FEASIBILITY OF VASCULAR REMODELING PARAMETER ESTIMATION FOR ASSESSING HYPERTENSIVE PREGNANCY DISORDERS

Hypertensive pregnancy disorders, such as preeclampsia, are leading sources of both maternal and fetal morbidity in pregnancy. Non-invasive imaging, such as ultrasound and magnetic resonance imaging (MRI), is an important tool in predicting and monitoring these high risk pregnancies. While imaging can measure hemodynamic parameters, such as uterine artery pulsatility and resistivity indices, the interpretation of such metrics for disease assessment rely on ad-hoc standards, which provide limited insight to the physical mechanisms underlying the emergence of hypertensive pregnancy disorders. To provide meaningful interpretation of measured hemodynamic data in patients, advances in computational fluid dynamics can be brought to bear. In this work, we develop a patient-specific computational framework that combines Bayesian inference with a reduced-order fluid dynamics model to infer remodeling parameters, such as vascular resistance, compliance and vessel cross-sectional area, known to be related to the development of hypertension. The proposed framework enables the prediction of hemodynamic quantities of interest, such as pressure and velocity, directly from sparse and noisy MRI measurements. We illustrate the effectiveness of this approach in two systemic arterial network geometries: an aorta with carotid and a maternal pelvic arterial network. For both cases, the model can reconstruct the provided measurements and infer parameters of interest. In the case of the maternal pelvic arteries, the model can make a distinction between the pregnancies destined to develop hypertension and those that remain normotensive, expressed through the value range of the predicted absolute pressure.

Description of Smoking Behavior in Adolescents ages 15-18 Years

Smoking is a problem that has not been solved until now. Smoking has spread to various groups, from children to the elderly, men and women. This smoking habit can harm adolescents directly or indirectly which has been proven to interfere with the growth and development of adolescents. Many factors are associated with smoking behavior in adolescents aged 15-18 years. These factors are discussed based on research articles and book references. Factors that influence the relationship include peer association, price, and lack of parental attention. Smoking can increase the risk of several diseases, such as cancer, pregnancy disorders, and hypertension. Smoking too often not only causes problems in the development and growth of adolescents.

A Potential Role and Contribution of Androgens in Placental Development and Pregnancy

Successful pregnancy requires the establishment of a highly regulated maternal–fetal environment. This is achieved through the harmonious regulation of steroid hormones, which modulate both maternal and fetal physiology, and are critical for pregnancy maintenance. Defects in steroidogenesis and steroid signaling can lead to pregnancy disorders or even fetal loss. The placenta is a multifunctional, transitory organ which develops at the maternal–fetal interface, and supports fetal development through endocrine signaling, the transport of nutrients and gas exchange. The placenta has the ability to adapt to adverse environments, including hormonal variations, trying to support fetal development. However, if placental function is impaired, or its capacity to adapt is exceeded, fetal development will be compromised. The goal of this review is to explore the relevance of androgens and androgen signaling during pregnancy, specifically in placental development and function. Often considered a mere precursor to placental estrogen synthesis, the placenta in fact secretes androgens throughout pregnancy, and not only contains the androgen steroid nuclear receptor, but also non-genomic membrane receptors for androgens, suggesting a role of androgen signaling in placental function. Moreover, a number of pregnancy disorders, including pre-eclampsia, gestational diabetes, intrauterine growth restriction, and polycystic ovarian syndrome, are associated with abnormal androgen levels and androgen signaling. Understanding the role of androgens in the placenta will provide a greater understanding of the pathophysiology of pregnancy disorders associated with androgen elevation and its consequences.

Longitudinal metabolic profiling of maternal obesity, gestational diabetes and hypertensive pregnancy disorders

Context Comprehensive assessment of metabolism in maternal obesity and pregnancy disorders can provide information about the shared maternal-fetal milieu and give insight into both maternal long-term health and intergenerational transmission of disease burden. Objective To assess levels, profiles and change in the levels of metabolic measures during pregnancies complicated by obesity, gestational diabetes (GDM) or hypertensive disorders. Design, Setting and Participants A secondary analysis of two study cohorts, PREDO and RADIEL, including 741 pregnant women. Main Outcome Measures We assessed 225 metabolic measures by nuclear magnetic resonance in blood samples collected at median 13 (interquartile range, 12.4-13.7), 20 (19.3-23.0) and 28 (27.0-35.0) weeks of gestation. Results Across all three time points women with obesity (body mass index, BMI≥30kg/m 2) in comparison to normal weight (BMI 18.5-24.99 kg/m 2) had significantly higher levels of most very-low-density-lipoprotein-related measures, many fatty and most amino acids and more adverse metabolic profiles. The change in the levels of most metabolic measures during pregnancy was smaller in obese than in normal weight women. GDM, preeclampsia and chronic hypertension were associated with metabolic alterations similar to obesity. The associations of obesity held after adjustment for GDM and hypertensive disorders, but many of the associations with GDM and hypertensive disorders were rendered non-significant after adjustment for BMI and the other pregnancy disorder. Conclusions This study shows that the pregnancy-related metabolic change is smaller in women with obesity, who display metabolic perturbations already in early pregnancy. Metabolic alterations of obesity and pregnancy disorders resembled each other suggesting a shared metabolic origin.

Maternal Hypertensive Pregnancy Disorders and Mental and Behavioral Disorders in the Offspring: a Review

Purpose of Review We review here recent original research and meta-analytic evidence on the associations of maternal hypertensive pregnancy disorders and mental and behavioral disorders in the offspring. Recent Findings Seven meta-analyses and 11 of 16 original research studies published since 2015 showed significant associations between maternal hypertensive pregnancy disorders and offspring mental and behavioral disorders. Evidence was most consistent in meta-analyses and high-quality cohort studies. The associations, independent of familial confounding, were observed on different mental and behavioral disorders in childhood and schizophrenia in adulthood. Preterm birth and small-for-gestational age birth emerged as possible moderators and mediators of the associations. Cross-sectional and case-control studies yielded inconsistent findings, but had lower methodological quality. Summary Accumulating evidence from methodologically sound studies shows that maternal hypertensive pregnancy disorders are associated with an increased risk of mental and behavioral disorders in the offspring in childhood. More studies on adult mental disorders are needed.

Listas de chequeo en obstetricia: ayudas cognitivas que salvan vidas

Objective: To propose the use of eight checklists in the country’s obstetric emergency rooms. Methods: An interdisciplinary team was established with physicians specializing in obstetrics and gynecology, perinatology, fetal maternal medicine, critical medicine, anesthesiology, infectology and neonatology. Upon determination of the main pathologies affecting maternal mortality in Venezuela, multiple checklists used in different centers worldwide, publications available in databases and expert opinions were reviewed. They adapted to the realities of the country and medical availability and prioritized medical actions, laboratory tests, drug treatment and diagnostic elements. Results: Checklists for postpartum hemorrhage, obstetric sepsis, hypertensive pregnancy disorders (preeclampsia with signs of severity and eclampsia), magnesium sulfate poisoning, placental acretism, maternal cardiopulmonary resuscitation, and trauma and pregnancy are presented. Conclusion: The checklists resulting from the initiative of the Society of Obstetrics and Gynecology of Venezuela are available to all health personnel who require them for implementation in educational simulation scenarios and in clinical practice, as an additional tool for finding better outcomes in patients who require high complexity management in maternity rooms. Keywords: Checklist, Postpartum hemorrhage, Obstetric sepsis, Hypertensive pregnancy disorders, Magnesium sulfate poisoning, Placental acretism, Maternal cardiopulmonary resuscitation, Trauma and pregnancy