2851
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Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170:1-7. [PMID: 23746796 DOI: 10.1016/j.ejogrb.2013.05.005] [Citation(s) in RCA: 758] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/18/2013] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
Reduction of maternal mortality is a target within the Millennium Development Goals. Data on the incidence of preeclampsia and eclampsia, one of the main causes of maternal deaths, are required at both national and regional levels to inform policies. We conducted a systematic review of the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally and in different regions and settings. We selected studies using pre-specified criteria, recorded database characteristics and assessed methodological quality of the eligible studies reporting incidence of any HDP during the period 2002-2010. A logistic model was then developed to estimate the global and regional incidence of HDP using pre-specified predictor variables where empiric data were not available. We found 129 studies meeting the inclusion criteria, from which 74 reports with 78 datasets reporting HDP were analysed. This represents nearly 39 million women from 40 countries. When the model was applied, the overall estimates are 4.6% (95% uncertainty range 2.7-8.2), and 1.4% (95% uncertainty range 1.0-2.0) of all deliveries for preeclampsia and eclampsia respectively, with a wide variation across regions. The figures we obtained give a general idea of the magnitude of the problem and suggest that some regional variations might exist. The absence of data in many countries is of concern, however, and efforts should be made to implement data collection and reporting for substantial statistics. The implementation of large scale surveys conducted during a short period of time could provide more reliable and up-to-date estimations to inform policy.
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Affiliation(s)
- Edgardo Abalos
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6, 2000 Rosario, Argentina.
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2852
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Calicchio R, Buffat C, Vaiman D, Miralles F. [Endothelial dysfunction: role in the maternal syndrome of preeclampsia and long-term consequences for the cardiovascular system]. Ann Cardiol Angeiol (Paris) 2013; 62:215-220. [PMID: 23721989 DOI: 10.1016/j.ancard.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/08/2013] [Indexed: 06/02/2023]
Abstract
Preeclampsia is a pregnancy disorder being a leading cause of maternal and fetal mortality and morbidity. It is a complex multisystem disease characterized by hypertension and proteinuria. In preeclampsia the placenta releases factors into the maternal circulation which cause a systemic endothelial dysfunction. Here, we review data demonstrating the central role played by the endothelium in the development of the maternal syndrome of preeclampsia. We present also original data showing how circulating factors present in the plasma of preeclamptic women can alter the transcriptome of endothelial cells. The expression of genes involved in essential functions such as vasoregulation, oxidative stress, apoptosis and cell proliferation show differential expression when endothelial cells are exposed to preeclamptic or normal pregnancy plasma. We conclude by discussing the growing evidences that the alterations of the endothelium during preeclampsia are linked to an increased risk of cardiovascular diseases latter on life. Therefore, a better understanding of the modifications undergone by the endothelial cells during preeclampsia is essential to develop new therapeutic approaches to both, manage preeclampsia and to prevent the long-term sequelae of the disease on women cardiovascular system.
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Affiliation(s)
- R Calicchio
- Inserm U1016-CNRS UMR8104, université Paris Descartes, institut Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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2853
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Abstract
Metabolic syndrome is a growing problem globally, and is a contributor to non-communicable diseases such as type II diabetes and cardiovascular disease. The risk of developing specific components of the metabolic syndrome such as obesity, hyperlipidemia, hypertension, and elevated fasting blood sugar has been largely attributed to environmental stressors including poor nutrition, lack of exercise, and smoking. However, large epidemiologic cohorts and experimental animal models support the "developmental origins of adult disease" hypothesis, which posits that a significant portion of the risk for adult metabolic conditions is determined by exposures occurring in the perinatal period. Maternal obesity and the rate of complications during pregnancy such as preterm birth, preeclampsia, and gestational diabetes continue to rise. As our ability to reduce perinatal morbidity and mortality improves the long-term metabolic consequences remain uncertain, pointing to the need for further research in this area.
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Affiliation(s)
- Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, 105 River St, Iowa City, IA 52242, USA
| | | | - Nisha I. Parikh
- Cardiovascular Division, The Queens Medical Center, Honolulu, HI 96813, USA
| | - Audrey F. Saftlas
- Department of Epidemiology, University of Iowa, 105 River St, Iowa City, IA 52242, USA
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2854
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Mohseni SM, Moez N, Naghizadeh MM, Abbasi M, Khodashenas Z. Correlation of random urinary protein to creatinine ratio in 24-hour urine samples of pregnant women with preeclampsia. J Family Reprod Health 2013; 7:95-101. [PMID: 24971109 PMCID: PMC4064777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine the value of random urinary protein to creatinine ratio (UPCR) for diagnosis of proteinuria in pregnant women with preeclampsia. Preeclampsia is the most common complication of pregnancy and one of the main causes of maternal mortality. So, early diagnosis of preeclampsia is very important. MATERIALS AND METHODS In this cross-sectional study 66 pregnant women suspected preeclampsia at ≥24 week of gestational age and BP ≥ 140/90 mm/Hg were checked by two urine samples of 10am and 4pm to determine random UPCR, as well as a 24-hour urine sample to evaluate 24-hour protein excretion. RESULTS The result revealed that 74.2% of the studied population had significant proteinuria. There was a correlation between UPCR and 24-hour urine protein excretion. Pearson's correlation coefficient was 0.502 at 10am and 0.428 at 4pm. The best cutoff for the random urine protein to creatinine ratio at 10am was 0.470 with sensitivity and specificity equal to 87.5% and 84.2%, respectively. The best cutoff for the random UPCR at 4pm was 0.595 with sensitivity and specificity equal to 91.7% and 94.7%, respectively. CONCLUSION Result of 24-hour urine collection showing random UPCR is considered as an appropriate situated method for emergency time.
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Affiliation(s)
- Sakineh Moaid Mohseni
- Department of Gynecology and Obstetrics, Shahed University of Medical Science Tehran, Iran
| | - Nafiseh Moez
- Shahed University of Medical Science, Tehran, Iran
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2855
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Errando CL, Pérez-Caballero P, Verdeguer-Ribes S, Vila-Montañés M. [Severe pre-eclampsia. An evidence-based practice proposal]. ACTA ACUST UNITED AC 2013; 60:371-83. [PMID: 23726726 DOI: 10.1016/j.redar.2013.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. MATERIAL AND METHODS A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. RESULTS A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. CONCLUSIONS Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Unversitario, Valencia, España.
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2856
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Rakova N, Muller DN, Staff AC, Luft FC, Dechend R. Novel ideas about salt, blood pressure, and pregnancy. J Reprod Immunol 2013; 101-102:135-139. [PMID: 23726817 DOI: 10.1016/j.jri.2013.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
The molecular mechanisms leading to preeclampsia are poorly understood. It has been related to certain immune mechanisms, as well as the pathological regulation of the renin-angiotensin system together with perturbed salt and plasma volume regulation. Finally, a non-specific, vascular, inflammatory response is generated, which leads to the clinical syndrome. Here, we present novel findings in salt (NaCl) metabolism implying that salt is not only important in blood pressure control and volume homeostasis, but also in immune regulation. Sodium and chloride can be stored without accumulation of water in the interstitium at hypertonic concentrations through interactions with proteoglycans. Macrophages in the interstitium act as osmosensors for salt, producing increased amounts of vascular endothelial factor C, which increases the density of the lymph-capillary network and the production of nitric oxide in vessels. An increased interstitial salt concentration activates the innate immune system, especially Th17 cells, and may be an important trigger for autoimmune diseases. The novel findings with the idea of sodium storage and local mechanisms of volume and immune regulation are appealing for preeclampsia and may unify the "immune" and "vascular" hypotheses of preeclampsia.
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Affiliation(s)
- Natalia Rakova
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Dominik N Muller
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Anne Cathrine Staff
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Ulleval, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany; HELIOS-Klinik, Berlin-Buch, Germany.
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2857
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Aref S, Goda H, Abdelaal E. Circulating Vascular Growth Factor (VEGF) Angiopoietin-1 (Angi-1) and Soluble Tie-2 Receptor in Pregnancy Complicated with Pre-eclampsia: A Prospective Study. J Obstet Gynaecol India 2013; 63:316-20. [PMID: 24431666 DOI: 10.1007/s13224-013-0388-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/27/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. Although the etiology of preeclampsia (PE) is still unclear, recent studies suggest that its major phenotypes, high blood pressure and proteinuria, are due in part to the disturbed angiogenic process. STUDY DESIGN This study included the following groups: (1) women with normal pregnancies (n = 150), (2) patients with PE (n = 88), and (3) patients who delivered small growth for date (SGA) neonate (n = 50). Maternal serum concentrations of VEGF, Angi-1, and sTie-2 were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. RESULTS The median maternal serum concentration of sVEGF and sAngi-1 was lower in normal pregnant women as compared to that in PE and SGA and the differences were statistically significant (P < 0.01). In contrast, there is a significant reduction in sTie-2 levels in PE and SGA groups as compared to that in normal pregnancy group (P < 0.01). Serum VEGF and Angi-1 were significantly higher in the late onset PE subgroup as compared to that in the early onset PE (P < 0.01), but sTie-2 was not significantly different in the 2 subgroups (P > 0.05). Serum VEGF, sAngi-1, and sTie-2 were significantly higher and Tie-2 was significantly lower in the severe PE subgroup as compared to that of the milder PE subgroup (P < 0.01 for all). CONCLUSION Patients with PE and those with SGA fetuses have lower median serum concentrations of sTie-2 and higher sVEGF and sAngi-1 than women with normal pregnancies. These findings lend support to the hypothesis that circulating angiogenic proteins may have an important biologic role in PE.
