1
|
Brodowski L, Knoth M, Zehner L, Pecks U. Assessing Severity and Need for Delivery in Early Onset Preeclampsia Before 32 Weeks of Gestation: a Delphi Consensus Procedure. Geburtshilfe Frauenheilkd 2024; 84:760-772. [PMID: 39114380 PMCID: PMC11303012 DOI: 10.1055/a-2361-0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/29/2024] [Indexed: 08/10/2024] Open
Abstract
Background Preeclampsia is a potentially life-threatening hypertensive pregnancy disorder that carries an acute risk of an unfavorable outcome of the pregnancy but also has consequences for the long-term health of the mother. Women who develop the early form of pre-eclampsia before the 32nd week of pregnancy have the highest risk and are also the most difficult to treat. The severity of pre-eclampsia is not characterized uniformly in Germany, so that the indication for delivery is rather individualized. The aim of this study was to reach a consensus on parameters that could serve as criteria for describing the severity of pre-eclampsia based on the urgency of delivery. To this end, a Delphi procedure was used to present a scenario in which a woman was admitted for preeclampsia before 32 gestational weeks and after completion of antenatal steroid therapy. Methods Clinicians specialized in maternal-fetal medicine from German-speaking countries completed five rounds of a modified Delphi questionnaire. Presented parameters were selected by the section "Hypertensive Pregnancy Diseases and Fetal Growth Restriction" of the German Society of Gynecology and Obstetrics after reviewing the literature. These included objectifiable laboratory or clinical parameters as well as subjective symptoms of the patient. In addition, nine fetal parameters were taken into account. The clinicians were asked to rate presented parameters as an indication for delivery on a Likert scale from 0 to 4 (no indication to absolute indication without delay). For each item, the predefined cut-off for group consensus was ≥ 70% agreement. Results A total of 126 experts were approached. Sixty-nine experts (54.8%) took part in the first round; of those 50 completed the entire Delphi procedure. A consensus was reached on 14 parameters to be considered rapid preparation for delivery without delay (4 points on the Likert scale). These were among others hepatic hematoma or liver capsule rupture, acute liver failure with fulminant coagulation disorder or disseminated intravascular coagulation, eclampsia, pathologic findings in imaging (e.g. cMRI) or electrocardiogram arranged for new onset of headache or retrosternal pain, respectively. Twenty-six parameters were rated as factors that should be considered in the decision without being absolute (1 to 3 points), and 13 parameters should have no influence on the decision to deliver (0 points). No consensus on severe hypertension as an indication for delivery could be reached for blood pressure values below 220/140 mmHg. Conclusion A consensus was reached on whether to deliver in preeclampsia typic clinical findings and symptoms. The results can serve as guidance for current clinical practice and for the definition of clinical endpoints in intervention studies. Nevertheless, the isolated criteria are a theoretical construction since the combined deterioration or summation of several factors rather than a single factor most likely influences the decision to deliver and reflect the severity of preeclampsia. Moreover, the degree of hypertension as an indication for delivery remains controversial, unless the patient suffers additionally from complaints. Future research should be enforced to incorporate long-term risks for the mother into a decision aid.
