the limitations of the present study, the results support that first trimester maternal glycemia combined with GCF-PlGF concentrations could be a surrogate biomarker for the future development of GDM in pre-symptomatic women.
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- 2018
18. The pattern and magnitude of 'in vivothrombin generation' differ in women with preeclampsia and in those with SGA fetuses without preeclampsia
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Roberto Romero, Nandor Gabor Than, Shali Mazaki-Tovi, Pooja Mittal, Chia Ling Nhan-Chang, Lami Yeo, Samuel Edwin, Edi Vaisbuch, Chong Jai Kim, Sonia S. Hassan, Francesca Gotsch, Sun Kwon Kim, Juan Pedro Kusanovic, Moshe Mazor, Tinnakorn Chaiworapongsa, and Offer Erez
- Subjects
Adult ,medicine.medical_specialty ,Lipoproteins ,Gestational Age ,030204 cardiovascular system & hematology ,Thrombin generation ,Article ,Preeclampsia ,Velocity index ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Thrombin ,Pre-Eclampsia ,Endogenous Thrombin Potential ,Pregnancy ,In vivo ,Internal medicine ,medicine ,Humans ,reproductive and urinary physiology ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Endocrinology ,Case-Control Studies ,Infant, Small for Gestational Age ,Pediatrics, Perinatology and Child Health ,Female ,business ,medicine.drug - Abstract
OBJECTIVE: We aimed to determine the differences in the pattern and magnitude of thrombin generation between patients with preeclampsia (PE) and those with a small-for-gestational-age (SGA) fetus. METHODS: This cross-sectional study included women in the following groups: 1) normal pregnancy (NP) (n=49); 2) PE (n=56); and 3) SGA (n=28). Maternal plasma thrombin generation (TGA) was measured, calculating: a) lag time (LT); b) velocity index (VI); c) peak thrombin concentration (PTC); d) time-to-peak thrombin concentration (TPTC); and e) endogenous thrombin potential (ETP). RESULTS: 1) The median TPTC, VI, and ETP differed among the groups (p=0.001, p=0.006, p
- Published
- 2017
19. Transabdominal collection of amniotic fluid 'sludge' and identification of Candida albicans intra-amniotic infection
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Paula Vargas, Roberto Romero, Eli Maymon, Rafael Valdés, Juan Pedro Kusanovic, Patricio Le Cerf, Karla Silva, Carolina Martinovic, María Elena Nilo, Offer Erez, Francisco Díaz, Víctor Córdova, and Fernando Ferrer
- Subjects
Adult ,medicine.medical_specialty ,Antifungal Agents ,Amniotic fluid ,Hyphae ,Gestational Age ,Cervix Uteri ,Chorioamnionitis ,Ultrasonography, Prenatal ,Article ,law.invention ,Gross examination ,03 medical and health sciences ,Obstetric Labor, Premature ,0302 clinical medicine ,Pregnancy ,law ,Funisitis ,Candida albicans ,Humans ,Medicine ,Vaginal bleeding ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Fetal Death ,Fluconazole ,030219 obstetrics & reproductive medicine ,biology ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Candidiasis ,Obstetrics and Gynecology ,Amniotic Fluid ,biology.organism_classification ,medicine.disease ,Gram staining ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Female ,medicine.symptom ,business ,Intrauterine Devices - Abstract
A G3P2 patient who conceived while using an intrauterine contraceptive device (IUD) presented at 20 weeks of gestation with mild irregular uterine contractions and vaginal bleeding. Sonographic examination at admission showed the presence of dense amniotic fluid "sludge" and a long sonographic uterine cervix (42 mm). To assess the microbiologic significance of amniotic fluid "sludge", we performed a transabdominal amniocentesis. The procedure was performed under real-time ultrasound, and fluid resembling pus at gross examination was noted. Rapid amniotic fluid analysis showed the presence of a high white blood cell count and structures resembling hyphae. Amniotic fluid cultures were positive for Candida albicans. Treatment was begun with broad-spectrum antibiotics, including Fluconazole, upon the visualization of pus in the "sludge" material because of the presence of hyphae in the Gram stain. Despite treatment, the patient went into spontaneous preterm labor and delivered five days after admission. Placental examination revealed acute fungal histologic chorioamnionitis and funisitis. This represents the first report of transabdominal collection and analysis of amniotic fluid "sludge" and the microbiologic detection of Candida albicans in this material. This report provides evidence that transabdominal retrieval of "sludge" is possible and may be of significant value for patient management and selection of antimicrobial agents.
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- 2017
20. Neonates from women with pregestational maternal obesity show reduced umbilical vein endothelial response to insulin
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Fabián Pardo, Carolina Pizarro, Juan Pedro Kusanovic, Marcelo Farías, Francisco Westermeier, Pablo J. Sáez, Luis Sobrevia, Francisco Mardones, José A. Poblete, Fernando Toledo, and Roberto Villalobos-Labra
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0301 basic medicine ,Adult ,medicine.medical_specialty ,Umbilical Veins ,Endothelium ,medicine.medical_treatment ,Primary Cell Culture ,Arginine ,Umbilical vein ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Insulin resistance ,Pregnancy ,Internal medicine ,medicine ,Human Umbilical Vein Endothelial Cells ,Humans ,Insulin ,Obesity ,Endothelial dysfunction ,Protein kinase B ,030219 obstetrics & reproductive medicine ,biology ,Chemistry ,Infant, Newborn ,Myography ,Obstetrics and Gynecology ,Endothelial Cells ,medicine.disease ,IRS1 ,Nitric oxide synthase ,Pregnancy Complications ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,Reproductive Medicine ,Case-Control Studies ,biology.protein ,Insulin Receptor Substrate Proteins ,Female ,Endothelium, Vascular ,Developmental Biology - Abstract
Objective Pregestational maternal obesity (PGMO) associates with foetoplacental vascular endothelial dysfunction and higher risk for insulin resistance in the neonate. We characterised the PGMO consequences on the insulin response of the human foetoplacental vasculature. Methods Umbilical veins were from pregnancies where the mother was with PGMO (body mass index 30–42.3 kg/m2, n = 33) or normal pregestational weight (PGMN) (body mass index 19.5–24.4 kg/m2, n = 21) with total gestational weight gain within the physiological range. Umbilical vein ring segments were mounted in a myograph for isometric force measurements. Primary cultures of human umbilical vein endothelial cells were used in passage 3. Vessel rings and cells were exposed to 1 nmol/L insulin (20 min) in the absence or presence of 100 μmol/L NG-nitro- l -arginine methyl ester (inhibitor of nitric oxide synthase, NOS). Results Vessel rings from PGMO showed reduced nitric oxide synthase-activity dependent dilation to insulin or calcitonin-gene related peptide compared with PGMN. PGMO associated with higher inhibitor phosphorylation of the insulin receptor substrate 1 (IRS-1) and lower activator phosphorylation of protein kinase B/Akt (Akt). Cells from PGMO also showed lower nitric oxide level and reduced activator serine1177 but increased inhibitor threonine495 phosphorylation of endothelial nitric oxide synthase (eNOS) and saturable transport of l -arginine. HUVECs from PGMO were not responsive to insulin. Conclusion The lack of response to insulin by the foetoplacental endothelium may result from reduced IRS-1/Akt/eNOS signalling in PGMO. These findings may result in higher risk of insulin resistance in neonates to PGMO pregnancies.
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- 2019
21. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis
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Max Monckeberg, Sebastian E. Illanes, Emiliano Pertossi, Roberto Romero, Ulises Guajardo, Pablo Silva, Pía Venegas, Manuel Schepeler, Rafael Valdés, Juan Pedro Kusanovic, Jyh K Nien, and Karla Silva
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Adult ,medicine.medical_specialty ,Amniotic fluid ,Cervical insufficiency ,medicine.medical_treatment ,Article ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,law ,Pregnancy ,White blood cell ,medicine ,Humans ,Cervical cerclage ,030212 general & internal medicine ,Cerclage, Cervical ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,Surgery ,medicine.anatomical_structure ,Gram staining ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Female ,Uterine Cervical Incompetence ,business - Abstract
Background The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. Methods This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration Results Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P Conclusion The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.
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- 2018
22. Clinical chorioamnionitis at term: the amniotic fluid fatty acyl lipidome
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Roberto Romero, Adi L. Tarca, Nikolina Docheva, Piya Chaemsaithong, Tinnakorn Chaiworapongsa, Kenneth V. Honn, Zhonghui Xu, Juan Pedro Kusanovic, Senlin Zhou, Ricardo Gomez, and Krishna Rao Maddipati
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Adult ,0301 basic medicine ,Epoxygenase ,medicine.medical_specialty ,Amniotic fluid ,Inflammation ,QD415-436 ,urologic and male genital diseases ,Biochemistry ,Gastroenterology ,eicosanoids ,Proinflammatory cytokine ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Pregnancy ,Internal medicine ,Lipidomics ,medicine ,Humans ,neoplasms ,Clinical chorioamnionitis ,030219 obstetrics & reproductive medicine ,omega-3 fatty acids ,biology ,business.industry ,Fatty Acids ,Cell Biology ,Lipid signaling ,Lipidome ,Amniotic Fluid ,lipoxygenase ,female genital diseases and pregnancy complications ,Chorioamnionitis ,Cross-Sectional Studies ,030104 developmental biology ,inflammation ,Metabolome ,biology.protein ,lipidomics ,Female ,intra-amniotic inflammation ,medicine.symptom ,Patient-Oriented and Epidemiological Research ,business - Abstract
Clinical chorioamnionitis at term (TCC) is the most common obstetrical infliction diagnosed in labor and delivery units worldwide and is associated with a substantial increase in maternal and neonatal morbidity and mortality. This obstetrical complication is a heterogeneous condition, as only half of patients have detectable microorganisms in the amniotic cavity. Because bioactive lipids play a key role in the initiation and resolution of an inflammatory response, we aimed to characterize the amniotic fluid lipidome in patients with TCC. We studied the amniotic fluid of patients in the following groups: 1) spontaneous labor at term without clinical chorioamnionitis (TLB) and 2) spontaneous labor at term with clinical chorioamnionitis (TCC). The TCC group was subdivided into a) those with microbial invasion of the amniotic cavity (TCC-MIAC) and b) those without microbial invasion of the amniotic cavity (TCC-noMIAC). The amniotic fluid concentration of proinflammatory lipid mediators did not differ between patients in TLB with TCC. In contrast, concentration of lipids with anti-inflammatory/proresolution properties was significantly lower in all patients with TCC than in those with TLB. These results suggest that while proinflammatory lipid mediators are involved in infection-driven intra-amniotic inflammation, a relative deficiency of anti-inflammatory/proresolution lipid mediator biosynthesis is a characteristic of TCC.
