- Email: [email protected]
Balloon catheter vs. Ocytocin for cervical ripening in patient with previous caesarean section: open-label multicenter randomised controlled trial
e104
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Induction of labour
Poster presentation
No Preference
Diabetes in Pregnancy
Balloon catheter vs. Ocytocin for cervical ripening in patient with previous caesarean section: open-label multicenter randomised controlled trial
Expression and localization of FoxO4 in normal term and gestational diabetic placentas
Mélie Sarreau 1,∗ , Stéphanie Ragot 1 , Patrice Poulain 2 , Brigitte Fontaine 3 , Olivier Morel 4 , Pascal Villemonteix 5 , Pierre Mares 6 , Alain Godard 7 , Fabrice Pierre 1
Department of Histology and Embryology, Akdeniz University School of Medicine, Antalya, Turkey E-mail address: [email protected] (L. Sati).
1
University Hospital of Poitiers, France University Hospital of Rennes, France 3 Hospital of Angouleme, France 4 University Hospital of Nancy, France 5 Hospital of Bressuire, France 6 University Hospital of Nîmes, France 7 Hospital of Chatellerault, France E-mail address: [email protected] (M. Sarreau). 2
Introduction: Induction of labour after caesarean is commonly admitted but rise risk of uterine rupture. Balloon catheter seems to be an interesting method decreasing hyperstimulation but is not validated in women with previous caesarean section. We compared efficacy and maternal-neonatal morbidity between balloon catheter and oxytocin for ripening unfavorable cervix on prior caesarean section. Methods: This study was an open label randomised controlled trial conducted in seven French hospitals. Inclusion criteria were prior medical indication of induction of labor in pregnant women over 37 weeks with unique transversal segmentary incision, Bishop score ≤4, no premature rupture of membrane, singleton in vertex presentation. Women were randomly allocated to induction of labour with a 50 mL balloon catheter during 12 h (BC) or oxytocin low doses perfusion (Ox). The primary outcome was vaginal birth (VB) rate. Second outcomes were maternal and neonatal complications. Analysis was done on an intention-to-treat basis. This study was registered on clinicaltrial.gov number NCT01711060. Results: Two thousand and five women were enrolled from Dec 26, 2010 to Dec 31, 2013 and 204 were considered for analysis: 101 in BC and 103 in Ox. VB rate was 50% (n = 51) in BC vs. 37% (n = 38) in Ox. Ballon efficacy varied with Bishop score (p interaction = 0.04) and was superior to Oxytocin in the subgroup Bishop score <4: VB rate was 50% (n = 41) vs. 30% (n = 25) with balloon catheter and oxytocin, respectively (p < 0.008; OR = 2.36; IC 95% = [1.25–4.46]). Maternal and neonatal morbidity did not differ significantly between the 2 groups: 2 dehiscence uterine rupture in BC vs. 1 in Ox, 1 vs. 4 maternal infection, 5 vs. 2 hemorrage and 11 vs. 5 neonatal transferts. Conclusion: Balloon catheter for vaginal birth after caesarean is effective in women with Bishop <4 compared to oxytocin alone without more adverse outcomes.
Leyla Sati ∗ , Bikem Soygur, Ciler Celik-Ozenci
The transcription factors and other signaling molecules involved in the pathogenesis of placental disorders of human pregnancy are very crucial. However, the regulation and interaction of these molecules in human are not fully understood. Forkhead box O (FoxO) proteins are a family of transcription factors that play important roles in regulating the expression of genes involved in cell growth, proliferation, differentiation, apoptosis, metabolism and homeostasis of stem/progenitor cells and also development. Previously, FoxO1 is implicated in the regulation of molecular events underlying the establishment of maternal-fetal circulatory interaction and also morphogenesis of the normal and pathological placentas including preeclampsia and fetal growth restriction. There is, however, no data available on the expression and localization of FoxO4 in gestational diabetic placenta which the chronic fetal hypoxia causes villous immaturity and increased fibrinoid necrosis potentially alters the placental structure, and affects the oxygen and nutrient exchange. Thus, the aim of this study was to characterize the localization and expression of FoxO4 from normal term and gestational diabetic placentas. Immunohistochemistry and Western Blot methods were performed to localize and determine FoxO4 protein in normal term (n = 4) and gestational diabetic placentas (n = 5). Both normal term and gestational diabetic placenta samples exhibited FoxO4 staining in the syncytiotrophoblast layer, which was both cytoplasmic and nuclear. FoxO4 staining was manly nuclear in the cytotrophoblasts. No or very weak FoxO4 expression within the villous stroma and endothelium was observed. Even if the staining patterns were similar in normal and diabetic placenta groups, the staining intensity, particularly in the syncytiotrophoblast layer, was dramatically decreased in some of the gestational diabetic placenta samples. No staining was present in the negative controls for FoxO4 in all placenta samples. Western Blot analysis also showed the decreased expression in diabetic placentas compared to normal term placentas (p < 0.05). Gestational diabetes is reported to alter apoptosis mechanism in placentas of gestational diabetes mellitus women. As previously reported FoxO proteins regulate apoptosis and activation of FoxO impairs glucose metabolism. The identification and altered expression of the FoxO4 in human gestational placenta suggests that they may play functional roles in this pregnancy complication. Thus, studying such pathological conditions is important to delineate the exact role of these transcription factors in human pregnancy. http://dx.doi.org/10.1016/j.ejogrb.2016.07.274
http://dx.doi.org/10.1016/j.ejogrb.2016.07.273
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Induction of labour
Poster presentation
No Preference
Diabetes in Pregnancy
Balloon catheter vs. Ocytocin for cervical ripening in patient with previous caesarean section: open-label multicenter randomised controlled trial
Expression and localization of FoxO4 in normal term and gestational diabetic placentas
Mélie Sarreau 1,∗ , Stéphanie Ragot 1 , Patrice Poulain 2 , Brigitte Fontaine 3 , Olivier Morel 4 , Pascal Villemonteix 5 , Pierre Mares 6 , Alain Godard 7 , Fabrice Pierre 1
Department of Histology and Embryology, Akdeniz University School of Medicine, Antalya, Turkey E-mail address: [email protected] (L. Sati).
