Association between maternal bleeding during gestation and congenital anomalies in the offspring

Ornoy, Asher; Benady, Sam; Kohen-Raz, Reuven; Russell, Alex

doi:10.1016/0002-9378(76)90171-x

Cited by 50 publications

(15 citation statements)

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“…Earlier retrospective studies showed an association between vaginal bleeding early in pregnancy and an increased incidence of congenital anomalies [9,10], but we did not find this in our study, in agreement with the findings from other more recent studies [4,5]. We observed that both the time of onset of bleeding and the number of episodes of bleeding have an effect on the outcome of pregnancy.…”

Section: Discussionsupporting

confidence: 89%

“…Many studies have shown an increase in the risk of preterm delivery [1][2][3][4][5][6][7], low birth weight [2][3][4][5]8], and small-for-gestational-age infants [2][3][4][5], as well as increased perinatal mortality [2][3][4]6,7,9], though a more recent study failed to show this increase [5]. Other complications were also shown to be increased, including congenital anomalies [9,10], abruptio placentae [4], malpresentations [2], and retention of placenta [5],…”

Section: Ras Tikreeti Zah Al-saadi the Outcome Of Pregnancies Complmentioning

confidence: 99%

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The Outcome of Pregnancies Complicated by Threatened Abortion

Tikreeti

Al-Saadi

1990

Ann Saudi Med

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A prospective study of 200 pregnancies complicated by threatened abortion was undertaken. Pregnancy outcome was compared with that in a selected group of 415 non-risk pregnant women. There was a significant association between threatened abortion and the following complications of pregnancy: impending preterm delivery, preterm delivery, preterm rupture of membranes, low birth weight, abruptio placentae, and perinatal mortality. No significant association was found between threatened abortion and placenta previa, pregnancy-induced hypertension, malpresentation, small-for-gestational-age infants, congenital anomalies, and postpartum hemorrhage. Preterm delivery rate and abruptio placentae constituted the most frequently observed complications for those cases in which there was more than one episode of bleeding. Pregnancies complicated by threatened abortion represent a high risk and need careful antepartum, intrapartum, and pediatric care. Abortion. 1990; 10(6): 593-597 Threatened abortion complicating early pregnancy is known to be associated with suboptimal pregnancy outcome. Many studies have shown an increase in the risk of preterm delivery [1][2][3][4][5][6][7], low birth weight [2][3][4][5]8], and small-for-gestational-age infants [2][3][4][5], as well as increased perinatal mortality [2][3][4]6,7,9], though a more recent study failed to show this increase [5]. Other complications were also shown to be increased, including congenital anomalies [9,10], abruptio placentae [4], malpresentations [2], and retention of placenta [5], RAS Tikreeti, ZAH Al-Saadi, The Outcome of Pregnancies Complicated by ThreatenedThe purpose of this prospective study was to assess the complications that can result from threatened abortion and compare our findings with those in a control group of non-risk pregnant women. The complication that caused the greatest concern is preterm delivery (before 37 completed weeks), as the mortality of preterm infants is high in developing countries because of lack of facilities and skilled personnel essential for effective neonatal intensive care. Materialand Methods Study groupsFrom January 1987 to November 1988, 200 women whose pregnancies were complicated by threatened abortion (vaginal bleeding with or without cramping and the absence of cervical dilatation before 20 weeks' gestation) and who continued pregnancy until at least the 28th week of pregnancy were studied. These 200 women were referred to as the "threatened abortion (TA) index group." All were scheduled to deliver at the Department of Obstetrics and Gynaecology, Medical City Teaching Hospital, Baghdad. Women were included in the study if they

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Section: Discussionsupporting

confidence: 89%

Section: Ras Tikreeti Zah Al-saadi the Outcome Of Pregnancies Complmentioning

confidence: 99%

The Outcome of Pregnancies Complicated by Threatened Abortion

Tikreeti

Al-Saadi

1990

Ann Saudi Med

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“…Maternal, fetal, or placental factors that diminish uteroplacental and fetal circulation are associated with an increased incidence of fetal CNS malformations (1)(2)(3). While marked intrauterine perfusion failure might be related to major malformations, less severe or shorter hypoperfusion may take part in the pathogenesis of minor or functional cerebral disturbances.…”

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confidence: 99%

Transient Intrauterine Hypotension Causes Apoptosis in Fetal Rat Brain and Affects Learning

