OBJECTIVES: To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS: This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS: The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION: In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

• Klíčová slova
• Doppler, adverse outcome, middle cerebral artery, neonatal, umbilical artery, umbilicocerebral ratio,
• MeSH
• arteria cerebri media diagnostické zobrazování   embryologie   MeSH
• arteriae umbilicales diagnostické zobrazování   embryologie   MeSH
• dospělí MeSH
• gestační stáří MeSH
• hmotnost plodu MeSH
• hypotrofický novorozenec MeSH
• lidé MeSH
• narození mrtvého plodu MeSH
• narození živého dítěte MeSH
• novorozenec MeSH
• obvod pasu MeSH
• plod krevní zásobení   diagnostické zobrazování   patofyziologie   MeSH
• porodní hmotnost MeSH
• prospektivní studie MeSH
• pulzatilní průtok MeSH
• referenční hodnoty MeSH
• reologie * MeSH
• růstová retardace plodu diagnostické zobrazování   patofyziologie   MeSH
• těhotenství MeSH
• ultrasonografie dopplerovská * MeSH
• ultrasonografie prenatální * MeSH
• vývoj plodu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVES: To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)). METHODS: The Ratio37 trial is an ongoing randomized, open-label, multicenter controlled study of women with a low-risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter- and intrarater reliability was assessed using the Fleiss-modified kappa statistic for ordinal scales. RESULTS: On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88-0.92) and 0.90 (95% CI, 0.88-0.93) for the MCA and UA, respectively. The corresponding inter-rater reliability values were 0.85 (95% CI, 0.81-0.89) and 0.84 (95% CI, 0.80-0.89), respectively. CONCLUSION: The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra- and inter-rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

• Klíčová slova
• Doppler, middle cerebral artery, quality control, randomized multicenter trial, reliability, umbilical artery,
• MeSH
• arteria cerebri media diagnostické zobrazování   embryologie   MeSH
• arteriae umbilicales diagnostické zobrazování   embryologie   MeSH
• dospělí MeSH
• lidé MeSH
• plod krevní zásobení   diagnostické zobrazování   embryologie   MeSH
• randomizované kontrolované studie jako téma MeSH
• reprodukovatelnost výsledků MeSH
• ultrasonografie dopplerovská normy   MeSH
• ultrasonografie prenatální normy   MeSH
• zajištění kvality zdravotní péče MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• multicentrická studie MeSH

During pregnancy, oxygen diffuses from maternal to fetal blood through villous trees in the placenta. In this paper, we simulate blood flow and oxygen transfer in feto-placental capillaries by converting three-dimensional representations of villous and capillary surfaces, reconstructed from confocal laser scanning microscopy, to finite-element meshes, and calculating values of vascular flow resistance and total oxygen transfer. The relationship between the total oxygen transfer rate and the pressure drop through the capillary is shown to be captured across a wide range of pressure drops by physical scaling laws and an upper bound on the oxygen transfer rate. A regression equation is introduced that can be used to estimate the oxygen transfer in a capillary using the vascular resistance. Two techniques for quantifying the effects of statistical variability, experimental uncertainty and pathological placental structure on the calculated properties are then introduced. First, scaling arguments are used to quantify the sensitivity of the model to uncertainties in the geometry and the parameters. Second, the effects of localized dilations in fetal capillaries are investigated using an idealized axisymmetric model, to quantify the possible effect of pathological placental structure on oxygen transfer. The model predicts how, for a fixed pressure drop through a capillary, oxygen transfer is maximized by an optimal width of the dilation. The results could explain the prevalence of fetal hypoxia in cases of delayed villous maturation, a pathology characterized by a lack of the vasculo-syncytial membranes often seen in conjunction with localized capillary dilations.

• MeSH
• biologické modely * MeSH
• choriové klky embryologie   MeSH
• difuze MeSH
• kapiláry metabolismus   fyziologie   MeSH
• krevní oběh * MeSH
• kyslík metabolismus   MeSH
• lidé MeSH
• placenta krevní zásobení   MeSH
• plod krevní zásobení   MeSH
• těhotenství MeSH
• zobrazování trojrozměrné * MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kyslík MeSH

OBJECTIVE: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency. DESIGN: Case report. SETTING: Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil. CASE REPORT: Hereditary hypofibrinolysis, which is mediated by 4G/4G homozygosity for the PAI-1 gene, is an independent risk factor for pregnancy complications, probably acting through thrombotic induction of placental insufficiency. We report a case of a low risk pregnancy, which separately presented placental insufficiency and fetal centralization at the beginning of the third trimester, without any other clinical manifestations during pregnancy. However, immediately after childbirth, the patient had a deep vein thrombosis of a lower limb. The anatomopathological examination of the placenta showed old and recent placental infarcts. Homozygosity for the 4G allele of PAI-1 gene was subsequently diagnosed as the sole probable causal factor.