1
University Hospital of Poitiers, France University Hospital of Rennes, France 3 Hospital of Angouleme, France 4 University Hospital of Nancy, France 5 Hospital of Bressuire, France 6 University Hospital of Nîmes, France 7 Hospital of Chatellerault, France E-mail address: [email protected] (M. Sarreau). 2
Introduction: Induction of labour after caesarean is commonly admitted but rise risk of uterine rupture. Balloon catheter seems to be an interesting method decreasing hyperstimulation but is not validated in women with previous caesarean section. We compared efficacy and maternal-neonatal morbidity between balloon catheter and oxytocin for ripening unfavorable cervix on prior caesarean section. Methods: This study was an open label randomised controlled trial conducted in seven French hospitals. Inclusion criteria were prior medical indication of induction of labor in pregnant women over 37 weeks with unique transversal segmentary incision, Bishop score ≤4, no premature rupture of membrane, singleton in vertex presentation. Women were randomly allocated to induction of labour with a 50 mL balloon catheter during 12 h (BC) or oxytocin low doses perfusion (Ox). The primary outcome was vaginal birth (VB) rate. Second outcomes were maternal and neonatal complications. Analysis was done on an intention-to-treat basis. This study was registered on clinicaltrial.gov number NCT01711060. Results: Two thousand and five women were enrolled from Dec 26, 2010 to Dec 31, 2013 and 204 were considered for analysis: 101 in BC and 103 in Ox. VB rate was 50% (n = 51) in BC vs. 37% (n = 38) in Ox. Ballon efficacy varied with Bishop score (p interaction = 0.04) and was superior to Oxytocin in the subgroup Bishop score <4: VB rate was 50% (n = 41) vs. 30% (n = 25) with balloon catheter and oxytocin, respectively (p < 0.008; OR = 2.36; IC 95% = [1.25–4.46]). Maternal and neonatal morbidity did not differ significantly between the 2 groups: 2 dehiscence uterine rupture in BC vs. 1 in Ox, 1 vs. 4 maternal infection, 5 vs. 2 hemorrage and 11 vs. 5 neonatal transferts. Conclusion: Balloon catheter for vaginal birth after caesarean is effective in women with Bishop <4 compared to oxytocin alone without more adverse outcomes.
Leyla Sati ∗ , Bikem Soygur, Ciler Celik-Ozenci
The transcription factors and other signaling molecules involved in the pathogenesis of placental disorders of human pregnancy are very crucial. However, the regulation and interaction of these molecules in human are not fully understood. Forkhead box O (FoxO) proteins are a family of transcription factors that play important roles in regulating the expression of genes involved in cell growth, proliferation, differentiation, apoptosis, metabolism and homeostasis of stem/progenitor cells and also development. Previously, FoxO1 is implicated in the regulation of molecular events underlying the establishment of maternal-fetal circulatory interaction and also morphogenesis of the normal and pathological placentas including preeclampsia and fetal growth restriction. There is, however, no data available on the expression and localization of FoxO4 in gestational diabetic placenta which the chronic fetal hypoxia causes villous immaturity and increased fibrinoid necrosis potentially alters the placental structure, and affects the oxygen and nutrient exchange. Thus, the aim of this study was to characterize the localization and expression of FoxO4 from normal term and gestational diabetic placentas. Immunohistochemistry and Western Blot methods were performed to localize and determine FoxO4 protein in normal term (n = 4) and gestational diabetic placentas (n = 5). Both normal term and gestational diabetic placenta samples exhibited FoxO4 staining in the syncytiotrophoblast layer, which was both cytoplasmic and nuclear. FoxO4 staining was manly nuclear in the cytotrophoblasts. No or very weak FoxO4 expression within the villous stroma and endothelium was observed. Even if the staining patterns were similar in normal and diabetic placenta groups, the staining intensity, particularly in the syncytiotrophoblast layer, was dramatically decreased in some of the gestational diabetic placenta samples. No staining was present in the negative controls for FoxO4 in all placenta samples. Western Blot analysis also showed the decreased expression in diabetic placentas compared to normal term placentas (p < 0.05). Gestational diabetes is reported to alter apoptosis mechanism in placentas of gestational diabetes mellitus women. As previously reported FoxO proteins regulate apoptosis and activation of FoxO impairs glucose metabolism. The identification and altered expression of the FoxO4 in human gestational placenta suggests that they may play functional roles in this pregnancy complication. Thus, studying such pathological conditions is important to delineate the exact role of these transcription factors in human pregnancy. http://dx.doi.org/10.1016/j.ejogrb.2016.07.274
http://dx.doi.org/10.1016/j.ejogrb.2016.07.273