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N Exalto

Publications and source records attributed to N Exalto.

At least 19 recordsLinked to original sources
PubMed2006

Histological classification of chorionic villous vascularization in early pregnancy.

BACKGROUND: The objective of the study was to assess the reproducibility of a new classification for early pregnancy chorionic villous vascularization (Grade: I, normal; IIA, mild hypoplasia; IIB, severe hypoplasia and III, avascular) for routine microscopic examination in daily clinical practice. METHODS: In this observational study, four observers scored first trimester chorionic villous vascularization. Scoring was performed in microscopic slides of chorionic tissue obtained by D&C in 30 patients with early pregnancy loss due to empty sac (n = 10), fetal death (n = 10) and termination of pregnancy (n = 10) using the new classification. Ultrasonographic measurement of trophoblastic thickness (TT) at the implantation site was available in all patients and in a reference group of 100 ongoing singleton pregnancies. The vascularization score could therefore be related to the TT. RESULTS: The new classification resulted in a good-to-excellent agreement in histological scoring (0.73-0.90) between investigators (kappa 0.64-0.86). TT was not related to either vascularization or pregnancy outcome and only partly to hydropic degeneration. CONCLUSION: The vascularization scoring system is a simple, valid and effective method for assessment of chorionic villous vascularization. It is helpful in understanding the underlying cause of pregnancy loss, as the classification can distinguish between normal and abnormal embryonic development. We did not find either a relation between TT and pregnancy outcome or between TT and vascularization.

Adult↗
PubMed2005

Vasculogenesis in complete and partial hydatidiform mole pregnancies studied with CD34 immunohistochemistry.

BACKGROUND: Defective chorionic villous vascularization is present in pregnancies complicated by absent or abnormal embryonic development. The aim of this study was to investigate the embryonic and/or maternal genomic influence on vasculogenesis in diploid complete hydatidiform mole (CHM) and in triploid partial hydatidiform mole (PHM) in comparison with normal development. METHODS: Mean villous stromal area and functional vascular area, vessels with a lumen and haemangiogenetic cords, peripherally or centrally located were measured and counted in chorionic villi of 12 CHM, 12 normal pregnancies (termination of pregnancy, TOP) and 15 PHM of which nine were without an embryo (PHM-E) and six were with an embryo (PHM + E), using quantitative CD34 immunohistochemistry. RESULTS: TOP showed significantly more vessels per chorionic villus, centrally and peripherally located (median, range), than CHM, PHM-E and PHM + E (4.0, 0-9 versus 0.0, 0-11, 0.0, 0-18 and 1.0, 0-21). CHM showed significantly more centrally located cords than PHM-E, PHM + E and TOP (1.5, 0-22 versus 1.0, 0-15, 0.5, 0-8 and 1.0, 0-2). CONCLUSIONS: Initiation of chorionic villous vasculogenesis is independent of the maternal genome (CHM). The development of an embryo, however, is obligatory for the modulation of normal vascularization resulting in a well developed vasculosyncytial membrane.

Adult↗
PubMed2003

[Drug treatment of gastro-esophageal reflux disease in pregnant women: consensus guidelines of gastroenterologists and gynaecologists].

Lifestyle changes are recommended as the first step in the treatment of pregnant women with heartburn. If symptoms persist, antacids or the mucoprotective sucralfate can be prescribed. If symptoms are persistent and severe, acid secretion inhibitors may be prescribed; the proton-pump inhibitor omeprazole is the drug of choice. It is unlikely that this drug could harm the fetus but the possibility cannot be entirely excluded. Prescription should be delayed until after the first trimester, whenever possible. Patients who have become pregnant while using these drugs can be reassured.

Adult↗
PubMed2002

Prepidil compared to Propess for cervical ripening.