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- 2016
23. Placental biomarkers and angiogenic factors in oral fluids of patients with preeclampsia
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Carlos Salomon, Alejandra Chaparro, Sebastian E. Illanes, Gregory E. Rice, Valeria Ramírez, Manuel Varas-Godoy, Carolina Inostroza, Dominique Gaedechens, Edgardo Zuñiga, Karla Silva, and Juan Pedro Kusanovic
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0301 basic medicine ,Placental growth factor ,Saliva ,medicine.medical_specialty ,business.industry ,Case-control study ,Obstetrics and Gynecology ,Gestational age ,030206 dentistry ,medicine.disease ,Gastroenterology ,Preeclampsia ,03 medical and health sciences ,Exact test ,030104 developmental biology ,0302 clinical medicine ,Placental alkaline phosphatase ,Internal medicine ,Medicine ,Alkaline phosphatase ,business ,Genetics (clinical) - Abstract
Objectives: The objectives of this study are to explore the feasibility of measuring endothelial and placental biomarkers in saliva and gingival crevicular fluid (GCF) and to determine if patients with preeclampsia (PE) have a different profile of these biomarkers in oral fluids. Method: A case-control study was conducted, including patients with PE (n=10) and a control group with normal pregnancies randomly selected (n=20) admitted at the Sotero del Rio Hospital in Santiago, Chile. A complete periodontal and obstetric history that involved the collection of oral fluids was performed at the same gestational age. Levels of Cd63 extracellular vesicles, placental alkaline phosphatase (PLAP), placental growth factor (PlGF), and sFlt-1 levels were determined by ELISA assays. Data analysis was performed with chi-square or Fisher's exact test, and Mann-Whitney U-test for continuous variables. The association was assessed using a multiple logistic regression model. Results: sFlt-1 concentrations in saliva and GCF were significantly higher in patients with PE (p=0.045 and p=0.033 respectively). Concentrations of PLAP were elevated in GCF of patients with PE (p=0.049). The PLAP/CD63 ratio in GCF of patients with PE was significantly higher (p=0.0008). No differences in PlGF levels were observed. Conclusion(s): GCF of patients with PE concentrates higher levels of biomarkers related with the PE development.
- Published
- 2016
24. VP52.17: Obstetric and perinatal results in patients with cervical length ≤15mm diagnosed in pregnancies ≥28 +0 weeks
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A. Arce, M. Mutizabal, and Juan Pedro Kusanovic
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medicine.medical_specialty ,Reproductive Medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,General Medicine ,business ,Cervical length - Published
- 2020
25. VP42.05: Case report: congenital atrioventricular block and fetal growth restriction in biamniotic bichorial twin pregnancy with of Ro/La autoantibodies
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P. Silva, C. Martinovic, D.P. Luna Seguel, V. Cordova, C. Solari, A. Rosas, P. Vargas, Juan Pedro Kusanovic, and R. Valdes
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Autoantibody ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Reproductive Medicine ,Fetal growth ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Atrioventricular block ,Twin Pregnancy - Published
- 2020
26. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study)
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Anouk Pels, Ben Willem J. Mol, Joel Singer, Terry Lee, Peter von Dadelszen, Wessel Ganzevoort, Elizabeth Asztalos, Laura A. Magee, Amiram Gafni, Andrée Gruslin, Michael Helewa, Eileen Hutton, Shoo Lee, Alexander Logan, Jennifer Menzies, Jean-Marie Moutquin, Kellie Murphy, Evelyne Rey, Sue Ross, Johanna Sanchez, Jim G. Thornton, Ross Welch, Trinh Hoac, Joanne Kirton, Katherine Trigiani, Ainy Zahid, Michael B. Bracken, Patricia Crowley, Lelia Duley, Richard Ehrenkranz, Kevin Thorpe, Sunny Chan, Michael Shi, Shelley Yu, Raquel de Lourdes Martin, Maria Florencia Bassi, Mirta Clara Caruso, Valeria Lagunas, Fernando Vera, Maria Mohedano de Duhalde, Alicia Beatriz Roque, Patricia Roldan, Esteban Marcos Duhalde, Viviana Dip, Jesus Daniel Aguirre, Elba Mirta Alicia Morales, Griselda Itati Abreo, Teresa De Sagastizabal, Carolina Gomez, Nadia Rizzi, Carlos Arias, Ricardo Antonio Bruno, Kassam Mahomed, Alison Drew, Ann Green, Jane Hoare, Bill Hague, Suzette Coat, Caroline Crowther, Peter Muller, Sophie Trenowden, Barry Walters, Claire Parker, Dorothy Graham, Craig Pennell, Eileen Sung, Angela Makris, Gaksoo Lee, Charlene Thornton, Annemarie Hennessy, Louise Farrell, Nelson Sass, Henri Korkes, Dayana Couto Ferreira, Renato Augusto Moreira de Sa, Monique Schmidt Marques Abreu, Rita Guerios Bornia, Nancy Ribeiro da Silva, Fernanda Freitas Oliveira Cardoso, Caio Coelho Marques, Jorge Hornos, Ricardo Leal Davdt, Letícia Germany Paula, Pedro Luis Zanella, Gabrielle Inglis, Ruth Dillon, Ashley Docherty, Anna Hutfield, Keith Still, Sayrin Lalji, Tamara Van Tent, Chris Hotz, Tracy Messmer, Joel G. Ray, Howard Berger, Leanne De Souza, Andrea Lausman, Tatiana Freire-Lizama, Kate Besel, Paul Gibson, Greta Ellsworth, Leslie Miller, T. Lee-Ann Hawkins, Michelle Hladunewich, Anna Rogowsky, Dini Hui, Virginia Collins, Isabelle Delisle, Cora Fanning, Nestor Demianczuk, Rshmi Khurana, Winnie Sia, Catherine Marnoch, Carmen Young, Cheryl Lux, Sophie Perreault, Valerie Tremblay, Sophie Desindes, Anne-Marie Côté, Veronique Dagenais, Heather Clark, Elaine O’Shea, Ruth Rennicks White, Shital Gandhi, Mary-Jean Martin, Cheryl Brush, Gareth Seaward, Jill Newstead-Angel, Judy Brandt, Jocelyne Martel, Kristine Mytopher, Elise Buschau, Erin Keely, Patti Waddell, Svetlana Shachkina, Alan Karovitch, Robert Anderson, Nicole Koenig, Theresa Yong, Marie Vasiliou, Peri Johnson, Beth Allan, Renato Natale, Laura Kennedy, Lucie Opatrny, Lorraine Lavigne, George Carson, Sheila Kelly, Joan Crane, Donna Hutchens, Juan Pedro Kusanovic, Christian Figueroa, Karla Silva Neculman, Juan Andres Ortiz, Paula Vargas, Pedro Ferrand, Jorge Carrillo, Rodrigo Cifuentes Borrero, Dahiana Marcela Gallo, Luisa Fernanda Moreno, Fred Kirss, Kristiina Rull, Anne Kirss, Tamas Major, Andrea Fodor, Tunde Bartha, Mordechai Hallak, Nardin Aslih, Saja Anabousi-Murra, Ester Pri-Or, Linda Harel, Sima Siev, Marwan Hakim, Christina Simona Khoury, Najla Hamati, Mazen El-Zibdeh, Lama Yousef, Ruth Hughes, Di Leishman, Barbra Pullar, Matthew Farrant, Malgorzata Swiatkowska-Freund, Krzysztof Preis, Anette Aleksandra Traczyk-Los, Anna Partyka, Joanna Preis-Orlikowska, Mariusz Lukaszuk, Grzegorz Krasomski, Michael Krekora, Anna Kedzierska-Markowicz, Katarzyna Zych-Krekora, Grzegorz H. Breborowicz, Anna Dera-Szymanowska, Jannet Bakker, Joost Akkermans, Eline van den Akker, Sabine Logtenberg, Steven Koenen, Maartje de Reus, David Borman, Martijn A. Oudijk, Annemiek Bolte, Viki Verfaille, Bart Graaf, Martina Porath, Corine Verhoeven, Maureen T.M. Franssen, Lida Ulkeman, Ineke Hamming, Jose H.M. Keurentjes, Ina van der Wal, S.W.A. Nij Bijvank, A.A. Lutjes, Henricus Visser, Hubertina Catharina Johanna Scheepers, Erik van Beek, Coby van Dam, Kathy van den Berg-Swart, Paula Pernet, Birgit van der Goes, Nico Schuitemaker, Gunilla Kleiverda, Marcel van Alphen, Ageeth Rosman, Ingrid Gaugler-Senden, Marieke Linders, Catherine Nelson-Piercy, Annette Briley, May Ching Soh, Kate Harding, Hayley Tarft, David Churchill, Katherine Cheshire, Julia Icke, Mausumi Ghosh, James Thornton, Yvonne Toomassi, Karen Barker, Joanne Fisher, Nicky Grace, Amanda Green, Joanne Gower, Anna Molnar, Shobhana Parameshwaran, Andrew Simm, George Bugg, Yvette Davis, Ruta Desphande, Yvette Gunn, Mohammed Houda, Nia Jones, Jason Waugh, Carly Allan, Gareth Waring, Steve A. Walkinshaw, Angela Pascall, Mark Clement-Jones, Michelle Dower, Gillian Houghton, Heather Longworth, Tej Purewal, Derek Tuffnell, Diane Farrar, Jennifer Syson, Gillian Butterfield, Vicky Jones, Rebecca Palethorpe, Tracey Germaine, Marwan Habiba, Debbie Lee, Olufemi Eniola, Lynne Blake, Jane Khan, Helen M. Cameron, Kim Hinshaw, Amanda Bargh, Eileen Walton, Olanrewaju Sorinola, Anna Guy, Zoe D’Souza, Rhiannon Gabriel, Jo Williams, Heidi Hollands, Olujimi Jibodu, Sara Collier, Pauline Tottie, Claire Oxby, James Dwyer, Franz Majoko, Helen Goldring, Sharon Jones, Janet Cresswell, Louise Underwood, Mary Kelly-Baxter, Rebecca Robinson, Dilly Anumba, Anne Chamberlain, Clare Pye, Clare Tower, Sue Woods, Lisa Horrocks, Fiona Prichard, Lynsey Moorhead, Sarah Lee, Louise Stephens, Cara Taylor, Suzanne Thomas, Melissa Whitworth, Jenny Myers, Ellen Knox, Katie Freitas, Mark Kilby, Amanda Cotterill, Khalil Abdo, Katrina Rigby, Julie Butler, Fiona Crosfill, Sean Hughes, Sanjeev Prashar, Fatimah Soydemir, Janet Ashworth, Lorraine Mycock, Jill Smith, Amaju Ikomi, Kerry Goodsell, Jean Byrne, Maxwell Masuku, Alice Pilcher, Meena Khandelwal, Gunda Simpkins, Michelle Iavicoli, Yon Sook Kim, Richard Fischer, Robin Perry, Eugene Y. Chang, Tamara D. Saunders, Betty W. Oswald, Kristin D. Zaks, Sarosh Rana, Dawn McCullough, Anna Sfakianaki, Cheryl Danton, Erin Kustan, Luisa Coraluzzi, Helen How, Christina Waldon, Jeffrey Livingston, Sherry Jackson, Lisa Greene, Dinesh Shah, Jorge E. Tolosa, Monica Rincon, Leonardo Pereira, Amy E. Lawrence, Janice E. Snyder, D. Michael Armstrong, Teresa Blue, Austin Hester, Kathryn Salisbury, Obstetrics and gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Midwifery Science, Graduate School, Obstetrics and Gynaecology, and APH - Digital Health
- Subjects
Gestational hypertension ,medicine.medical_specialty ,Randomization ,Hypertension in Pregnancy ,Birth weight ,artikel tijdschrift ,Preeclampsia ,fetal growth restriction ,preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,hypertension pregnancy-induced ,030212 general & internal medicine ,humans ,Pregnancy ,030219 obstetrics & reproductive medicine ,pregnancy outcome ,Obstetrics ,business.industry ,Gestational age ,blood pressure ,medicine.disease ,3. Good health ,Blood pressure ,business - Abstract
For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.
