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Makouei M, Hartup LA, Neuhoff BK, Boyd AR, Daftaribesheli L, Mirmoeeni S, Azari Jafari A, Godoy DA, Seifi A. The pathophysiologic, diagnostic, and therapeutic aspects of posterior reversible encephalopathy syndrome during pregnancy. J Matern Fetal Neonatal Med 2021; 35:8735-8743. [PMID: 34879767 DOI: 10.1080/14767058.2021.2001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with a wide range of symptoms, including visual disturbances, headache, vomiting, seizures, and altered consciousness. This review describes the pathophysiology of PRES, as well as the clinical, diagnostic, and therapeutic intervention during pregnancy. The gold standard for diagnosis of PRES is Magnetic Resonance Imaging (MRI), helping to differentiate it from other similar conditions. The aim of this paper is to review the principal aspects of PRES, general care, blood pressure control, and seizures prevention while avoiding potential injuries to the mother and fetus in the event of pregnancy. We concluded that PRES can be effectively treated and reversed if prompt diagnostic action is made, and adequate care is initiated.
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Affiliation(s)
- Mahsa Makouei
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lindsay Anne Hartup
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barbara Kate Neuhoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angela Rodriguez Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Laleh Daftaribesheli
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Hospital Carlos Malbran, Catamarca, Argentina
| | - Ali Seifi
- Division of Neuro Critical Care, Department of Neurosurgery, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
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Preeclampsia: Pathophysiology and management. J Gynecol Obstet Hum Reprod 2020; 50:101975. [PMID: 33171282 DOI: 10.1016/j.jogoh.2020.101975] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 01/16/2023]
Abstract
Preeclampsia is a pregnancy-related multisystem disorder, frequently encountered pregnancy-related medical complications next to gestational diabetes mellitus. It is the onset of hypertension during pregnancy. The preeclampsia can be of two types, placental or maternal preeclampsia. Among these two types former, i.e., placental preeclampsia is more severe than the latter. According to the recent survey by National Health Portal of India, the incidence of preeclampsia is about 8-10 % among pregnant women. Though our understanding of preeclampsia has improved in recent years, the development and interpretation of the clinical tests remain difficult for preeclampsia. Hence, we have made an attempt to understand the pathophysiology, associated conditions/consequences, treatment and management/prevention of the condition in this review.
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Benfateh M, Cissoko S, Boufettal H, Feige JJ, Samouh N, Aboussaouira T, Benharouga M, Alfaidy N. Risk factors and poor prognostic factors of preeclampsia in Ibn Rochd University Hospital of Casablanca: about 401 preeclamptic cases. Pan Afr Med J 2018; 31:225. [PMID: 31447983 PMCID: PMC6691300 DOI: 10.11604/pamj.2018.31.225.14401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/14/2018] [Indexed: 11/11/2022] Open
Abstract
Preeclampsia is a gestational pathology that complicates 2 to 8% of pregnancies and is one of the major causes of maternal and fetal morbidity and mortality worldwide. The aim of this work was to study the epidemiological profile of preeclampsia in Casablanca and to identify risk factors as well as factors of poor maternal and fetal prognosis. 401 preeclamptic cases were collected in the gynecology-obstetrics "C" Service of Lalla Meryem Maternity of Ibn Rochd University Hospital of Casablanca (2010-2011) were included in this study and a statistical analysis with the SPSS software version (16.0) was performed. We used the Chi-2 test to analyze qualitative variables and Student's test and ANOVA (analysis of variance) for quantitative variables. The incidence of preeclampsia was (7.1%). The epidemiological profile was that of a primipara (57.6%), average age 30 years and (66.8%) of pregnancies were not followed. Multiparity was a factor of poor maternal prognosis (p = 0.007). The low gestational age and no prenatal care were factors of maternal as well as fetal prognosis. Risk factors frequently found in our patients were obesity (15.21%) and chronic hypertension (5.73%) as vascular-renal history; abortion (16.46%) and perinatal death (5.24%) as obstetric history. Preeclampsia is a common obstetric pathology in our context. Better prenatal care and early diagnosis could reduce its incidence.