OBJECTIVES: To compare the efficacy and safety of intracervical PGE(2) gel (Prepidil) with intravaginal PGE(2) insert (Propess) in cervical ripening and induction of labour. STUDY DESIGN: This was a retrospective analysis of patients with single pregnancies, intact membranes and a viable fetus who required cervical ripening. In the first half of 1998, all patients received Prepidil and in the first half of 1999 all patients received Propess. In both periods 50 consecutive files were retrieved and compared. RESULTS: The Prepidil and Propess group were similar in patient characteristics, indication for induction of labour and delivery outcome. Cervical ripening within 24 h was achieved in the Propess group in 80% as compared to 56% in the Prepidil group. The application-membrane rupture-interval was shorter in the Propess group compared to the Prepidil group (23.7 +/- 21.3 h versus 56.4 +/- 77.7 h, P = 0.009) as well as the application-delivery interval (29.8 +/- 22.0 h versus 62.0 +/- 78.8 h, P = 0.039). In the Propess group 62% delivered within 24 h compared to 28% in the Prepidil group. A smaller number of applications was observed in the Propess group (1.2 versus 1.8, P < 0.005). Both methods proved to be safe in cervical priming and no relevant differences in mode of delivery and outcome of labour were detected. None of the patients required an emergency caesarean section during the treatment with prostaglandines. CONCLUSIONS: Both prostaglandin E(2) agents are safe and effective in achieving cervical ripening; however the vaginal insert demonstrated a shorter application-delivery interval. The hospital stay was consequently shorter, contributing to cost effectiveness.

Administration, Intravaginal↗
PubMed1998

Microscopic investigation of villi from chorionic villous sampling.

The aim of the present study was to investigate the morphology of cytogenetically normal chorionic villi from chorionic villous sampling (CVS) specimens. This information can serve as a reference for morphological investigation of cytogenetically abnormal CVS specimens. We were also interested in any relationship between chorionic villous architecture and the outcome of pregnancy. In a reference group (n = 94, normal karyotype and ongoing pregnancies), we observed a considerable variation in villous diameter (range 116-377 microm) and vascular density (range 0.5-6.7 vessels/villus) and a high incidence of morphological criteria, classically mentioned in relation to chromosomal or other abnormalities, such as: fibrinoid deposition (74.5%), trophoblastic layer degeneration (3.2%) and abnormal proliferation (7.4%), avascular villi (54.2%), stromal oedema (55.3%), trophoblastic inclusions (23.4%) and fibrosis (23.4%). In the cytogenetic abnormal group (n = 10), neither the diameter nor the vascular density of the villi differed from the values observed in the reference group. In the reference group, we only observed a tendency for larger birthweights in relation to respectively larger and more vascularized villi. It is concluded that in CVS specimens, chorionic villous architecture and morphological criteria do not have any clinical relevance, neither do they have any important predictive value.

Birth Weight↗
PubMed1997

First trimester development of human chorionic villous vascularization studied with CD34 immunohistochemistry.

Normal chorionic villous vascularization is essential for the undisturbed development of pregnancy. Defective vasculogenesis may play a role in pathological pregnancy. To assess pathological chorionic villous vascularization, normal vascularization has to be defined first. Few data are available on this topic. The aim of this study was therefore to investigate normal chorionic villous vascularization in ultrasound-dated first trimester pregnancies from week 5 menstrual age to week 12 (n = 41), using quantitative CD34 immunohistochemistry. Two important processes in chorionic villous vascularization were quantitatively illustrated: (i) maturation, reflected by an increase of the total number of luminized vessels as opposed to non-luminized haemangioblastic cords and (ii) margination, due to a decrease of villous stromal area and an increase of total villous vascular area. The percentage of villous stromal area occupied by vascular elements (area difference %) increased from 0.7% in week 5-2.5% in week 10. Therefore, the area of the villous stroma occupied by vascular elements increases and the vessels are situated closer to the trophoblastic layer suitable for fetal-maternal exchange. There was also a trend in increased number of peripheral vessels (2.0 in week 5 to 4.6 in week 10), supporting both developmental mechanisms. In conclusion, in exactly dated normal human first trimester pregnancies, development of the chorionic villous vascular system seems to be mostly characterized by maturation of luminized vessels from primitive haemangioblastic cords, and margination to a situation of peripherally located vessels.

Antigens, CD34↗
PubMed1995

Ovarian activity suppression by two different low-dose triphasic oral contraceptives.

In an open, randomized study in an outpatient clinic of a large teaching hospital, thirty-one female volunteers with regular cycles and established ovulation by ultrasonography were given one of two triphasic oral contraceptives containing ethinylestradiol combined with levonorgestrel or desogestrel during six cycles of treatment. The main outcome measures were transvaginal ultrasonography and serum E2 and P measurements in pill cycles 1, 3 and 6. No ovarian activity was found in 10 subjects. Among the remaining 21 women who showed ovarian activity, most follicle-like structures developed in the pill-free week and decreased in size or disappeared in the first pill week. One women taking triphasic desogestrel had evidence of a luteinized unruptured follicle and one women taking triphasic levonorgestrel had a possible ovulation. The latter women also showed symptoms of lower abdominal pain. A statistically significant difference in ovarian activity between the two oral contraceptives could not be established. The two triphasic oral contraceptives suppressed ovarian activity to the same degree. A trend was seen towards increasing ovarian activity with duration of use in both treatment groups.

