Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft
Your browser is old, please click here to upgrade your browser. For the best experience on our site we recommend disabling this feature. Jantzie 1,2Jesse L. Winer 3Jessie R. Maxwell 1Lindsay A. Chan 3Shenandoah Robinson 3,4 1 Department of Pediatrics, University of New Mexico2 Department of Neurosciences, University of New Mexico3 Department of Neurosurgery, Boston Children's Hospital4 Department of Neurology, Harvard Medical School By clicking "Submit", you agree to our policies.
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Unable to load video. Please check your Internet connection and reload this page. If the problem continues, please let us know and we'll try to Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft. An unexpected error occurred. Encephalopathy of prematurity encompasses the central nervous system abnormalities associated with injury from preterm birth.
This report describes a clinically relevant rat model of in utero transient Krampfadern der unteren Extremitäten auf dem Start hypoxia-ischemia and intra-amniotic lipopolysaccharide administration LPS that mimics chorioamnionitis, and the related impact of infectious stimuli and placental underperfusion on CNS development.
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats. Encephalopathy of prematurity EoP is a term that encompasses the central nervous system CNS abnormalities associated with preterm birth.
To best advance translational objectives and uncover new therapeutic strategies for brain injury associated with preterm birth, preclinical models of EoP must include similar mechanisms of prenatal global injury observed in humans and involve multiple components of the maternal-placental-fetal system.
Ideally, models should produce a similar spectrum of functional deficits in the mature animal and recapitulate multiple aspects of the pathophysiology.
In pregnant Sprague Dawley rats, TSHI via uterine artery occlusion on embryonic day 18 E18 induces a graded placental underperfusion defect associated with increasing CNS damage in the fetus. When combined with intra-amniotic LPS injections, placental inflammation is increased and CNS damage is compounded with associated white matter, gait and imaging abnormalities. Moreover, this model allows for the dissection of inflammation induced by divergent injury types.
PBI from prematurity, also termed encephalopathy of prematurity EoPaffects the entire central nervous system CNS. CNS injury often commences von Laser-Entfernung von Krampfadern Beinen utero, and is exacerbated by antenatal processes including chorioamnionitis and postnatal complications such as hypoxia and sepsis.
PBI from systemic insults alters neurodevelopment and leads to cerebral palsy, epilepsy, cognitive delay and numerous neuropsychiatric disorders affecting emotional regulation, memory and executive function 1,2.
Although much progress has been made, a limited understanding remains of how the cellular and molecular consequences of CNS injury from preterm birth click at this page to the multitude of neurological sequelae in children who are born preterm.
This lack of knowledge hinders real-time diagnosis of CNS injury severity and informed dosing of emerging interventions. Additionally, age-appropriate therapeutic strategies for this vulnerable patient population remain elusive. Intrauterine inflammation is very common in extreme prematurity and involves a complex fetal-maternal-placental inflammatory cascade 3.
Intrauterine infection is often subclinical. Specific placental findings consistent with acute inflammation, or histologic chorioamnionitis, are major determinants of the fetal inflammatory response and are coincident with brain injury associated with preterm birth Indeed, the fetal inflammatory response has distinct clinical implications for long-term outcomes from preterm birth.
Infants who are small for gestational age SGA or who experience infection are exceptionally vulnerable to neurological deficits 3,4. Further, chorioamnionitis is associated with cognitive impairment at two years 8.
Evidence of maternal vascular underperfusion in the placenta of infants born extremely preterm is also associated with cerebral palsy in childhood 9. The synergistic impact of chorioamnionitis and placental perfusion defects is well illustrated by the remarkably high risk of abnormal neurologic outcomes in this patient population at two years of age 10, To mimic human systemic placental perfusion defects and chorioamnionitis associated with pathogen-induced inflammation, we developed a model of prenatal transient systemic hypoxia-ischemia TSHI combined with intra-amniotic lipopolysaccharide LPS in rats.