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Affiliation(s)
- Salah Aref
- Hematology Unit, Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Hosam Goda
- Obstetric and Gynacology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ebrahim Abdelaal
- Hematology Unit, Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
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2858
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Abstract
Background: During normal pregnancy, changes in thyroid function are well documented; however, information regarding thyroid function in preeclampsia is scanty. Aim: The present study was planned to study thyroid hormones in mild and severe preeclamptic women and normotensive women and correlate them with outcome of pregnancy. Subject and Methods: Thyroid hormones were analyzed in mild (n = 50) and severe (n = 50) cases of preeclamptic women and normotensive women (n = 100). Results: Thyroid-stimulating hormone (TSH) and TT4 levels were higher in mild preeclampsia as compared with severe preeclampsia (P < 0.001 and P < 0.01, respectively). TT3 levels were lower in preeclampsia (more so in severe preeclamptics as compared with normotensive pregnant and non-pregnant women). Preeclamptic with raised TSH levels had significantly higher mean arterial blood pressure and low birth weight (BW). A negative correlation was observed between BW and TSH levels (r = 0.296, P < 0.001) and BW and TT4 levels. A positive correlation was observed between BW and TT3 levels. Conclusion: These findings indicate that there is a state of biochemical hypothyroidism that correlates with severity of preeclampsia and influences obstetric outcome in these women. Identification of thyroid hormone in pregnancy might be of help in predicting occurrence of preeclampsia.
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Affiliation(s)
- S Kharb
- Department of Biochemistry, Pt. BDS PGIMS, Rohtak, India
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2859
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Kaneko Y, Yoshita K, Kabasawa H, Imai N, Ito Y, Ueno M, Nishi S, Narita I. A case of membranoproliferative glomerulonephritis developed over twenty years with three different findings of renal pathology. CEN Case Rep 2013; 2:76-83. [PMID: 28509225 DOI: 10.1007/s13730-012-0042-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022] Open
Abstract
A 31-year-old woman with proteinuria, hypocomplementemia, rheumatoid factor, and high serum polyclonal IgM concentration was admitted to our hospital for renal biopsy. She had a past history of two renal biopsies. When she was 12 years old, she developed proteinuria, microscopic hematuria, and hypocomplementemia. She was diagnosed as having 'IgM nephropathy' based on minor glomerular abnormalities as determined by light microscopy and IgM and C3 deposition in the mesangial region by immunofluorescence microscopy at the first biopsy. Despite corticosteroid treatment, her proteinuria did not improve and she discontinued regular outpatient checkups. When she was 29 years old and pregnant, she developed preeclampsia and, after delivery, a second renal biopsy was implemented. She was diagnosed as having progressed 'IgM nephropathy' with endotheliosis induced by preeclampsia. She was treated with angiotensin II receptor blocker and her proteinuria diminished; however, 1 year after the delivery, she developed proteinuria again, along with microscopic hematuria and hypocomplementemia. A third renal biopsy was conducted at 31 years of age and she was diagnosed as having membranoproliferative glomerulonephritis (MPGN) type I on the basis of diffuse mesangial proliferation, endocapillary hypercellularity with double contour of the capillary wall, and lobular formation in glomeruli, as determined by light microscopy. Immunofluorescence staining demonstrated deposits of C3, C4, C1q, and IgM in the mesangial region and capillary wall. She underwent corticosteroid therapy followed by normalization of urinalysis and serum complement level. Although she had initially been diagnosed with 'IgM nephropathy', she was finally diagnosed with secondary MPGN and was successfully treated by corticosteroid therapy.
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Affiliation(s)
- Yoshikatsu Kaneko
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
| | - Kazuhiro Yoshita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | | | - Naofumi Imai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Yumi Ito
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Mitsuhiro Ueno
- University Health Center, Joetsu University of Education, Joetsu, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
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2860
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Tayal D, Goswami B, Patra SK, Tripathi R, Khaneja A. Association of inflammatory cytokines, lipid peroxidation end products and nitric oxide with the clinical severity and fetal outcome in preeclampsia in Indian women. Indian J Clin Biochem 2013; 29:139-44. [PMID: 24757293 DOI: 10.1007/s12291-013-0320-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/24/2013] [Indexed: 11/25/2022]
Abstract
Preeclampsia is a multisystem disorder associated with maternal hypertension, placental abnormalities and adverse fetal outcomes. The various pathways involved in its etiology include endothelial dysfunction, inflammatory milieu, lipid peroxidation and immunological imbalance. The present study was conducted to evaluate the causative and predictive role of nitric oxide, lipid peroxidation end products (MDA) and inflammatory cytokines (IL-6, TNF-α) in clinical presentation, severity and fetal outcome in preeclampsia. The study population was divided into 3 groups- Non- pregnant females comprising the control population; G1 and G2 groups included normal pregnant and pregnant females with preeclampsia with 50 patients in each group. Nitric Oxide and MDA levels were found to be highest in the preeclamptic patients as compared to other two groups. ROC curve analysis shows the superiority of the inflammatory markers as determinants of severity of preeclampsia which suggests the emerging role of pro inflammatory markers in the various pathological changes in preeclampsia. TNF-α emerged as the best marker in multivariate analysis and thus, has the potential for being used as a marker for PIH. Our study illustrates the multifactorial etiology of preeclampsia involving oxidative stress, proinflammatory milieu and endothelial dysfunction.
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Affiliation(s)
- Devika Tayal
- Department of Biochemistry, Lala Ram Swaroop Institute, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - S K Patra
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Reva Tripathi
- Department of Obstetrics & Gynaecology, Maulana Azad Medical College & Associated LN Hospital, New Delhi, India
| | - Alka Khaneja
- Department of Biochemistry, Maulana Azad Medical College & Associated LN Hospital, New Delhi, India
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2861
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Rijvers CAH, Marzano S, Winkens B, Bakker JA, Kroon AA, Spaanderman MEA, Peeters LLH. Early-pregnancy asymmetric dimethylarginine (ADMA) levels in women prone to develop recurrent hypertension. Pregnancy Hypertens 2013; 3:118-23. [PMID: 26105948 DOI: 10.1016/j.preghy.2013.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/29/2012] [Accepted: 01/03/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate early-pregnancy levels of ADMA (asymmetric dimethylarginine) in recurrent hypertensive pregnancy. STUDY DESIGN In this retrospective observational study, blood samples from 35 normotensive women with a previous hypertensive pregnancy were obtained preconceptionally and at 12, 16 and 20weeks in their next pregnancy. We assessed ADMA, symmetric dimethylarginine (SDMA), l-arginine and l-citrulline. We analyzed differences in longitudinal patterns between normotensive (NT, n=18) and recurrent hypertensive (HT, n=17) pregnancies by linear mixed models, with a sub-analysis for preeclampsia (PE, n=6). MAIN OUTCOME MEASURES ADMA, SDMA, l-arginine and l-citrulline. RESULTS Pre-pregnant SDMA and l-citrulline were lower in HT. At 12weeks, ADMA and ADMA/SDMA ratio correlated inversely with PAPP-A and β-hCG, respectively. In both groups, ADMA-related compounds changed inconsistently with advancing (mid-trimester) pregnancy, although in HT, l-arginine tended to decrease between 16 and 20weeks, a decline consistent in PE. CONCLUSION These data support a modest role for ADMA and related metabolites in the pathogenesis of hypertensive pregnancy.
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Affiliation(s)
- C A H Rijvers
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - S Marzano
- Department of Obstetrics and Gynecology, Universita La Sapienza, 00185 Rome, Italy.
| | - B Winkens
- Department of Methodology and Statistics, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - J A Bakker
- Department of Clinical Genetics, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - A A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - L L H Peeters
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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2862
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Abstract
Pregnancy complications such as preeclampsia and diabetes affect approximately 5 to 10 % of all pregnancies and compromise maternal and fetal health during gestation. Complications during pregnancy may also contribute to the development of hypertension and future cardiovascular risk in the mother. Moreover, fetal exposure to hypertension and diabetes during pregnancy can program hypertension and cardiovascular disease in the offspring. Transgenerational transmission of programmed cardiovascular risk highlights the importance of understanding the mechanisms that link complications during pregnancy with later hypertension in her offspring and subsequent generations. However, experimental studies are needed to investigate the cause and effect of increased blood pressure in the mother following a complicated pregnancy and provide insight into the development of preventative measures that may improve the long-term cardiovascular health of women and their offspring.
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Affiliation(s)
- Suttira Intapad
- Department of Physiology and Biophysics and the Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS, 39216
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2863
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Abstract
This study aimed to investigate the implication of some apoptotic and lipid peroxidation markers in preeclampsia (PE). A total of 25 women with PE and 25 age- and parity-matched normal pregnant women were enrolled in this study. The malondialdehyde (MDA) level, caspase-9 activity and the percentage of DNA fragmentation were significantly higher in placental tissue of PE than in control women. The serum level of MDA was significantly elevated in women with PE having delivery by cesarean section (CS) than in women with PE having vaginal delivery. In vitro study demonstrated that the addition of 0.5 mM Fe(2+) and 0.1 mM ascorbate caused increase in the production of MDA level in placental tissue with PE than normal placentas, and vitamin E (100 µM) caused lower inhibition of in vitro lipid peroxidation in placental tissue with PE when compared with normal tissue. The activity of caspase-9 and percentage of DNA fragmentation were associated with the severity of the PE and both could differentiate between PE and control women with 88% and 100% sensitivity and 96% and 100% specificity, respectively. The activities of caspase-8 and/or -9 were positively correlated with the maternal age but only caspase-8 was negatively correlated with neonatal birth weight and placental weight. In conclusion, the elevations of MDA, caspase-9 activity and the percentage of DNA fragmentation in the placentas of women with PE implicate the involvement of lipid peroxidation and apoptosis in PE. The placenta represents a considerable source of the elevated circulating MDA in PE.
