Cíl studie: Podle Světové zdravotnické organizace patří sepse, spolu s hemoragiemi, komplikacemi hypertenzních chorob a potratů, ke čtyřem hlavním příčinám úmrtí v souvislosti s těhotenstvím. Cílem této studie je analýza případu septického šoku v graviditě. Typ studie: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha. Metodika a výsledky: Na případu septického šoku ve 25. týdnu gravidity, který se vyvinul na podkladě pyelonefritidy vyvolané E. coli, jsou prezentována úskalí diagnostiky a léčby těchto závažných stavů v těhotenství. Závěr: Předpokladem úspěšné léčby septického šoku v těhotenství je především včasná diagnostika sepse a mezioborová spolupráce.
Objective: According to the World Health Organisation, sepsis is one of the four main causes of pregnancy-related mortality worldwide, together with hemorrhage, hypertensive disease and abortion. The main goal of this paper is an analysis of one case of septic shock in pregnancy. Design: A case report. Setting: Department of Obstetrics and Gynaecology of the First Faculty of Medicine and General Teaching Hospital, Prague. Methods and results: Authors would like to draw attention to the pitfalls of diagnosis and treatment of septic shock which developed in 25th week of pregnancy on the basis of pyelonephritis due to E. coli. Conclusions: Early diagnosis of sepsis and an interdisciplinary co-operation are the main prerequisities for successful treatment.
- Klíčová slova
- urosepse, antenatální bakteriální infekce,
- MeSH
- bakteriální infekce farmakoterapie MeSH
- Escherichia coli MeSH
- infekce močového ústrojí MeSH
- infekční komplikace v těhotenství * etiologie terapie MeSH
- klinické laboratorní techniky MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- mladý dospělý MeSH
- předčasný porod MeSH
- pyelonefritida * diagnóza farmakoterapie komplikace terapie MeSH
- sepse MeSH
- septický šok * etiologie farmakoterapie MeSH
- syndrom systémové zánětlivé reakce * etiologie terapie MeSH
- těhotenství MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Unfavorable post-partum changes to mental well-being affect more than half of all women, and are a risk to the health of both mother and baby. Their effects place strains on health and social systems. Currently, no generally accepted theory exists of the causes and mechanisms of post-partum mental disorders. METHODS: Literature search up to 2012, using PubMed and search words: neuroactive steroids, post-partum mental disorders, depression, corticotropin-releasing hormone and estrogens. RESULTS: There are several theories for post-partum depression. One is that autoimmune diseases are involved. Others revolve around genes responsible or that lead to increased disposition to the disorder. It is likely however that the process is associated with the separation of the placenta and the fetal zone of fetal adrenal gland, the main sources of corticotropin-releasing hormone and sexual and neuroactive steroids during pregnancy, and the ability of the receptor system to adapt to these changes. The central nervous system is able to produce neurosteroids, but the drop in levels of peripheral steroids likely leads to a sudden deficit in neuroinhibitory steroids modulating ionotropic receptors in the brain. CONCLUSIONS: Post-partum depression is a multifactorial disease with unknown etiology. It is probably associated with sudden changes in the production of hormones influencing the nervous system, and on the other hand the ability of the receptor system to adapt to these changes. When the relative changes in concentrations of hormones, rather than their absolute levels, is likely more important.
