<p>Preterm birth is the leading cause
of newborn mortality, with 15 million babies born premature worldwide every
year. Children that do survive early delivery are more likely to develop
cognitive abnormalities, motor deficits, heart disease, cerebral palsy, and
more. While little is known about the pathophysiology of preterm birth, several
pregnancy-related complications are related to preterm birth, namely cervical
insufficiency and preeclampsia. In the former, premature cervical remodeling
and softening can result in the shortening of the cervix, increasing a woman’s
risk of preterm birth; this condition is called cervical insufficiency (CI),
which is the inability of the cervix to remain closed as a result of weakened
tissues. CI is currently measured by a one-dimensional sonographic cervical
length, where < 25 mm indicates shortening. Preeclampsia is a disorder that
can be explained through the Page kidney phenomenon: compression of the left
renal vein (LRV) causes renal venous outflow obstruction, leading to elevated
intrarenal pressure and hypertension. The supine pressor test (SPT) is a diagnostic
tool for preeclampsia where a positive test is defined by an increase of 20
mmHg in diastolic blood pressure (BP) when shifting from the left lateral
recumbent to the supine position. Due to the intense risk of morbidity and
mortality for both the mother and the fetus, the need to monitor BP changes is
critical. Currently, there is an unmet clinical need to characterize the
hemodynamic and geometric properties of the female reproductive organs
throughout gestation. Utilizing ultrasound imaging can increase our knowledge
about the 3D anatomy and systemic changes during pregnancy, unravel risk
factors, establish preventative methods, and standardize treatment plans. In
this thesis research, we developed a murine model to 1) examine the
pathophysiology of renal vein stenosis, and 2) investigate the effects of
stenosis on various cervical dimensions. Renal vein stenosis was found to greatly
impact blood flow velocities, as well as cervical width (<i>p<0.05</i>). LRV
and cervical area and height also trend towards significance, and there is
negative damage to the left kidney and placentae within the stenosed cohort. We
also conducted a human study that showed reduced change in postural BP in
patients with higher body mass index (BMI). Systolic and diastolic BP in the
supine position was significantly greater than in the lateral position for all
BMIs with a baseline increase in BP of approximately 9-14 mmHg. These findings
suggest that therapeutic positioning and close monitoring of BP could mitigate
the risk of developing related disorders in pregnancy.</p>
| Identifer | oai:union.ndltd.org:purdue.edu/oai:figshare.com:article/12247523 |
| Date | 05 May 2020 |
| Creators | Jessica L Ma (8799200) |
| Source Sets | Purdue University |
| Detected Language | English |
| Type | Text, Thesis |
| Rights | CC BY-NC-SA 4.0 |
| Relation | https://figshare.com/articles/Hemodynamic_and_Geometric_Changes_of_the_Female_Reproductive_System_in_Health_and_Disease/12247523 |
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