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Affiliation(s)
- O G Shaker
- 1Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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2864
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Tirosh D, Benshalom-Tirosh N, Novack L, Press F, Beer-Weisel R, Wiznitzer A, Mazor M, Erez O. Hypothyroidism and diabetes mellitus - a risky dual gestational endocrinopathy. PeerJ 2013; 1:e52. [PMID: 23638390 PMCID: PMC3628609 DOI: 10.7717/peerj.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/28/2013] [Indexed: 12/11/2022] Open
Abstract
Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome. Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296). Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84). Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.
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Affiliation(s)
- Dan Tirosh
- Department of Obstetrics & Gynecology, Soroka University Medical Center , Beer Sheva , Israel
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2865
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Shetty S, Patil R, Ghosh K. Role of microparticles in recurrent miscarriages and other adverse pregnancies: a review. Eur J Obstet Gynecol Reprod Biol 2013; 169:123-9. [PMID: 23490540 DOI: 10.1016/j.ejogrb.2013.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/22/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
The multiple functions attributed to microparticles (MPs) include blood coagulation, inflammation, tumorigenesis, angiogenesis, immunomodulatory functions and intercellular cross talk. These have drawn considerable interest during the last few years. The prothrombotic nature of MPs has linked them with almost all groups of thrombotic disorders including recurrent miscarriage (RM) and other abnormal pregnancy outcomes. Two authors (SS and RP) conducted a search independently on the computerized databases MEDLINE and EMBASE using relevant key words. Contradictory reports were observed on the association of MPs with RM. While most of the reports showed increased prevalence of MPs, both platelet and endothelial cell derived, in RM, some did not show any association. Almost all the reports showed a strong association of MPs with preeclampsia (PE), while the association with other adverse pregnancy conditions was not very conclusive. It may be concluded that MPs by themselves may result in adverse conditions or that they may be additive factors to an already existing prothrombotic state due to acquired or genetic thrombophilia or some unknown thrombophilic condition, besides the pre-existing hypercoagulable status of pregnancy.
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Affiliation(s)
- Shrimati Shetty
- National Institute of Immunohaematology (ICMR), 13th Floor, KEM Hospital, Parel, Mumbai, India.
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2866
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Abstract
We report a 42-year-old woman with underlying hypertension, mild renal dysfunction and proteinuria who presented as an obstetric emergency with uncontrolled hypertension and nephrotic syndrome. The rapid deterioration in her kidney function and worsening of her symptoms led to an urgent termination of her twin pregnancy. Although a clinical improvement was noticed within 10 days, the persistently elevated serum creatinine required further evaluation. A kidney biopsy showed changes consistent with acute tubular necrosis and resolving preeclampsia superimposed on focal segmental glomerulosclerosis and hypertensive kidney disease. The importance of a kidney biopsy in confirming clinical suspicions and determining patient prognosis is emphasized.
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Affiliation(s)
- Kiran Kandukurti
- Division of Nephrology, Department of Internal Medicine, State University of New York, Buffalo, N.Y., USA
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2867
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Chiba K, Yamada T, Kawaguchi S, Takeda M, Nishida R, Yamada T, Morikawa M, Minakami H. Clinical significance of proteinuria determined with dipstick test, edema, and weekly weight gain ⩾500g at antenatal visit. Pregnancy Hypertens 2013; 3:161-5. [PMID: 26106028 DOI: 10.1016/j.preghy.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine how urine dipstick test, edema, and/or excessive weight gain (EWG, defined as ⩾500g/week) at antenatal visits predict significant proteinuria (defined as a protein-to-creatinine ratio [P/Cr, mg/mg] ⩾0.27) and preeclampsia. METHODS Data from 3279 antenatal visits between 30 and 36weeks of gestation were studied in 783 women with singleton pregnancies. In 24 preeclamptic pregnancies, data from 89 antenatal visits at and before diagnosis of preeclampsia were used. Spot P/Cr was determined in women with repeated positive dipstick test results in two successive antenatal visits or in those with a positive dipstick test result tested in the presence of hypertension. RESULTS Proteinuria on dipstick test, edema, and EWG appeared often in both women with and without preeclampsia; 66.7% vs. 27.7%, 83.3% vs. 44.1%, and 91.7% vs. 81.6%, respectively. However, repeated positive dipstick test results in two successive antenatal visits yielded sensitivity of 45.5%, specificity of 95.2%, and positive and negative predictive values of 30.0% and 97.4%, respectively, for detection of significant proteinuria and corresponding figures of 33.3%, 94.1%, 14.0%, and 98.0% for prediction of preeclampsia. CONCLUSION Repeated positive dipstick test results in two successive antenatal visits warrant a need for a confirmation test of significant proteinuria.
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Affiliation(s)
- Kentaro Chiba
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Takashi Yamada
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Satoshi Kawaguchi
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Masamitsu Takeda
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Ryutaro Nishida
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
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2868
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Kim YJ. Pathogenesis and promising non-invasive markers for preeclampsia. Obstet Gynecol Sci 2013; 56:2-7. [PMID: 24327973 DOI: 10.5468/OGS.2013.56.1.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 11/24/2012] [Accepted: 11/24/2012] [Indexed: 01/15/2023] Open
Abstract
Preeclampsia is one of the leading causes of maternal mortality/morbidity and preterm delivery in the world, affecting 3% to 5% of pregnant women. The pathophysiology of preeclampsia likely involves both maternal and fetal/placental factors. Abnormalities in the development of placental vessels early in pregnancy may result in placental hypoperfusion, hypoxia, or ischemia. Hypoperfusion, hypoxia, and ischemia are critical components in the pathogenesis of preeclampsia because the hypoperfused placenta transfers many factors into maternal vessels that alter maternal endothelial cell function and lead to the systemic symptoms of preeclampsia. There are several hypotheses to explain the pathogenesis of preeclampsia, including altered angiogenic balance, circulating angiogenic factors (such as marinobufagenin, a bufadienolide trigger), and activation of the renin-angiotensin system. Epigenetically-modified cell-free nucleic acids that circulate in plasma and serum might be novel markers with promising non-invasive clinical applications in the diagnosis of preeclampsia.
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2869
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Yang GY, Lee KA, Park MH, Park HS, Ha EH, Chun SH, Kim YJ. Urinary nephrin: A new predictive marker for pregnancies with preeclampsia and small-for-gestational age infants. Obstet Gynecol Sci 2013; 56:22-8. [PMID: 24327976 DOI: 10.5468/OGS.2013.56.1.22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/18/2012] [Accepted: 10/11/2012] [Indexed: 12/13/2022] Open
Abstract
Objective The objective of this study was to determine the differences in urinary nephrin among controls, gravidas with preeclampsia (PE), and small-for-gestational age (SGA) infants. We also determined whether or not maternal urinary concentrations of nephrin are associated with the subsequent development of PE and SGA infants. Methods We analyzed maternal urinary levels of nephrin in women who were normal controls (n=50), women who were delivered SGA infants (n=40), and gravidas with PE (n=33) in the first, second and third trimesters. Urinary nephrin concentrations were measured with nephrin enzyme-linked immunosorbent assay kits. Results The levels of urinary nephrin were higher in gravida developing preeclampsia or SGA than in controls after adjusting serum creatinine (P<0.05 for both). Maternal urine concentrations of nephrin were higher in pregnancies complicated by SGA and PE in the third trimester (P<0.05), and also higher in pregnancies complicated by SGA in the first trimester (P<0.05). The sensitivity and specificity of nephrin in predicting SGA from normal pregnancies were 67% and 89% in the first trimester, 60% and 79% in the second trimester, and 80% and 84% in the third trimester, respectively. The sensitivity and specificity of nephrin in predicting PE from normal pregnancies were 67% and 83% in the first trimester and 73% and 79% in the third trimester, respectively. Conclusion We suggest that urinary nephrin can be used as an early marker in pregnancies at risk for developing PE and SGA infants.
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2870
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Park JH, Chung D, Cho HY, Kim YH, Son GH, Park YW, Kwon JY. Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia. Obstet Gynecol Sci 2013; 56:8-14. [PMID: 24327974 DOI: 10.5468/OGS.2013.56.1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/27/2012] [Accepted: 06/27/2012] [Indexed: 11/10/2022] Open
Abstract
Objective To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. Methods Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. Results Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (≥300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. Conclusion Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.
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2871
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Hamedi B, Shomali Z. Postpartum Spontaneous Rupture of Spleen in a Woman with Severe Preeclampsia: Case Report and Review of the Literature. Bull Emerg Trauma 2013; 1:46-48. [PMID: 27162822 PMCID: PMC4771243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 06/05/2023] Open
Abstract
Splenic rupture during pregnancy is considered a catastrophic condition associated with high maternal and fetal mortality and morbidity. Herein, we report a case of severe preeclampsia that underwent cesarean delivery with subsequent spontaneous splenic rupture. A 21-year-old primigravid woman was transferred to our center due to severe preeclampsia that underwent cesarean delivery because of uncontrolled blood pressure and low platelet count. She developed coffee ground vomiting postoperatively and clinical evidence of free fluid was present. Emergency laparotomy was performed and revealed an approximately 2.5-3 cm defect in splenic capsule with active bleeding from the ruptured site. The site of splenic laceration was packed with gauze. Postoperative period was uneventful and she was discharged on day 15 after admission. As spontaneous splenic rupture is associated with severe complications, its differential diagnosis should be kept in mind in pregnant women with severe preeclampsia.
