Journal of Obstetrics and Gynaecology, Apr 1, 2013
confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show a... more confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show any features of complete mole as was expected, as the molar placenta gradually resolved. A decrease in the size of molar portion of placenta on USS has been reported in the literature (Lee et al. 2010) but not complete disappearance, which makes our case unique. So far in the literature, about 63 cases of live births in CHMF cases have been reported. Th e estimated live birth rate is around 35 – 40% (Sebire et al. 2002; Dolapcioglu et al. 2009). Th e risk of developing pre-eclampsia is reported from 19% to 26% and is indicative of a poor outcome (Wee and Jauniaux 2005). Th e risk of PTD is reported to be higher (33 – 57%) in CHMF cases compared with a complete mole (Massardier et al. 2009). It appears that continuation of pregnancy is not a risk factor for development of PTD, as the rates did not diff er between women undergoing elective 1st trimester termination and those who continued pregnancy (Sebire et al. 2002). In conclusion, in CHMF, we can expect the molar part to either become quiescent or resorb allowing the pregnancy to continue or to grow extensively leading to severe maternal and fetal complications. Formerly, most of them were terminated but recently, this approach has started to change. Continuation of pregnancy can be recommended aft er careful counselling of the couple with close antenatal and postnatal surveillance.
We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bond... more We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure for the surgical treatment of stress urinary incontinence in women. A total of 65 patients diagnosed with stress urinary incontinence underwent a transobturator suburethral tape procedure with a fusion welded, nonwoven, nonknitted polypropylene mesh, with or without a central silicone coated section, at our institution. All women were followed and if vaginal erosion was diagnosed, cystoscopy and vaginoscopy were performed, the mesh was partially or completely removed and, if necessary, posterior cough test and urodynamic study were performed. Of the 65 patients 9 (13.8%) were diagnosed with vaginal erosion at the vaginal incision during a relatively long postoperative period (mean 290 days). All presented with vaginal discharge and 1 had a severe complication (obturator abscess). Complete mesh removal was necessary in 8 patients and only 2 (22%) had recurrent stress urinary incontinence. A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).
Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for mo... more Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for monitoring uterine dynamics. Bipolar recordings of EHG have proven to provide valuable information to predict labor. Recently it has been stated that uterine EHG bursts could also be identified in Laplacian recordings on abdominal surface. Taking into account that Laplacian potential technique permits to acquire more localized electrical activity than conventional recordings; these recordings could also be helpful for deducing uterine contraction efficiency. The aim of this paper is to examine the feasibility of Laplacian potential EHG recording for labor prediction and to compare it with monopolar recordings. To this purpose, a total of 42 EHG recordings were acquired from women of similar gestational age: 29 antepartum patients, and 13 patients in labor. Then linear and non-linear classifiers have been implemented using EHG burst parameters as input features. Experimental results show significant differences in temporal and spectral parameters in both monopolar and Laplacian potential recordings between the two groups. In addition, support vector machine based classifier achieved an accuracy of 93% for labor prediction for monopolar recordings, 92% for bipolar recordings and 91% for Laplacian potential.
Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta.... more Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta. Appropriate depth of placental invasion is needed to support a healthy pregnancy; shallow invasion is associated with the development of severe preeclampsia (sPE). Maternal contribution to sPE through failed decidualization is an important determinant of placental phenotype. However, the molecular mechanism underlaying the in vivo defect linking decidualization to sPE is unknown. Here, we discover the footprint encoding this decidualization defect comprising of 166 genes using global gene expression profiling in decidua from women who developed sPE in a previous pregnancy. This signature allowed us to effectively segregate samples into sPE and control groups. Estrogen receptor 1 (ESR1) and progesterone receptor B (PGR-B) were found highly interconnected with the dynamic network of defective decidualization fingerprint. ESR1 and PGR-B gene expression and protein abundance were remarkably...