- Published
- 2018
27. Effectiveness on maternal and offspring metabolic control of a home-based dietary counseling intervention and DHA supplementation in obese/overweight pregnant women (MIGHT study): A randomized controlled trial-Study protocol
- Author
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Paola Casanello, Ricardo Uauy, Pablo Olmos, María Luisa Garmendia, Juan Pedro Kusanovic, Camila Corvalán, Marcela Flores, Alfredo Bravo, and Marcela Araya
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Docosahexaenoic Acids ,Offspring ,Directive Counseling ,030209 endocrinology & metabolism ,Overweight ,law.invention ,Fetal Macrosomia ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Insulin resistance ,Randomized controlled trial ,Clinical Protocols ,Double-Blind Method ,law ,Pregnancy ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Obesity ,Prenatal Nutritional Physiological Phenomena ,business.industry ,Infant, Newborn ,Prenatal Care ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Gestational diabetes ,Diabetes, Gestational ,Treatment Outcome ,Dietary Supplements ,Female ,medicine.symptom ,Diet, Healthy ,Insulin Resistance ,business ,Follow-Up Studies - Abstract
Background Lifestyle interventions are the primary prevention strategy for gestational diabetes (GDM) in obese/overweight women; however, these interventions have shown limited effectiveness. Omega-3 polyunsaturated fatty acids (PUFAs) intake has shown beneficial effects on glucose metabolism, lipid fractions and inflammatory factors in women who already have GDM. Combining PUFAs supplementation with a lifestyle intervention could achieve lower increase of glucose levels by improving insulin sensitivity. Our aim is to assess two prenatal nutritional interventions (home-based dietary counseling and/or docosahexaenoic acid (DHA) supplementation) delivered to obese/overweight women during pregnancy for them and their offspring to achieve better metabolic control. Methods/design Randomized controlled trial, 2 × 2 factorial design. Eligible pregnant women will be randomly allocated to one of the four parallel arms: 1) Home-based dietary counseling +800 mg/day DHA supplementation (n = 250); 2) 800 mg/day DHA (n = 250); 3) Home-based dietary counseling +200 mg/day DHA (n = 250); 4) 200 mg/day DHA (n = 250). Primary outcomes are: GDM; macrosomia; and neonatal insulin resistance. Data analyses will be done on an intention-to-treat basis. Discussion We expect the present study to contribute to the understanding of the potential effectiveness of an omega-3 supplementation on the risk of developing GDM in overweight/obese pregnant women. We will also test if the combination of having better dietary habits alongside with omega 3 supplementation will improve insulin sensitivity and as consequence, a lower elevation of glucose levels could be achieved. Trial Registration: NCT02574767
- Published
- 2018
28. The diagnostic performance of the beta-glucan assay in the detection of intra-amniotic infection with Candida species
- Author
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Offer Erez, Adi L. Tarca, Percy Pacora, Sonia S. Hassan, Chaur-Dong Hsu, Juan Pedro Kusanovic, Eli Maymon, Bogdan Panaitescu, and Roberto Romero
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Adult ,Fetal Membranes, Premature Rupture ,Amniotic fluid ,beta-Glucans ,Gestational Age ,Beta-glucan ,Ultrasonography, Prenatal ,Article ,Microbiology ,Cell wall ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Predictive Value of Tests ,Pregnancy ,Biological fluids ,Medicine ,Bioassay ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Candida albicans ,Candida ,Fetus ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Candidiasis ,Obstetrics and Gynecology ,biology.organism_classification ,medicine.disease ,Amniotic Fluid ,chemistry ,Intra-amniotic infection ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Female ,business ,Intrauterine Devices - Abstract
A bioassay based on the detection of beta-glucan, a constituent of the cell wall of fungi, has been successfully used to diagnose fungal infections in a variety of biological fluids but not yet in the amniotic fluid.To determine the diagnostic performance of a beta-glucan bioassay in the detection of Candida species in the amniotic fluid of women who either did or did not have an intrauterine contraceptive device (IUD) in place during an episode of spontaneous preterm parturition.The study population comprised women who had a singleton pregnancy without congenital or chromosomal abnormalities, who experienced preterm labor or preterm prelabor rupture of the fetal membranes, and who underwent a transabdominal amniocentesis for clinical indications. Samples of amniotic fluid were cultured for aerobic and anaerobic bacteria, genital mycoplasmas, and Candida species, and assayed for beta-glucan, using the (1→3)-beta-d-glucan-specific Limulus amebocyte lysate test (beta-glucan assay) in all cases. Amniotic fluid interleukin (IL)-6 assay results were also available for all cases. The beta-glucan assay takes about 1 hour to run: a concentration80 pg/mL was considered positive for fungi. Sterile intra-amniotic inflammation of the amniotic cavity was defined by the presence of an amniotic fluid IL-6 concentration ≥2.6 ng/mL and a negative amniotic fluid culture.(1) One hundred ninety-seven (197) women met the study criteria, of whom 58 (29.4%) had an IUD in place; (2) 20 (10.2%) women had a culture of proven intra-amniotic Candida species-related infection, 19 of whom had a positive beta-glucan assay [sensitivity, 95% (19/20; 95% confidence interval (CI): 75.1-99.9%)]; and (3) the specificity of the beta-glucan assay was 75.1% [133/177; 95% CI: 68.1-99.9%]. It was affected by the presence of nonfungal intra-amniotic infections and an IUD, but not by the presence of sterile intra-amniotic inflammation, and there was a significant interaction between the presence of an IUD and nonfungal intra-amniotic infections (estimated for the interaction effect = 2.1923, p value =.026). The assay's specificity was reduced when nonfungal intra-amniotic infections were diagnosed but only in women who did not have an IUD. Among women without an IUD, the assay's specificity was 91.4% (117/128); it was 93% (106/114) for those without intra-amniotic infection, and 78.6% (11/14) for those with a nonfungal intra-amniotic infection; the difference was not significant (p = .09). Among women with an IUD, the assay's specificity was 32.7% (16/49); 42.9% (9/21) for those with a nonfungal intra-amniotic infection; and 25% (7/28) for those without intra-amniotic infection; and the difference was significant (p = .03).The beta-glucan assay is a sensitive, rapid, point-of-care test used to diagnose intra-amniotic Candida species-related infection, and it has a high specificity in pregnant women who did not have an IUD in place.
