101
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Diemunsch P, Langer B, Noll E. Principes généraux de la prise en charge hospitalière de la prééclampsie. ACTA ACUST UNITED AC 2010; 29:e51-8. [DOI: 10.1016/j.annfar.2010.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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102
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Sunderji S, Gaziano E, Wothe D, Rogers LC, Sibai B, Karumanchi SA, Hodges-Savola C. Automated assays for sVEGF R1 and PlGF as an aid in the diagnosis of preterm preeclampsia: a prospective clinical study. Am J Obstet Gynecol 2010; 202:40.e1-7. [PMID: 19762001 DOI: 10.1016/j.ajog.2009.07.025] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/15/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the utility of soluble vascular endothelial growth factor 1 (sVEGF R1) and placental growth factor (PlGF) levels in the clinical diagnosis of preeclampsia. STUDY DESIGN Plasma was collected prospectively from 457 subjects (n = 409 without preeclampsia, n = 48 with preeclampsia) at 20-36 weeks' gestation. Automated immunoassays were used to measure free sVEGF R1 and free PlGF. RESULTS Clinical sensitivities of 0.96 and specificities of 0.96 and 0.95 were calculated for sVEGF R1 and PlGF, respectively, for aiding in the diagnosis of preeclampsia. Among subjects with chronic hypertension, sVEGFR1 was dramatically elevated and PlGF decreased in those with superimposed preeclampsia (P < .001 for superimposed preeclampsia vs chronic hypertension for both biomarkers). The ratio of sVEGFR1/PlGF provided a better test to aid in the diagnosis of preeclampsia than either analyte alone (3% false positive rate). CONCLUSION Free sVEGF R1 and PlGF were useful in differentiating women with preterm preeclampsia from normotensive and hypertensive subjects.
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103
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Rath W, Fischer T. The diagnosis and treatment of hypertensive disorders of pregnancy: new findings for antenatal and inpatient care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:733-8. [PMID: 19997586 PMCID: PMC2788901 DOI: 10.3238/artebl.2009.0733] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 04/28/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. New guidelines and findings from clinical trials must be taken into account so that the diagnosis and treatment of HDP can be optimized. METHODS Current guidelines, Cochrane reviews, metaanalyses, and randomized, controlled trials were retrieved by a search in PubMed and the Cochrane Library for reports published from 2006 to March 2009. These publications were then analyzed and evaluated for their evidence levels (EL). RESULTS AND CONCLUSIONS Aside from hypertension and proteinuria, the definition of preeclampsia (PE) should also take organ dysfunction into account. Important aspects of antenatal care include the following: the early recognition of risk factors, measurement of the uterine arteries in the 1st and 2nd trimesters with Doppler ultrasonography (A diagnostic tool which is now well established), prophylactic oral administration of 100 mg of acetylsalicylic acid daily from the beginning of pregnancy, particularly in high-risk patients (EL I++), and appropriate measurement of blood pressure and urinary protein. Patients should be hospitalized whenever indicated. Therapeutic goals are adequate treatment of hypertension, as well as seizure prophylaxis with magnesium sulphate in severe preeclampsia to prevent maternal cerebrovascular complications (EL I++). If delivery is indicated, it should be performed, regardless of the gestational age (EL IV). Careful monitoring during the puerperium and a general medical review six weeks after delivery are essential. Women with preeclampsia have a significantly elevated long-term risk of developing cardiovascular diseases in later life (EL I++).
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Affiliation(s)
- Werner Rath
- Gynäkologie und Geburtshilfe, Medizinische Fakultät des Universitätsklinikum Aachen (RWTH), Germany.
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104
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Affiliation(s)
- Donna D Johnson
- Medical University of South Carolina, Charleston, SC 29425, USA.