- MeSH
- dospělí MeSH
- lidé MeSH
- metabolomika metody MeSH
- pohlavní steroidní hormony krev MeSH
- poporodní deprese krev MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
In this review we focused on steroid metabolomics in human fetuses and newborns and its role in the physiology and pathophysiology of human pregnancy and subsequent stages of human life, and on the physiological relevance of steroids influencing the nervous systems with regards to their concentrations in the fetus. Steroid profiling provides valuable data for the diagnostics of diseases related to altered steroidogenesis in the fetal and maternal compartments and placenta. We outlined a potential use of steroid metabolomics for the prediction of reproductive disorders, misbalance of hypothalamic-pituitary-adrenal axis, and impaired insulin sensitivity in subsequent stages of human life. A possible role of steroids exhibiting a non-genomic effect in the development of gestational diabetes and in the neuroprotection via negative modulation of AMPA/kainate receptors was also indicated. Increasing progesterone synthesis and catabolism, declining production of tocolytic 5β-pregnane steroids, and rising activities of steroid sulfotransferases with the approaching term may be of importance in sustaining pregnancy. An increasing trend was demonstrated with advancing gestation toward the production of ketones (and 3β-hydroxyl groups in the case of 3α-hydroxy-steroids) was demonstrated in the fetus on the expense of 3α-hydroxy-, 17β-hydroxy-, and 20α-hydroxy-groups weakening in the sequence C17, C3, and C20. There was higher production of active progestogen but lower production of active estrogen and GABAergic steroids with the approaching term. Rising activities of placental CYP19A1 and oxidative isoforms of HSD17B, and of fetal CYP3A7 with advancing gestation may protect the fetus from hyperestrogenization. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.
- MeSH
- estrogeny fyziologie MeSH
- hormony kůry nadledvin fyziologie MeSH
- lidé MeSH
- mozek metabolismus MeSH
- plod metabolismus MeSH
- pohlavní steroidní hormony fyziologie MeSH
- progestiny fyziologie MeSH
- těhotenství MeSH
- vývoj plodu MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Postpartum depression affects 10-15 % women after childbirth. There is no currently generally accepted theory about the causes and mechanisms of postpartum mental disorders. The principal hypothesis concerns the association with sudden changes in the production of hormones affecting the nervous system of the mother and, on the other hand, with the ability of receptor systems to adapt to these changes. We observed changes in steroidogenesis in the period around spontaneous delivery. We collected three samples of maternal blood. The first sampling was 4 weeks prior to term; the second sampling was after the onset of uterine contractions (the beginning of spontaneous labour); the third sampling was during the third stage of labour (immediately after childbirth). Additionally, we collected mixed umbilical cord blood. The almost complete steroid metabolome was analyzed by gas chromatography-mass spectrometry followed by RIA for some steroids. Mental changes in women in the peripartum period were observed using the Hamilton Depression Rating Scale. The local Ethics Committee approved the study. We found already the changes in androgens levels correlating with postpartum mood disorders four weeks prior to childbirth. The strongest correlations between steroid and postpartum mood change were found in venous blood samples collected from mothers after childbirth and from umbilical cord blood. The main role played testosterone, possibly of maternal origin, and estrogens originating from the fetal compartment. These results suggest that changes in both maternal and fetal steroidogenesis are involved in the development of mental changes in the postpartum period. Descriptions of changes in steroidogenesis in relation to postpartum depression could help clarify the causes of this disease, and changes in some steroid hormones are a promising marker of mental changes in the postpartum period.
- MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- dospělí MeSH
- lidé MeSH
- metabolomika metody MeSH
- plynová chromatografie s hmotnostně spektrometrickou detekcí MeSH
- pohlavní steroidní hormony krev MeSH
- poporodní deprese krev diagnóza MeSH
- radioimunoanalýza MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Steroids are important markers in pregnancy. Although estimating their levels separately in umbilical arterial (UA) and venous blood (UV) enable more precise insights into the functioning fetoplacental unit compared to using mixed umbilical blood (UM), selective aspiration of UA and UV is technically more demanding than collecting UM. We measured the levels of 67 unconjugated steroids and steroid polar conjugates in UA and UV using GC-MS in 80 women giving birth within weeks 28 to 42 of gestation. The samples were sorted into three groups: women entering labor within weeks 28-32 (group A, n=19), weeks 33-37 (group B, n=19), and weeks 38-42 (group C, n=42) of gestation, respectively. The preterm labors were due to pathologies unrelated to steroid status. Most unconjugated steroids exhibited pronounced arteriovenous differences (AVD). The AVD were less distinct in more stable steroid conjugates. Most steroids positively correlate with gestational age, but unconjugated 5beta-reduced pregnanes show negative correlations, as do testosterone and androstenediol, substrates for the placental synthesis of estrogens. Tight correlations between steroids in UA and UV indicate that steroid measurements in UA, UV and UM can be accurately derived from each other, which is important for the diagnostics of steroid related diseases in newborns.
