Clinical aspects of cervical insufficiency

Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the risk of recurrence is high, and a policy of prophylactic cerclage may be safer than one of serial cervical length measurements followed by cerclage, tocolysis and bed rest in case of cervical shortening or dilatation. In low risk cases, however, prophylactic cerclage is not useful. There is a need for more basic knowledge of cervical ripening, objective assessment of cervical visco-elastic properties, and randomized controlled trials of technical aspects of cervical cerclage (e.g. suturing technique)

Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

Contains fulltext : 95846.pdf (publisher's version ) (Open Access)BACKGROUND: Pregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and especially perianal Crohn's disease. METHODS: This is a retrospective cohort study which was performed in a tertiary level referral hospital in the Netherlands. From the IBD database, female patients aged 18-80 years in 2004 were selected. Data analysis took place in the years 2005 and 2006. Eventually, 114 women with at least one pregnancy after the diagnosis of Crohn's disease were eligible for the study. Differences between groups were analyzed using Wilcoxon Mann Whitney tests and Chi-square analysis with 2 x 2 or 2 x 3 contingency tables. Two-tailed values were used and p values < 0.05 were considered statistically significant. RESULTS: 21/114 women (18%) had active luminal disease prior to pregnancy, with significantly more pregnancy related complications compared to women with inactive luminal disease (Odds ratio 2.8; 95% CI 1.0 - 7.4). Caesarean section rate was relatively high (37/114, 32%), especially in patients with perianal disease prior to pregnancy compared to women without perianal disease (Odds ratio 4.6; 95% CI 1.8 - 11.4). Disease progression after childbirth was more frequent in patients with active luminal disease prior to pregnancy compared to inactive luminal disease (Odds ratio 9.7; 95% CI 2.1 - 44.3). Progression of perianal disease seems less frequent after vaginal delivery compared with caesarean section, in both women with prior perianal disease (18% vs. 31%, NS) and without prior perianal disease (5% vs 14%, NS). There were no more fistula-related complications after childbirth in women with an episiotomy or second degree tear. CONCLUSION: A relatively high rate of caesarean sections was observed in women with Crohn's disease, especially in women with perianal disease prior to pregnancy. A protective effect of caesarean section on progression of perianal disease was not observed. However, this must be interpreted carefully due to confounder effect by indication for caesarean section

Adaptive changes of mesenteric arteries in pregnancy: a meta-analysis

van Drongelen J, Hooijmans CR, Lotgering FK, Smits P, Spaanderman ME. Adaptive changes of mesenteric arteries in pregnancy: a meta-analysis. Am J Physiol Heart Circ Physiol 303: H639-H657, 2012. First published July 20, 2012; doi:10.1152/ajpheart.00617.2011.-The vascular response to pregnancy has been frequently studied in mesenteric artery models by investigating endothelial cell (EC)- and smooth muscle cell (SMC)-dependent responses to mechanical (flow-mediated vasodilation, myogenic reactivity, and vascular compliance) and pharmacological stimuli (G protein-coupled receptor responses: Gq(EC), Gs(SMC), Gq(SMC)). It is unclear to what extent these pathways contribute to normal pregnancy-induced vasodilation across species, strains, and/or gestational age and at which receptor level pregnancy affects the pathways. We performed a meta-analysis on responses to mechanical and pharmacological stimuli associated with pregnancy-induced vasodilation of mesenteric arteries and included 55 (188 responses) out of 398 studies. Most included studies (84%) were performed in Wistar and Sprague-Dawley rats (SDRs) and compared late gestation versus nonpregnant controls (80%). Pregnancy promotes flow-mediated vasodilation in all investigated species. Only in SDRs, pregnancy additionally stimulates both vasodilator Gq(EC) sensitivity (EC50 reduced by -0.76 [-0.92, -0.60] log[M]) and Gs(SMC) sensitivity (EC50 reduced by -0.51 [-0.82, -0.20] log[M]), depresses vasopressor Gq(SMC) sensitivity (EC50 increase in SDRs by 0.23 [0.16, 0.31] log[M]), and enhances arterial compliance. We conclude that 1) pregnancy facilitates flow-mediated vasodilation at term among all investigated species, and the contribution of additional vascular responses is species and strain specific, and 2) late pregnancy mediates vasodilation through changes at the receptor level for the substances tested. The initial steps of vasodilation in early pregnancy remain to be elucidated