et al. 2003

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Hypotensive episodes are frequent during pregnancy, and their functional effect on fetal brain has not been studied. We produced systemic hypotension for 30 min during mid-gestation in pregnant rats and examined their offspring on postnatal days 1 and 28. When compared with sham controls, the brain of the hypotensive group contained more TUNEL-positive cells in the hippocampal and periventricular regions on both time points. Spatial learning assessed by water milk maze test was impaired in 28-day-old pups of the hypotensive mothers. According to these results, transient maternal hypotension can induce apoptotic cell death in fetal brain and affect learning. Similar mechanisms may be considered and investigated in the pathogenesis of human learning disorders. Maternal, fetal, or placental factors that diminish uteroplacental and fetal circulation are associated with an increased incidence of fetal CNS malformations (1-3). While marked intrauterine perfusion failure might be related to major malformations, less severe or shorter hypoperfusion may take part in the pathogenesis of minor or functional cerebral disturbances. A frequent cause of hypoperfusion in pregnant women is hypotension: uteroplacental blood flow is known to diminish at blood pressures below 110/65 mm Hg. Hypotension may occur spontaneously, but is most frequently induced by position or drug treatment (4 -6). Orthostatic hypotension in late pregnancy was found to be associated with low birth weight (7,8). Although hypotension is considered potentially harmful for the fetus, its symptoms may be unnoticed or disregarded in pregnancy, and little clinical evidence exists on the effects of moderate and transient hypotension. In our previous experiments simulating hypotensive episodes encountered in pregnant women, we reported that transient maternal hypotension increased apoptotic cell death in the fetal brain (9). In the current study, we investigated the effect of intrauterine hypotensive episodes on cognitive functions in addition to morphologic features. METHODS Gestational hypotension.Ten 3-mo-old pregnant Wistar rats were included in the study: on the 15th day of pregnancy, five were subjected to transient hypotension by femoral artery catheterization (hypotension group) and five underwent all procedures except hypotension (control group) as described before (9). According to preliminary experiments this was associated with an average 46% reduction in uterine blood flow. Briefly, rats were anesthetized following an overnight fasting by intraperitoneal 30 mg/kg ketamine (Ketalar®, Eczacibasi, Istanbul) and 8 mg/kg xylazine (Rompun®, Bayer, Istanbul), the left femoral artery was catheterized, blood pressure (BP) was recorded using a pressure transducer (Transbridge W P I, Sarasota, FL, U.S.A.) and data were sent to computer via MacLab 4/s data acquisition unit (AD instruments, Castle Hill, Australia). Heart rate (HR) and mean BP

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“…31, No. 1,2014 in phosphate-buffered saline, Zymed Histostain kit) for 30 minutes. After a final wash in phosphate-buffered saline, the peroxidase activity was visualised by incubating the specimens in diaminobenzidine.…”

Section: Histopathology and Immunohistochemistrymentioning

confidence: 99%

Effect of Transient Maternal Hypotension on Apoptotic Cell Death in Foetal Rat Brain

Özyürek¹,

Bayrak²,

Pehlivanoğlu³

et al. 2014

Balkan Med J

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Maternal hypotension during gestation is associated with foetal brain malformations (1-3). The brain stem and midbrain are particularly vulnerable to severe maternal hypotension. Intrauterine hypoxic/ischemic injury as a result of reduced utero-placental blood flow has been linked to serious neurological deficits in the offspring including cranial nerve palsies, abnormal brain stem-evoked responses, and cerebral palsy (4). Furthermore, several case reports demonstrate facial limb hypogenesis syndrome (5), arthrogryposis multiplex (6), and paraplegia (7) associated with maternal hypotension. Therefore, cerebral hypoxic/ischemic injury in the foetus induced by maternal hypotension contributes to neonatal morbidity and mortality (8).Although these various outcomes have been known for years, the pathophysiology of foetal brain malformations related to maternal perfusion failure is still unclear. Necrosis and apoptosis have been proposed as possible pathways that lead to cerebral pathology in the foetus (3, 9). Not only the form and the extent of neuronal death but also the time course of the injury depend on the severity of the ischemic insult (9). Accordingly, we previously observed a significant increase in apoptosis in the hippocampal region, periventricular matrix, and cerebral cortex of newborns on postnatal days 1 and 28, which was dependent on the timing and severity of intrauterine hypotension (3, 10). As mentioned above, the effects of maternal hypotension on development of the foetal brain have been reported in a limited number of studies in the postnatal period, but, to our knowledge, not in the antenatal period. Therefore, we aimed to investigate the effects of transient systemic maternal hypotension on apoptotic cell death in the inBackground: Intrauterine perfusion insufficiency induced by transient maternal hypotension has been reported to be associated with foetal brain malformations. However, the effects of maternal hypotension on apoptotic processes in the foetal brain have not been investigated experimentally during the intrauterine period. Aims: The aim of this study was to investigate the effects of transient maternal hypotension on apoptotic cell death in the intrauterine foetal brain. Study Design: Animal experimentation. Methods: Three-month-old female Wistar albino rats were allocated into four groups (n=5 each). The impact of hypoxic/ischemic injury induced by transient maternal hypotension on the 15th day of pregnancy (late gestation) in rats was investigated at 48 (H17 group) or 96 hours (H19 group) after the insult. Control groups underwent the same procedure except for induction of hypotension (C17 and H17 groups). Brain sections of one randomly selected foetus from each pregnant rat were histopathologically evaluated for hypoxic/ischemic injury in the metencephalon, diencephalon, and telencephalon by terminal transferase-mediated dUTP nick end labelling and active cysteine-dependent aspartate-directed protease-3 (caspase-3) positivity for cell death. Results: The number of terminal tra...

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Association between maternal bleeding during gestation and congenital anomalies in the offspring

Cited by 50 publications

References 9 publications

The Outcome of Pregnancies Complicated by Threatened Abortion

The Outcome of Pregnancies Complicated by Threatened Abortion

Transient Intrauterine Hypotension Causes Apoptosis in Fetal Rat Brain and Affects Learning

Effect of Transient Maternal Hypotension on Apoptotic Cell Death in Foetal Rat Brain

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