• MeSH
• arteria cerebri media fyziologie   MeSH
• arteriae umbilicales fyziologie   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• inhibitor aktivátoru plazminogenu 1 genetika   MeSH
• lidé MeSH
• nemoci plodu diagnóza   diagnostické zobrazování   genetika   MeSH
• novorozenec MeSH
• placentární insuficience diagnóza   genetika   MeSH
• plod krevní zásobení   MeSH
• polymorfismus genetický * MeSH
• prenatální diagnóza MeSH
• pulzatilní průtok MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• třetí trimestr těhotenství MeSH
• ultrasonografie prenatální MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• inhibitor aktivátoru plazminogenu 1 MeSH

OBJECTIVE: To evaluate the intensity of the fetal inflammatory response, characterized by umbilical cord blood IL-6 levels, and neonatal outcome in the preterm prelabor rupture of membranes (PPROM) pregnancies using the pulsatile fetal splenic vein flow pattern. METHODS: Women with singleton pregnancies complicated by PPROM at a gestational age between 24 + 0 and 36 + 6 weeks were included in the study. Doppler evaluation of the fetal splenic vein flow was performed. The flow-velocity waveform pattern was evaluated qualitatively as continuous or pulsatile. The umbilical cord blood interleukin-6 (IL-6) levels were evaluated after delivery. The fetal inflammatory response was defined as IL-6 >11 pg/mL. RESULTS: In total, 129 women were included. The fetuses with pulsatile splenic vein flow exhibited higher IL-6 levels in umbilical cord blood (median: 56.7 pg/mL versus 5.6 pg/mL; p < 0.0001) and had a higher rate of fetal inflammatory response syndrome (71% versus 35%; p = 0.0005) than fetuses with continuous flow. The pulsatile flow pattern was related to a higher rate of early onset neonatal sepsis (odds ratio 4.2; 95% confidence interval: 1.3-13.5). CONCLUSION: The presence of pulsatile fetal splenic vein flow in PPROM pregnancies is associated with fetal inflammatory response and neonatal morbidity.

• MeSH
• chorioamnionitida krev   epidemiologie   patofyziologie   MeSH
• dospělí MeSH
• fetální krev chemie   metabolismus   MeSH
• interleukin-6 analýza   krev   MeSH
• lidé MeSH
• mladý dospělý MeSH
• nemoci novorozenců diagnóza   epidemiologie   etiologie   MeSH
• novorozenec MeSH
• plod krevní zásobení   imunologie   MeSH
• předčasný odtok plodové vody * krev   diagnóza   epidemiologie   patofyziologie   MeSH
• prognóza MeSH
• regionální krevní průtok * MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• vena lienalis fyziologie   MeSH
• výsledek těhotenství epidemiologie   MeSH
• zánět krev   epidemiologie   patofyziologie   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
• Názvy látek
• interleukin-6 MeSH

UNLABELLED: The purpose of this study was to summarize the new published data on the Doppler flowmetry in preeclampsia. METHODS: We summarize the new published data on the Doppler flowmetry in uteroplacental, fetoplacental and fetal circulation in preeclampsia. The present review summarized the results of clinical research on the Doppler flowmetry in the screening of risk of preclampsia, in the diagnosis of preclampsia and in the fetal risk in preclampsia (Ref. 19). Full Text (Free, PDF) www.bmj.sk.

• MeSH
• lidé MeSH
• placentární oběh MeSH
• plod krevní zásobení   MeSH
• preeklampsie diagnostické zobrazování   patofyziologie   MeSH
• reologie * MeSH
• rychlost toku krve * MeSH
• těhotenství MeSH
• ultrasonografie MeSH
• uterus krevní zásobení   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

(32)P-postlabelling and PAH-ELISA using the antiserum #29 were employed to analyze DNA adducts in venous and umbilical cord blood and the placenta of 79 mothers giving birth to 80 living babies in Prague (Czech Republic). Ambient air exposure was measured by stationary measurements of basic air pollutants (PM2.5, c-PAHs) during the entire pregnancy. Tobacco smoke exposure was assessed by questionnaire data and by plasma cotinine levels. The total DNA adduct levels in the lymphocytes of mothers and newborns were elevated by 30-40% (p<0.001) compared with the placenta. B[a]P-like DNA adduct (adduct with the identical chromatographic mobility on TLC as major BPDE derived DNA adduct) levels were elevated in the blood of mothers compared with the placenta and the blood of newborns (p<0.05 and p<0.01). In tobacco smoke-exposed mothers, higher DNA adduct levels in the blood of mothers and newborns compared with the placenta were found (p<0.001), whereas the total and B[a]P-like adduct levels were comparable in the blood of mothers and newborns. B[a]P-like adducts were elevated in the blood of mothers unexposed to tobacco smoke compared with that of corresponding newborns and the placenta (p<0.01). Total and B[a]P-like DNA adducts were increased in the placenta of tobacco smoke-exposed compared with unexposed mothers (p<0.001 and p<0.01). In lymphocytes of tobacco smoke-exposed mothers, the comparison of total adduct levels (1.18+/-0.67 vs. 0.92+/-0.28) and B[a]P-like DNA adducts (0.22+/-0.12 adducts/10(8) nucleotides vs. 0.15+/-0.06 adducts/10(8) nucleotides) with newborns indicated a 30-40% increase of adducts in mothers. Almost equal PAH-DNA adduct levels were detected by anti-BPDE-DNA ELISA in the placenta of tobacco smoke-exposed and -unexposed mothers. Our results suggest a protective effect of the placental barrier against the genotoxic effect of some tobacco smoke components between the circulation of mother and child. We found a correlation between adduct levels in the blood of mothers and newborns.