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Affiliation(s)
| | - Zahra Shomali
- Corresponding author: Zahra Shomali ,Address: Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Zand Avenue, PO Box: 713451818 Shiraz, Iran. Tel: +98-917-1878020 Fax: +98-711-6483561. e-mail:
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2872
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OANCEA MIHAELADANIELA, COSTIN NICOLAE, POP DARIAMARIA, CIORTEA RAZVAN, MIHU DAN. Evaluation of serum β-hCG and PAPP-A levels in pregnant women at risk of developing preeclampsia. Clujul Med 2013; 86:347-51. [PMID: 26527976 PMCID: PMC4462458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIM Preeclampsia remains a major problem of modern obstetrics with insufficiently elucidated etiology; early detection would diminish maternal and fetal mortality and morbidity. The aim of this study was to determine the serum values of β-hCG in the first and second trimesters of pregnancy and PAPP-A values in the first trimester of pregnancy in pregnant women with risk factors for preeclampsia, in order to evaluate their relevance in the prediction of this disorder. MATERIAL AND METHODS We performed a prospective longitudinal study on 120 pregnant women divided into two groups according to the evolution of pregnancy: group I - 26 pregnant women who developed preeclampsia and group II - 94 pregnant women who did not develop preeclampsia and had a physiological evolution of pregnancy. RESULTS Our results indicate the association between high β-hCG levels in the first and second trimesters of pregnancy and the development of PE, β-hCG having the highest predictive power in the second trimester. We also obtained a positive association between low serum levels in PAPP-A in the first trimester and onset of PE. The predictive power of conjugated β-hCG and PAPP-A values in the first trimester of pregnancy was better that any other marker analyzed separately. CONCLUSIONS Increased β-hCG levels in the first and second trimesters of pregnancy and low PAPP-A levels in the second trimester of pregnancy are associated with a higher risk for PE, the study providing only a modest efficiency of the prediction capacity.
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2873
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Polavarapu SS, Parton LA, Maramreddy H, Hsu CD. Are placental Fas and Fas ligand gene polymorphisms associated with preeclampsia? Pregnancy Hypertens 2013; 3:34-8. [PMID: 26105738 DOI: 10.1016/j.preghy.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 07/25/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Increased placental trophoblastic apoptosis has been reported in pregnancies complicated by preeclampsia. Fas-Fas ligand is one of the major signal transduction pathways of apoptosis. The objective of this study was to determine if placental Fas and Fas ligand gene polymorphisms differ between patients with and without preeclampsia. STUDY DESIGN Forty-five singleton placentas were studied. Twenty-three placentas were from preeclamptic pregnancies and 22 were from normotensive controls. Genotyping was performed for Fas-1377, Fas-691, Fas-670, Fas ligand-844, Fas ligand-1174, Fas ligand-2777. Chi-square and Fisher's exact tests were used for statistical analysis. RESULTS There were no significant differences in maternal age, parity or race between the two groups. There were no significant differences in genotypes or allele frequencies for the Fas-1377, Fas-691, Fas-670, Fas ligand-844, Fas ligand-1174 and Fas ligand-2777. CONCLUSION Immune intolerance of maternal and placental interaction plays an important role in the pathogenesis of preeclampsia. Our findings do not support the role of placental Fas and Fas ligand gene polymorphisms in the pathogenesis of preeclampsia.
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Affiliation(s)
- Satya S Polavarapu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Westchester Medical Center, United States.
| | - Lance A Parton
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States
| | - Hima Maramreddy
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States
| | - Chaur-Dong Hsu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Westchester Medical Center, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Nassau University Medical Center, United States
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2874
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Sowmya S, Ramaiah A, Sunitha T, Nallari P, Jyothy A, Venkateshwari A. Evaluation of Interleukin-10 (G-1082A) Promoter Polymorphism in Preeclampsia. J Reprod Infertil 2013; 14:62-6. [PMID: 23926566 PMCID: PMC3719316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/17/2012] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific syndrome that may be life-threatening, especially to the fetus. Several causes have been reported that may have a possible role in the development of the disorder. Interleukin-10 affect maternal intravascular inflammation, as well as endothelial dysfunction. The aim of this study was to investigate the association between IL-10 G-1082A polymorphism and preeclampsia. METHODS A total of eighty-eight pregnant women with preeclampsia and 100 women with normal pregnancy attending the Gynecological unit of Government Maternity Hospital, Petlaburz, Hyderabad, India, were considered for the study. A standard amplification refractory mutation system (ARMS) PCR was carried out for genotyping IL-10 G-1082A promoter polymorphism in all the participants. Genotypic distribution of the control and patient groups were compared with values predicted by Hardy-Weinberg equilibrium using χ(2) test. Odd ratios (OR) and their respective 95% confidence intervals were used to measure the strength of association between IL-10 gene polymorphism and preeclampsia. RESULTS The frequencies of IL-10 G-1082A genotypes, GG, GA and AA, were 17.8%, 41.09% and 41.09% in women with preeclampsia and 25%, 28% and 47% in the controls respectively. There was no significant difference in the distribution of genotypes and alleles of IL-10 G-1082A between the two groups (Test power=0.66). CONCLUSION The present study suggests that the IL-10 G-1082A gene promoter polymorphism is not a major genetic regulator in the etiology of preeclampsia.
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Affiliation(s)
- Sabnavis Sowmya
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, India
| | - Aruna Ramaiah
- Government Maternity Hospital, Petlaburz, Hyderabad, India
| | - Tella Sunitha
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, India
| | | | - Akka Jyothy
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, India
| | - Ananthapur Venkateshwari
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, India,Corresponding Author: Ananthapur Venkateshwari, Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500 016, India. E-mail:
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2875
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Jacquemyn Y. Why hypertension is good new and preeclampsia bad news-demonstrating the failure of prevention. World J Obstet Gynecol 2012; 1:40-41. [DOI: 10.5317/wjog.v1.i4.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypertensive disorders in pregnancy continue to be an intriguing and potentially lethal complication in humans and some other primates. In a simplistic way the current hypothesis is that the genesis of preeclampsia starts at 12 to 14 wk gestation with failure of trophoblast invasion in the spiral arteries, resulting in some degree of hypoxemia in the placenta. The hypoperfused placental tissue starts to secrete variable amounts of angiogenic and antiangiogenic factors which eventually cause endothelial damage all over the pregnant women’s body with one of the many signs of preeclampsia as the clinical endpoint. For some incomprehensible reason a major interest has existed for decades concerning the early prediction of preeclampsia, most commonly tested using uterine artery Doppler (the earlier the better) and various serum markers, alone or in combination. Any new model for detection has been welcomed enthusiastically, although nothing has changed in the outcome of women presenting with preeclampsia.
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2876
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Shahvaisizadeh F, Movafagh A, Omrani MD, Vaisi-Raygani A, Rahimi Z, Rahimi Z. Synergistic effects of angiotensinogen -217 G→A and T704C (M235T) variants on the risk of severe preeclampsia. J Renin Angiotensin Aldosterone Syst 2012. [PMID: 23178514 DOI: 10.1177/1470320312467555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The rate-limiting step of the renin-angiotensin system is the enzymatic cleavage of angiotensinogen (AGT) by renin. The aims of the present study were to investigate the association between AGT T704C (M235T) and -217 G→A polymorphisms with the risk of preeclampsia and synergistic effects of both polymorphisms on the susceptibility to preeclampsia. METHODS We studied AGT variants in 170 women with preeclampsia, including 84 women with mild and 86 women with severe forms of preeclampsia, and 100 age and parity matched controls. RESULTS There was a trend towards increased risk of severe preeclampsia in the presence of -217 AA (odds ratio (OR)=1.5, 95% confidence interval (CI)= 0.38-5.84, p=0.57) and TC+CC genotypes (OR=1.32, 95% CI= 0.67-2.58, p=0.42). However, the interaction of both alleles of -217A and 704C highly increased the risk of severe preeclampsia, by 2.23-fold, although this did not reach statistical significance. The frequency of the CC genotype of the T704C polymorphism in early-onset preeclampsia tended to be higher (35%) compared with that in patients with late-onset preeclampsia (21.7%). CONCLUSIONS The present study demonstrates that both variants of AGT -217 G→A and T704C might work in synergism to influence the risk of severe preeclampsia, which needs to be confirmed in studies with larger sample size.
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Affiliation(s)
- Farhad Shahvaisizadeh
- Department of Medical Genetics, Medical School, Shahid Beheshti University of Medical Sciences, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, Medical School, Shahid Beheshti University of Medical Sciences, Iran
| | - Mir Davood Omrani
- Department of Medical Genetics, Medical School, Shahid Beheshti University of Medical Sciences, Iran
| | - Asad Vaisi-Raygani
- Department of Biochemistry, Medical School, Kermanshah University of Medical Sciences, Iran
| | - Ziba Rahimi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Iran
| | - Zohreh Rahimi
- Department of Biochemistry, Medical School, Kermanshah University of Medical Sciences, Iran Medical Biology Research Center, Kermanshah University of Medical Sciences, Iran
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2877
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Dover N, Gulerman HC, Celen S, Kahyaoglu S, Yenicesu O. Placental growth factor: as an early second trimester predictive marker for preeclampsia in normal and high-risk pregnancies in a Turkish population. J Obstet Gynaecol India 2012; 63:158-63. [PMID: 24431629 DOI: 10.1007/s13224-012-0279-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 07/24/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test. MATERIALS AND METHODS In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group. RESULTS In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml. CONCLUSION Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.
