scholarly journals Placental Exosomes Trigger Maternal Inflammation and Vascular Dysfunction in Preeclampsia

2021 ◽  
Vol 2 (12) ◽  
pp. 1211-1215
Author(s):  
Olufunke O Arishe ◽  
Abbi Lane-Cordova ◽  
R. Clinton Webb
Keyword(s):  
Maternal Mortality ◽  
Pregnant Women ◽  
Disease Progression ◽  
Chronic Inflammation ◽  
Vascular Dysfunction ◽  
Maternal Circulation ◽  
Maternal Inflammation ◽  
Specific Disease

Preeclampsia is a pregnancy-specific disease associated with inadequate placental formation, chronic inflammation, and maternal vascular dysfunction. Preeclampsia affects about 5-8% of pregnant women and it is a prevalent cause of maternal mortality. The level and composition of exosomes in the maternal circulation are altered in preeclampsia, and studies have shown that the major source of this greater level of exosomes is the placenta. We propose that exosomal contents from the placenta trigger maternal inflammation and vascular dysfunction, thereby exacerbating the disease progression. This mini-review will focus on the content of placental exosomes and how they could contribute to the development of preeclampsia.

scholarly journals Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

2017 ◽  
Vol 312 (1) ◽  
pp. R5-R12 ◽  
Author(s):  
Frank T. Spradley
Keyword(s):  
Pregnant Women ◽  
Vascular Dysfunction ◽  
Hypertensive Disorder ◽  
Metabolic Abnormalities ◽  
Obese Women ◽  
Maternal Circulation ◽  
Increased Risk ◽  
Tnf Α ◽  
Hypertensive Disorder Of Pregnancy ◽  
Factor Α

Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.

Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Geographic Location ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

FAKTOR– FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN ANEMIA PADA IBU HAMIL DI PUSKESMAS TALANG RATU PALEMBANG TAHUN 2014

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Yuhemy Zurizah Yuhemy Zurizah
Keyword(s):  
Mortality Rate ◽  
Health Service ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Health Center ◽  
Significant Relationship ◽  
World Health ◽  
Chi Square ◽  
Cross Sectional ◽  
Maternal Mortality Rate