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- 2017
29. Tissue factor activity in women with preeclampsia or SGA: a potential explanation for the excessive thrombin generation in these syndromes
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Nandor Gabor Than, Roberto Romero, Edi Vaisbuch, Tinnakorn Chaiworapongsa, Sun Kwon Kim, Moshe Mazor, Chia Ling Nhan-Chang, Shali Mazaki-Tovi, Offer Erez, Lami Yeo, Chong Jai Kim, Francesca Gotsch, Juan Pedro Kusanovic, Pooja Mittal, Zhong Dong, and Sonia S. Hassan
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0301 basic medicine ,Adult ,medicine.medical_specialty ,Lipoproteins ,Placenta ,Article ,Preeclampsia ,Thromboplastin ,03 medical and health sciences ,Tissue factor ,Young Adult ,0302 clinical medicine ,Tissue factor pathway inhibitor ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,medicine ,Humans ,Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,Thrombin ,Obstetrics and Gynecology ,medicine.disease ,Hypoplasia ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Infant, Small for Gestational Age ,Small for gestational age ,Female ,business - Abstract
OBJECTIVE: The aim of this study was to determine whether the activity of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in the plasma of women with preeclampsia (PE) and a small-for-gestational-age (SGA) neonate differs from that of women with normal pregnancy and whether they are related to specific placental lesions.. METHODS: This cross-sectional study included the following groups: 1) normal pregnancy (n=68); 2) PE (n= 128); and 3) SGA (n=56). Maternal plasma TF and TFPI activity was determined with chromogenic assays. RESULTS: 1) The median maternal plasma TF activity, but not TFPI activity, differed among the study groups (p
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- 2017
30. Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation
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Roberto Romero, Juan Pedro Kusanovic, Zhong Dong, Nikolina Docheva, Noppadol Chaiyasit, Sonia S. Hassan, Piya Chaemsaithong, Gaurav Bhatti, Percy Pacora, Lami Yeo, and Offer Erez
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Adult ,medicine.medical_specialty ,Amniotic fluid ,Adolescent ,Enzyme-Linked Immunosorbent Assay ,Inflammation ,Systemic inflammation ,Likelihood ratios in diagnostic testing ,Gastroenterology ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,White blood cell ,Humans ,Medicine ,030212 general & internal medicine ,Risk factor ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Interleukin-6 ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Fetal Diseases ,Chorioamnionitis ,Matrix Metalloproteinase 8 ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Immunology ,Amniocentesis ,Female ,Anaerobic bacteria ,medicine.symptom ,business - Abstract
Objective Clinical chorioamnionitis is the most common infection/inflammatory process diagnosed in labor and delivery units worldwide. The condition is a syndrome that can be caused by (1) intra-amniotic infection, (2) intra-amniotic inflammation without demonstrable microorganisms (i.e. sterile intra-amniotic inflammation), and (3) maternal systemic inflammation that is not associated with intra-amniotic inflammation. The presence of intra-amniotic inflammation is a risk factor for adverse maternal and neonatal outcomes in a broad range of obstetrical syndromes that includes clinical chorioamnionitis at term. Although the diagnosis of intra-amniotic infection has relied on culture results, such information is not immediately available for patient management. Therefore, the diagnosis of intra-amniotic inflammation could be helpful as a proxy for intra-amniotic infection, while results of microbiologic studies are pending. A rapid test is now available for the diagnosis of intra-amniotic inflammation, based on the determination of neutrophil collagenase or matrix metalloproteinase-8 (MMP-8). The objectives of this study were (1) to evaluate the diagnostic indices of a rapid MMP-8 test for the identification of intra-amniotic inflammation/infection in patients with the diagnosis of clinical chorioamnionitis at term, and (2) to compare the diagnostic performance of a rapid MMP-8 test to that of a conventional enzyme-linked immunosorbent assay (ELISA) interleukin (IL)-6 test for patients with clinical chorioamnionitis at term. Materials and methods A retrospective cohort study was conducted. A transabdominal amniocentesis was performed in patients with clinical chorioamnionitis at term (n=44). Amniotic fluid was analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital Mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Amniotic fluid IL-6 concentrations were determined by ELISA, and rapid MMP-8 results were determined by Yoon's MMP-8 Check®. Intra-amniotic inflammation was defined as an elevated amniotic fluid IL-6 concentration ≥2.6 ng/mL, and intra-amniotic infection was diagnosed by the presence of microorganisms in the amniotic fluid accompanied by intra-amniotic inflammation. The diagnostic indices of Yoon's MMP-8 Check® for the identification of intra-amniotic inflammation were calculated. In order to objectively compare Yoon's MMP-8 Check® with the ELISA IL-6 test for the identification of intra-amniotic inflammation, we used an amniotic fluid white blood cell (WBC) count ≥50 cells/mm3 to define intra-amniotic inflammation. Results (1) A positive rapid MMP-8 test had a sensitivity of 82.4% (28/34), specificity of 90% (9/10), positive predictive value of 96.6% (28/29), negative predictive value of 60% (9/15), positive likelihood ratio 8.2 (95% CI 1.3-53.2), and negative likelihood ratio 0.2 (95% CI 0.1-0.4) for the identification of intra-amniotic inflammation (prevalence 77.3%); (2) a positive rapid MMP-8 test had a sensitivity of 91.7% (22/24), specificity of 65% (13/20), positive predictive value of 75.9% (22/29), negative predictive value of 86.7% (13/15), positive likelihood ratio of 2.6 (95% CI 1.4-4.8), and negative likelihood ratio of 0.1 (95% CI 0.03-0.5) for the identification of intra-amniotic infection; (3) the rapid MMP-8 test had a significantly higher specificity than the ELISA IL-6 test in the identification of intra-amniotic inflammation as determined by an amniotic fluid WBC count ≥50 cells/mm3. The sensitivity and accuracy of the rapid MMP-8 test were comparable to those of the ELISA IL-6 test; and (4) importantly, the rapid MMP-8 test had 100% sensitivity and 100% negative predictive value in the identification of neonates affected with fetal inflammatory response syndrome (FIRS). Conclusion The rapid diagnosis of intra-amniotic inflammation is possible by analysis of amniotic fluid using a point-of-care test for MMP-8. Patients with a positive test are at risk of delivering a neonate affected with systemic inflammation, a risk factor for adverse neonatal outcome.
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- 2017
31. Eicosanomic profiling reveals dominance of the epoxygenase pathway in human amniotic fluid at term in spontaneous labor
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Roberto Romero, Kenneth V. Honn, Sen Lin Zhou, Krishna Rao Maddipati, Adi L. Tarca, Hernán Muñoz, Tinnakorn Chaiworapongsa, Zhonghui Xu, and Juan Pedro Kusanovic
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Adult ,Epoxygenase ,medicine.medical_specialty ,Amniotic fluid ,Term Birth ,Biochemistry ,Research Communications ,chemistry.chemical_compound ,Pregnancy ,Internal medicine ,Lipidomics ,Genetics ,medicine ,Metabolome ,Humans ,Prostaglandin E2 ,Molecular Biology ,Arachidonic Acid ,Labor, Obstetric ,biology ,Lipid metabolism ,Lipid signaling ,Amniotic Fluid ,Lipid Metabolism ,Endocrinology ,chemistry ,biology.protein ,Eicosanoids ,Female ,Arachidonic acid ,Oxidoreductases ,Biotechnology ,medicine.drug - Abstract
Lipid mediators play an important role in reproductive biology, especially, in parturition. Enhanced biosynthesis of eicosanoids, such as prostaglandin E2 (PGE2) and PGF2α, precedes the onset of labor as a result of increased expression of inducible cyclooxygenase 2 (COX-2) in placental tissues. Metabolism of arachidonic acid results in bioactive lipid mediators beyond prostaglandins that could significantly influence myometrial activity. Therefore, an unbiased lipidomic approach was used to profile the arachidonic acid metabolome of amniotic fluid. In this study, liquid chromatography–mass spectrometry was used for the first time to quantitate these metabolites in human amniotic fluid by comparing patients at midtrimester, at term but not in labor, and at term and in spontaneous labor. In addition to exposing novel aspects of COX pathway metabolism, this lipidomic study revealed a dramatic increase in epoxygenase- and lipoxygenase-pathway-derived lipid mediators in spontaneous labor with remarkable product selectivity. Despite their recognition as anti-inflammatory lipid mediators and regulators of ion channels, little is known about the epoxygenase pathway in labor. Epoxygenase pathway metabolites are established regulators of vascular homeostasis in cardiovascular and renal physiology. Their presence as the dominant lipid mediators in spontaneous labor at term portends a yet undiscovered physiological function in parturition.—Maddipati, K. R., Romero, R., Chaiworapongsa, T., Zhou, S.-L., Xu, Z., Tarca, A. L., Kusanovic, J. P., Munoz, H., Honn, K. V. Eicosanomic profiling reveals dominance of the epoxygenase pathway in human amniotic fluid at term in spontaneous labor.
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- 2014
32. Detection of Anti-HLA Antibodies in Maternal Blood in the Second Trimester to Identify Patients at Risk of Antibody-Mediated Maternal Anti-Fetal Rejection and Spontaneous Preterm Delivery
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Roberto Romero, Jezid Miranda, Chong Jai Kim, JoonHo Lee, Steven J. Korzeniewski, Tinnakorn Chaiworapongsa, Bo Hyun Yoon, Yi Xu, Adi L. Tarca, Piya Chaemsaithong, Juan Pedro Kusanovic, Wonsuk Yoo, Nandor Gabor Than, and Sonia S. Hassan
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Adult ,medicine.medical_specialty ,Adolescent ,Immunology ,Human leukocyte antigen ,Article ,Antibodies ,Young Adult ,Fetus ,HLA Antigens ,Isoantibodies ,Pregnancy ,medicine ,Humans ,Immunology and Allergy ,business.industry ,Obstetrics ,Histocompatibility Antigens Class I ,Histocompatibility Antigens Class II ,Infant, Newborn ,Case-control study ,Obstetrics and Gynecology ,Gestational age ,Middle Aged ,medicine.disease ,Transplantation ,Reproductive Medicine ,Premature birth ,Case-Control Studies ,Pregnancy Trimester, Second ,Premature Birth ,Gestation ,Female ,business - Abstract
Problem Maternal anti-fetal rejection is a mechanism of disease in spontaneous preterm labor. The objective of this study was to determine whether the presence of human leukocyte antigen (HLA) panel-reactive antibodies (PRA) during the second trimester increases the risk of spontaneous preterm delivery. Methods of study This longitudinal case-control study included pregnant women with spontaneous preterm deliveries (n = 310) and control patients with normal term pregnancies (n = 620), matched for maternal age and gravidity. Maternal plasma samples obtained at 14–16, 16–20, 20–24, and 24–28 weeks of gestation were analyzed for HLA class I and class II PRA positivity using flow cytometry. The fetal HLA genotype and maternal HLA alloantibody epitope were determined for a subset of patients with positive HLA PRA. Results (i) Patients with spontaneous preterm delivery were more likely to exhibit HLA class I (adjusted OR = 2.54, P
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- 2013
33. 'Trophoblast islands of the chorionic connective tissue' (TICCT): A novel placental histologic feature
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Roberto Romero, H. El Azzamy, C. J. Kim, M. Jin, Jung Sun Kim, So Yeon Ahn, Nandor Gabor Than, Tinnakorn Chaiworapongsa, Steven J. Korzeniewski, Faisal Qureshi, Deug Chan Lee, Joon Seok Hong, Juan Pedro Kusanovic, Vanessa Topping, JoonHo Lee, Suzanne M. Jacques, and Sonia S. Hassan
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Male ,Michigan ,endocrine system ,Placenta Diseases ,Placenta ,Connective tissue ,Biology ,Article ,White People ,Sex Factors ,Pregnancy ,medicine ,Humans ,Clinical significance ,Chile ,reproductive and urinary physiology ,urogenital system ,Keratin-7 ,Infant, Newborn ,Obstetrics and Gynecology ,Trophoblast ,Chorion ,Hispanic or Latino ,Anatomy ,female genital diseases and pregnancy complications ,Trophoblasts ,Black or African American ,Parity ,medicine.anatomical_structure ,Reproductive Medicine ,Feature (computer vision) ,embryonic structures ,Premature Birth ,Female ,Infant, Premature ,Developmental Biology - Abstract
We found isolated or clustered trophoblasts in the chorionic connective tissue of the extraplacental membranes, and defined this novel histologic feature as the "trophoblast islands of the chorionic connective tissue" (TICCT). This study was conducted to determine the clinical significance of TICCT.Immunohistochemistry for cytokeratin-7 was performed on the chorioamniotic membranes (N = 2155) obtained from singleton pregnancies of 1199 uncomplicated term and 956 preterm deliveries. The study groups comprised 1236 African-American and 919 Hispanic women. Gestational age ranged from 24(+0) weeks to 41(+6) weeks. Multiple logistic regression analysis was performed to investigate the magnitude of association between patient characteristics and the presence of TICCT.The likelihood of TICCT was significantly associated with advancing gestational age both in term (OR: 1.29, 95% CI: 1.16-1.45, p0.001) and preterm deliveries (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001) . Hispanic women were less likely than African-American women to have TICCT across gestation in term (OR: 0.23, 95% CI: 0.18-0.31, p0.001) and preterm pregnancies (OR: 0.41, 95% CI: 0.29-0.58, p0.001). Women with a female fetus were significantly more likely to have TICCT than women with a male fetus, in both term (OR: 1.64, 95% CI: 1.28-2.11, p0.001) and preterm gestations (OR: 2.04, 95% CI: 1.46-2.85, p0.001). TICCT was 40% less frequent in the presence of chronic placental inflammation [term (OR: 0.60, 95% CI: 0.45-0.81, p = 0.001) and preterm gestations (OR: 0.58, 95% CI: 0.40-0.84, p = 0.003)] and in parous women at term (OR: 0.60, 95% CI: 0.44-0.81, p = 0.001).Our findings suggest that the duration of pregnancy, fetal sex, and parity may influence the behavior of extravillous trophoblast and placental mesenchymal cells.