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Affiliation(s)
- Necmiye Dover
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpaşa Bulvarı, Samanpazarı, Ankara, Turkey
| | - Hacer C Gulerman
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpaşa Bulvarı, Samanpazarı, Ankara, Turkey
| | - Sevki Celen
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpaşa Bulvarı, Samanpazarı, Ankara, Turkey
| | - Serkan Kahyaoglu
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpaşa Bulvarı, Samanpazarı, Ankara, Turkey
| | - Okan Yenicesu
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpaşa Bulvarı, Samanpazarı, Ankara, Turkey
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2878
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Euser AG, Wiegman MJ, Cantineau AEP, Zeeman GG. Flash pulmonary edema during cesarean section in a woman with preeclampsia. Pregnancy Hypertens 2012; 2:371-3. [PMID: 26105605 DOI: 10.1016/j.preghy.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pulmonary edema may complicate preeclampsia. We report intraoperative flash pulmonary edema in a preeclamptic woman with Rendu-Osler-Weber syndrome. CASE The patient was admitted at 33(+6) weeks gestation with preeclampsia. After rapid sequence induction and endotracheal intubation for cesarean section, flash pulmonary edema developed without evidence of cardiac dysfunction. She was mechanically ventilated and treated with furosemide. Following brisk diuresis she was extubated the next day and discharged on postoperative day 9 in good clinical condition. CONCLUSION Endotracheal intubation for general anesthesia can cause acutely increased blood pressure, which, with concomitant low oncotic pressure, we believe contributed to intraoperative flash pulmonary edema. We present this case to raise awareness of this complication when general anesthesia is used for cesarean section in preeclampsia.
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Affiliation(s)
- Anna G Euser
- University Medical Center Groningen, Department of Obstetrics and Gynecology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Marjon J Wiegman
- University Medical Center Groningen, Department of Obstetrics and Gynecology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Astrid E P Cantineau
- University Medical Center Groningen, Department of Obstetrics and Gynecology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Gerda G Zeeman
- University Medical Center Groningen, Department of Obstetrics and Gynecology, Hanzeplein 1, 9700 RB Groningen, The Netherlands; Erasmus Medical Center Rotterdam, Department of Obstetrics and Gynecology, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
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2879
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Kakkar T, Singh V, Razdan R, Digra SK, Gupta A, Kakkar M. Placental laterality as a predictor for development of preeclampsia. J Obstet Gynaecol India 2013; 63:22-5. [PMID: 24431595 DOI: 10.1007/s13224-012-0241-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 06/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To find whether placental laterality as determined by ultrasound can be used as predictor for the development of preeclampsia. METHODS This prospective study was conducted in the Department of Obstetrics and Gynecology, Govt. Medical College, Jammu from 2006 to 2007. 150 pregnant women attending antenatal clinic both OPD and IPD at 18-24 weeks of gestation without any high risk factor were subjected to ultrasound examination, and placental location was determined. These cases were followed for the development of signs and symptoms of preeclampsia. RESULT Out of the total 150 women, 84 (56 %) had laterally located placenta and of them, 56 (66.6 %) developed preeclampsia, while the remaining 66 (44 %) had centrally located placenta and of them, 24 (36.3 %) developed preeclampsia. So, the overall risk of developing preeclampsia with laterally located placenta was 5.09 (odds ratio) and 95 % confidence interval (2.40-10.88). The difference was found to be statistically significant, p value (0.00002) by χ(2) test. CONCLUSION From the above study, we concluded that females with laterally located placenta determined by USG at 18-24 weeks of gestation have five times greater risk of developing preeclampsia.
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2880
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Elsen C, Rivas-Echeverría C, Sahland K, Sánchez R, Molma L, Pahl L, Wallinger R, Volz J, Wacker J, Frühauf J. Vitamins E, A and B 2 as Possible Risk Factors for Preeclampsia - under Consideration of the PROPER Study ("Prevention of Preeclampsia by High-Dose Riboflavin Supplementation"). Geburtshilfe Frauenheilkd 2012; 72:846-852. [PMID: 25308984 PMCID: PMC4168367 DOI: 10.1055/s-0032-1315365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/12/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022] Open
Abstract
In the course of the prospective, randomized, double-blind trial the influence of a high-dose riboflavin substitution on the risk for preeclampsia was studied in a high-risk collective 1. The present contribution evaluates supplementary data from the already published PROPER trial. The patients were from the two study centers Mérida, Venezuela, and Moshi, Tanzania, they were randomized from the 20th week of pregnancy and received either 15 mg riboflavin daily or placebo. Clinical and laboratory checks were carried out at four-week intervals up to childbirth. Concerning the question of whether there is a relationship between the serum levels of antioxidative vitamins and the risk of developing preeclampsia, it was found that no relationship could be detected between the measured laboratory values of vitamins E, A and B2 and the total risk of developing a hypertensive disease of pregnancy. On comparisons between patients with severe preeclampsia, those with a mild form, and the general healthy population, however, significant differences in the levels of antioxidative vitamins E and A as well as the FAD level were seen. The patients from Tanzania showed on the whole significantly lower vitamin levels than those from Venezuela, possibly due to the better nutritional situation in Venezuela. Considering the results altogether, the role of antioxidative parameters in the pathophysiology of preeclampsia remains unclear. However, the collected data provide valuable hints for future preventative strategies.
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Affiliation(s)
- C. Elsen
- Frauenklinik, St. Josefs-Hospital Wiesbaden, Wiesbaden
| | | | - K. Sahland
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - R. Sánchez
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - L. Molma
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - L. Pahl
- Kilimanjaro Christian Medical Center (KCMC), Moshi, United Republic of Tanzania
| | - R. Wallinger
- Kilimanjaro Christian Medical Center (KCMC), Moshi, United Republic of Tanzania
| | - J. Volz
- Frauenklinik, Klinikum Bielefeld, Bielefeld
| | - J. Wacker
- Frauenklinik, Fürst-Stirum-Klinik Bruchsal, Bruchsal
| | - J. Frühauf
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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2881
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Bhattacharyya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk and low-risk women. J Obstet Gynaecol India 2012; 62:297-300. [PMID: 23730033 DOI: 10.1007/s13224-012-0219-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/01/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To observe the role of uterine artery Doppler flow velocimetry at midtrimester in prediction of preeclampsia. METHOD 179 women carrying <16 weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24-26 weeks. Any notch in uterine artery, unilateral or bilateral, or RI > 0.6, was considered abnormal. Women were followed up and development of preeclampsia noted. RESULT Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48 % in high-risk and 57.14 and 95.83 % in low-risk group, respectively. Relative risk with 95 % confidence interval was 5.427 (2.272-12.958) in high-risk and 13.65 (5.669-32.865) in low-risk women. CONCLUSION Doppler velocimetry of uterine artery at 24 weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.
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2882
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Pal A, Roy D, Adhikary S, Roy A, Dasgupta M, Mandal AK. A prospective study for the prediction of preeclampsia with urinary calcium level. J Obstet Gynaecol India 2012; 62:312-6. [PMID: 23730036 DOI: 10.1007/s13224-012-0223-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 06/04/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To assess the efficacy of calciuria as a diagnostic test for the prediction of preeclampsia, and also to determine the changes in urinary excretion of calcium in preeclampsia and normotensive women. METHODS A prospective study was conducted on 60 primi mothers in the age group of 20-30 years, and all were enrolled at 16 weeks of gestation with clinical follow up by 4 weeks and 24 h urinary calcium and creatinine estimation. Ten mothers developed preeclampsia (study groups) and fifty remained normotensive (control groups). By means of Receiver-operator curve, a cut-off level of urinary calcium in 24 h was chosen for predicting preeclampsia. RESULTS Preeclamptic women excreted significantly less total urine calcium (87.0 ± 3.59 mg/24 h) than normotensive women (303.68 ± 17.699 mg/24 h) (p < 0.0001) at 40 weeks of gestation. Urinary calcium and calcium/creatinine (Ca:Cr) ratio decreases progressively from 28 weeks to 40 weeks in the study group when compared to normotensive group. CONCLUSIONS Preeclamptic women excrete less calcium than normotensive women. This parameter would predict preeclampsia earlier in pregnancy.
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Affiliation(s)
- Amitava Pal
- Department of Gynecology and Obstetrics, Burdwan Medical College, Burdwan, India
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2883
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Rangasamy S, Rao A. Replacing 24-h Albumin Excretion with a Shorter Collection Period in Preeclampsia. J Obstet Gynaecol India 2012; 62:424-8. [PMID: 23904703 PMCID: PMC3500938 DOI: 10.1007/s13224-012-0299-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 08/07/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate whether the gold standard of 24-h urinary albumin excretion in preeclamptic women could be substituted by a shorter collection period. METHODS From each woman, three spot, two 12-h, and one 24-h urine samples were collected. For each sample, urine albumin concentrations in milligram per liter were analyzed by the immunoturbidimetric method. The albumin concentrations in the spot and 12-h collections (day and night) were compared with the 24-h urine collection. RESULTS Albumin concentrations in both 12-h collections were fitted closely with the concentrations of the 24-h collection. The median difference between the 24-h collection and the day collection was 43 mg/L and the correlation coefficient was 0.96 (p < 0.0001). The median difference between the night collection and the 24-h collection was -31 mg/L and the correlation coefficient was 0.98 (p < 0.0001). CONCLUSION The gold standard of 24-h urinary albumin concentrations in preeclamptic women can be substituted with a 12-h collection. Spot samples were weaker as compared to the 12-h collection.