Collapse
Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Maria Knoth
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Leonie Zehner
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
- Maternal Health and Midwifery, Julius-Maximilians-University, Würzburg, Germany
| |
Collapse
|
2
|
Elfassy T, Kulandavelu S, Dodds L, Mesa RA, Rundek T, Sharashidze V, Paidas M, Daviglus ML, Kominiarek MA, Stickel AM, Perreira KM, Kobayashi MA, Garcia TP, Isasi CR, Lipton RB, González HM. Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos. Obstet Gynecol 2024; 143:785-793. [PMID: 38574370 PMCID: PMC11098694 DOI: 10.1097/aog.0000000000005571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To evaluate whether hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are associated with cognitive decline later in life among U.S. Hispanic/Latina individuals. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a prospective population-based study of Hispanic/Latino individuals aged 18-74 years from four U.S. communities. This analysis included parous individuals aged 45 years or older who participated in the HCHS/SOL clinic study visit 1 (2008-2011) neurocognitive assessment and subsequently completed a repeat neurocognitive assessment as part of the Study of Latinos-Investigation of Neurocognitive Aging ancillary study visit 2 (2015-2018). Hypertensive disorders of pregnancy were assessed retrospectively by self-report of any gestational hypertension, preeclampsia, or eclampsia. Cognitive functioning was measured at both study visits with the Brief Spanish-English Verbal Learning Test, Digit Symbol Substitution, and Word Fluency. A regression-based approach was used to define cognitive decline at visit 2 as a function of cognition at visit 1 after adjustment for age, education, and follow-up time. Linear regression models were used to determine whether hypertensive disorders of pregnancy or their component diagnoses were associated with standardized cognitive decline after adjustment for sociodemographic characteristics, clinical and behavioral risk factors, and follow-up time. RESULTS Among 3,554 individuals included in analysis, the mean age was 56.2 years, and 467 of individuals (13.4%) reported at least one hypertensive disorder of pregnancy. Individuals with hypertensive disorders of pregnancy compared with those without were more likely to have higher mean systolic blood pressure, fasting glucose, and body mass index. After an average of 7 years of follow-up, in fully adjusted models, gestational hypertension was associated with a 0.17-SD relative decline in Digit Symbol Substitution scores (95% CI, -0.31 to -0.04) but not other cognitive domains (Brief Spanish-English Verbal Learning Test or Word Fluency). Neither preeclampsia nor eclampsia was associated with neurocognitive differences. CONCLUSION The presence of preeclampsia or eclampsia was not associated with interval neurocognitive decline. In this cohort of U.S. Hispanic/Latina individuals, gestational hypertension alone was associated with decreased processing speed and executive functioning later in life.
Collapse
Affiliation(s)
- Tali Elfassy
- Department of Medicine, the Department of Pediatrics, the Interdisciplinary Stem Cell Institute, the Department of Public Health Sciences, the Department of Neurology, Evelyn F. McKnight Brain Institute, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, and the Department of Psychology, University of Miami, Miami, Florida; the Department of Radiology, New York University Grossman School of Medicine, New York, and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; the Department of Public Health, University of Illinois at Chicago, and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Department of Neurosciences, University of California, San Diego, San Diego, California; and the Department of Social Medicine and the Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Billah SM, Khan ANS, Rokonuzzaman SM, Huq NL, Khan MA, Priyanka SS, Mannan II, Rahman S, Arifeen SE, George J. Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study. BMJ Open 2021; 11:e046638. [PMID: 34321295 PMCID: PMC8319977 DOI: 10.1136/bmjopen-2020-046638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
STUDY OBJECTIVE To evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh. STUDY DESIGN AND SETTINGS Cross-sectional study; conducted in 26 primary care facilities. OUTCOME MEASURES Accurate diagnosis of the hypertensive disorders of pregnancy. METHOD In total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation. RESULT Of the 'true' cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had 'some protein' in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility. CONCLUSION The FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.
Collapse
Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - S M Rokonuzzaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nafisa Lira Huq
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sabrina Sharmin Priyanka
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Setara Rahman
- Maternal Health & Family Planning, JHPIEGO, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Joby George
- MaMoni Health Systems Strengthening, Save the Children Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
4
|
|
5
|
Association of CYP11B2 gene polymorphism with preeclampsia in north east of Iran (Khorasan province). Gene 2020; 733:144358. [PMID: 31935507 DOI: 10.1016/j.gene.2020.144358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Identification the genetic factors in preeclampsia (PE) are useful to increase the current knowledge of the pathophysiology of the disorder. The genetic factors implicated for all cases of PE remain to be determined. This study was aimed to investigate association between ADD1 1378G > T, AGTR2 1675G > A, AGTR1 1166A > C, NOS3 894 G > T and CYP11B2 -344C > T gene polymorphisms in Iranian women with PE. MATERIAL AND METHODS 117 pregnant women with PE and 103 healthy women without affected previous pregnancy by PE were selected. Genomic DNA was extracted from peripheral blood and real-time PCR was performed to investigate the polymorphisms using a commercial kit. RESULTS There was a significant difference in CYP11B2 -344C > T gene polymorphism between case and control groups (P = 0.025). The odds ratio was 0.71 (CI 95% = 0.28-1.79). There were no statistical significant differences between other genetic polymorphisms. CONCLUSION Our results showed a significant association between CYP11B2 -344C > T gene polymorphism with PE. This finding suggests that mentioned polymorphism may be associated with susceptibility to PE at least in IRAN.