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- 2013
34. Characterization of visceral and subcutaneous adipose tissue transcriptome in pregnant women with and without spontaneous labor at term: Implication of alternative splicing in the metabolic adaptations of adipose tissue to parturition
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Adi L. Tarca, Edi Vaisbuch, Shali Mazaki-Tovi, Roberto Romero, Sonia S. Hassan, Zhong Dong, Nandor Gabor Than, Juan Pedro Kusanovic, and Tinnakorn Chaiworapongsa
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Intra-Abdominal Fat ,Term Birth ,Subcutaneous Fat ,Adipose tissue ,Adipokine ,Article ,Transcriptome ,03 medical and health sciences ,Exon ,Young Adult ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Gene expression ,Medicine ,Humans ,Prospective Studies ,Endoplasmic Reticulum Chaperone BiP ,Heat-Shock Proteins ,Adaptor Proteins, Signal Transducing ,Glutathione Transferase ,Oligonucleotide Array Sequence Analysis ,030219 obstetrics & reproductive medicine ,business.industry ,Gene Expression Profiling ,Alternative splicing ,Infant, Newborn ,Parturition ,Obstetrics and Gynecology ,Membrane Proteins ,LIM Domain Proteins ,Adaptation, Physiological ,Gene expression profiling ,Alternative Splicing ,030104 developmental biology ,Endocrinology ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Objective:The aim of this study was to determine gene expression and splicing changes associated with parturition and regions (visceral vs. subcutaneous) of the adipose tissue of pregnant women.Study design:The transcriptome of visceral and abdominal subcutaneous adipose tissue from pregnant women at term with (n=15) and without (n=25) spontaneous labor was profiled with the Affymetrix GeneChip Human Exon 1.0 ST array. Overall gene expression changes and the differential exon usage rate were compared between patient groups (unpaired analyses) and adipose tissue regions (paired analyses). Selected genes were tested by quantitative reverse transcription-polymerase chain reaction.Results:Four hundred and eighty-two genes were differentially expressed between visceral and subcutaneous fat of pregnant women with spontaneous labor at term (q-value 1.5). Biological processes enriched in this comparison included tissue and vasculature development as well as inflammatory and metabolic pathways. Differential splicing was found for 42 genes [q-value 2] between adipose tissue regions of women not in labor. Differential exon usage associated with parturition was found for three genes (Conclusion:We show for the first time evidence of implication of mRNA splicing and processing machinery in the subcutaneous adipose tissue of women in labor compared to those without labor.
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- 2016
35. Lipidomic analysis of patients with microbial invasion of the amniotic cavity reveals up-regulation of leukotriene B4
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Piya Chaemsaithong, Noppadol Chaiyasit, Ricardo Gomez, Roberto Romero, Kenneth V. Honn, Sen Lin Zhou, Krishna Rao Maddipati, Adi L. Tarca, Juan Pedro Kusanovic, Tinnakorn Chaiworapongsa, and Zhonghui Xu
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0301 basic medicine ,Adult ,Amniotic fluid ,Leukotriene B4 ,Term Birth ,Inflammation ,Gestational Age ,Biochemistry ,Proinflammatory cytokine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Obstetric Labor, Premature ,Pregnancy ,Genetics ,medicine ,Humans ,Pregnancy Complications, Infectious ,Molecular Biology ,chemistry.chemical_classification ,030219 obstetrics & reproductive medicine ,Arachidonate 5-Lipoxygenase ,Labor, Obstetric ,biology ,Research ,Lipidome ,Amniotic Fluid ,Up-Regulation ,030104 developmental biology ,chemistry ,Arachidonate 5-lipoxygenase ,Immunology ,biology.protein ,Arachidonic acid ,Female ,medicine.symptom ,Biomarkers ,Biotechnology ,Polyunsaturated fatty acid - Abstract
Bioactive lipids derived from the metabolism of polyunsaturated fatty acids are important mediators of the inflammatory response. Labor per se is considered a sterile inflammatory process. Intra-amniotic inflammation (IAI) due to microorganisms (i.e., intra-amniotic infection) or danger signals (i.e., sterile IAI) has been implicated in the pathogenesis of preterm labor and clinical chorioamnionitis at term. Early and accurate diagnosis of microbial invasion of the amniotic cavity (MIAC) requires analysis of amniotic fluid (AF). It is possible that IAI caused by microorganisms is associated with a stereotypic lipidomic profile, and that analysis of AF may help in the identification of patients with this condition. To test this hypothesis, we analyzed the fatty acyl lipidome of AF by liquid chromatography-mass spectrometry from patients in spontaneous labor at term and preterm gestations. We report that the AF concentrations of proinflammatory lipid mediators of the 5-lipoxygenase pathway are significantly higher in MIAC than in cases of sterile IAI. These results suggest that the concentrations of 5-lipoxygenase metabolites of arachidonic acid, 5-hydroxyeicosatetraenoic acid, and leukotriene B4 in particular could serve as potential biomarkers of MIAC. This finding could have important implications for the rapid identification of patients who may benefit from anti-microbial treatment.-Maddipati, K. R., Romero, R., Chaiworapongsa ,T., Chaemsaithong, P., Zhou, S.-L., Xu, Z., Tarca, A. L., Kusanovic, J. P., Gomez, R., Chaiyasit, N., Honn, K. V. Lipidomic analysis of patients with microbial invasion of the amniotic cavity reveals up-regulation of leukotriene B4.
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- 2016
36. Resultado de estudio prenatal invasivo para el diagnóstico de aneuploidía en el Hospital Sótero del Río
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Rafael Valdés, Rosa Pardo, Francisco Díaz, Zasha Parra, Sebastián Sepúlveda M, Carolina Martinovic, Juan Pedro Kusanovic, Paula Vargas I, Cecilia Mellado, Carolina Salas, Patricio Cortes, Karla Silva, Fernando Ferrer, and Víctor Córdova
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0301 basic medicine ,genetic amniocentesis ,medicine.medical_specialty ,Population ,Aneuploidy ,trisomías ,Perinatal outcome ,030105 genetics & heredity ,03 medical and health sciences ,0302 clinical medicine ,Prenatal genetic diagnosis ,aneuploidía ,medicine ,030212 general & internal medicine ,aneuploidy ,education ,trisomies ,Gynecology ,education.field_of_study ,Fetus ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Diagnóstico genético prenatal ,Perinatal morbidity ,amniocentesis genética ,Amniocentesis ,Trisomy ,business ,Demography - Abstract
RESUMEN Antecedentes: Las aneuploidias y malformaciones congenitas son causa importante de morbi-mortalidad perinatal e infantil en Chile. Objetivo: Evaluar la realidad local del diagnostico genetico antenatal para mejorar el resultado perinatal. Metodos: Estudio retrospectivo y descriptivo. Se realizo amniocentesis a embarazadas con indicacion de estudio genetico prenatal por sospecha ecografica de alteraciones cromosomicas, entre octubre de 2010 y marzo de 2015, en el Hospital Sotero del Rio. Resultados: Los hallazgos ecograficos mas frecuentes fueron: cardiopatias congenitas, malformaciones del sistema nervioso central y restriccion de crecimiento fetal precoz. 164 pacientes aceptaron el estudio invasivo antenatal, obteniendose resultados de 154. El promedio de edad materna y edad gestacional del examen fueron 30 anos y 27+3 semanas, respectivamente. En embarazos con trisomia 21 y 13, el 71% de las pacientes tenia sobre 35 anos. Un 31% de las muestras presentaron cariotipo anormal, siendo la mas frecuente la trisomia 21 (14%), trisomia 18 (9%), monosomia X (4,5%) y trisomia 13 (2,6%). Conclusion: El diagnostico genetico prenatal permite un adecuado manejo perinatal, coordinacion apropiada entre las unidades de Obstetricia y Neonatologia, y la preparacion de las pacientes y sus familias para un pronostico perinatal adverso. PALABRAS CLAVES: Diagnostico genetico prenatal, aneuploidia, amniocentesis genetica, trisomias SUMMARY Background: Malformations and aneuploidy are a major cause of perinatal morbidity and mortality in Chile. Invasive techniques are offered to determine the fetal karyotype, when there is an abnormal finding in the ultrasound. Aims: To assess the local situation of prenatal genetic diagnosis to improve the management of this population. Methods: This is a retrospective and descriptive study of patients from october 2010 to march 2015, who had an amniocentesis for genetic testing due suspected fetal malformations or aneuploidy. Results: The sonographic findings most frequently found were: congenital heart disease, malformations of the central nervous system and early growth restrictions. 164 patients agree to perform invasive prenatal genetic, obtaining 154 results. The average maternal age was 30 years and the mean gestational age at amniocentesis was 27+3 weeks. In trisomy 21 pregnancies, 71% of patients were higher than 35 years. 31% of the samples had abnormal karyotype: trisomy 21 (14%), trisomy 18 (9%), Turner’s syndrome (4.5%) and trisomy 13 (3%). Conclusions: Prenatal genetic diagnosis allows appropriate perinatal management and contributes to prepare the patient and their families for an adverse perinatal outcome.
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- 2016
37. Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection?
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Piya Chaemsaithong, Roberto Romero, Steven J. Korzeniewski, Sonia S. Hassan, Nikolina Docheva, Tinnakorn Chaiworapongsa, Lami Yeo, Alicia Martínez-Varea, Juan Pedro Kusanovic, Bo Hyun Yoon, and Ahmed I. Ahmed
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Adult ,medicine.medical_specialty ,Amniotic fluid ,Adolescent ,medicine.drug_class ,Antibiotics ,Chorioamnionitis ,Gastroenterology ,Article ,Young Adult ,Pregnancy ,Internal medicine ,Funisitis ,medicine ,Humans ,Leukocytosis ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Interleukin-6 ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Gold standard (test) ,medicine.disease ,Amniotic Fluid ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Female ,medicine.symptom ,Inflammation Mediators ,business - Abstract
The diagnosis of clinical chorioamnionitis is based on a combination of signs [fever, maternal or fetal tachycardia, foul-smelling amniotic fluid (AF), uterine tenderness and maternal leukocytosis]. Bacterial infections within the amniotic cavity are considered the most frequent cause of clinical chorioamnionitis and an indication for antibiotic administration to reduce maternal and neonatal morbidity. Recent studies show that only 54% of patients with the diagnosis of clinical chorioamnionitis at term have bacteria in the AF and evidence of intra-amniotic inflammation. The objective of this study was to examine the performance of the clinical criteria for the diagnosis of chorioamnionitis to identify patients with microbial-associated intra-amniotic inflammation (also termed intra-amniotic infection).This retrospective cross-sectional study included 45 patients with the diagnosis of clinical chorioamnionitis at term, whose AF underwent analysis for: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad primers], and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay. The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of each clinical sign and their combination to identify clinical chorioamnionitis were determined using microbial-associated intra-amniotic inflammation [presence of microorganisms in the AF using cultivation or molecular techniques and elevated AF IL-6 concentrations (≥2.6 ng/mL)] as the gold standard.: The accuracy of each clinical sign for the identification of microbial-associated intra-amniotic inflammation (intra-amniotic infection) ranged between 46.7% and 57.8%. The combination of fever with three or more clinical criteria did not substantially improve diagnostic accuracy.In the presence of a fever during labor at term, signs used to diagnose clinical chorioamnionitis do not accurately identify the patient with proven intra-amniotic infection (i.e., those with microorganisms detected by culture or molecular microbiologic techniques and an associated intra-amniotic inflammatory response).