Journal of Obstetrics and Gynaecology, Apr 1, 2013
confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show a... more confi rmed the diagnosis of a CHMF. Histopathology of the placenta aft er delivery did not show any features of complete mole as was expected, as the molar placenta gradually resolved. A decrease in the size of molar portion of placenta on USS has been reported in the literature (Lee et al. 2010) but not complete disappearance, which makes our case unique. So far in the literature, about 63 cases of live births in CHMF cases have been reported. Th e estimated live birth rate is around 35 – 40% (Sebire et al. 2002; Dolapcioglu et al. 2009). Th e risk of developing pre-eclampsia is reported from 19% to 26% and is indicative of a poor outcome (Wee and Jauniaux 2005). Th e risk of PTD is reported to be higher (33 – 57%) in CHMF cases compared with a complete mole (Massardier et al. 2009). It appears that continuation of pregnancy is not a risk factor for development of PTD, as the rates did not diff er between women undergoing elective 1st trimester termination and those who continued pregnancy (Sebire et al. 2002). In conclusion, in CHMF, we can expect the molar part to either become quiescent or resorb allowing the pregnancy to continue or to grow extensively leading to severe maternal and fetal complications. Formerly, most of them were terminated but recently, this approach has started to change. Continuation of pregnancy can be recommended aft er careful counselling of the couple with close antenatal and postnatal surveillance.
We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bond... more We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure for the surgical treatment of stress urinary incontinence in women. A total of 65 patients diagnosed with stress urinary incontinence underwent a transobturator suburethral tape procedure with a fusion welded, nonwoven, nonknitted polypropylene mesh, with or without a central silicone coated section, at our institution. All women were followed and if vaginal erosion was diagnosed, cystoscopy and vaginoscopy were performed, the mesh was partially or completely removed and, if necessary, posterior cough test and urodynamic study were performed. Of the 65 patients 9 (13.8%) were diagnosed with vaginal erosion at the vaginal incision during a relatively long postoperative period (mean 290 days). All presented with vaginal discharge and 1 had a severe complication (obturator abscess). Complete mesh removal was necessary in 8 patients and only 2 (22%) had recurrent stress urinary incontinence. A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).
Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for mo... more Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for monitoring uterine dynamics. Bipolar recordings of EHG have proven to provide valuable information to predict labor. Recently it has been stated that uterine EHG bursts could also be identified in Laplacian recordings on abdominal surface. Taking into account that Laplacian potential technique permits to acquire more localized electrical activity than conventional recordings; these recordings could also be helpful for deducing uterine contraction efficiency. The aim of this paper is to examine the feasibility of Laplacian potential EHG recording for labor prediction and to compare it with monopolar recordings. To this purpose, a total of 42 EHG recordings were acquired from women of similar gestational age: 29 antepartum patients, and 13 patients in labor. Then linear and non-linear classifiers have been implemented using EHG burst parameters as input features. Experimental results show significant differences in temporal and spectral parameters in both monopolar and Laplacian potential recordings between the two groups. In addition, support vector machine based classifier achieved an accuracy of 93% for labor prediction for monopolar recordings, 92% for bipolar recordings and 91% for Laplacian potential.
Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta.... more Decidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta. Appropriate depth of placental invasion is needed to support a healthy pregnancy; shallow invasion is associated with the development of severe preeclampsia (sPE). Maternal contribution to sPE through failed decidualization is an important determinant of placental phenotype. However, the molecular mechanism underlaying the in vivo defect linking decidualization to sPE is unknown. Here, we discover the footprint encoding this decidualization defect comprising of 166 genes using global gene expression profiling in decidua from women who developed sPE in a previous pregnancy. This signature allowed us to effectively segregate samples into sPE and control groups. Estrogen receptor 1 (ESR1) and progesterone receptor B (PGR-B) were found highly interconnected with the dynamic network of defective decidualization fingerprint. ESR1 and PGR-B gene expression and protein abundance were remarkably...
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Papers by Alfredo Perales