Collapse
|
6
|
Abstract
Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2-8% of pregnancies globally (). In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is much lower in high-income countries than in developing countries, 16% of maternal deaths can be attributed to hypertensive disorders (). In the United States, the rate of preeclampsia increased by 25% between 1987 and 2004 (). Moreover, in comparison with women giving birth in 1980, those giving birth in 2003 were at 6.7-fold increased risk of severe preeclampsia (). This complication is costly: one study reported that in 2012 in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately borne by premature births (). This Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia.
Collapse
|
7
|
Tochio A, Obata S, Saigusa Y, Shindo R, Miyagi E, Aoki S. Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria? J Obstet Gynaecol Res 2019; 45:1576-1583. [DOI: 10.1111/jog.14017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Azusa Tochio
- Perinatal Center for Maternity and NeonatesYokohama City University Medical Center Yokohama Japan
| | - Soichiro Obata
- Perinatal Center for Maternity and NeonatesYokohama City University Medical Center Yokohama Japan
| | - Yusuke Saigusa
- Department of Biostatistics and EpidemiologyYokohama City University Graduate School of Medicine and University Medical Center Yokohama Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and NeonatesYokohama City University Medical Center Yokohama Japan
| | - Etsuko Miyagi
- Department of Obstetrics and GynecologyYokohama City University Hospital Yokohama Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and NeonatesYokohama City University Medical Center Yokohama Japan
| |
Collapse
|
8
|
Re-evaluation of abruptio placentae and other maternal complications during expectant management of early onset pre-eclampsia. Pregnancy Hypertens 2019; 16:38-41. [PMID: 31056158 DOI: 10.1016/j.preghy.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Expectant management of appropriately selected cases of early pre-eclampsia in a dedicated, tertiary in-patient setting with frequent non-invasive maternal and fetal surveillance, prolongs pregnancy, improves perinatal outcome and mitigates the impact of maternal complications. As the rate of abruptio placentae in a large descriptive study performed nearly 20 years ago was 20%, a study to re-evaluate the rate of abruptio placentae and other maternal complications was performed. STUDY DESIGN A retrospective study that included all women admitted for expectant management with stable early pre-eclampsia (≥24 and <34 weeks' gestation) was performed at Tygerberg Hospital, a secondary and tertiary referral centre in South Africa over a period of 12 months. MAIN OUTCOME MEASURES Abruptio placentae and other maternal complications. RESULTS During the study period, 9137 women were delivered at the study institution. The data of 102 of 106 women admitted for expectant management of early pre-eclampsia were available. Thirty-four (33%) reached the elective delivery threshold of 34 weeks. Seventeen women (17%) experienced ≥1 complication. There were four cases (4%) each with abruptio placentae, HELLP syndrome and renal insufficiency. Three of the cases with abruptio placentae were asymptomatic, only being diagnosed at caesarean section for fetal distress. Nine women developed mild/moderate ascites. There were no admissions to the critical care unit and no deaths. CONCLUSIONS Abruptio placentae occurred in 4% of women managed expectantly with early pre-eclampsia and was most often asymptomatic before delivery.