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- 2016
38. Clinical chorioamnionitis is characterized by changes in the expression of the alarmin HMGB1 and one of its receptors, sRAGE
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Roberto Romero, Juan Pedro Kusanovic, Chong Jai Kim, Youssef Hussein, Tinnakorn Chaiworapongsa, Zeynep Alpay Savasan, Zhong Dong, and Sonia S. Hassan
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Amniotic fluid ,biology ,business.industry ,Obstetrics and Gynecology ,Inflammation ,HMGB1 ,RAGE (receptor) ,Glycation ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Extracellular ,Medicine ,medicine.symptom ,business ,Receptor ,Neuroinflammation - Abstract
Objective: High mobility group box-1 (HMGB1) protein is an alarmin, a normal cell constituent, which is released into the extracellular environment upon cellular stress/damage and capable of activating inflammation and tissue repair. The receptor for advanced glycation end products (RAGE) can bind HMGB1. RAGE, in turn, can induce the production of pro-inflammatory cytokines; this may be modulated by the soluble truncated forms of RAGE, including soluble RAGE (sRAGE) and endogenous secretory RAGE (esRAGE). The objectives of this study were to determine whether: 1) clinical chorioamnionitis at term is associated with changes in amniotic fluid concentrations of HMGB1, sRAGE and esRAGE; and 2) the amniotic fluid concentration of HMGB1 changes with labor or as a function of gestational age. Methods: Amniotic fluid samples were collected from the following groups: 1) mid-trimester (n = 45); 2) term with (n = 48) and without labor (n = 22) without intra-amniotic infection; and 3) term with clinical chorioamnioni...
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- 2012
39. Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome
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Bo Hyun Yoon, Stanley M. Berry, Roberto Romero, Tinnakorn Chaiworapongsa, Juan Pedro Kusanovic, Samuel S. Edwin, Eleazar Soto, Sonia S. Hassan, and Moshe Mazor
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Adult ,medicine.medical_specialty ,Time Factors ,Article ,Young Adult ,Obstetric Labor, Premature ,Pregnancy ,medicine ,Humans ,Young adult ,Retrospective Studies ,Fetus ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,Hydrogen-Ion Concentration ,Hypoxia (medical) ,Fetal Blood ,medicine.disease ,Systemic Inflammatory Response Syndrome ,Systemic inflammatory response syndrome ,Fetal Diseases ,Cross-Sectional Studies ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Female ,Base excess ,Blood Gas Analysis ,medicine.symptom ,Cordocentesis ,business - Abstract
Fetal hypoxemia has been proposed to be one of the mechanisms of preterm labor (PTL) and delivery. This may have clinical implications since it may alter: (i) the method/frequency of fetal surveillance and (ii) the indications and duration of tocolysis to an already compromised fetus. The aim of this study was to examine whether there is a difference in the fetal blood gas analysis [pH, PaO(2) and base excess (BE)] and in the prevalence of fetal acidemia and hypoxia between: (i) patients in PTL who delivered within 72 hours vs. those who delivered more than 72 hours after cordocentesis and (ii) patients with fetal inflammatory response syndrome (FIRS) vs. those without this condition.Patients admitted with PTL underwent amniocentesis and cordocentesis. Ninety women with singleton pregnancies and PTL were classified according to (i) those who delivered within 72 hours (n = 30) and after 72 hours of the cordocentesis (n = 60) and (ii) with and without FIRS. FIRS was defined as a fetal plasma concentration of IL-611 pg/mL. Fetal blood gases were determined. Acidemia and hypoxemia were defined as fetal pH and PaO(2) below the 5th percentile for gestational age, respectively. For comparisons between the two study groups, ΔpH and ΔPaO(2) were calculated by adjusting for gestational age (Δ = observed value - mean for gestational age). Non-parametric statistics were employed.No differences in the median Δ pH (-0.026 vs. -0.016), ΔPaO(2) (0.25 mmHg vs. 5.9 mmHg) or BE (-2.4 vs. -2.6 mEq/L) were found between patients with PTL who delivered within 72 hours and those who delivered 72 hours after the cordocentesis (p0.05 for all comparisons). Fetal plasma IL-6 concentration was determined in 63% (57/90) of fetuses and the prevalence of FIRS was 28% (16/57). There was no difference in fetal pH, PaO(2) and BE between fetuses with and without FIRS (p0.05 for all comparisons). Moreover, there was no difference in the rate of fetal acidemia between fetuses with and without FIRS (6.3 vs. 9.8%; p0.05) and fetal hypoxia between fetuses with or without FIRS (12.5 vs. 19.5%; p0.05).Our data do not support a role for acute fetal hypoxemia and metabolic acidemia in the etiology of PTL and delivery.
- Published
- 2011
40. Peripheral CD300a+CD8+ T Lymphocytes with a Distinct Cytotoxic Molecular Signature Increase in Pregnant Women with Chronic Chorioamnionitis
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Yi Xu, Sonia S. Hassan, Roberto Romero, Gaurav Bhatti, Chong Jai Kim, Jung Sun Kim, Federica Tarquini, JoonHo Lee, Adi L. Tarca, I. Birgitta Sundell, Juan Pedro Kusanovic, and Pooja Mittal
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Myeloid ,Immunology ,Obstetrics and Gynecology ,Biology ,Chorioamnionitis ,medicine.disease ,GZMB ,medicine.anatomical_structure ,Immune system ,Reproductive Medicine ,Antigen ,CX3CR1 ,medicine ,Immunology and Allergy ,Cytotoxic T cell ,CD8 - Abstract
Citation Xu Y, Tarquini F, Romero R, Kim CJ, Tarca AL, Bhatti G, Lee J, Sundell IB, Mittal P, Kusanovic JP, Hassan SS, Kim J-S. Peripheral CD300a+CD8+ T lymphocytes with a distinct cytotoxic molecular signature increase in pregnant women with chronic chorioamnionitis. Am J Reprod Immunol 2012; 67: 184–197 Problem CD300a is an immunomodulatory molecule of the immunoglobulin receptor superfamily expressed in the leukocytes of myeloid and lymphoid lineages. However, its biological function on CD8+ T lymphocytes remains largely unknown. This study was conducted to assess the biological significance of CD300a expression in T lymphocytes and to determine whether its expression in peripheral T lymphocytes changes in pregnant women presenting with antifetal rejection. Methods of Study Microarray analysis was performed using total RNA isolated from peripheral CD300a+ and CD300a− T lymphocytes. Flow cytometric analysis of the peripheral blood samples of pregnant women and pathologic examination of the placentas were conducted. Results A large number of genes (N = 1245) were differentially expressed between CD300a− and CD300a+ subsets of CD8+ T lymphocytes, which included CCR7, CD244, CX3CR1, GLNY, GZMB, GZMK, IL15, ITGB1, KLRG1, PRF1, and SLAMF7. Gene ontology analysis of differentially expressed genes demonstrated enrichment of biological processes such as immune response, cell death, and signal transduction. CD300a expression in CD8+ T lymphocytes was coupled to a more cytotoxic molecular signature. Of note, the proportion of CD300a+CD8+ T lymphocytes increased in pregnant women with chronic chorioamnionitis (antifetal rejection of the chorioamniotic membranes; P
- Published
- 2011
41. Damage-associated molecular patterns (DAMPs) in preterm labor with intact membranes and preterm PROM: a study of the alarmin HMGB1
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Zeynep Alpay Savasan, Roberto Romero, Youssef Hussein, Tinnakorn Chaiworapongsa, Chong Jai Kim, Yi Xu, Juan Pedro Kusanovic, Zhong Dong, and Sonia S. Hassan
- Subjects
Adult ,Fetal Membranes, Premature Rupture ,Amniotic fluid ,Adolescent ,Inflammation ,Pregnancy Proteins ,HMGB1 ,Chorioamnionitis ,Article ,Sepsis ,Young Adult ,Obstetric Labor, Premature ,Mediator ,Pregnancy ,Stress, Physiological ,Extracellular ,Humans ,Medicine ,Amnion ,HMGB1 Protein ,Pregnancy Complications, Infectious ,Retrospective Studies ,biology ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Blockade ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Immunology ,Metabolome ,biology.protein ,Female ,medicine.symptom ,business ,DNA Damage - Abstract
Preterm parturition is a syndrome caused by multiple etiologies. Although intra-amniotic infection is causally linked with intrauterine inflammation and the onset of preterm labor, other patients have preterm labor in the absence of demonstrable infection. It is now clear that inflammation may be elicited by activation of the Damage-Associated Molecular Patterns (DAMPs), which include pathogen-associated molecular patterns (PAMPs) as well as "alarmins" (endogenous molecules that signal tissue and cellular damage). A prototypic alarmin is high-mobility group box 1 (HMGB1) protein, capable of inducing inflammation and tissue repair when it reaches the extracellular environment. HMGB1 is a late mediator of sepsis, and blockade of HMGB1 activity reduces mortality in an animal model of endotoxemia, even if administered late during the course of the disorder. The objectives of this study were to: (1) determine whether intra-amniotic infection/inflammation (IAI) is associated with changes in amniotic fluid concentrations of HMGB1; and (2) localize immunoreactivity of HMGB1 in the fetal membranes and umbilical cord of patients with chorioamnionitis.Amniotic fluid samples were collected from the following groups: (1) preterm labor with intact membranes (PTL) with (n=42) and without IAI (n=84); and (2) preterm prelabor rupture of membranes (PROM) with (n=38) and without IAI (n=35). IAI was defined as either a positive amniotic fluid culture or amniotic fluid concentration of interleukin-6 (IL-6) ≥ 2.6ng/mL. HMGB1 concentrations in amniotic fluid were determined by ELISA. Immunofluorescence staining for HMGB1 was performed in the fetal membranes and umbilical cord of pregnancies with acute chorioamnionitis.(1) Amniotic fluid HMGB1 concentrations were higher in patients with IAI than in those without IAI in both the PTL and preterm PROM groups (PTL IAI: median 3.1 ng/mL vs. without IAI; median 0.98 ng/mL; p0.001; and preterm PROM with IAI median 7.3 ng/mL vs. without IAI median 2.6 ng/mL; p=0.002); (2) patients with preterm PROM without IAI had a higher median amniotic fluid HMGB1 concentration than those with PTL and intact membranes without IAI (p0.001); and (3) HMGB1 was immunolocalized to amnion epithelial cells and stromal cells in the Wharton's jelly (prominent in the nuclei and cytoplasm). Myofibroblasts and macrophages of the chorioamniotic connective tissue layer and infiltrating neutrophils showed diffuse cytoplasmic HMGB1 immunoreactivity.(1) intra-amniotic infection/inflammation is associated with elevated amniotic fluid HMGB1 concentrations regardless of membrane status; (2) preterm PROM was associated with a higher amniotic fluid HMGB1 concentration than PTL with intact membranes, suggesting that rupture of membranes is associated with an elevation of alarmins; (3) immunoreactive HMGB1 was localized to amnion epithelial cells, Wharton's jelly and cells involved in the innate immune response; and (4) we propose that HMGB1 released from stress or injured cells into amniotic fluid may be responsible, in part, for intra-amniotic inflammation due to non-microbial insults.