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105
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Sandrim VC, Palei ACT, Luizon MR, Izidoro-Toledo TC, Cavalli RC, Tanus-Santos JE. eNOS haplotypes affect the responsiveness to antihypertensive therapy in preeclampsia but not in gestational hypertension. THE PHARMACOGENOMICS JOURNAL 2009; 10:40-5. [PMID: 19704415 DOI: 10.1038/tpj.2009.38] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Variations of the endothelial nitric oxide synthase (eNOS) gene have been associated with hypertensive disorders of pregnancy. We examined whether eNOS polymorphisms affect the therapeutic responses of women with gestational hypertension (GH) or preeclampsia (PE). We studied 304 hypertensive pregnant women (152 GH and 152 PE), who were stratified according to clinical and laboratorial parameters of therapeutic responsiveness. We compared the frequencies of three eNOS genetic polymorphisms (T-786C, Glu298Asp and b/a intron 4) in responsive and nonresponsive PE and GH patients. We found no significant differences in genotype or allele distributions when responsive and nonresponsive groups were compared (both PE or GH; all P>0.05). However, the eNOS haplotype distribution differed in PE (but not in GH)-responsive and -nonresponsive groups (P=0.0003). The 'C-Glu-a' and 'T-Asp-a' hapotypes were associated with responsiveness and nonresponsiveness to therapy, respectively (both P<0.001), thus suggesting that eNOS haplotypes affect the responsiveness to antihypertensive therapy in PE.
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Affiliation(s)
- V C Sandrim
- Santa Casa de Belo Horizonte, Av. Francisco Sales 1111, Belo Horizonte, MG, Brazil
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106
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Lindheimer MD, Taler SJ, Cunningham FG. ASH position paper: hypertension in pregnancy. JOURNAL OF CLINICAL HYPERTENSION (GREENWICH, CONN.) 2009. [PMID: 19614806 DOI: 10.1111/j.1751‐7176.2009.00085.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The American Society of Hypertension is publishing a series of Position Papers in their official journals throughout the 2008-2009 years. The following Position Paper originally appeared: JASH. 2008;2(6):484-494. Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension, Inc (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous magnesium sulfate is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists.
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Affiliation(s)
- Marshall D Lindheimer
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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107
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Abstract
The main objective of expectant management in women with severe pre-eclampsia (PE) remote from term is to improve neonatal outcome. Maternal conditions, however, may worsen during expectant management. This highlights the importance of balancing the risks between maternal and perinatal outcomes. Traditionally, women with severe PE remote from term are delivered expeditiously, regardless of gestational age. We here have reported several retrospective, case-control, observational, prospective, or randomized trials in which expectant management in women with severe PE was feasible in well-selected patients without prejudicing maternal safety, and we have described our rationale and guidelines for this management.
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Affiliation(s)
- Bassam Haddad
- Department of Obstetrics and Gynecology, University Paris XII, Creteil, France.
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108
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Abstract
Abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. The key factor in the pathophysiology is hemorrhage at the decidual-placental interface. Small episodes may escape clinical detection, but severe grades impact significantly on fetal and maternal morbidity and mortality, with the most frequent complications being fetal death, severe maternal shock, disseminated intravascular coagulopathy, and renal failure. Important risk factors for the development of abruptio placentae are previous abruption, hypertensive diseases, abdominal trauma, growth restriction, and smoking. The diagnosis is essentially made on the clinical picture that includes vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions. The essence of management is restoration of circulating volume followed by delivery of the fetus and placenta, most often by cesarean section when the diagnosis is clear and the fetus alive and viable. Aggressive resuscitation and expeditious vaginal delivery are the goals when the fetus is dead.
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Affiliation(s)
- David R Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, Tygerberg, South Africa.
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109
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Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009; 200:481.e1-7. [PMID: 19019323 DOI: 10.1016/j.ajog.2008.07.048] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/02/2008] [Accepted: 07/28/2008] [Indexed: 11/18/2022]
Abstract
Preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets syndrome are major obstetric disorders that are associated with substantial maternal and perinatal morbidities. As a result, it is important that clinicians make timely and accurate diagnoses to prevent adverse maternal and perinatal outcomes associated with these syndromes. In general, most women will have a classic presentation of preeclampsia (hypertension and proteinuria) at > 20 weeks of gestation and/or < 48 hours after delivery. However, recent studies have suggested that some women will experience preeclampsia without > or = 1 of these classic findings and/or outside of these time periods. Atypical cases are those that develop at < 20 weeks of gestation and > 48 hours after delivery and that have some of the signs and symptoms of preeclampsia without the usual hypertension or proteinuria. The purpose of this review was to increase awareness of the nonclassic and atypical features of preeclampsia-eclampsia. In addition, a stepwise approach toward diagnosis and treatment of patients with these atypical features is described.