Collapse
|
9
|
Euliano TY, Michalopoulos K, Singh S, Gregg AR, Del Rio M, Vasilopoulos T, Johnson AM, Onkala A, Darmanjian S, Euliano NR, Ho M. Photoplethysmography and Heart Rate Variability for the Diagnosis of Preeclampsia. Anesth Analg 2018; 126:913-919. [PMID: 28991110 PMCID: PMC5820156 DOI: 10.1213/ane.0000000000002532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The goal of this study was to determine a set of timing, shape, and statistical features available through noninvasive monitoring of maternal electrocardiogram and photoplethysmography that identifies preeclamptic patients. METHODS Pregnant women admitted to Labor and Delivery were monitored with pulse oximetry and electrocardiogram for 30 minutes. Photoplethysmogram features and heart rate variability were extracted from each data set and applied to a sequential feature selection algorithm to discriminate women with preeclampsia with severe features, from normotensive and hypertensive controls. The classification boundary was chosen to minimize the expected misclassification cost. The prior probabilities of the misclassification costs were assumed to be equal. RESULTS Thirty-seven patients with clinically diagnosed preeclampsia with severe features were compared with 43 normotensive controls; all were in early labor or beginning induction. Six variables were used in the final model. The area under the receiver operating characteristic curve was 0.907 (standard error [SE] = 0.004) (sensitivity 78.2% [SE = 0.3%], specificity 89.9% [SE = 0.1%]) with a positive predictive value of 0.883 (SE = 0.001). Twenty-eight subjects with chronic or gestational hypertension were compared with the same preeclampsia group, generating a model with 5 features with an area under the curve of 0.795 (SE = 0.007; sensitivity 79.0% [SE = 0.2%], specificity 68.7% [SE = 0.4%]), and a positive predictive value of 0.799 (SE = 0.002). CONCLUSIONS Vascular parameters, as assessed noninvasively by photoplethysmography and heart rate variability, may have a role in screening women suspected of having preeclampsia, particularly in areas with limited resources.
Collapse
Affiliation(s)
- Tammy Y. Euliano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Anthony R. Gregg
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Mariem Del Rio
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Department of Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida
| | - Amber M. Johnson
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Allison Onkala
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Monique Ho
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida
| |
Collapse
|
10
|
Kaculini E, Idrizi L, Duli M, Koroshi A, Shehu A, Spahia N, Barbullushi M. Preeclampsia: from Pathophysiology to Treatment. BANTAO JOURNAL 2017. [DOI: 10.1515/bj-2016-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Preeclampsia is a multisystem disorder unique to human pregnancy and is its most common glomerular complication. It occurs in 2% to 8% of pregnancies and is a major contributor to maternal mortality worldwide. Although the pathophysiology of this syndrome is not fully understood, many pathogenetic mechanisms are involved in this disorder. The role of the placenta is crucial in the development of this disorder. Some pathogenetic mechanisms involved in this disease comprise defective deep placentation, autoantibodies to type-1 angiotensin II receptor, endothelial dysfunction, oxidative stress, platelet and thrombin activation, intravascular inflammation, and the imbalance between angiogenic and antiangiogenic factors which is thought to be one of the most crucial mechanisms. Further understanding of the full picture could enhance our current knowledge of the pathogenesis of preeclampsia and improve its treatment. Thus, based on specific biomarkers the diagnosis and subclassification of preeclampsia might be more accurate in identifying patients at risk, monitoring disease progression and providing effective interventions
Collapse
Affiliation(s)
- Enton Kaculini
- Faculty of Medical Sciences, Albanian University, Tirana , Albania
| | - lma Idrizi
- Department of Internal Medicine, Service of Nephrology, University Hospital Center “Mother Teresa”, Tirana , Albania
| | - Marsida Duli
- Faculty of Medical Sciences, Albanian University, Tirana , Albania
| | - Alketa Koroshi
- Department of Internal Medicine, Service of Nephrology, University Hospital Center “Mother Teresa”, Tirana , Albania
| | - Alma Shehu
- Medical Representative, Novartis Pharma, Tirana , Albania
| | - Nereida Spahia
- Department of Internal Medicine, Service of Nephrology, University Hospital Center “Mother Teresa”, Tirana , Albania
| | - Myftar Barbullushi
- Department of Internal Medicine, Service of Nephrology, University Hospital Center “Mother Teresa”, Tirana , Albania
| |
Collapse
|
11
|
Stepan H, Kuse-Föhl S, Klockenbusch W, Rath W, Schauf B, Walther T, Schlembach D. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75:900-914. [PMID: 28435172 PMCID: PMC5396549 DOI: 10.1055/s-0035-1557924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Hypertensive pregnancy disorders contribute significantly to perinatal as well as maternal morbidity and mortality worldwide. Also in Germany these diseases are a major course for hospitalization during pregnancy, iatrogenic preterm birth and long-term cardiovascular morbidity. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. Recommendations: This guideline summarizes the state-of-art for classification, risk stratification, diagnostic, treatment of hypertensive pregnancy disorders.