- MeSH
- arteriae umbilicales metabolismus MeSH
- dospělí MeSH
- fetální krev metabolismus MeSH
- lidé MeSH
- metabolom fyziologie MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- předčasný porod krev MeSH
- pupečník metabolismus MeSH
- steroidy krev MeSH
- těhotenství MeSH
- venae umbilicales metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
Práce prezentuje prenatální diagnostiku, možnosti terapie a následnou péči u plodů a novorozenců s kongenitálním chylothoraxem na podkladě zhodnocení 14 případů na naší klinice v letech 1993 až 2012. Povšechný hydrops plodu byl popsán ve 4 případech (29 %), v 10 případech (71 %) byla provedena odlehčovací amniodrenáž a ve 3 případech (21 %) prenatální odlehčovací punkce hrudníku. Spontánně bylo porozeno 11 plodů (78 %), hrudní drenáž byla nezbytná v průměru 9 dnů po porodu. Mortalita dosáhla v souboru 29 % (4 případy). V článku popisujeme vyšetřovací algoritmy, terapeutické prenatální i postnatální postupy a je zdůrazněna nutnost mezioborové spolupráce.
The work presents prenatal diagnosis, treatment and care options in fetuses and neonates with congenital chylothorax based on a detailed evaluation of 14 cases recorded in our department between years 1993 and 2012. Generalized fetal hydrops was described in 29% of cases, therapeutic amnio drainage performed in 71% and prenatal thoracentesis in 21% of cases. 78% of fetuses were delivered spontaneously; thoracic drainage was necessary nine days after birth in average. Mortality reached 29%. The following text describes diagnostic algorithms, prenatal and postnatal therapeutic options with emphasis on the need for interdisciplinary cooperation.
- MeSH
- chylotorax * diagnóza chirurgie komplikace terapie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- dospělí MeSH
- drenáž metody MeSH
- kojenec MeSH
- komorbidita MeSH
- lidé MeSH
- mortalita MeSH
- novorozenec * MeSH
- prenatální diagnóza metody MeSH
- retrospektivní studie MeSH
- statistika jako téma MeSH
- těhotenství MeSH
- týmová péče o pacienty MeSH
- ultrasonografie prenatální * metody MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec * MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
Progesterone and estradiol are the foremost steroid hormones in human pregnancy. However, the origin of maternal progesterone has still not been satisfactorily explained, despite the generally accepted opinion that maternal LDL-cholesterol is a single substrate for placental synthesis of maternal progesterone. The question remains why the levels of progesterone are substantially higher in fetal as opposed to maternal blood. Hence, the role of the fetal zone of fetal adrenal (FZFA) in the synthesis of progesterone precursors was addressed. The FZFA may be directly regulated by placental CRH inducing an excessive production of sulfated 3ß-hydroxy-5-ene steroids such as sulfates of dehydroepiandrosterone (DHEAS) and pregnenolone (PregS). Due to their excellent solubility in plasma these conjugates are easily transported in excessive amounts to the placenta for further conversion to the sex hormones. While the significance of C19 3ß-hydroxy-5-ene steroid sulfates originating in FZFA for placental estrogen formation is mostly recognized, the question “Which maternal and/or fetal functions may be served by excessive production of PregS in the FZFA?“ - still remains open. Our hypothesis is that, besides the necessity to synthesize de novo all the maternal progesterone from cholesterol, it may be more convenient to utilize the fetal PregS. The activities of sulfatase and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) are substantially higher than the activity of cytochrome P450scc, which is rate-limiting for the placental progesterone synthesis from LDL-cholesterol. However, as in the case of progesterone synthesis from maternal LDL-cholesterol, the relative independence of progesterone levels on FZFA activity may be a consequence of substrate saturation of enzymes converting PregS to progesterone. Some of the literature along with our current data (showing no correlation between fetal and maternal progesterone but significant partial correlations between fetal and maternal 20?