• MeSH
• 7,8-dihydro-7,8-dihydroxybenzo(a)pyren 9,10-oxid metabolismus   MeSH
• adukty DNA krev   metabolismus   MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• ELISA MeSH
• fetální krev metabolismus   MeSH
• kotinin krev   MeSH
• kouření * MeSH
• látky znečišťující vzduch krev   MeSH
• lidé MeSH
• lymfocyty účinky léků   MeSH
• maternofetální výměna látek MeSH
• matka - expozice noxám * MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• placenta účinky léků   MeSH
• plod krevní zásobení   MeSH
• polycyklické aromatické uhlovodíky krev   MeSH
• těhotenství 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
• Názvy látek
• 7,8-dihydro-7,8-dihydroxybenzo(a)pyren 9,10-oxid MeSH
• adukty DNA MeSH
• benzo(a)pyrene-7,8-dihydrodiol-9,10-epoxide-DNA MeSH Prohlížeč
• biologické markery MeSH
• kotinin MeSH
• látky znečišťující vzduch MeSH
• polycyclic aromatic hydrocarbons-DNA adduct MeSH Prohlížeč
• polycyklické aromatické uhlovodíky MeSH

OBJECTIVE: The purpose of this study was to summarize the published data on the anatomical structure of the ductus venosus, the mechanism of regulation of the ductus venosus shunting and its role in the fetal survival and the possible use of the measurement of the ductus venosus shunting in the clinical practice. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové. METHODS: We summarized published data on the ductus venosus shunting in the fetal venosus circulation with the regulatory mechanisms, doppler ultrasound diagnostic methods and the medical importance. CONCLUSION: The present review summarizes the results of clinical and experimental research on the ductus venosus in the fetal circulation.

• MeSH
• Downův syndrom patologie   MeSH
• hypoxie plodu patologie   MeSH
• lidé MeSH
• plod krevní zásobení   MeSH
• rychlost toku krve MeSH
• těhotenství MeSH
• ultrasonografie dopplerovská MeSH
• ultrasonografie prenatální MeSH
• vény abnormality   embryologie   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• lidé MeSH
• nemoci plodu diagnostické zobrazování   MeSH
• plod krevní zásobení   MeSH
• růstová retardace plodu diagnostické zobrazování   MeSH
• rychlost toku krve MeSH
• těhotenství MeSH
• ultrasonografie prenatální * MeSH
• venae umbilicales diagnostické zobrazování   MeSH
• vény MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

For a long time, intermediate filament protein nestin was recognized as a specific constituent of the cytoskeleton of developing neural cells and skeletal muscle. Recent reports by other investigators demonstrated that nestin may also be expressed in other cell types. Here we give evidence that nestin is expressed by endothelial cells of developing blood vessels in the rat. Using anti-Rat-401 monoclonal antibody we identified high levels of nestin in the endothelium lining all blood vessels of E14-15 rat foetuses. Immunoreactivity for nestin was detected in both extraembryonic (chorion, placenta, umbilical cord) and intraembryonic blood vessels. In the body of the foetus, we observed nestin-positive endothelial cells in vessels located in the areas of the mesenchyme as well as in vessels supplying the developing organs (central nervous system, liver, lung, spleen, heart, digestive tube). The strongest positive signal was given by the endothelium of newly vascularized tissues. In contrast to the developing tissues, expression of nestin by vascular endothelial cells was greatly reduced in adult tissues.

• MeSH
• cévní endotel embryologie   metabolismus   MeSH
• cévy embryologie   metabolismus   MeSH
• fyziologická neovaskularizace MeSH
• gestační stáří MeSH
• imunohistochemie MeSH
• krysa rodu Rattus MeSH
• nestin MeSH
• novorozená zvířata MeSH
• plod krevní zásobení   metabolismus   MeSH
• potkani Wistar MeSH
• proteiny intermediálních filament metabolismus   MeSH
• proteiny nervové tkáně * MeSH
• těhotenství MeSH
• tkáňová distribuce MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• Nes protein, rat MeSH Prohlížeč
• nestin MeSH
• proteiny intermediálních filament MeSH
• proteiny nervové tkáně * MeSH