Adaptive changes of mesenteric arteries in pregnancy: a meta-analysis

Item does not contain fulltextThe vascular response to pregnancy has been frequently studied in mesenteric artery models by investigating endothelial cell (EC)- and smooth muscle cell (SMC)-dependent responses to mechanical (flow-mediated vasodilation, myogenic reactivity, and vascular compliance) and pharmacological stimuli (G protein-coupled receptor responses: Gq(EC), Gs(SMC), Gq(SMC)). It is unclear to what extent these pathways contribute to normal pregnancy-induced vasodilation across species, strains, and/or gestational age and at which receptor level pregnancy affects the pathways. We performed a meta-analysis on responses to mechanical and pharmacological stimuli associated with pregnancy-induced vasodilation of mesenteric arteries and included 55 (188 responses) out of 398 studies. Most included studies (84%) were performed in Wistar and Sprague-Dawley rats (SDRs) and compared late gestation versus nonpregnant controls (80%). Pregnancy promotes flow-mediated vasodilation in all investigated species. Only in SDRs, pregnancy additionally stimulates both vasodilator Gq(EC) sensitivity (EC(50) reduced by -0.76 [-0.92, -0.60] log[M]) and Gs(SMC) sensitivity (EC(50) reduced by -0.51 [-0.82, -0.20] log[M]), depresses vasopressor Gq(SMC) sensitivity (EC(50) increase in SDRs by 0.23 [0.16, 0.31] log[M]), and enhances arterial compliance. We conclude that 1) pregnancy facilitates flow-mediated vasodilation at term among all investigated species, and the contribution of additional vascular responses is species and strain specific, and 2) late pregnancy mediates vasodilation through changes at the receptor level for the substances tested. The initial steps of vasodilation in early pregnancy remain to be elucidated

Effect of pregnancy at mid gestation on in vivo and whole organ perfusion# renal vascular resistance (RVR), renal flow and glomerular filtration rate (GFR) in absence and presence of NO and sympathetic blockade.

<p>The effect of pregnancy on RVR, renal flow (effects of renal plasma/blood/perfusion flow (RPF/RBF/RPPF) combined) and GFR is presented as percentage mean difference (MD) and its 95% CI. Studies and totals based on Long Evans rats (LER), Munich Wistar rats (MWR), Sprague Dawley rats (SDR) and Wistar Hannover rats (WHR). 1, 2, 3 represents first, second and third part of mid gestation. # Whole organ perfusion experiments, excluded in the “Overall in vivo“ analysis. * Experiments performed under anesthesia. I² represents the amount of heterogeneity. n.a.  =  not applicable.</p

Literature search-strategy for Embase.

<p>Literature search-strategy for Embase.</p

Effect of pregnancy at mid and late gestation on renal artery responses to stimuli involved in vasoconstriction through the GqSMC-coupled pathway in presence and absence of blockade.

<p>The effect of pregnancy on EC₅₀ (the dose of stimulus inducing 50% response) is depicted as mean difference (MD) and its 95% confidence interval (95% CI). E_max (maximum response) is presented as standardized mean difference (SMD) and its 95% CI. Studies and totals based on Long Evans rats (LER), Sprague Dawley rats (SDR), sheep and guinea pigs (GP). 1, 2, 3 represents first, second and third part of mid and late gestation. I² represents the amount of heterogeneity. n.a.  =  not applicable.</p

Effect of mid and late pregnancy on renal artery responses to nitric oxide (NO) and potassium.

<p>The effect of pregnancy on EC₅₀ (the dose of stimulus inducing 50% response) is depicted as mean difference (MD) and its 95% confidence interval (95% CI). E_max (maximum response) is presented as standardized mean difference (SMD) and its 95% CI. Studies and totals based on Long Evans rats (LER), Sprague Dawley rats (SDR) and sheep. 1, 2, 3 represents first, second and third part of mid and late gestation. I² represents the amount of heterogeneity. n.a.  =  not applicable.</p

Effect of pregnancy at late gestation on renal artery responses to stimuli involved in vasodilation through the GqEC-coupled pathway in the presence and absence of blockade.

<p>The effect of pregnancy on EC₅₀ (the dose of stimulus inducing 50% response) is depicted as mean difference (MD) and its 95% confidence interval (95% CI). E_max (maximum response) is presented as standardized mean difference (SMD) and its 95% CI. Studies and totals based on Sprague Dawley rats (SDR) and guinea pigs (GP). 1, 2, 3 represents first, second and third part of late gestation. I² represents the amount of heterogeneity. n.a.  =  not applicable.</p