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Affiliation(s)
- Savitha Rangasamy
- Department of Obstetrics and Gynecology, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
- Prabhu Polyclinic, 95, New Scheme Road, Pollachi, 642002 Tamil Nadu India
| | - Arun Rao
- Department of Obstetrics and Gynecology, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
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2884
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Rahimi Z, Rahimi Z, Mozafari H, Parsian A. Preeclampsia and angiotensin converting enzyme (ACE) I/D and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms: association with ACE I/D polymorphism. J Renin Angiotensin Aldosterone Syst 2012; 14:174-80. [PMID: 22719026 DOI: 10.1177/1470320312448950] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of the present study was to investigate the association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms with the risk of preeclampsia and lipid peroxidation in preeclamptic women from Western Iran. METHODS One hundred and ninety-eight preeclamptic women (128 women with mild and 70 with severe forms) and 100 age- and parity-matched controls were enrolled in this case-control study. RESULTS The presence of D allele of ACE was associated with a 1.8-fold increased risk of preeclampsia (p=0.002) in total preeclamptic patients. The frequency of AT1R AC+CC genotypes was higher in mild preeclamptic women (32%) compared to controls (27.2%) (p>0.05). In mild preeclamptic women with ID genotype, the level of total antioxidant capacity (TAC) was significantly decreased compared to those with II genotype. Also, there was a trend toward increasing malondialdehyde (MDA) and decreasing TAC levels in mild and severe preeclamptic women with AT1R AA through CC genotypes. CONCLUSIONS Our study indicates that lipid peroxidation and oxidative stress are involved in the development of preeclampsia that might be influenced by polymorphism in the renin-angiotensin-aldosterone system genes.
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Affiliation(s)
- Zohreh Rahimi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Iran.
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2885
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Das B, Saha-Roy S, Das Gupta A, Lahiri TK, Das HN. Assessment of placental oxidative stress in pre-eclampsia. J Obstet Gynaecol India 2012; 62:39-42. [PMID: 23372288 DOI: 10.1007/s13224-012-0150-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/17/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To study oxidative stress in placental tissue as well as in serum in pre-eclamptic women. METHODS Fifty pre-eclamptic cases and fifty normal pregnant women were selected in the study. Thio barbituric acid reacting substances (TBARS) was measured as oxidative stress marker and superoxide dismutase (SOD) and GSH (reduced glutathione) were measured for assessment of antioxidant status in placental tissue extract and serum. RESULTS TBARS and SOD activity were increased significantly (P < 0.001) in both placental homogenate and serum in pre-eclamptic women. Level of GSH was not altered much. CONCLUSION Placental oxidative stress can be assessed by measuring serum oxidative stress markers and this may help in prevention of further progress of this condition.
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2886
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Abu Samra K. The eye and visual system in the preeclampsia/eclampsia syndrome: What to expect? Saudi J Ophthalmol 2012; 27:51-3. [PMID: 23964188 DOI: 10.1016/j.sjopt.2012.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/14/2012] [Indexed: 10/28/2022] Open
Abstract
The preeclampsia/eclampsia syndrome is a multisystem disorder that can include cardiovascular changes, hematologic abnormalities, hepatic and renal impairment, and neurologic or cerebral manifestations. It also can affect the eye and visual pathways. Visual symptoms concern up to 25% of patients with severe preeclampsia and 50% of patients with eclampsia. This review discusses the ophthalmic complications of preeclampsia/eclampsia with focus on the hypertensive retinopathy, exudative retinal detachment and cortical blindness.
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Affiliation(s)
- Khawla Abu Samra
- Ross Eye Institute, 1176 Main Street, Buffalo, NY 14209, United States
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2887
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Abstract
OBJECTIVES To evaluate the parameters of oxidative stress and anti oxidant defense in preeclampsia and thereby find any etiological correlation. METHODS Study was carried out on pregnant and non pregnant women attending or admitted in the Obstetrics and Gynecology Department of SSG Hospital, Baroda between 1st June 2007 to 31st May 2008. Each serum sample from different groups was evaluated for malondialdehyde (MDA), a product of lipid peroxidation process as a marker for oxidative stress and reduced Glutathione, Superoxide Dismutase, and Catalase for antioxidant enzyme activity and a comparison drawn and analyzed using t-test and χ(2) test. RESULTS The levels of MDA (a lipid peroxidation product) increased significantly in pregnancy compared to non-pregnant females and further significantly increased in preeclampsia compared to normal pregnant females. The superoxide dismutase levels, catalase levels and vit-E levels were found to be increased in preeclamptic females as compared to normal pregnant females. CONCLUSION Preeclampsia is found to be a condition with markedly increased oxidative stress as is evidenced by highly significantly increased levels of MDA, a marker of lipid peroxidation. Levels of antioxidant enzymes, viz. reduced glutathione, superoxide dismutase, catalase and vitamin E have been found to be increased in preeclampsia as compared to normal pregnant females. This may be a compensatory mechanism for handling the increased oxidative stress.
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Affiliation(s)
- J T Gohil
- Shri Sayaji General Hospital, Baroda, India
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2888
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ALTUNTAŞ E, YENICESU A, MUTLU A, MUDERRIS S, ÇETIN M, ÇETIN A. An evaluation of the effects of hypertension during pregnancy on postpartum hearing as measured by transient-evoked otoacoustic emissions. Acta Otorhinolaryngol Ital 2012; 32:31-6. [PMID: 22500064 PMCID: PMC3324967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/02/2011] [Indexed: 11/21/2022]
Abstract
The aim of this study was to compare the ratio of hearing loss evaluated with transient evoked otoacoustic emission (TEOAEs) testing in normal and hypertensive pregnant women during the first week after delivery. This was a prospective, case-control study. The hypertensive pregnancy group included 96 women with gestational hypertension preeclampsia, eclampsia, or HELLP syndrome, while the normal pregnancy group included age-matched 107 women with normal pregnancy. Postpartum first week, pure tone hearing threshold levels of all women were measured at 0.25, 1, 2, 4 and 6 kHz. TEOAEs testing results were also recorded. All subjects also underwent a detailed ear noise and throat examination. Hearing loss with TEOAE during the first postpartum week was detected in seven (7.3%) women in the hypertensive pregnancy group and in three (2.8%) women in normal pregnancy group. Mean hearing thresholds and individual thresholds at each of the examined frequencies (0.25-6 kHz) were similar in the two groups. Bone and air conduction pure tone average and TEOAE results were not statistically significantly different in the hypertensive pregnancy and normal pregnancy groups. Lastly, the ratios of hearing loss with TEOAE were significantly higher in women with HELLP syndrome compared to women with severe and mild preeclampsia.
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Affiliation(s)
- E.E. ALTUNTAŞ
- Address for correspondence: Emine Elif Altuntaş MD, Cumhuriyet University Faculty of Medicine, Department of Otorhinolaryngology Sivas, Turkey. Tel. +90 532 6438887. Fax +90 346 2581300. E-mail:
| | - A.G.I. YENICESU
- Department of Obstetrics and Gynecology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - A.E. MUTLU
- Department of Obstetrics and Gynecology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | | | - M. ÇETIN
- Department of Obstetrics and Gynecology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - A. ÇETIN
- Department of Obstetrics and Gynecology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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2889
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Pisani I, Tiralongo GM, Gagliardi G, Scala RL, Todde C, Frigo MG, Valensise H. The maternal cardiovascular effect of carbetocin compared to oxytocin in women undergoing caesarean section. Pregnancy Hypertens 2012; 2:139-42. [PMID: 26105099 DOI: 10.1016/j.preghy.2012.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/24/2011] [Accepted: 01/17/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare haemodynamic changes, measured noninvasively using the USCOM monitor, after combined spino-epidural anaesthesia and after administration of two different uterotonic drugs, oxytocin and carbetocin, in a population of pregnant women during elective caesarean delivery. METHODS Haemodynamic measurements were obtained with the USCOM system, by positioning a probe at maternal suprasternal notch (SSN) until the aortic valve flow's profile was optimally identified. Evaluations of the haemodynamic profile were obtained in seven different moments: before anaesthesia; during skin incision; 60, 180 and 300s after administration of uterotonic drug, at closure of the uterus, at closure of the skin. Doses of uterotonic drugs were: Oxytocin 5UI in 500cc NaCl eV, Carbetocin 100mcg in bolus eV. Main measured parameters were: heart rate, mean blood pressure, stroke volume, cardiac output and total vascular resistance. RESULTS We enrolled 32 pregnant women. Patients were randomized in two groups: oxytocin and carbetocin. A reduction in mean blood pressure, a reduction of total vascular resistance and an increase of cardiac output and of stroke volume were seen, while heart rate values remained stable in both treatment groups. No statistically significant differences were found. DISCUSSION Administration of carbetocin is associated with a substantial global haemodynamic stability in patients undergoing elective caesarean section without any difference with oxytocin. This observation allows us to consider carbetocin comparable to oxytocin, with minimum haemodynamic impact on the maternal circulation. This minimal effect on global haemodynamic stability might extend the use of this uterotonic drug in patients at high haemorrhagic risk with preeclampsia.