Our goal was to adapt our model of Von Krampfadern Behandlung Samara alone in rats to include intrauterine inflammation, to facilitate preclinical modeling of CNS injury associated with preterm birth. TSHI alone has revealed persistent loss of oligodendroglial lineage cells, cortical neurons, increased cell death, and elevated pro-inflammatory cytokine levels, with progressive ischemic intervals leading to a graded pattern of injury consistent with prenatal brain injury Modifications to the ischemic components of this model have also demonstrated deficits in memory encoding, short and long-term memory and mild musculoskeletal alterations in rats as they Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft Please Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft JoVE to your librarian.
NOTE: Prior to commencing the procedure, seal, sterilize and autoclave Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft surgical instruments and surgical drapes. Additionally, prepare post-operative medications in sterile vials including 0.
Also prepare the lipopolysaccharide LPS solution sterilely: 0. Placentas examined on E19 and E21 are grossly edematous with micro-hemorrhage, and necrosis throughout the decidua and labyrinth. Significant inflammatory infiltrate and increased vascularity is also observed. Brains examined on P2 reveal ventriculomegaly, as well as white matter and subplate Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft loss compared to shams.
These data are consistent with impaired developmental upregulation of KCC2 during a critical postnatal period of circuit maturation and these findings are consistent with our prior reports of the effects of TSHI alone in the CA3 hippocampus Please click here to view a larger Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft of this figure.
Western blots performed from membrane preparations of micro-dissected cortical tissue, show in utero transient systemic hypoxia-ischemia and intra-amniotic LPS administration on embryonic day 18 E18 significantly reduces expression Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft KCC2, a neuron-specific potassium chloride co-transporter central to the development of integrated cerebral circuits and inhibition, on postnatal day Encephalopathy of prematurity is difficult to model in animals because of the complex interaction of etiologies, neurodevelopmental time course, intricacy of human cerebral network formation, overlapping mechanisms of injury, and the diverse phenotypes of CNS insults manifest in human preterm infants.
EoP is associated with specific cell-type vulnerabilities i. However, significant progress can be made when animal models replicate the human condition as closely as possible. Here, we developed a model a prenatal insult that incorporates the heterogeneity of mechanisms of CNS injury observed in the preterm infant, allowing for subsequent evaluation of both gray and white matter source and recovery.
In humans, ascending bacterial infections weaken the amnion and precipitate premature rupture of membranes. Additionally, placental perfusion defects stress the placental interface and disrupt placental homeostasis.
Thus, placental underperfusion compounds CNS injury from an intrauterine infection. Undeniably, it is challenging to model the common clinical scenario of ascending http://newohioreview.com/blog/trophischen-geschwueren-schmerzen-in-den-beinen.php infections that precede chorioamnionitis in rodents as they have a duplex uterus.
Each uterine horn has its own cervix, and multiple pregnancies are carried at once. Despite these challenges, preclinical models have been adapted to involve multiple components of the maternal-placental-fetal unit and incorporate Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft utero inflammation to various degrees.
While no individual preclinical model is ideal to test every specific hypothesis, the model Krampfadern Foto vor von Operation der herein incorporates the cellular and molecular abnormalities, behavioral and functional impairment, maternal-placental-fetal system, and the intrauterine infection and placental inflammation component common to so many read more births 20, The choice of species used to model EoP impacts the interpretation of please click for source data in the context of the inherent limitations posed by the species.
In the simplest terms, birth does not equate to similar points of CNS development across all animals The model described here can be performed in both pregnant mice and rats, although pup survival in mice is significantly decreased in inexperienced or stressed dams. Similar to differences among species, the timing of injury during gestation has a crucial role in the neurodevelopmental trajectory of the offspring. The spatiotemporal regulation of neural cell developmental stages of proliferation, migration and differentiation differs amongst various mammals These cell-specific developmental Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft influence the vulnerability to injury.
For example, the overlap of the timing of oligodendrocyte lineage and GABAergic neuronal development with the timing of preterm birth makes these cells particularly susceptible to perinatal insults We previously showed O4-immunoreactive immature oligodendrocytes are most affected at this stage of development Moreover, we have demonstrated premature loss of the subplate, reduced KCC2 expression, lower seizure threshold and impaired gait 12,13,15 consistent with dysregulated GABAergic signaling in preterm infants The model described here offers numerous benefits over previous models in rodents used to study perinatal brain injury from preterm birth It incorporates the entire maternal-placental-fetal system and causes both brain and placental injury.