  ABSTRACT Maternal Mortality Rate is a barometer of mother health service in a country. At this time maternal mortality rate in Indonesia is still very high. Indonesia Demography Survey on 2007, maternal mortality rate is about 28 per 100.000 of live births. The direct cause of maternal mortality in Indonesia as well as in the other country is hemorraghe (25%), sepsis (15%), eklampsia (12%), abstructed labor (8%). World Health Organization (WHO), 35-37% of pregnant women in developing coutries get anemy. Causing factor’s of anemy on pregnant women is age of pregnant, parity, economi socio, job, education, and nutritional status. Purpose of this research is to know the associated factors with incidence of anemy on pregnant women at the Health Center Talang Ratu Palembang in 2014. This research use analytic survey method with “cross sectional” approach. Population in this research is all of preganant women in medical treatment at Talang Ratu Palembang in 2014. Sample taking in this research with non random samplingmethod and accidental sampling technic. Analysis with univariatly and bivariatlywith Chi Square Statistic test with significant level α 0,05. The result of this research show that from 35 respondent there is (48,6%) respondent with anemy, high–risk age (28,6%), high parity (60,0%) and low economi socio (37,1%). This result show that there is significant relationship between age with incidence of anemy on pregnant women at the health center Talang Ratu Palembang in 2014 with p value0,027, there is significant relationship between parity with incidence of anemy on pregnant women at the health center Talang Ratu Palemabang in 2014 with p value0,023, and there is significant relationship between economi socio with incidence of anemy on pregnant women at the health center Talang Ratu Palembang in 2014 with p value0,026. Of the result, the author hope that health service worker at Talang Ratu health center can improve health service to pregnant women and often giving information about anemy on pregnant and nutritional for pregnant women during pregnancy.     ABSTRAK Angka Kematian Ibu (AKI) merupakan barometer pelayanan kesehatan ibu di suatu negara. Pada saat ini angka kematian ibu di Indonesia masih sangat tinggi. Menurut Survey Demografi dan Kesehatan Indonesia (SDKI) tahun 2007, angka kematian kematian ibu adalah 28 per 100.000 kelahiran hidup. Penyebab langsung kematian ibu di Indonesia seperti halnya Negara lain adalah perdarahan (25%), sepsis (15%), eklampsi (12%), partus lama (8%). Menurut World Health Organization (WHO), 35-37% ibu hamil di negara berkembang dan 18% di negara  maju mengalami anemia. Faktor penyebab terjadinya anemia pada ibu hamil secara tidak langsung adalah umur ibu, paritas, sosial ekonomi, pekerjaan, pendidikan, jarak kehamilan, dan status gizi.Tujuan penelitian ini adalah untuk mengetahui faktor - faktor apa saja yang berhubungan dengan kejadian anemia pada ibu hamil di Puskesmas Talang Ratu Palembang Tahun 2014. Penelitian ini menggunakan metode survey analitikdengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh ibu hamil yang berobat di Puskesmas Talang Ratu Palembang Tahun 2014. Pengambilan sampel pada penelitian ini dengan metode non random sampling dengan teknik Accidental sampling. Analisis dilakukan secara univariat dan bivariat. Dengan uji statistik chi square tingkat kemaknaan α 0,05. Hasil penelitian menunjukkan dari 35 responden terdapat (48,6%) responden yang anemia, umur yang beresiko  tinggi (28,6%), paritas tinggi (60,0%), dan sosial ekonomi rendah (37,1%). Hasil penelitian ini menunjukkan ada hubungan yang bermakna antara umur dengan kejadian anemia pada ibu hamil di Puskesmas Talang Ratu Palembang Tahun 2014 dengan  p value0,027,  ada hubungan bermakna antara paritas dengan kejadian anemia pada ibu hamil di Puskesmas Talang Ratu Palembang Tahun 2014 dengan p value0,023 dan ada hubungan yang bermakna antara sosial ekonomi dengan kejadian anemia pada ibu hamil di Puskesmas Talang Ratu Palembang Tahun 2014 dengan p value0,026. Dari hasil penelitian ini penulis berharap petugas kesehatan di Puskesmas Talang Ratu Palembang meningkatkan pelayanan kesehatan pada ibu hamil dan lebih sering melaksanakan penyuluhan anemia pada kehamilan dan nutrisi yang baik bagi ibu hamil.    

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KESEDIAAN IBU BERSALIN UNTUK PEMASANGAN IUD POST PLACENTA

2019 ◽  
Vol 1 (2) ◽  
pp. 28-34
Author(s):  
Saiful Batubara ◽  
Risqi Utami
Keyword(s):  
Maternal Mortality ◽  
Pregnant Women ◽  
Third Trimester ◽  
Chi Square ◽  
Purposive Sampling ◽  
Factors Associated ◽  
Analyze Data

Intra Uterine Device post placenta is the installation in the first 10 minutes to 48 hours after the birth placenta plays a role in reducing maternal mortality through prevention of pregnancy, delaying pregnancy, and spacing pregnancies, the effectiveness of use up to 99.4% can prevent 5-10 years of pregnancy. This study aims to determine the factors associated with maternal willingness to post Post Placenta IUD. The study used a questionnaire with a population of third trimester pregnant women who examined their pregnancies and a sample of 98 people by purposive sampling. Analyze data with Chi Square. The results showed that the majority of pregnant women were not willing to do post placenta IUD installation of 58.2% which was influenced by age, parity, knowledge and support of the husband.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

The Risk of Birth

2021 ◽  
pp. 1-31
Author(s):  
Hannah Barker
Keyword(s):  
Maternal Mortality ◽  
Pregnant Women ◽  
Fifteenth Century ◽  
Life Insurance ◽  
Third Party ◽  
Potential Contribution ◽  
Reproductive Labor ◽  
Enslaved Women

Abstract Why did fifteenth-century Genoese slaveholders insure the lives of enslaved pregnant women? I argue that their assessment of the risks associated with childbirth reflected their views on the connection between slavery, property, and lineage. Genoese slaveholders saw the reproductive labor of enslaved women as a potential contribution to their lineage as well as their property. Because their children by enslaved women might become their heirs, Genoese slaveholders were inclined to worry about and seek protection against the risk of maternal mortality. In the context of the commercial revolution and the rise of third-party insurance, they developed life insurance for enslaved pregnant women to complement the fines already required of those who illegally impregnated enslaved women and thereby endangered their lives.