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Affiliation(s)
- I Pisani
- Department of Obstetrics and Gynecology, University of Tor Vergata, Rome, Italy.
| | - G M Tiralongo
- Department of Obstetrics and Gynecology, University of Tor Vergata, Rome, Italy
| | - G Gagliardi
- Department of Obstetrics and Gynecology, University of Tor Vergata, Rome, Italy
| | - R L Scala
- Department of Obstetrics and Gynecology, University of Tor Vergata, Rome, Italy
| | - C Todde
- UOS Anesthesia and Reanimation in Obstetrics and Gynecology, Fatebenefratelli San Giovanni Calibita Hospital, Rome, Italy
| | - M G Frigo
- UOS Anesthesia and Reanimation in Obstetrics and Gynecology, Fatebenefratelli San Giovanni Calibita Hospital, Rome, Italy
| | - H Valensise
- Department of Obstetrics and Gynecology, University of Tor Vergata, Rome, Italy
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2890
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Abstract
OBJECTIVES To correlate the severity of the disease, maternal and perinatal outcome with Lactic Dehydrogenase (LDH) levels in serum in patients of preeclampsia and eclampsia. METHODS A prospective comparative study was conducted in the department of Obstetrics and Gynecology in the collaboration with department of Pathology, CSM Medical University, Lucknow. Out of 146 women studied, 39 were normal pregnant women, 35 were of mild preeclampsia, 36 of severe preeclampsia and 36 of eclampsia. The statistical analysis was done by Chi-square test (for proportional data) analysis of variance and sample "t" test (for parametric data). RESULTS LDH levels were significantly elevated in women with preeclampsia and eclampsia (<0.001). Higher LDH levels had significant correlation with high blood pressure (P < 0.10) as well as poor maternal and perinatal outcome. CONCLUSION High serum LDH levels correlate well with the severity of the disease and poor outcomes in patients of preeclampsia and eclampsia.
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Affiliation(s)
- S P Jaiswar
- Department of Obstetrics and Gynecology, Queen Mary Hospital, CSMMU, Lucknow, UP India
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2891
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Huang Q, Gao Y, Yu Y, Wang W, Wang S, Zhong M. Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia. Rev Obstet Gynecol 2012; 5:9-15. [PMID: 22582122 PMCID: PMC3349919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To assess whether a single urinary spot urinary albumin:creatinine ratio (ACR) can be used to estimate 24-hour urinary protein excretion in women with preeclampsia. METHODS ACR and 24-hour urinary protein excretion were measured in 50 consecutive patients with preeclampsia. ACR was determined in a spot midstream urine sample and the amount of protein excretion was quantified in a 24-hour urine collection performed the following day. The correlation between the spot ACR and 24-hour urine protein excretion was assessed, and the diagnostic value of ACR was expressed in terms of specificity and sensitivity. Receiver operating characteristic curve analysis was used to determine the best cutoff values of the spot ACR for mild preeclampsia (proteinuria ≥ 0.3 g/24 h) and severe preeclampsia (defined in China as proteinuria ≥ 2 g/24 h). RESULTS A strong correlation was evident between the spot ACR and 24-hour urinary protein excretion (r = .938; P < .001). The optimal spot ACR cutoff point was 22.8 mg/mmol for 0.3 g/24 h of protein excretion (mild preeclampsia) with a sensitivity and specificity of 82.4% and 99.4%, respectively, and 155.6 mg/mmol for 2 g/24 h of protein excretion (severe preeclampsia) with a sensitivity and specificity of 90.6% and 99.6%, respectively. CONCLUSIONS Compared with 24-hour urinary protein excretion, the spot urinary ACR may be a simple, convenient, and accurate indicator of significant proteinuria in women with preeclampsia.
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Affiliation(s)
- Qitao Huang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
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2892
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Khadem N, Ayatollahi H, Vahid Roodsari F, Ayati S, Dalili E, Shahabian M, Mohajeri T, Shakeri MT. Comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. Iran J Reprod Med 2012; 10:47-52. [PMID: 25242974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 04/30/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The physiological changes in thyroid gland during pregnancy have been suggested as one of the pathophysiologic causes of preeclampsia. OBJECTIVE The aim of this study was comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. MATERIALS AND METHODS In this case-control study, 40 normal pregnant women and 40 cases of preeclampsia in third trimester of pregnancy were evaluated. They were compared for serum levels of Free T3 (FT3), Free T4 (FT4) and TSH. The data was analyzed by SPSS software with the use of t-student, Chi-square, Independent sample T-test and Bivariate correlation test. p≤0.05 was considered statistically significant. RESULTS The mean age was not statistically different between two groups (p=0.297). No significant difference was observed in terms of parity between two groups (p=0.206). Normal pregnant women were not significantly different from preeclampsia cases in the view of FT3 level (1.38 pg/ml vs. 1.41 pg/ml, p=0.803), FT4 level (0.95 pg/ml vs. 0.96 pg/ml, p=0.834) and TSH level (3.51 μIU/ml vs. 3.10 μIU/ml, p=0.386). CONCLUSION The findings of the present study do not support the hypothesis that changes in FT3, FT4 and TSH levels could be possible etiology of preeclampsia.
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2893
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Sadat Z, Abedzadeh Kalahroudi M, Saberi F. The effect of short duration sperm exposure on development of preeclampsia in primigravid women. Iran Red Crescent Med J 2012; 14:20-4. [PMID: 22737549 PMCID: PMC3372022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 05/09/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Preeclampsia is one of the most serious complications, and affecting about 3% of pregnancies. The aim of this study was to estimate the impact short duration of exposure to sperm on development of preeclampsia. METHODS The duration of sperm exposure with the biological father (cohabitation without barrier methods) <3, <6 months were evaluated among 120 primigravid women with preeclampsia and 120 women without preeclampsia in a case-control study. RESULTS The short duration of exposure to sperm was more common in women with preeclampsia compared with controls (29.2 versus 14.2 for <3 months, adjOR 2.6 (95% CI=1.32-5.13) and (45 versus 29.2 for <6 months, adjOR 2.4 (95% CI=1.35-4.32). Regardless of the contraceptive method, short duration of cohabitation was more common in preeclamptic group (14.2 versus 5.8 for <3 months, adjOR 3.38 (95% CI=1.28-8.92) and (29.7 versus 13.3 for <6 months, adjOR 2.64(95% CI=1.24-5.79). CONCLUSION It was concluded that short duration of exposure to sperm was more common in women with preeclampsia compared with controls.
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Affiliation(s)
- Z Sadat
- Trauma Research Center, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - M Abedzadeh Kalahroudi
- Trauma Research Center, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran,Correspondence: Masoumeh Abedzadeh Kalahroudi, MSc, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran. Tel.: +98-361-5550021, Fax: +98-361-5556633, E-mail:
| | - F Saberi
- Department of Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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2894
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Mehrabian F, Jazi SMH, Javanmard SH, Kaviani M, Homayouni V. Circulating endothelial cells (CECs) and E-selectin: Predictors of preeclampsia. J Res Med Sci 2012; 17:15-21. [PMID: 23248652 PMCID: PMC3523433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 12/19/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Circulating endothelial cells (CECs) and E-selectin are known as sensitive and specific markers of endothelial dysfunction. This study investigated whether CECs and E-selectin are surrogate biomarkers of preeclampsia and if measurement of CECs and E-selectin, early in the third trimester, could be a means of predicting preeclampsia. METHODS In this prospective, descriptive-analytic study, rollover test was performed on 523 pregnant women during 28-30 weeks of gestation. CECs were measured by anti-CD 146-driven immunomagnetic isolation in women with positive rollover test. They were followed up prospectively until delivery without any active intervention. Women with and without preeclampsia were determined. The number of CECs and level of E-selectin were compared in the two studied groups. RESULTS From the 47 pregnant women with positive rollover test who were selected and followed up, 22 individuals were diagnosed with preeclampsia while the remainder were normotensive. Mean CEC numbers was significantly higher in preeclamptic women than normal pregnancies (24.7 cells/mL vs. 13 cells/mL). The best cut-off point for CEC numbers was 6.5 with a sensitivity of 78.9% and a specificity of 69.1%. The level of E-selectin was significantly higher in mothers with preeclampsia (p < 0.05). CONCLUSIONS Higher levels of CECs and E-selectin in women with positive rollover test who developed preeclampsia prior to onset of the complication were predictive of preeclampsia. However, larger studies are needed to confirm these findings.
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Affiliation(s)
- Ferdous Mehrabian
- Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohammad Hashemi Jazi
- Associate Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Assistant Professor, Department of Physiology, Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,
Corresponding author: Shaghayegh Haghjooy Javanmard
E-mail:
| | - Mahshid Kaviani
- Resident, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vida Homayouni
- PhD Student, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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2895
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Cross SN, Ratner E, Rutherford TJ, Schwartz PE, Norwitz ER. Bevacizumab-mediated interference with VEGF signaling is sufficient to induce a preeclampsia-like syndrome in nonpregnant women. Rev Obstet Gynecol 2012; 5:2-8. [PMID: 22582121 PMCID: PMC3349918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Preeclampsia (gestational proteinuric hypertension) complicates 5% to 8% of all pregnancies, and is a major cause of maternal and perinatal morbidity and mortality. It is a multisystem disorder specific to human pregnancy and the puerperium. Although the etiology is unknown, increasing evidence from both animal and human studies suggests that an imbalance in circulating pro-(vascular endothelial growth factor [VEGF], placental growth factor) and anti-angiogenic factors (soluble fms-like tyrosine kinase 1, soluble endoglin) may be important. Bevacizumab (Avastin®; Genentech, South San Francisco, CA), a humanized recombinant monoclonal IgG antibody that binds VEGF, has been shown to inhibit endothelial cell proliferation, suppress angiogenesis, and shrink a variety of solid tumors. We present two cases of bevacizumab toxicity that mimic preeclampsia with a reversible syndrome characterized by acute-onset severe hypertension, proteinuria, central nervous system irritability (headache, photophobia, blurred vision, seizures), abnormal laboratory tests (elevated liver function tests, thrombocytopenia), and evidence of reversible posterior leukoencephalopathy on neuroimaging. In both cases, the clinical and laboratory manifestations returned to normal with discontinuation of bevacizumab therapy and supportive care. Bevacizumab toxicity can mimic preeclampsia in nonpregnant women. These data suggest that interference with VEGF signaling is sufficient to induce a preeclampsia-like syndrome in nonpregnant patients. VEGF signaling therefore appears to play a central role-perhaps the central role-in the pathogenesis of preeclampsia, and provides a potential biomarker for the prediction, prevention, and treatment of this dangerous disorder.
