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PubMed | San Sebastián University, Catholic University of the Holy Conception, Institute Clinic Of Ginecologia and University of Los Andes, Chile
Type: Journal Article | Journal: Prenatal diagnosis | Year: 2016

This work aimed to study the effect of uteroplacental circulation restriction on endothelial kidney damage in a fetal rabbit model.New Zealand rabbits were subjected to 40% to 50% of uteroplacental artery ligation at day 25 of pregnancy. After 5days, surviving fetuses were harvested by cesarean section. The gene and protein expressions of selected enzymes associated with nitric oxide production and oxidative stress were analyzed in fetal kidney homogenates.The placenta weight (6.060.27, p<0.0319) and fetal body (19.901.03, p<0.0001) were significantly reduced in the uteroplacental circulation restriction group. The kidneys from restricted fetuses presented a mild vascular congestion and glomerular capillary congestion, without inflammation or hypertrophy. We found endothelial nitric oxide synthase phosphorylation inhibition (0.230.13, p<0.012) and arginase-2 (0.290.14, p<0.023) protein induction in fetal kidneys of the circulation restriction group. Finally, the kidneys from circulation-restricted fetuses showed increased inducible nitric oxide synthase messenger RNA (mRNA) (2.680.24, p<0.01) and reduced heme oxygenase-1 mRNA (231.3, p<0.003), with increased reactive oxygen species (1.690.09, p<0.001) and nitrotyrosine protein (1.740.28, p<0.003) levels, without changes in Nox mRNA.We describe significant deregulation of vascular activity and oxidative damage in kidneys of fetal rabbits that have been exposed to restriction of the uterine circulation. 2016 John Wiley & Sons, Ltd.


Gonzalez-Tendero A.,University of Barcelona | Torre I.,University of Barcelona | Garcia-Canadilla P.,University of Barcelona | Garcia-Canadilla P.,University Pompeu Fabra | And 9 more authors.
American Journal of Physiology - Heart and Circulatory Physiology | Year: 2013

Intrauterine growth restriction (IUGR) affects 7-10% of pregnancies and is associated with cardiovascular remodeling and dysfunction, which persists into adulthood. The underlying subcellular remodeling and cardiovascular programming events are still poorly documented. Cardiac muscle is central in the fetal adaptive mechanism to IUGR given its high energetic demands. The energetic homeostasis depends on the correct interaction of several molecular pathways and the adequate arrangement of intracellular energetic units (ICEUs), where mitochondria interact with the contractile machinery and the main cardiac ATPases to enable a quick and efficient energy transfer. We studied subcellular cardiac adaptations to IUGR in an experimental rabbit model. We evaluated the ultrastructure of ICEUs with transmission electron microscopy and observed an altered spatial arrangement in IUGR, with significant increases in cytosolic space between mitochondria and myofilaments. A global decrease of mitochondrial density was also observed. In addition, we conducted a global gene expression profile by advanced bioinformatics tools to assess the expression of genes involved in the cardiomyocyte energetic metabolism and identified four gene modules with a coordinated over-representation in IUGR: oxygen homeostasis (GO: 0032364), mitochondrial respiratory chain complex I (GO:0005747), oxidative phosphorylation (GO: 0006119), and NADH dehydrogenase activity (GO:0003954). These findings might contribute to changes in energetic homeostasis in IUGR. The potential persistence and role of these changes in long-term cardiovascular programming deserves further investigation. © 2013 the American Physiological Society.


Martinez J.M.,Institute Clinic Of Ginecologia | Prat J.,Hospital Sant Joan Of Deu | Gomez O.,Institute Clinic Of Ginecologia | Crispi F.,Institute Clinic Of Ginecologia | And 4 more authors.
Fetal Diagnosis and Therapy | Year: 2013

This is the first report of fetoscopy to successfully treat a case of bilobar bronchial atresia presenting in the form of a massive right lung tumor causing severe thoracic compression with mediastinal shift, pulmonary hypoplasia and eventually fetal hydrops. The presence of an echolucent tubular structure in the pulmonary hilum was identified as the intrapulmonary continuation of the interrupted main bronchus, and led to the diagnosis of main bronchial atresia. After extensive discussion and counseling, a fetoscopic operation was designed and indicated. The procedure consisted of a fetal tracheoscopy and access to the right main bronchus, which was perforated with a diode laser until a communication with the dead end of the intrapulmonary main bronchus was achieved. After the operation a significant reduction in size was observed, hydrops and mediastinal shift disappeared and O/E LHR increased to 85%. The fetus was born at term and lobectomy of two dysplastic pulmonary lobes was performed. The infant is developing well at 14 months of age. This report demonstrates that fetoscopic airway decompression can achieve fetal survival in the rare event of main bronchus atresia. Copyright © 2012 S. Karger AG, Basel.