While prior investigations of unilateral carotid ligations and systemic hypoxia in neonatal rats have shed mechanistic insight into numerous pathophysiological processes i.
In addition to the applications described, the model described here may be an informative tool for investigation of other organ systems impacted by prematurity, including necrotizing enterocolitis NECheart, lung, renal Johanniskraut und Krampfadern hypothalamic-pituitary axis dysfunction.
Owing to the complexities of LPS pharmacology and differences in maternal and fetal pharmacodynamics, intraperitoneal LPS injections in dams are less likely to produce the same fetal inflammatory response shown here.
Further, LPS does not http://newohioreview.com/blog/ovarian-krampfadern-behandlung.php the placenta reliably 20, Previously, we attempted direct cervical application of LPS and intrauterine injection similar to what has been described in other mouse models However, we found that mortality and inconsistency of CNS injury was significantly increased among pups within the same litter.
Increasing doses of LPS administered to the amniotic compartment results in increased fetal mortality. LPS has the advantage over direct infection with typical intrauterine gram-negative bacteria in that it activates inflammatory signaling through toll-like receptor 4 without causing active bacterial infection and the associated risk of pathogen spread.
However, this model could be modified to include common pathogens and organisms isolated from human placentas, including group B streptococcuswhich causes placental and neuropathological abnormalities, and autistic-like behavior in rats Similarly, Ureaplasma lipoprotein multiple-banded antigen can simulate Ureaplasma species infection. Since Ureaplasma is the most common cause of human chorioamnionitis 35this could also be an avenue for future investigation.
As more inactivated-infectious agents become available, it will be informative to determine how they differentially impact neurodevelopment and the efficacy of neuro-reparative interventions.
Limitations of this model include amniotic fluid loss from the intra-amniotic injections. Although no effect is noted with intra-amniotic injections of sterile saline, the gauge of Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft needle Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft to perform the injections is a crucial technical element. Care must be taken not to use needles larger than 31 G.
The authors are Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft to Dan Firl, Chris Corbett and Jesse Denson, PhD. Funding was provided by NIH NINDS R01 NS to SR, the P30 CoBRE Pilot Program to LJ and the Child Health Signature Program to LJ at the University of New Mexico.
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The JoVE video player is compatible with HTML5 and Adobe Flash. Keywords: MedicineIssueInflammationintra-amnioticin uteroratchorioamnionitisplacentapretermintrauterine Jantzie, L. Gently apply ophthalmic ointment to each eye to prevent corneal drying. During the procedure continually monitor temperature, respiration rate and heart rate of the Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft. Maternal physiology should remain stable throughout the procedure.
Surgical Prep and Scrub. Using small animal clippers remove all hair in the lower abdominal region. Shave in a rectangular pattern with care to avoid nicking the nipples or generating razor rash that can be irritating for future nursing of live born pups.
Confirm depth of anesthesia via absence of toe-pinch reflex. Using sterile surgical towels, drape the animal. Take care to place the drapes at an appropriate angle such that they maximize the amount of irrigation fluid they absorb whilst not obstructing blood flow to the uterine horns.
Using a scalpel make a 3 cm midline incision in the prepared abdominal skin. Bluntly dissect the skin layer from the abdominal fascia with scissors. Using forceps and surgical scissors, elevate the abdominal fascial layer and make an incision of the avascular linea alba to gain access to the peritoneal cavity. Place surgical gauze on the exterior of the incision and moisten with sterile saline. Using blunt forceps and external pressure on the abdomen, gently remove the uterine horns from the peritoneal cavity and arrange on the moistened gauze.
Carefully avoid entanglement and contact with intestines. Arrange fetuses using forceps by contacting only the muscular tissue in between individual Behandlung von varikösen Cremes und Salben sacs. Expose and isolate the 4 uterine arteries using blunt dissection. NOTE: Care must be taken to dissect the uterine arteries. Surrounding tissue and vessels themselves are extremely delicate.