-dihydroprogesterone (Prog20?) and between Prog20? and progesterone within the maternal blood) indicate that the localization of individual types of 17ß-hydroxysteroid dehydrogenase is responsible for a higher proportion of estrone and progesterone in the fetus, but also a higher proportion of estradiol and Prog20? in maternal blood. Type 2 17ß-hydroxysteroid dehydrogenase (17HSD2), which oxidizes estradiol to estrone and Prog20? to progesterone, is highly expressed in placental endothelial cells lining the fetal compartment. Alternatively, syncytium, which is directly in contact with maternal blood, produces high amounts of estradiol and Prog20? due to the effects of type 1, 5 and 7 17ß-hydroxysteroid dehydrogenases (17HSD1, 17HSD5, and 17HSD7, respectively). The proposed mechanisms may serve the following functions: 1) providing substances which may influence the placental production of progesterone and synthesis of neuroprotective steroids in the fetus; and 2) creating hormonal milieu enabling control of the onset of labor.
- MeSH
- 17-hydroxysteroidní dehydrogenasy metabolismus MeSH
- 3-hydroxysteroid dehydrogenasy metabolismus MeSH
- dospělí MeSH
- dydrogesteron analogy a deriváty krev MeSH
- estradiol krev MeSH
- fetální krev metabolismus MeSH
- financování organizované MeSH
- hydroxyprostaglandindehydrogenasy metabolismus MeSH
- LDL-cholesterol metabolismus MeSH
- lidé MeSH
- mladý dospělý MeSH
- nadledviny metabolismus MeSH
- nástup porodu metabolismus MeSH
- progesteron biosyntéza krev MeSH
- steryl-sulfatasa metabolismus MeSH
- těhotenství MeSH
- venae umbilicales MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
Cíl studie: Přehledový článek o roli neuroaktivních a neuroprotektivních steroidů v lidském těhotenství. Typ studie: Přehledový článek. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. lékařské fakulty UK a Všeobecné fakultní nemocnice, Praha. Závěr: Porod je multifaktoriální proces. Bylo zkoumáno již mnoho mechanismů iniciace porodu. Hladina estrogenů vzrůstá ke konci těhotenství, což pravděpodobně způsobuje zvýšená aktivita fetálních nadledvin. Tato zóna je stimulována postupným zvyšováním produkce placentárního kortikoliberinu, což způsobuje nadměrnou produkci konjugovaného 3ß-hydroxy-5-en-steroidů, které jsou transportovány cirkulací do placenty a následně metabolizovány na aktivní hormony. Některé metabolity progesteronu pravděpodobně působí v těhotenství udržováním modulace ligandů iontových kanálů v CNS a periferii. Otázkou v této studii bylo, jestli katabolismus těhotenství udržujících metabolitů progesteronu urychluje podobně jako estrogeny.
Objective: Review of the physiological role of neuroactive and neuroprotective steroids in human pregnancy. Design: A review article. Setting: Gynecological-Obstetrical Clinic, 1st Medical Facult, Charles University and General Hospital, Prague. Conclusion: Human parturition is a multi-factorial process. Various mechanisms related to the onset of labor were suggested. Estrogens show accelerating increase in late pregnancy, which probably reflect the increasing activity of fetal zone of the fetal adrenal. This zone is stimulated by progressive increase of placental CRH resulting in excessive production of conjugated 3ß-hydroxy-5-en-steroids, which are transported by circulation to placenta and further metabolized to active hormones. Some progesterone metabolites probably participate in pregnancy sustaining via modulation of ligand-gated ion channels in the CNS and periphery. In this review, the question was addressed whether the catabolism of pregnancy sustaining progesterone metabolites accelerate like the estrogen formation.