Egana-Ugrinovic G.,Institute Clinic Of Ginecologia | Egana-Ugrinovic G.,Institute dInvestigacions Biomediques August Pi i Sunyer IDIBAPS | Egana-Ugrinovic G.,University of Barcelona | Sanz-Cortes M.,Institute Clinic Of Ginecologia | And 11 more authors.
Prenatal Diagnosis | Year: 2014

Objective: The aim of this study is to evaluate corpus callosum (CC) development by Magnetic Resonance Imaging (MRI) in late-onset intrauterine growth restricted (IUGR) fetuses compared to appropriate for gestational age and its association with neurobehavioral outcome. Method: One hundred and seventeen late-onset IUGR and 73 control fetuses were imaged using a 3T MRI scanner at term, obtaining T2 half-Fourier acquisition single-shot turbo spin-echo anatomical slices. CC length, thickness, total area and the areas after a subdivision in 7 portions were assessed. Neonatal Behavioral Assessment Scale test was performed on IUGR newborns at 42±1weeks. Results: IUGR fetuses showed significantly smaller CC (Total CC Area IUGR: 1.3996±0.26 vs. AGA: 1.664±0.31; p<0.01) and smaller subdivision areas as compared with controls. The differences were slightly more pronounced in fetuses with very low birth weight and/or abnormal brain and/or abnormal uterine Doppler. CC measurements were significantly associated with neurobehavioral outcome in IUGR cases. Conclusions: CC development was significantly altered in late-onset IUGR fetuses and correlated with worse neurobehavioral performance. CC could be further explored as a potential imaging biomarker to predict abnormal neurodevelopment in pregnancies at risk. © 2014 John Wiley & Sons, Ltd.


Espuna M.,Institute Clinic Of Ginecologia | Puig M.,Institute Clinic Of Ginecologia | Carmona F.,Institute Clinic Of Ginecologia
Gynecological Surgery | Year: 2010

Dyspareunia is a sexual dysfunction defined as genital pain experienced before, during, or after sexual intercourse. Pain during intercourse is a difficult clinical problem and one of the commonest complaints in gynecological practice. The causes of dyspareunia may be classified as organic, emotional, and psychological. Pelvic organ prolapse (POP) has been considered a cause of dyspareunia and sexual dysfunction may be affected positively or negatively by surgical treatment of prolapse. In this paper, the authors review the de novo dyspareunia after POP surgery. They conclude that the incidence of de novo dyspareunia was higher in series with vaginal repairwith synthetic mesh than in abdominal sacropexy. © Springer-Verlag 2010.


Cruz-Martinez R.,Institute Clinic Of Ginecologia | Figueras F.,Institute Clinic Of Ginecologia | Hernandez-Andrade E.,Institute Clinic Of Ginecologia | Puerto B.,Institute Clinic Of Ginecologia | Gratacos E.,Institute Clinic Of Ginecologia
American Journal of Obstetrics and Gynecology | Year: 2010

Objective: The objective of this study was to compare the temporal sequence of fetal brain hemodynamic changes in near-term small-for-gestational-age fetuses as measured by spectral Doppler indices or by fractional moving blood volume. Study Design: Cerebral tissue perfusion measured by fractional moving blood volume, cerebroplacental ratio, anterior cerebral artery, and middle cerebral artery pulsatility indices were weekly performed in a cohort of singleton consecutive small-for-gestational-age fetuses with normal umbilical artery delivered after 37 weeks of gestation. Results: A total of 307 scans were performed on 110 small-for-gestational-age fetuses. Mean gestational age at diagnosis and at delivery was 35.7 and 38.6 weeks, respectively. The proportion of fetuses with abnormal fractional moving blood volume, cerebroplacental ratio, anterior cerebral artery-pulsatility index, and middle cerebral artery-pulsatility index values was 31.3%, 16.8%, 17.2%, and 10.8% at 37 weeks of gestation and 42.7%, 23.6%, 20.9%, and 16.4% before delivery. Conclusion: The presence of brain redistribution in small-for-gestational-age fetuses was detected earlier and in a higher proportion of fetuses using cerebral tissue perfusion rather than spectral Doppler indices. © 2010 Mosby, Inc. All rights reserved.