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Affiliation(s)
- Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
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110
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Lindheimer MD, Taler SJ, Cunningham FG. ASH position paper: hypertension in pregnancy. J Clin Hypertens (Greenwich) 2009; 11:214-25. [PMID: 19614806 PMCID: PMC8673190 DOI: 10.1111/j.1751-7176.2009.00085.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 09/01/2008] [Indexed: 01/24/2023]
Abstract
The American Society of Hypertension is publishing a series of Position Papers in their official journals throughout the 2008-2009 years. The following Position Paper originally appeared: JASH. 2008;2(6):484-494. Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension, Inc (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous magnesium sulfate is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists.
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Affiliation(s)
- Marshall D Lindheimer
- Department of Obstetrics & Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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111
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Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 113:687-701. [PMID: 19300336 PMCID: PMC2771454 DOI: 10.1097/aog.0b013e318197bd8a] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In August 2007, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health Office of Rare Diseases, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics cosponsored a 2-day workshop to reassess the body of evidence supporting antepartum assessment of fetal well-being, identify key gaps in the evidence, and formulate recommendations for further research. Participants included experts in obstetrics and fetal physiology and representatives from relevant stakeholder groups and organizations. This article is a summary of the discussions at the workshop, including synopses of oral presentations on the epidemiology of stillbirth and fetal neurological injury, fetal physiology, techniques for antenatal monitoring, and maternal and fetal indications for monitoring. Finally, a synthesis of recommendations for further research compiled from three breakout workgroups is presented.
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Affiliation(s)
- Caroline Signore
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD
| | - Roger K. Freeman
- Pediatrix Medical Group, Fort Lauderdale, FL
- Department of Obstetrics and Gynecology; University of California, Irvine; Women's Hospital at Long Beach Memorial Medical Center; Long Beach, CA
| | - Catherine Y. Spong
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD
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Raga F, Sanz-Cortés M, Bonilla-Musoles F. Three-dimensional ultrasound diagnosis of ruptured subcapsular liver hematoma caused by HELLP syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:838-839. [PMID: 18773431 DOI: 10.1002/uog.5407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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113
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Bombrys AE, Barton JR, Nowacki EA, Habli M, Pinder L, How H, Sibai BM. Expectant management of severe preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management. Am J Obstet Gynecol 2008; 199:247.e1-6. [PMID: 18771971 DOI: 10.1016/j.ajog.2008.06.086] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/07/2008] [Accepted: 06/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of the study was to determine perinatal outcome and maternal morbidities based on gestational age (GA) at the onset of expectant management in severe preeclampsia at less than 27 weeks. STUDY DESIGN This was a retrospective analysis of outcome in patients with severe preeclampsia. Forty-six patients (51 fetuses) with severe preeclampsia at less than 27 weeks were studied. Corticosteroids were administered beyond 23 weeks. Perinatal and maternal complications (a composite maternal morbidities including HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, pulmonary edema, eclampsia, and renal insufficiency were analyzed. RESULTS Four patients had multifetal gestations (1 triplet, 3 twins). Median days of prolongation was 6 (range 2-46). Overall perinatal survival was 29 of 51 (57%). Birthweights of 27 (53%) were less than 10%, and 18 (35%) were less than 5%. There were no perinatal survivors in those with a GA less than 23 weeks, at 23 to 23 6/7 weeks, 2 of 10 (20%) survived, and both reached 26 weeks at delivery. For those at 24 to 24 6/7, 25 to 25 6/7, and 26 to 26 6/7 weeks, the perinatal survival rates were 5 of 7 (71%), 13 of 17 (76%), and 9 of 10 (90%), respectively; but rates of respiratory complications were high. There were no maternal deaths, but overall maternal morbidity was 21 of 46 (46%), but was 9 of 14 (64%) in those at less than 24 weeks. CONCLUSION Perinatal outcome in severe preeclampsia in the midtrimester is dependent on GA at onset of expectant management and GA at delivery. Given the high maternal morbidity and extremely low perinatal survival in expectant management at less than 24 weeks, termination of pregnancies should be offered after extensive counseling.
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115
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116
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État des connaissances : prise en charge thérapeutique de la prééclampsie. ACTA ACUST UNITED AC 2008; 37:5-15. [DOI: 10.1016/j.jgyn.2007.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 08/23/2007] [Accepted: 09/07/2007] [Indexed: 12/15/2022]
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