- Published
- 2011
42. Maternal HLA Panel-Reactive Antibodies in Early Gestation Positively Correlate with Chronic Chorioamnionitis: Evidence in Support of the Chronic Nature of Maternal Anti-fetal Rejection
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JoonHo Lee, Roberto Romero, Sonia S. Hassan, Yi Xu, Juan Pedro Kusanovic, Ji Young Park, Chong Jai Kim, Jung Sun Kim, and Tinnakorn Chaiworapongsa
- Subjects
Pregnancy ,Fetus ,animal structures ,Immunology ,Panel reactive antibody ,Obstetrics and Gynecology ,Context (language use) ,Human leukocyte antigen ,Biology ,urologic and male genital diseases ,medicine.disease ,Chorioamnionitis ,female genital diseases and pregnancy complications ,Reproductive Medicine ,Premature birth ,medicine ,Immunology and Allergy ,Young adult ,hormones, hormone substitutes, and hormone antagonists ,circulatory and respiratory physiology - Abstract
Problem Maternal tolerance of the fetus is essential for viviparity, yet anti-fetal rejection occurs in several pregnancy complications. Chronic chorioamnionitis (CCA) is a feature of anti-fetal cellular rejection. There is a robust association between CCA and maternal seropositivity for anti-HLA panel reactive antibodies (PRA) at the time of delivery. This longitudinal study was performed to assess maternal HLA PRA status in early gestation and the temporal evolution of maternal HLA PRA in the context of CCA and thereby to determine whether HLA PRA during the course of pregnancy is useful for the detection of anti-fetal rejection.
- Published
- 2011
43. Late-onset preeclampsia is associated with an imbalance of angiogenic and anti-angiogenic factors in patients with and without placental lesions consistent with maternal underperfusion
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Roberto Romero, Juan Pedro Kusanovic, Chong Jai Kim, Sonia S. Hassan, Eleazar Soto, Lami Yeo, Youssef Hussein, Tinnakorn Chaiworapongsa, and Giovanna Ogge
- Subjects
Adult ,Placental growth factor ,medicine.medical_specialty ,Adolescent ,Placenta ,Enzyme-Linked Immunosorbent Assay ,Receptors, Cell Surface ,Pregnancy Proteins ,Article ,Preeclampsia ,Young Adult ,chemistry.chemical_compound ,Pre-Eclampsia ,Antigens, CD ,Ischemia ,Pregnancy ,Internal medicine ,medicine ,Humans ,Age of Onset ,Placenta Growth Factor ,Retrospective Studies ,Vascular Endothelial Growth Factor Receptor-1 ,business.industry ,Endoglin ,Case-control study ,Obstetrics and Gynecology ,medicine.disease ,Vascular Endothelial Growth Factor Receptor-2 ,Vascular endothelial growth factor ,Cross-Sectional Studies ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,Female ,Age of onset ,business ,Biomarkers - Abstract
An imbalance between maternal angiogenic/anti-angiogenic factors concentrations has been observed in preeclampsia (PE) and other obstetrical syndromes. However, the frequency of pathologic findings in the placenta and the changes in maternal plasma angiogenic/anti-angiogenic factor concentrations differ between late- and early-onset PE. The aim of this study was to determine if the maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 and 2 (sVEGFR-1 and sVEGFR-2) are different in late-onset PE with and without placental pathologic findings consistent with maternal underperfusion.A cross-sectional study was conducted including 64 uncomplicated women and 66 women with late-onset PE (34 weeks) who had blood samples and placenta available for pathologic examination. Patients with late-onset PE were divided into those with and without placental histologic findings consistent with maternal underperfusion as proposed by the Society for Pediatric Pathology. Maternal plasma concentrations of PlGF, sEng, sVEGFR-1 and sVEGRF-2 were determined by ELISA. Non-parametric statistics were used for analysis.1) the prevalence of placental histological findings consistent with maternal underperfusion among women with late-onset PE was higher than that of those with an uncomplicated pregnancy (47% (31/66) vs. 7.8% (5/64), respectively; p 0.01); 2) patients with late-onset PE and histological findings consistent with maternal underperfusion had a significantly lower median plasma concentration of PlGF, plasma PlGF/sVEGFR-1 ratio and plasma PlGF/sEng ratio than those with late-onset PE without placental underperfusion lesions (each p 0.05); 3) the most common pathological findings in the placenta of patient with PE were lesions consistent with villous changes (77%, 24/31); and 4) isolated vascular lesions in the placenta were found only in 2 cases (6.5%), and the rest had a combination of villous and vascular lesions.Nearly half of the patients with late-onset PE have placental lesions consistent with maternal underperfusion. These lesions are associated with an imbalance in the maternal concentration of angiogenic/anti-angiogenic factors. We propose that there is a link between maternal underperfusion and an anti-angiogenic state characterized by the changes in the concentrations of angiogenic and anti-angiogenic factors in women with late onset PE.
- Published
- 2011
44. Maternal plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in patients presenting to the obstetrical triage area with the suspicion of preeclampsia
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Zeynep Alpay Savasan, Roberto Romero, Zhong Dong, Juan Pedro Kusanovic, Eleazar Soto, Sonia S. Hassan, Tinnakorn Chaiworapongsa, Adi L. Tarca, Bhatti Gaurav, and Giovanna Ogge
- Subjects
Adult ,Placental growth factor ,Gestational hypertension ,medicine.medical_specialty ,Receptors, Cell Surface ,Pregnancy Proteins ,Article ,Preeclampsia ,Young Adult ,Pre-Eclampsia ,Antigens, CD ,Pregnancy ,medicine ,Humans ,Young adult ,Obstetrics and Gynecology Department, Hospital ,Placenta Growth Factor ,Retrospective Studies ,Vascular Endothelial Growth Factor Receptor-1 ,business.industry ,Obstetrics ,Endoglin ,Obstetrics and Gynecology ,Retrospective cohort study ,Prognosis ,medicine.disease ,Vascular Endothelial Growth Factor Receptor-2 ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,Triage ,business ,Biomarkers - Abstract
To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and -2 could identify patients at risk for developing preeclampsia (PE) requiring preterm delivery.Patients presenting with the diagnosis "rule out PE" to the obstetrical triage area of our hospital at37 weeks of gestation (n = 87) were included in this study. Delivery outcomes were used to classify patients into four groups: I) patients without PE or those with gestational hypertension (GHTN) or chronic hypertension (CHTN) who subsequently developed PE at term (n = 19); II): mild PE who delivered at term (n = 15); III): mild disease (mild PE, GHTN, CHTN) who subsequently developed severe PE requiring preterm delivery (n = 26); and IV): diagnosis of severe PE (n = 27). Plasma concentrations of PlGF, sEng, sVEGFR-1 and -2 were determined at the time of presentation by ELISA. Reference ranges for analytes were constructed by quantile regression in our laboratory (n = 180; 1046 samples). Comparisons among groups were performed using multiples of the median (MoM) and parametric statistics after log transformation. Receiver operating characteristic curves, logistic regression and survival analysis were employed for analysis.The mean MoM plasma concentration of PlGF/sVEGFR-1, PlGF/sEng, PlGF, sVEGFR-1 and -2, and sEng in Group III was significantly different from Group II (all p0.05). A plasma concentration of PlGF/sVEGFR-1 ≤ 0.05 MoM or PlGF/sEng ≤0.07 MoM had the highest likelihood ratio of a positive test (8.3, 95% CI 2.8-25 and 8.6, 95% CI 2.9-25, respectively), while that of PlGF ≤0.396 MoM had the lowest likelihood ratio of a negative test (0.08, 95% CI 0.03-0.25). The association between low plasma concentrations of PlGF/sVEGFR-1 (≤0.05 MoM) as well as that of PlGF/sEng (≤0.07 MoM) and the development of severe PE remained significant after adjusting for gestational age at presentation, average systolic and diastolic blood pressure, and a history of chronic hypertension [adjusted odds ratio (OR) = 27 (95% CI 6.4-109) and adjusted OR 30 (95% CI 6.9-126), respectively]. Among patients who presented34 weeks gestation (n = 59), a plasma concentration of PlGF/sVEGFR-10.033 MoM identified patients who delivered within 2 weeks because of PE with a sensitivity of 93% (25/27) and a specificity of 78% (25/32). This cut-off was associated with a shorter interval-to-delivery due to PE [hazard ratio = 6 (95% CI 2.5-14.6)].Plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in the obstetrical triage area. These observations support the value of these biomarkers in the clinical setting for the identification of the patient at risk for disease progression requiring preterm delivery.