Cruz-Lemini M.,Institute Clinic Of Ginecologia | Crispi F.,Institute Clinic Of Ginecologia | Valenzuela-Alcaraz B.,Institute Clinic Of Ginecologia | Figueras F.,Institute Clinic Of Ginecologia | And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2014

Objective Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants. Study Design One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes. Results Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P <.001). Conclusion Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.


Comas M.,Institute Clinic Of Ginecologia | Crispi F.,Institute Clinic Of Ginecologia | Gomez O.,Institute Clinic Of Ginecologia | Puerto B.,Institute Clinic Of Ginecologia | And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2011

Objectives To construct gestational age (GA)- and estimated fetal weight (EFW)-adjusted reference ranges for tissue Doppler cardiac function parameters from 24 to 41 weeks' gestation. Methods This was a prospective cross-sectional observational study involving 213 singleton pregnancies between 24 and 41 weeks' gestation. Myocardial peak velocities and myocardial performance index (MPIâ) were measured by tissue Doppler ultrasonography (values indicated by 'prime') in the left and right annulus and interventricular septum. Left and right atrioventricular parameters were also measured by conventional Doppler and ratios between the values found by the two methods calculated. Regression analysis was used to determine GA- and EFW-adjusted reference ranges and to construct nomograms for tissue Doppler parameters. Results All myocardial peak velocities, left and right Eâ/Aâ and left MPIâ showed a progressive increase with GA. In contrast, left and right E/Eâ showed a progressive decline. Septal Eâ/Aâ, and right and septal MPIâ remained constant. Myocardial peak velocities showed a progressive increase with increasing fetal weight. Conclusions Normal data of fetal myocardial peak velocities, their ratios and MPIâ by tissue Doppler adjusted by GA and EFW are provided. The reported reference values may be useful in research or clinical studies and can be used in fetuses with intrauterine growth restriction. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.


Cruz-Lemini M.,Institute Clinic Of Ginecologia | Cruz-Lemini M.,University of Barcelona | Crispi F.,Institute Clinic Of Ginecologia | Crispi F.,University of Barcelona | And 10 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2013

Objective To compare the ability of two different methods for longitudinal annular motion measurement, M-mode and tissue Doppler imaging (TDI), to demonstrate cardiac dysfunction in intrauterine-growth-restricted (IUGR) fetuses. Methods Cardiac longitudinal annular motion in the basal free wall of the left ventricle (mitral annulus), interventricular septum and tricuspid annulus was assessed in 23 early-onset IUGR cases and 43 controls by TDI (annular peak velocities) and M-mode (displacement). Results All annular parameters were significantly decreased in the IUGR group with respect to controls using both methods. M-mode showed a trend towards equal performance as classifier between cases and controls, as compared to TDI, mainly in the tricuspid annulus. Conclusions Both M-mode and TDI demonstrate annular motion changes and consequently cardiac dysfunction in IUGR fetuses. M-mode imaging is simpler to perform and could be as sensitive as TDI for detecting subtle changes. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd.


Sanz-Cortes M.,Institute Clinic Of Ginecologia | Figueras F.,Institute Clinic Of Ginecologia | Padilla N.,Institute Clinic Of Ginecologia | Amat-Roldan I.,Institute Clinic Of Ginecologia | Gratacos E.,Institute Clinic Of Ginecologia
Ultrasound in Obstetrics and Gynecology | Year: 2010

Objective: To assess microstructural and metabolic brain differences between small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) fetuses at 37 weeks' gestation by magnetic resonance imaging (MRI) spectroscopy and diffusion weighted imaging. Methods: Eight SGA and five matched AGA singleton fetuses, all with normal umbilical artery Doppler, were evaluated using MRI at 37 weeks to measure markers of brain microstructure and metabolism. The metabolic spectrum of N-acetyl-aspartate/choline, choline/creatine, inositol/choline and creatine/choline ratios in the left frontal lobe and the apparent diffusion coefficient from the right and left basal ganglia and frontal and occipital lobes, pyramidal tract and corpus callosum were analyzed and compared. Results: As compared with controls, SGA fetuses showed a significant increase in inositol/choline ratio (SGA, 0.57 vs. AGA, 0.25; P = 0.04) and significantly higher ADC values in the pyramidal tract (SGA, 119.87 × 10-5 mm2/s vs. AGA, 105.11 × 10-5 mm2/s; P = 0.04). Conclusion: s SGA fetuses with normal umbilical artery Doppler present microstructural and metabolic brain changes, suggesting the existence of an abnormal inutero brain development in fetuses with this condition. Copyright © 2010 ISUOG.

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