Damage to maternal vessels can cause bleeding, and in severe cases, fetal and maternal death. Placement of Aneurysm Clips. Place a rat 30 G aneurysm clip on each uterine artery. Ensure cessation of Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft flow, including proximal and distal pulses, and darkening of the uterine vessels including individual placentas.
Cover the exposed horns and entire surgical field with gauze and irrigate with sterile saline. Take care to keep the field moist with irrigation approximately every 10 min. After 60 min, remove the gauze and irrigate the field. Ensure that the uterine horns and vessels are adequately moistened for successful clip removal. Gently remove each aneurysm clip using forceps. Take care not to cause trauma to the vessel, and maintain tissue integrity during removal.
Thoroughly irrigate the uterine horns and field, taking care to remove any stray threads of gauze from the amniotic sacs. Injection of Lipopolysaccharide in to Amniotic Sacs. Use blunt forceps to stabilize and rotate each amniotic sac in to an optimal position for injection.
NOTE: Use only an ultra-fine 0. Using larger gauge needles will result in chronic amniotic fluid loss, fetal death and reabsorption of the pregnancy. Small amounts of amniotic fluid leakage upon removal of the syringe can be mitigated by direct pressure to the amniotic sac.
Some rat fetuses may tolerate a degree of oligohydramnios. However, acute amniotic fluid loss from puncture with large gauge needles, or accidental puncture resulting in chronic fluid Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft, results in fetal loss and in severe cases, loss of neighboring pregnancies. Irrigate the uterine horns 3x with sterile saline.
Using forceps, carefully return the uterine horns to the peritoneal cavity. Ensuring adequate space between the amniotic sacs and Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft midline incision, re-approximate the musculofascial layer edges using a running silk suture. Be aware of the placement of the amniotic sacs while closing the muscle incision. Be careful to not to suture into or through a sac. Re-approximate the skin layer, using a running silk suture, closing the skin layer.
NOTE: The laparotomy should be closed in two layers of continuous sutures to allow for skin and muscular expansion with increasing gestation. Continuous sutures allow for evenly distributed wound tension. Interrupted sutures are less desired as multiple knots are irritating and can be easily chewed by the rat upon recovering from anesthesia.
Surgical staples are not desired. Inject 1 ml of 0. Administer one dose of 0. Turn off isoflurane and towel dry rat as necessary. Place in clean home cage and monitor recovery from anesthesia. Ensure rat does not become hypothermic. Postoperative Recovery and Care. Monitor the rat every hr for 72 hr and then daily until pups are born approximately E22 or E Monitor learn more here for signs of pain, discomfort, vaginal bleeding or bleeding from the surgical site.
Inspect the sutures and incision and take care to ensure rat is not chewing or removing their sutures prematurely. Although exceptionally rare, rats that compromise their sutures are at risk for wound dehiscence. NOTE: Occasionally rats may ingest excessive amounts of bedding or non-food items, termed pica, as a side effect of buprenorphine administration.
Although very uncommon, rats must be http://newohioreview.com/blog/ein-kompressionskleidungsstueck-krampf-was.php for pica and potential subsequent bowel obstruction. Tissue Processing and Cryosectioning.
Using surgical scissors decapitate rat pups and gently remove the brain from the skull. NOTE: Once brains drop in the sucrose solution they are ready to be sectioned on a cryostat. Rapidly freeze brains and mount on cryostat pestle for acquisition of frozen coronal sections.
Ensure sections are collected serially. Allow slides to dry at room temperature overnight. Take slide mounted frozen sections and warm to room temperature. NOTE: Prepare all solutions fresh. Transfer slides to a staining rack. Dip slides 10x in double-distilled deionized water ddH 2 O.
Time in hematoxylin can be optimized depending on degree of purple staining. Dip slides 4x in tap H 2 O, and let stand in clean Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft H 2 O for 1 min. NOTE: Xylene steps and coverslipping should occur in a fume hood. Incubate slides in fresh changes of xylene for 15 min. Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft with Permount and let dry in fume hood.