Collapse
Affiliation(s)
- H. Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - S. Kuse-Föhl
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - W. Klockenbusch
- Universitätsklinikum Münster, Klinik und Poliklinik für Frauenheilkunde und
Geburtshilfe, Abt. für Geburtshilfe, Münster
| | - W. Rath
- Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH
Aachen, Aachen
| | - B. Schauf
- Frauenklinik Sozialstiftung Bamberg, Bamberg
| | - T. Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork,
Ireland
| | - D. Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
| |
Collapse
|
12
|
Alves JA, Miyague AH, de Sousa PC, Maia SB, da Silva Costa F, Martins WP. Brachial Artery Flow Mediated Dilation in the First Trimester to Predict the Occurrence of Hypertensive Disorders during Pregnancy. Fetal Diagn Ther 2015; 37:316-20. [DOI: 10.1159/000366059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/21/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To determine whether brachial artery flow-mediated dilation (FMD) assessed by ultrasonography during the late first trimester is able to predict the occurrence of hypertensive disorders during pregnancy. Methods: Maternal endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery in 487 pregnant women at 11-13+6 weeks' gestation. Subjects were prospectively followed and grouped according to the outcomes related to hypertensive disorders. We determined the areas under receiver operating characteristic (ROC) curve with their respective 95% confidence intervals (CI) for using low FMD results to predict the occurrence of hypertensive disorders during pregnancy. Results: Among 487 women, 9 (1.8%) were diagnosed with early-onset preeclampsia, 22 (4.5%) were diagnosed with late-onset preeclampsia, 47 (9.7%) developed gestational hypertension, and the remaining 409 (84%) pregnancies were unaffected by hypertensive disorders. Area under ROC curve analyses demonstrated that FMD was not able to predict pregnancies that developed hypertensive disorders. Conclusions: We conclude that FMD should not be considered a potential first-trimester marker of hypertensive disorders during pregnancy.
Collapse
|
13
|
|
14
|
Fokom-Domgue J, Noubiap JJN. Diagnosis of hypertensive disorders of pregnancy in sub-Saharan Africa: a poorly assessed but increasingly important issue. J Clin Hypertens (Greenwich) 2014; 17:70-3. [PMID: 25348088 DOI: 10.1111/jch.12429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joël Fokom-Domgue
- Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | | |
Collapse
|
15
|
|
16
|
Abstract
Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6-8 % of pregnancies. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy-related maternal deaths in the USA, accounting for 579 (12.3 %) of the 4,693 maternal deaths that occurred between 1998 and 2005. In low-income and middle-income countries, preeclampsia and its convulsive form, eclampsia, are associated with 10-15 % of direct maternal deaths. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. In this review, we have compared and contrasted the recommendations from different treatment guidelines and outlined some newer perspectives on management. We aim to provide a clinically oriented guide to the drug treatment of hypertension in pregnancy.