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2896
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Abstract
BACKGROUND/AIMS Preeclampsia (PE) is a cause of glomerulopathy worldwide. Urinary retinol-binding protein (RBP) is a marker of proximal tubular dysfunction, albuminuria is an endothelial injury marker, urine protein:creatinine ratio (PCR) may have a predictive value for renal disease later in life, and, recently, podocyturia has been proposed as a sensitive tool in pregnancy, but it needs to be tested. The aim of this study was to evaluate renal involvement in PE and healthy pregnancy. METHODS Case-control study with 39 pregnant women assessed after 20 weeks of gestation (25 in the control group, CG, and 14 in the PE group) by performing urinary tests. RESULTS Mean (±SD) age and gestational age of the CG were 26.9 ± 6.4 years and 37.1 ± 5.0 weeks, and of the PE group 26.4 ± 6.9 years and 30.6 ± 5.6 weeks, respectively (p = 0.001). Mean (±SD) urinary RBP (p = 0.017), albuminuria (p = 0.002), and urinary albumin concentration (UAC) ratio (p = 0.006) of the CG were 0.4 ± 0.7 mg/l, 7.3 ± 6.9 mg/l, and 8.2 ± 6.7 mg/g and of the PE group 2.0 ± 4.4 mg/l, 2,267.4 ± 2,130.8 mg/l (p = 0.002), and 3,778.9 ± 4,296.6 mg/g (p = 0.006), respectively. Mean (±SD) urine PCR in the PE group was 6.7 ± 6.1 g/g (p < 0.001). No statistical differences were found between podocyturia in the CG and PE group (p = 0.258). CONCLUSIONS Urinary RBP, PCR, albuminuria, and UAC ratio were elevated in the PE group in comparison to the CG. Podocyturia did not predict PE.
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Affiliation(s)
- T.A. Facca
- Disciplines of Obstetrics and Nephrology of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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2897
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Karimi S, Yavarian M, Azinfar A, Rajaei M, Azizi Kootenaee M. Evaluation the frequency of factor V Leiden mutation in pregnant women with preeclampsia syndrome in an Iranian population. Iran J Reprod Med 2012; 10:59-66. [PMID: 25242976 PMCID: PMC4163265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 05/18/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Role of genetic factors in etiology of preeclampsia is not confirmed yet. OBJECTIVE Gene defect frequency varies in different geographic areas as well as ethnic groups. In this study, the role of factor V Leiden mutation in the pathogenesis of preeclampsia syndrome among the pregnant population of northern shore of Persian Gulf in Iran, were considered. MATERIALS AND METHODS Between Jan. 2008 and Dec. 2009, in a nested case control study, pregnant women with preeclampsia (N=198) as cases and healthy (N=201) as controls were enrolled in the study. DNA were extracted from 10 CC peripheral blood and analyzed for presence of factor V Leiden mutation in these subjects. The maternal and neonatal outcomes of pregnancy according to the distribution of factor V Leiden were also compared among cases. RESULTS In total, 17(8.6%) of cases and 2(1%) of controls showed the factor V Leiden mutation. The incidence of factor V Leiden was typically higher in preeclamptic women than control group (OR: 9.34 %95 CI: 2.12-41.01). There was no difference in incidence rate of preterm delivery< 37 weeks (OR: 1.23 %95 CI: 0.38-4.02), very early preterm delivery<32 weeks (OR: 1.00 %95 CI: 0.12-8.46), intra uterine fetal growth restriction (IUGR) (OR: 1.32 %95 CI: 0.15-11.30 ),and the rate of cesarean section (OR: 0.88 %95 CI: 0.29-2.62 ) among cases based on the prevalence of factor V Leiden mutation. CONCLUSION The pregnant women with factor V Leiden mutation are prone for preeclampsia syndrome during pregnancy, but this risk factor was not correlated to pregnancy complications in the studied women.
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Affiliation(s)
- Samieh Karimi
- Department of Obstetrics and Gynecology, Hormozgan Fertility and Infertility Research Center, Shariati Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Majid Yavarian
- Department of Human Molecular and Clinical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Azinfar
- Department of Obstetrics and Gynecology, Hormozgan Fertility and Infertility Research Center, Shariati Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Minoo Rajaei
- Department of Obstetrics and Gynecology, Hormozgan Fertility and Infertility Research Center, Shariati Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Azizi Kootenaee
- Department of Obstetrics and Gynecology, Hormozgan Fertility and Infertility Research Center, Shariati Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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2898
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Vettorazzi J, Torres FV, de Ávila TT, Martins-Costa SH, Souza DO, Portela LV, Ramos JG. Serum S100B in pregnancy complicated by preeclampsia: A case-control study. Pregnancy Hypertens 2012; 2:101-5. [PMID: 26105095 DOI: 10.1016/j.preghy.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Revised: 07/17/2011] [Accepted: 11/30/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Serum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women. MATERIAL AND METHODS Serum S100B protein was measured in normotensive pregnant women (n=15) and in women with mild PE (n=12) or severe PE (n=34). The serum S100B level (μg/L) was determined by an luminometric assay. RESULTS Sixty-one expectant mothers were studied, aged 26.6±8.7 (mean±SD) years and with a gestational age of 33.3±4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20±0.19), as compared with mild PE (0.07±0.05) or normotensive groups (0.04±0.05). CONCLUSION Elevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.
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2899
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Solanki R, Maitra N. Echocardiographic assessment of cardiovascular hemodynamics in preeclampsia. J Obstet Gynaecol India 2011; 61:519-22. [PMID: 23024520 DOI: 10.1007/s13224-011-0084-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 05/11/2011] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To assess maternal cardiovascular function using echocardiography in normal and preeclamptic women in the third trimester of pregnancy. METHODS 40 subjects, 20 with preeclampsia and 20 normotensive controls with >34 weeks gestation and singleton pregnancy were recruited. Baseline characteristics, maternal and fetal outcome were studied with systolic and diastolic parameters on echocardiography. RESULTS The following parameters were higher in preeclamptic subjects as compared to normotensive controls-mean cardiac output (66.85 ± 4.56 ml/min vs. 56.1 ± 1.77 ml/min); mean LV diastolic mass (131.15 ± 16.85 vs. 104.90 ± 23.17 g); systolic mass (88.5 ± 7.34 vs. 83.33 ± 23.84 g); total vascular resistance (1396.85 ± 150.2 vs. 1204.5 ± 71.182 dyne, s cm(5)). Women with preeclampsia delivered smaller babies (2410 ± 426.16 g) as compared to normotensive controls (2895 ± 276.20 g). Student 't' test was used as a test of significance. CONCLUSION Women with preeclampsia have significant systolic and diastolic dysfunction compared to normotensive controls. Blood pressure monitoring alone is insufficient to identify effectively, risk of cardiovascular complications in these subjects.
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Affiliation(s)
- Rizwana Solanki
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, India
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2900
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Celik H, Avcı B, Alper T. Comparison of maternal serum levels of interleukin-10, interleukin-12, and interleukin-2 in normal and preeclamptic pregnancies. Pregnancy Hypertens 2012; 2:39-42. [PMID: 26104988 DOI: 10.1016/j.preghy.2011.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 09/22/2011] [Accepted: 09/28/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was 2 fold: (1) to compare the maternal serum levels of IL-10, IL-12, and IL-2 in preeclamptic and normal pregnant women, and (2) to study the serum levels of these cytokines in preeclamptic pregnancies with and without intrauterine growth retardation. STUDY DESIGN Forty women with singleton pregnancies complicated by preeclampsia (32 severe and 8 mild) and 29 normotensive healthy pregnant women were included in the study. Preeclamptic patients were further divided into 2 groups according to the presence or absence of intrauterine growth retardation. Maternal serum levels of IL-10, IL 12, and IL-2 were compared between these groups using enzyme-linked immunosorbent assays. RESULTS Maternal serum levels of IL-10 were significantly higher in the preeclampsia group than in controls (p<0.001). There were no statistically significant differences in maternal serum concentrations of IL-2 and IL-10 between the study and control groups (p>0.05). Serum levels of IL-2 and IL-10 in the patients with preeclampsia complicated by IUGR were elevated in comparison with the uncomplicated preeclampsia group. These differences were statistically significant (p<0.05 for both). CONCLUSIONS IL-10 may be involved in the pathologic process of preeclampsia. Increased serum levels of IL-10 and IL-2 in preeclampsia complicated with IUGR suggests a possible role of these cytokines in IUGR.
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