Association between masked hypertension and late-onset fetal growth restriction at advanced maternal age

Fetal growth restriction (FGR) is a major risk factor for complicated pregnancy including stillbirth. The all-pathophysiology results in uteroplacental insufficiency. Hypertension chronic or pregnancy-related complicates the all-prenatal periods. The relationship between fetal growth restriction and hypertension is well-known and this risk increases with maternal age. Late-onset FGR is diagnosed >32 weeks. Masked hypertension (MH) is a phenotype of hypertension when clinic blood pressure is in the normal range in the office but elevated outside the office. This study examined the risk of late-onset FGR and masked hypertension at advanced maternal age. Sixty pregnant women over 40 years old were included in the study who delivered at our hospital with late-onset fetal growth restriction diagnosis. After taking detailed anamnesis from all individuals included in the study, detailed physical examination, obstetric examination and ambulatory blood pressure monitoring (ABPM) were performed. Women with maternal chronic hypertension, pregestational or gestational diabetes mellitus, chronic kidney disease, rheumatoid disease history, tobacco use, cardiac arrhythmia, fetal genetic abnormality or placental abnormality were excluded from the study. The prevalence of masked hypertension was statistically significantly higher in the group with late intrauterine growth. (n:13, 43% vs n:5, 16.7% p=0.02). Office systolic BP (125.5±4.1 mmHg vs 118.5±5.7 mmHg p=0.016), 24-hour systolic BP measurement (125±9 mmHg vs 119.7±5.7 mmHg p=0.03), and ambulatory nocturnal diastolic BP measurement (66.7±10 mmHg vs. 61.±5.5 mmHg p=0.03) was higher in the group with late FGR. Hypertension can lead to complications in the perinatal period. There is a bad association between FGR and hypertension. Masked hypertension should be considered especially in advanced age pregnant individuals with FGR. [Med-Science 2023; 12(4.000): 1193-7

The role of trimetazidine in ischemia/reperfusion damage treatment in an ovary torsion model experimentally induced in rats

The aim of this experimental animal study was to investigate the histopathological and biochemical efficacy of trimetazidine (TMZ) in decreasing ovary damage in an ovary ischaemia/reperfusion (I/R) model in the rat. A total of 35 Wistar albino female rats were randomly separated into five groups, n = 7 per group: Group 1: Sham (S) was only given a laparotomy procedure. Group 2: Ischaemia (I) group with 2-hour ischaemia using a vascular sutur. Group 3: Ischaemia/Reperfusion (I/R) group with 2 hour ischaemia and 2-hour reperfusion. Group 4: Sham + 10 mg/kg orally TMZ (S + TMZ). Group 5: I/R + 10 mg/kg oral TMZ (I/R + TMZ) group with 2 hours ischaemia and 2 hours reperfusion after the administration orally 10 mg/kg oral TMZ. Two daily doses of TMZ were orally administered to Group 4 (S + TMZ) and Group 5 (I/R + TMZ) for three days. TMZ significantly decreased vascular congestion, haemorrhage, and polymorphonuclear leukocyte infiltration in group 5 compared to group 3 (p  .05). TMZ which is an antioxidant agent can efficiently prevent in I/R damage in rat ovaries but further studies are necessary in order to implement it in the clinical settings.IMPACT STATEMENT What is already known on this subject? Adnexial torsion is the most common gynecological emergency and there are no specific clinical, laboratories, or radiological findings for adnexal torsion. Unfortunatelly, the currently accepted treatment is adnexal detorsion. Cytoprotective effects of Trimetazidine (TMZ), an antianginal drug, are well-defined and it has been demonstrated to improve oxidative stress markers and limits membrane damage induced by reactive oxygen species and protects tissues from free radicals with its antioxidant effects. The aim of this study is to investigate the effects of TMZ in experimentally induced adnexal torsion in rats and to investigate possible effects in maintaining ovarian reserve to prevent I/R damage or reperfusion damage. What do the results of this study add? Our study showed that TMZ significantly decreased vascular congestion, haemorrhage, and PMNL infiltration. TMZ decreased the malondialdehyde, total oxidant status, and the oxidative stress index values, but these decreases were not statistically significant. What are the implications of these findings for clinical practice and/or further research? Although various antioxidant drugs and chemicals have been used to protect the ovaries against I/R damage, they have not been demostrated to prevent it completely. TMZ, an antioxidant efficacy agent, has been shown to prevent ovarian I/R damage by suppressing inflammation in terms of histopathological parameters. Further studies involving a greater number of experimental animals are required before using TMZ for the treatment of humans with I/R damage in the clinical setting

Effect of Doxycycline on Aseptic Reperfusion Injury in Ovarian Torsion

Objective: Reperfusion injury occurs when the condition causing ischemia in ovarian torsion is corrected and the blood supply is re-established. The aim of this study is to evaluate whether doxycycline treatment reduces reperfusion injury in a rat model. Study Design: Thirty-five female albino Wistar rats were split into the five groups. Sham: Sham operation; ischemia (I): 2 hours of ischemia; ischemia and reperfusion (I/R): 2 hours of ischemia followed by 2 hours of reperfusion; Sham-Dc: Sham operation and doxycycline 10-mg/kg (2 hours prior to surgery); I/R-Dc: 2-hours of ischemia and doxycycline 10-mg/kg and 2-hours of reperfusion. The groups were compared in terms of histological and biochemical features. A semi-quantitative histological assessment scoring system was used for the histological examination. Follicular cell degeneration, vascular congestion, haemorrhage and inflammatory cell count were evaluated for histological analysis. For biochemical analysis of reperfusion injury, the body's total antioxidant status and total oxidant status were measured using a fully automatic method. The oxidative stress index was calculated by dividing total antioxidant status by total oxidant status. Results: In the sham group the ovaries were histologically normal. Oedema, vascular congestion, bleeding, leukocyte infiltration and follicle degeneration were increased in other groups (p<0.05). There was less leukocyte infiltration in the I/R-Dc group compared to I/R group. Other histological features were similar in these groups. Doxycycline increased the malondialdehyde, total antioxidant and total oxidant status levels in Sham-Dc and I/R-Dc groups. This increase was statistically significant between Sham and Sham-Dc groups. However, although there was an increase in the biochemical markers in the I/R-Dc group, this increase was not significant compared to I/R group. Conclusion: Doxycycline treatment in ovarian torsion does not reduce I/R injury. Doxycycline may even increase reperfusion injury, according to biochemical findings