Collapse
Affiliation(s)
- Catherine M Brown
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | | |
Collapse
|
17
|
Craici IM, Wagner SJ, Weissgerber TL, Grande JP, Garovic VD. Advances in the pathophysiology of pre-eclampsia and related podocyte injury. Kidney Int 2014; 86:275-85. [PMID: 24573315 PMCID: PMC4117806 DOI: 10.1038/ki.2014.17] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/04/2013] [Accepted: 11/14/2013] [Indexed: 12/12/2022]
Abstract
Pre-eclampsia is a pregnancy-specific hypertensive disorder that may lead to serious maternal and fetal complications. It is a multisystem disease that is commonly, but not always, accompanied by proteinuria. Its cause(s) remain unknown, and delivery remains the only definitive treatment. It is increasingly recognized that many pathophysiological processes contribute to this syndrome, with different signaling pathways converging at the point of systemic endothelial dysfunction, hypertension, and proteinuria. Different animal models of pre-eclampsia have proven utility for specific aspects of pre-eclampsia research, and offer insights into pathophysiology and treatment possibilities. Therapeutic interventions that specifically target these pathways may optimize pre-eclampsia management and may improve fetal and maternal outcomes. In addition, recent findings regarding placental, endothelial, and podocyte pathophysiology in pre-eclampsia provide unique and exciting possibilities for improved diagnostic accuracy. Emerging evidence suggests that testing for urinary podocytes or their markers may facilitate the prediction and diagnosis of pre-eclampsia. In this review, we explore recent research regarding placental, endothelial, and podocyte pathophysiology. We further discuss new signaling and genetic pathways that may contribute to pre-eclampsia pathophysiology, emerging screening and diagnostic strategies, and potential targeted interventions.
Collapse
Affiliation(s)
- Iasmina M Craici
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Steven J Wagner
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Joseph P Grande
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
18
|
Hall D, Gebhardt S, Theron G, Grové D. Pre-eclampsia and gestational hypertension are less common in HIV infected women. Pregnancy Hypertens 2013; 4:91-6. [PMID: 26104261 DOI: 10.1016/j.preghy.2013.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether pre-eclampsia and gestational hypertension are less common in HIV infected women. METHODS This prospective cohort study was performed in the Western Cape province of South Africa. HIV negative and positive pregnant women without chronic renal or chronic hypertensive disease were continuously recruited. During the study period HIV positive patients received either mono- or triple (HAART) antiretroviral therapy for prevention of vertical transmission or maternal care. Only routine clinical management was performed. The development of hypertensive disease during pregnancy was recorded. RESULTS 1093 HIV positive and 1173 HIV negative cases were identified during pregnancy and evaluated again after delivery. Significantly fewer cases of pre-eclampsia n=35 (3.2%) were recorded in the HIV positive group than in the HIV negative group, n=57 (4.9%) (p=0.045; OR 0.65 95% CI 0.42-0.99). There were also significantly fewer cases of gestational hypertension recorded in the HIV positive group compared to the HIV negative group (p=0.026; OR 0.53 95% CI 0.30-0.94). Multiple logistic regression analysis confirmed the reductive effect of HIV on pre-eclampsia and gestational hypertension. CONCLUSION Pre-eclampsia and gestational hypertension are less common in HIV infected women being managed with mono- or triple anti-retroviral therapy.
Collapse
Affiliation(s)
- David Hall
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa.