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- 2011
45. miR-210 Targets Iron-Sulfur Cluster Scaffold Homologue in Human Trophoblast Cell Lines
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Sorin Draghici, Roberto Romero, Daniel Montenegro, Ernest Kim, Juan Pedro Kusanovic, Pooja Mittal, Chong Jai Kim, Tinnakorn Chaiworapongsa, Adi L. Tarca, Beth L. Pineles, Jung Sun Kim, JoonHo Lee, Sonia S. Hassan, Deug Chan Lee, and Sun Young Kim
- Subjects
medicine.medical_specialty ,biology ,Obstetrics ,Choriocarcinoma ,Trophoblast ,Placentation ,medicine.disease ,female genital diseases and pregnancy complications ,Pathology and Forensic Medicine ,Preeclampsia ,Andrology ,medicine.anatomical_structure ,Placenta ,embryonic structures ,biology.protein ,medicine ,Small for gestational age ,ISCU ,Siderosis ,reproductive and urinary physiology - Abstract
This study was performed to assess the biological significance of miR-210 in preeclampsia and small-for-gestational-age (SGA) pregnancies. Placental miR-210 expression was evaluated by quantitative RT-PCR (RT-qPCR) in the following groups: i) appropriate-for-gestational-age pregnancies (n = 72), ii) preeclampsia (n = 52), iii) SGA (n = 66), and iv)preeclampsia with SGA (n = 31). The effects of hypoxia (1% O2) on miR-210 and iron-sulfur cluster scaffold homologue (ISCU) expressions and miR-210 binding to ISCU 3′ UTR were examined in Swan 71 and BeWo cell lines. Perls' reaction (n = 229) and electron microscopy (n = 3) were conducted to verify siderosis of trophoblasts. miR-210 expression was increased in preeclampsia and SGA cases and was decreased with birth weight and gestational age. In both cell lines, miR-210 was induced by hypoxia, whereas ISCU expression was decreased. The luciferase assay confirmed miR-210 binding to ISCU mRNA 3′ UTR. RNA interference knockdown of ISCU expression in Swan 71, but not in BeWo, cells resulted in autophagosomal and siderosomal iron accumulation and a fourfold decrease of Matrigel invasion (P = 0.004). Placental ISCU expression was decreased in preeclampsia (P = 0.002) and SGA (P = 0.002) cases. Furthermore, hemosiderin-laden trophoblasts were more frequent in the placental bed of preterm preeclampsia and/or SGA births than in control cases (48.7% versus 17.9%; P = 0.004). Siderosis of interstitial trophoblasts is a novel pathological feature of preeclampsia and SGA. The findings herein suggest that ISCU down-regulation by miR-210 perturbing trophoblast iron metabolism is associated with defective placentation.
- Published
- 2011
46. Varicella-zoster virus (chickenpox) infection in pregnancy
- Author
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Jack D. Sobel, Juan Pedro Kusanovic, Roberto Romero, Ronald F. Lamont, Edi Vaisbuch, Shali Mazaki-Tovi, and D Carrington
- Subjects
Chickenpox ,integumentary system ,business.industry ,viruses ,Congenital Varicella Syndrome ,Varicella zoster virus ,virus diseases ,Obstetrics and Gynecology ,Disease ,medicine.disease ,medicine.disease_cause ,Rash ,Virus ,Vaccination ,Pneumonia ,Immunology ,Medicine ,medicine.symptom ,business - Abstract
Congenital varicella syndrome, maternal varicella-zoster virus pneumonia and neonatal varicella infection are associated with serious fetomaternal morbidity and, not infrequently, mortality. Vaccination against varicella-zoster virus can prevent the disease, and outbreak control limits the exposure of pregnant women to the infectious agent. Maternal varicella-zoster immunoglobulin administration before rash development, with or without antiviral medication, can modify the progression of the disease.
- Published
- 2011
47. Urgencias en obstetricia
- Author
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Oyarzún E and P. Juan Pedro Kusanovic
- Subjects
Maternal mortality ,vaginal bleeding ,miscarriage ,metrorragia ,embolía de líquido amniótico ,cardiac arrest ,General Medicine ,uterine atony ,mortalidad perinatal ,inercia uterina ,Mortalidad materna ,desprendimiento de placenta ,placental abruption ,eclampsia ,paro cardiorrespiratorio ,amniotic fluid embolism ,perinatal mortality ,Medicine ,shoulder dystocia ,retención de hombros ,aborto ,placenta previa - Abstract
ResumenTradicionalmente, el embarazo es considerado un evento fisiológico. Sin embargo, cerca de un 20% de las embarazadas desarrolla patologías obstétricas que se asocian a mortalidad materna y perinatal. A nivel mundial, cada año medio millón de mujeres fallece durante el embarazo y parto debido a estas complicaciones. Desafortunadamente, un número significativo de las urgencias obstétricas ocurre en pacientes sin factores de riesgo, por lo que la prevención, identificación precoz e intervención a tiempo de estos eventos juegan un rol fundamental para contrarrestar un resultado perinatal adverso. En el presente capítulo hemos seleccionado las emergencias que concentran la mayor morbimortalidad de nuestra especialidad. Si bien algunas han quedado fuera, creemos que los temas aquí presentados representan las urgencias obstétricas más importantes que enfrentamos a diario, para las cuales debemos estar preparados con el fin de realizar un manejo óptimo del embarazo y parto para la obtención de un resultado perinatal favorable.SummaryTraditionally, pregnancy is considered a physiologic condition. However, close to 20% of pregnant women develop obstetrical diseases that are associated to maternal and perinatal mortality. Worldwide, every year half a million of women die during pregnancy, labor and delivery due to these complications. Unfortunately, a significant number of obstetrical emergencies occur among patients without risk factors, so that prevention, early identification and timely intervention play a key role to overcome an adverse pregnancy outcome. In the present chapter, we have selected the emergencies that concentrate most of the morbidity and mortality of our field. Although some have not been included, we believe that the obstetrical emergencies presented herein represent the most important ones that we face daily, and for which we should be prepared in order to execute the best possible obstetrical care either during pregnancy or at the time of delivery to obtain a favourable perinatal outcome.
- Published
- 2011
48. Four‐chamber view and ‘swing technique’ (FAST) echo: a novel and simple algorithm to visualize standard fetal echocardiographic planes
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Giovanna Ogge, Roberto Romero, Edi Vaisbuch, Wesley Lee, Juan Pedro Kusanovic, Cristiano Jodicke, Sonia S. Hassan, and Lami Yeo
- Subjects
Heart Defects, Congenital ,Gestational Age ,Article ,Ultrasonography, Prenatal ,Plane (Unicode) ,Fetal Heart ,Pregnancy ,Reference Values ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Echocardiography, Four-Dimensional ,Observer Variation ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Echo (computing) ,Ultrasound ,Reproducibility of Results ,Obstetrics and Gynecology ,General Medicine ,Anatomy ,Swing ,Visualization ,Reproductive Medicine ,Line (geometry) ,Female ,Artificial intelligence ,business ,Fetal echocardiography ,Rotation (mathematics) ,Algorithms - Abstract
Objective To describe a novel and simple algorithm (four-chamber view and ‘swing technique’ (FAST) echo) for visualization of standard diagnostic planes of fetal echocardiography from dataset volumes obtained with spatiotemporal image correlation (STIC) and applying a new display technology (OmniView). Methods We developed an algorithm to image standard fetal echocardiographic planes by drawing four dissecting lines through the longitudinal view of the ductal arch contained in a STIC volume dataset. Three of the lines are locked to provide simultaneous visualization of targeted planes, and the fourth line (unlocked) ‘swings’ through the ductal arch image (swing technique), providing an infinite number of cardiac planes in sequence. Each line generates the following plane(s): (a) Line 1: three-vessels and trachea view; (b) Line 2: five-chamber view and long-axis view of the aorta (obtained by rotation of the five-chamber view on the y-axis); (c) Line 3: four-chamber view; and (d) ‘swing line’: three-vessels and trachea view, five-chamber view and/or long-axis view of the aorta, four-chamber view and stomach. The algorithm was then tested in 50 normal hearts in fetuses at 15.3-40 weeks' gestation and visualization rates for cardiac diagnostic planes were calculated. To determine whether the algorithm could identify planes that departed from the normal images, we tested the algorithm in five cases with proven congenital heart defects. Results In normal cases, the FAST echo algorithm (three locked lines and rotation of the five-chamber view on the y-axis) was able to generate the intended planes (longitudinal view of the ductal arch, pulmonary artery, three-vessels and trachea view, five-chamber view, long-axis view of the aorta, four-chamber view) individually in 100% of cases (except for the three-vessels and trachea view, which was seen in 98% (49/50)) and simultaneously in 98% (49/50). The swing technique was able to generate the three-vessels and trachea view, five-chamber view and/or long-axis view of the aorta, four-chamber view and stomach in 100% of normal cases. In the abnormal cases, the FAST echo algorithm demonstrated the cardiac defects and displayed views that deviated from what was expected from the examination of normal hearts. The swing technique was useful for demonstrating the specific diagnosis due to visualization of an infinite number of cardiac planes in sequence. Conclusions This novel and simple algorithm can be used to visualize standard fetal echocardiographic planes in normal fetal hearts. The FAST echo algorithm may simplify examination of the fetal heart and could reduce operator dependency. Using this algorithm, inability to obtain expected views or the appearance of abnormal views in the generated planes should raise the index of suspicion for congenital heart disease. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2011
49. The vaginal microbiome: new information about genital tract flora using molecular based techniques
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Roberto Romero, Jack D. Sobel, Robert A. Akins, Juan Pedro Kusanovic, Sonia S. Hassan, Ronald F. Lamont, and Tinnakorn Chaiworapongsa
- Subjects
Flora ,Pregnancy ,biology ,medicine.drug_class ,Vaginal flora ,Antibiotics ,Obstetrics and Gynecology ,medicine.disease ,biology.organism_classification ,medicine.anatomical_structure ,Lactobacillus ,Immunology ,Vagina ,medicine ,Microbiome ,Bacterial vaginosis - Abstract
Vaginal microbiome studies provide information that may change the way we define vaginal flora. Normal flora appears dominated by one or two species of Lactobacillus. Significant numbers of healthy women lack appreciable numbers of vaginal lactobacilli. Bacterial vaginosis (BV) is not a single entity, but instead consists of different bacterial communities or profiles of greater microbial diversity than is evident from cultivation-dependent studies. BV should be considered a syndrome of variable composition that results in different symptoms, phenotypical outcomes, and responses to different antibiotic regimens. This information may help to elucidate the link between BV and infection-related adverse outcomes of pregnancy.
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- 2011
50. Current debate on the use of antibiotic prophylaxis for caesarean section
- Author
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Shali Mazaki-Tovi, Ronald F. Lamont, Edi Vaisbuch, Jack D. Sobel, Sun Kwon Kim, Juan Pedro Kusanovic, Neils Uldbjerg, and Roberto Romero
- Subjects
Pregnancy ,medicine.medical_specialty ,business.industry ,Obstetrics ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Obstetrics and Gynecology ,medicine.disease ,Chemoprophylaxis ,medicine ,Caesarean section ,Endometritis ,Antibiotic prophylaxis ,business ,Surgical incision ,Antibacterial agent - Abstract
Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tract infection. Most surgical site infections occur after discharge from the hospital, and are increasingly being used as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics before surgical incision. An exception is made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage to the neonate.
- Published
- 2010
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