Browsing by Author "Gonçalves, Daniela"
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- CERVICAL PREGNANCY: DIFFERENT CLINICAL SCENARIOS LEADING TO ITS DIAGNOSISPublication . Galvão, Ana; Gonçalves, Daniela; Moreira, Marta; Gonçalves, Joaquim; Braga, JorgeWe report all the cases of cervical pregnancy managed in our institution in the past ten years. One of them was treated with methotrexate. The other one was the result of in vitro fertilization, leading to an early embryo reduction. The last one was misdiagnosed as an uterine abortion and was submitted to dilatation and curettage with profuse bleeding, uterine perforation and need of laparotomy. As it continues to be a rare condition, the most important step in cervical pregnancy continues to be thinking about the possibility of its occurrence, because if it remains unrecognized it may have an end in an unfavorable outcome.
- Delayed interval delivery of a second twin resulting in septic shock in the motherPublication . Galvão, Ana; Gonçalves, Daniela; Rocha, Ana; Rodrigues, Ana; Buchner, Graça; Cunha, Ana; Braga, JorgeDelayed interval delivery is an option in the extremely preterm twin pregnancies, in an attempt to decrease morbidity for the remaining fetuses. We report a case of diamniotic dichorionic pregnancy complicated by premature rupture of membranes of the first fetus at 20 weeks gestation. Premature delivery of the first twin occured nine days latter. Delayed interval delivery of the second twin was attempted using bed rest, tocolysis and antibiotics. Unfortunately, 14 days later spontaneous labour ensued and the birth took place with the mother presenting signs of chorioamnionitis. Septic shock occurred in the mother, with need of mechanical ventilation and aminergic support. It seems to us that it is important to present unsuccessful cases like this in order to discuss what are the optimal management options, while there is no universal agreement on this issue.
- The endocannabinoid 2-arachidonoylglycerol promotes endoplasmic reticulum stress in placental cellsPublication . Almada, Marta; Costa, Lia; Fonseca, Bruno; Alves, Patrícia; Braga, Jorge; Gonçalves, Daniela; Teixeira, Natércia; Correia-da-Silva, GeorginaProliferation, differentiation and apoptosis of trophoblast cells are required for normal placental development. Impairment of those processes may lead to pregnancy-related diseases. Disruption of endoplasmic reticulum (ER) homeostasis has been associated with several reproductive pathologies including recurrent pregnancy loss and preeclampsia. In the unfolded protein response (UPR), specific ER-stress signalling pathways are activated to restore ER homeostasis, but if the adaptive response fails, apoptosis is triggered. Protein kinase RNA-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme 1 (IRE1) and Activating transcription factor 6 (ATF6) are central players in UPR and in ER-stress-induced apoptosis, as well as downstream transcription factors, as C/EBP homologous protein (CHOP). Our previous studies have shown that the endocannabinoid 2-arachidonoylglycerol (2-AG) modulates trophoblast cell turnover. Nevertheless, the role of ER-stress on 2-AG induced apoptosis and cannabinoid signalling in trophoblast has never been addressed. In this work, we used BeWo cells and human primary cytotrophoblasts isolated from term-placenta. The expression of ER-stress markers was analysed by qRT-PCR and Western blotting. ROS generation was assessed by fluorometric methods, while apoptosis was detected by the evaluation of caspase -3/-7 activities and Poly (ADP-ribose) polymerase (PARP) cleavage. Our findings indicate that 2-AG is able to induce ER-stress and apoptosis. Moreover, the eukaryotic initiation factor 2 (eIF2α)/CHOP pathway involved in ER-stress-induced apoptosis is triggered through a mechanism dependent on cannabinoid receptor CB2 activation. The results bring novel insights on the importance of ER-stress and cannabinoid signalling on 2-AG mechanisms of action in placenta.