| | - Stefan Gebhardt
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa; Department of Obstetrics and Gynecology, Paarl Hospital, South Africa
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa
| | - Debbie Grové
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, South Africa
| |
Collapse
|
19
|
Gómez-Arriaga PI, Herraiz I, López-Jiménez EA, Gómez-Montes E, Denk B, Galindo A. Uterine artery Doppler and sFlt-1/PlGF ratio: usefulness in diagnosis of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:530-537. [PMID: 23303638 DOI: 10.1002/uog.12400] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the usefulness of the mean pulsatility index of the uterine arteries (mPI-UtA) and automated measurement of the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio on suspicion or at diagnosis of pre-eclampsia (PE). METHODS Patients with singleton pregnancies with PE (n = 60) diagnosed according to current recommendations, or with suspected PE (n = 32) defined by (1) blood pressure (BP) ≥ 160/100 mmHg, (2) BP ≥ 140/90 mmHg or proteinuria, together with suggestive clinical symptoms or (3) intrauterine growth restriction (IUGR) at < 34 + 0 weeks, were enrolled and mPI-UtA and the sFlt-1/PlGF ratio were measured. Values > 95(th) centile were considered abnormal. All cases were classified according to occurrence of PE and/or IUGR and subclassified, depending on gestational age at delivery, as early (< 34 + 0 weeks) or late (≥ 34 + 0 weeks). RESULTS PE was confirmed in 72 cases, in which 32 early deliveries occurred. Isolated IUGR was diagnosed in nine early cases and one late case, while the remaining 10 cases were late deliveries without PE or IUGR. In pregnancies in which PE and IUGR were excluded, mPI-UtA was abnormal in 40% but the sFlt-1/PlGF ratio was normal in 100%. In early PE, mPI-UtA at diagnosis was abnormal in 100% of cases with IUGR and in 91% without IUGR, while sFlt-1/PlGF was abnormal in 100% and 96%, respectively. In late PE, mPI-UtA was abnormal in 50% and 37% of cases with and without IUGR while the sFlt-1/PlGF ratio was abnormal in 50% and 26%, respectively. CONCLUSION Abnormal mPI-UtA and sFlt-1/PlGF ratio are common in early PE. In late PE, mPI-UtA is normal in most cases and thus not diagnostically useful. The sFlt-1/PlGF ratio shows high specificity but low sensitivity to confirm PE when suspected.
Collapse
Affiliation(s)
- P I Gómez-Arriaga
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid 28041, Spain
| | | | | | | | | | | |
Collapse
|
20
|
August P. Preeclampsia: a "nephrocentric" view. Adv Chronic Kidney Dis 2013; 20:280-6. [PMID: 23928394 DOI: 10.1053/j.ackd.2013.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 01/12/2023]
Abstract
To the obstetrician, preeclampsia is a placental syndrome becoming clinically apparent in later pregnancy and presenting with maternal hypertension, proteinuria, and in some cases liver and central nervous system dysfunction, which, if not addressed in a timely fashion can lead to significant maternal and fetal morbidity and mortality. As such, the only satisfactory cure is delivery of the fetus, after which most, if not all, of the manifestations disappear. The nephrologist, who often is consulted only when patients develop more serious manifestations such as accelerating hypertension, acute kidney injury, and microangiopathic features, often has a different perspective. She/he sees a woman with hypertension and proteinuric kidney disease with mildly reduced glomerular filtration rate. Exciting discoveries regarding the pathogenesis of this syndrome have helped to reconcile these two views; however, much remains unknown. This review focuses on the hypertension and kidney manifestations of the disease, acknowledging that complex placental pathogenic alterations are clearly an important, if not the most important, initiator of the later maternal signs and symptoms.
Collapse
|
21
|
Shaker OG, Sadik NAH. Pathogenesis of preeclampsia: Implications of apoptotic markers and oxidative stress. Hum Exp Toxicol 2013; 32:1170-8. [PMID: 23515498 DOI: 10.1177/0960327112472998] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
Collapse
Affiliation(s)
- O G Shaker
- 1Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | |
Collapse
|
22
|
Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM. The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Pregnancy Hypertens 2013; 3:44-7. [DOI: 10.1016/j.preghy.2012.11.001] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
|
23
|
Pastore MR, De Benedetto U, Gagliardi M, Pierro L. Characteristic SD-OCT Findings in Preeclampsia. Ophthalmic Surg Lasers Imaging Retina 2012; 43:S139-41. [DOI: 10.3928/15428877-20121001-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/27/2012] [Indexed: 11/20/2022]
|
24
|
Tranquilli AL, Landi B, Giannubilo SR, Sibai BM. Preeclampsia: No longer solely a pregnancy disease. Pregnancy Hypertens 2012; 2:350-7. [DOI: 10.1016/j.preghy.2012.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/19/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022]
|
25
|
|