Image slides with a light microscope. The authors have nothing to disclose. PDI Alcohol Prep Pads. Mini Arco Rechargeable Clippers. Small, 6 inch sterile. Superfrost Plus Microscope Slides. Surgipath Gill II Hematoxylin. Fisher Finest Premium Coverglass.
Preterm birth associated neurodevelopmental impairment estimates at regional and global levels for Long term this web page outcomes after intrauterine and neonatal insults a systematic review.
Intermittent or sustained systemic inflammation and the preterm brain. Microbiologic and histologic characteristics of the extremely preterm infant's placenta predict white matter damage and later cerebral palsy.
Inflammatory responses in the placenta and umbilical cord. Semin Fetal Neonatal Med. Chronic chorioamnionitis is the most common placental lesion Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft late preterm birth. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.
Chorioamnionitis and early childhood outcomes among extremely low gestational age neonates. Second and third trimester placental hemodynamics and the risks of pregnancy complications the Generation R Study. Fetal placental inflammation but not adrenal activation is associated with extreme preterm delivery.
Am J Obstet Gynecol. Hemodynamic disturbances in premature infants born after chorioamnionitis association with cord blood cytokine concentrations. Postnatal Erythropoietin Mitigates Impaired Cerebral Cortical Development Following Subplate Loss from Prenatal Hypoxia Ischemia. Erythropoietin attenuates loss of potassium chloride co transporters following prenatal brain injury. Erythropoietin signaling promotes oligodendrocyte development following prenatal systemic hypoxic ischemic brain injury.
Postnatal erythropoietin treatment mitigates neural cell loss after systemic prenatal hypoxic ischemic injury. Developmental changes induced by graded prenatal systemic hypoxic ischemic insults in rats.
Neuroanatomical sensorimotor and cognitive deficits in adult rats with white matter injury following prenatal ischemia. Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft of prenatal ischemia on behavior cognitive abilities and neuroanatomy in adult rats with white matter damage. Mild musculoskeletal and locomotor alterations in adult rats with white matter injury following prenatal ischemia. Intl J Devel Neurosci.
Complex pattern of interaction between Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft utero hypoxia ischemia and intra amniotic inflammation disrupts brain development and motor function. Selective vulnerability of late oligodendrocyte progenitors to hypoxia ischemia. Developmental Expression of N Methyl d Aspartate NMDA Receptor Subunits in Human White and Gray Matter Potential Mechanism of Increased Vulnerability in the Immature Brain. Preclinical Models of Encephalopathy of Prematurity.
Modeling transformations of neurodevelopmental sequences across article source species. Development of neurotransmitter systems during critical periods. Development and specification of GABAergic cortical interneurons.
Human oligodendroglial development Relationship to periventricualr leukomalacia. Neonatal loss of gamma amino butyric acid pathway expression after human perinatal brain injury.
Late development of the GABAergic system in the human cerebral cortex and white matter. J Neuropathol Exp Neurol. Arrested oligodendrocyte lineage maturation in chronic perinatal white matter injury.
Neonatal loss of gamma aminobutyric acid pathway expression after human perinatal brain injury. Effects of prenatal infection on brain development and behavior a review of findings from animal models. A mouse model of term chorioamnionitis unraveling causes of adverse neurological outcomes. White matter injury and autistic like behavior predominantly affecting male rat offspring exposed to group B streptococcal maternal inflammation.
Effects of Ureaplasma parvum lipoprotein multiple banded antigen on pregnancy outcome in mice. Sign in to use this feature!
Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft Embolisation von Gebärmutter-Myomen (synonym: Uterusarterienembolisation / UAE, Uterine Fibroid Embolisation / UFE, Myomembolisation) - PDF
Fest steht: "Die Plazenta nistet sich in Verletzung der Gebärmutterarterie Blutfluss während der Schwangerschaft achten bis Teilweise verordnet er blutdrucksenkende Mittel. Das HELLP-Syndrom gilt als weitere schwere Komplikation.
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