scholarly journals The Determinants of Husband Behavior in The Care of Pregnant Women

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Elviera Gamelia ◽  
Siti Masfiah ◽  
Indah Purnama Sari
Keyword(s):  
Mortality Rate ◽  
Prenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Family Income ◽  
Subjective Norm ◽  
Infant Mortality Rate ◽  
Behavior Control ◽  
Cross Sectional ◽  
Level Of Education

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in Banyumas District are still below The Minimum Service Standard (MSS), especially in Puskesmas (Public Health Center) I Ajibarang. The strategies for reducing maternal mortality are conducted by increasing mothers health status during pregnancy. This study aims at determining the factors of husbands role in womens prenatal care. Cross-sectional method was used. The populations were all of the pregnant women in Puskesmas I Ajibarang. Proportional random sampling was applied to select 90 pregnant women. Logistic regression was used to determine factors. Theory of planned behavior was used to explore the determinants of husbands role. The results show that the level of education, family income, the knowledge, the attitude, and subjective norm are not related to husbands role in mother prenatal care. However, husbands behavior control (p=0.045) and intention (p=0.000) have relation with husbands role in women prenatal care. Variable of intention is the most dominant variable related to husbands role in womens prenatal care.

scholarly journals Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms

2015 ◽  
Vol 309 (11) ◽  
pp. R1326-R1343 ◽  
Author(s):  
Frank T. Spradley ◽  
Ana C. Palei ◽  
Joey P. Granger
Keyword(s):  
Endothelial Dysfunction ◽  
Vascular Dysfunction ◽  
Clinical Manifestations ◽  
Migration And Invasion ◽  
Metabolic Factors ◽  
Maternal Circulation ◽  
Soluble Factors ◽  
Placental Perfusion ◽  
Increased Risk ◽  
Placental Ischemia

Preeclampsia (PE) is a pregnancy-specific disorder typically presenting as new-onset hypertension and proteinuria. While numerous epidemiological studies have demonstrated that obesity increases the risk of PE, the mechanisms have yet to be fully elucidated. Growing evidence from animal and human studies implicate placental ischemia in the etiology of this maternal syndrome. It is thought that placental ischemia is brought about by dysfunctional cytotrophoblast migration and invasion into the uterus and subsequent lack of spiral arteriole widening and placental perfusion. Placental ischemia/hypoxia stimulates the release of soluble placental factors into the maternal circulation where they cause endothelial dysfunction, particularly in the kidney, to elicit the clinical manifestations of PE. The most recognized of these factors are the anti-angiogenic sFlt-1 and pro-inflammatory TNF-α and AT1-AA, which promote endothelial dysfunction by reducing levels of the provasodilator nitric oxide and stimulating production of the potent vasoconstrictor endothelin-1 and reactive oxygen species. We hypothesize that obesity-related metabolic factors increase the risk for developing PE by impacting various stages in the pathogenesis of PE, namely, 1) cytotrophoblast migration and placental ischemia; 2) release of soluble placental factors into the maternal circulation; and 3) maternal endothelial and vascular dysfunction. This review will summarize the current experimental evidence supporting the concept that obesity and metabolic factors like lipids, insulin, glucose, and leptin affect placental function and increase the risk for developing hypertension in pregnancy by reducing placental perfusion; enhancing placental release of soluble factors; and by increasing the sensitivity of the maternal vasculature to placental ischemia-induced soluble factors.

scholarly journals Senescent cells exacerbate chronic inflammation and contribute to periodontal disease progression in old mice

2021 ◽  
Author(s):  
Ruben Aquino‐Martinez ◽  
Brittany A. Eckhardt ◽  
Jennifer L. Rowsey ◽  
Daniel G. Fraser ◽  
Sundeep Khosla ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
Disease Progression ◽  
Chronic Inflammation ◽  
Old Mice

scholarly journals A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy

2020 ◽  
Vol 37 (08) ◽  
pp. 837-844 ◽  
Author(s):  
John R. Barton ◽  
George R. Saade ◽  
Baha M. Sibai
Keyword(s):  
Pregnant Women ◽  
Disease Progression ◽  
Complete Blood Count ◽  
Gestational Hypertension ◽  
Epigastric Pain ◽  
Signs And Symptoms ◽  
Health Care Facilities ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. Key Points

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