Adult↗
PubMed1995

Early human nutrition.

The Human yolk sac has long been considered a vestigial organ, an evolutionary remnant. In the last decade, however, it has been discovered that the human yolk sac plays an active and crucial role during organogenesis. Due to an absent maternal intervillous circulation during the first 12 weeks of pregnancy, the concept of transport of nutrients and oxygen to the embryo must be thoroughly reconsidered. Here the yolk sac plays an essential role by its active and passive transport to the embryo, and by its production of necessary substances. Animal experiments have demonstrated that hyperglycaemia has an initial deleterious effect on yolk sac structure, which then results in embryopathy. Study of the yolk sac by means of ultrasound has not become an important diagnostic method yet. On the basis of clinical studies and animal experiments, however, it may be expected that this organ plays a crucial role in the development of spontaneous abortion and structural congenital defects.

Animal Nutritional Physiological Phenomena↗
PubMed1995

The Euro-Team Early Pregnancy (ETEP) protocol for recurrent miscarriage.

The underlying causes and rationale for treatment of recurrent abortion are not entirely clear. The Euro-Team early pregnancy protocol was developed as a diagnostic work-up based on the evaluation of risk factors. Possibilities for therapy can be based only on the expectancy that elimination of some risk factors may improve the prognosis.

Abortion, Habitual↗
PubMed1991

[Echography in the first pregnancy trimester has prognostic value].

Clinical and ultrasound data of 403 first-trimester pregnancies were collected prospectively. Consequences for determination of gestational age as well as the risk of spontaneous abortion were investigated. There was a clear relation between embryonal growth delay and the risk of spontaneous abortion: the risk of spontaneous abortion was significantly higher if the crown-rump length lagged 7 or more days behind the expected gestation time based on the duration of the amenorrhoea (16% versus 5.0%; p less than 0.01). It is important to know the exact duration of pregnancy, because a difference of one or two weeks can be critical in terms of survival or disability. 22.7% of the pregnant women who had a regular menstrual cycle before this pregnancy appeared to have an embryonal growth delay of seven days or more in relation to the reference curve. This illustrates the necessity of crown-rump length measurements in order to obtain accurate assessment of gestational age, which is fundamental in obstetric care.

Abortion, Spontaneous↗
PubMed1991

Premature menopause because of an inherited deletion in the long arm of the X-chromosome.

A family is described in which both a mother and an infertile daughter had premature menopause at the ages of 31 and 28 years, respectively. Initially, an extensive investigation revealed no apparent cause for their conditions. However, when cytogenetic analysis in the daughter was performed, a terminal deletion in the long arm of one of the X-chromosomes was found. The karyotype was: 46,Xdel(X),(q25-qter). Chromosomal investigation in the mother showed an identical deletion. The karyotype of the patient's 35-year-old sister is normal. She has a normal menstrual cycle and two normal children. The presence of such familial cases suggests that chromosomal investigation should be considered in young women with oligomenorrhea, especially those whose mothers have experienced a premature menopause.

Adult↗
PubMed1989

Thyroid hormone binding in early pregnancy and the risk of spontaneous abortion.

Serum thyroxine (T4), free thyroxine (FT4) and thyroxine binding globulin (TBG) were measured at 6, 8, 10, 12, 14 and 16 weeks menstrual age (MA) in 32 pregnant females, who had been selected for a high risk of spontaneous abortion on account of previous abortion (18 cases) or ovulation induction (14 cases). Eight of these subjects experienced a spontaneous abortion occurring between 8 and 20 weeks. The other women, who carried to term, served as controls. In the abortion group, mean pre-abortion TBG and T4 levels were lower than in the control group from the 6th week on. In spite of this, the way T4 changes with TBG was very similar in both groups. No detectable change or difference with respect to control values were observed for FT4. These observations are taken as evidence against impaired maternal thyroid function playing a role in the unsuccessful outcome of pregnancy. Decreased TBG was detected on the average at 5.2 (range 0-13) weeks before abortion. Diagnostic sensitivity and positive predictive value were estimated as about 70 and 80%, respectively, for the high-risk group, indicating that serum TBG might only play a minor role as a predictor of the outcome of pregnancy.

Abortion, Spontaneous↗