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Affiliation(s)
- Meriem Benfateh
- Unité de Culture Cellulaire, CED, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, Maroc
| | - Souadou Cissoko
- Unité de Culture Cellulaire, CED, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, Maroc
| | - Houssine Boufettal
- Service C de Gynécologie, CHU Ibn Rochd, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, Maroc
| | - Jean-Jacques Feige
- Institut de Biosciences et Biotechnologie du CEA de Grenoble, Unité U1036 INSERM, Grenoble, France
| | - Naima Samouh
- Service C de Gynécologie, CHU Ibn Rochd, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, Maroc
| | - Touria Aboussaouira
- Unité de Culture Cellulaire, CED, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, Maroc
| | - Mohamed Benharouga
- Commissariat à l'Energie Atomique (CEA), DSV-iRTSV, 17 rue des Martyrs, France-Université Grenoble-Alpes, Centre National de la Recherche Scientifique, UMR 5249, 38054 Grenoble Cedex 9, France
| | - Nadia Alfaidy
- Institut de Biosciences et Biotechnologie du CEA de Grenoble, Unité U1036 INSERM, Grenoble, France
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Abstract
Introduction: Hypertension in pregnancy is one of the three factors of maternal mortality. Etiology of the disease is unknown, but the many factors contributing to the identification and control of it can be taken a step to prevent and reduce the symptoms of the disease. The purpose of this study was to determine the prevalence of preeclampsia (high-blood pressure) in different seasons of the year. Methods: The present retrospective cross-sectional study was conducted on more than 8,000 pregnant women visiting Assali specialized hospital from 2011 to 2013. Required data was collected through questionnaire checklist. The Chi-square test with multiple comparisons was used to compare the frequencies of pregnancy-induced hypertension (PIH) according to the month of year, and adjustment of multiplicity was conducted using Bonferroni's method. Student's t-test was used to compare the means of PIH prevalence rates. In all analyses, P < 0.05 was taken to indicate statistical significance. Results: In these 8000 woman admitted to labor, overall prevalence of PIH was 3.8 ± 0.6%. The prevalence rate of PIH was highest in the summer (4.5%) and lowest frequent in the winter (2.7%), respectively. In July, the prevalence rate was significantly higher than those for any other month (4.7%), and in March, it was lower prevalence than for any month (2.2%), respectively. Using the Chi-square test, a significant difference between the incidence of disease was observed in summer and winter (P < 0.001). Conclusion: The prevalence rate of PIH was higher for delivery in summer and early spring and lowest for winter delivery among Khorramabad women based on these results; it seems that changes in temperature and humidity in different seasons can affect preeclampsia, and preeclampsia increases with increasing frequency temperature.
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Affiliation(s)
- Fatemeh Janani
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farahnaz Changaee
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
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Actualité sur le syndrome HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets). Rev Med Interne 2016; 37:406-11. [DOI: 10.1016/j.revmed.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/11/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022]
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Valery S, Picone O, Coatantiec Y, Frati A, Labrousse C, Ayoubi JM. Prématurité modérée 34–37SA : description des causes et conséquences néonatales immédiates dans une maternité de niveau 2. ACTA ACUST UNITED AC 2015; 43:582-7. [DOI: 10.1016/j.gyobfe.2015.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
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Geyl C, Clouqueur E, Lambert J, Subtil D, Debarge V, Deruelle P. [Links between preeclampsia and intrauterine growth restriction]. ACTA ACUST UNITED AC 2014; 42:229-33. [PMID: 24533991 DOI: 10.1016/j.gyobfe.2014.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Preeclampsia is one of the most frequent and most serious complications of pregnancy. Its occurrence is around 5% of the pregnancies. Its pathophysiology is complex and includes several hypotheses. Preeclampsia is inconsistently associated with intrauterine growth retardation (IUGR). The determinants that explain the variability of this association are unknown. The objective of our study was to identify in a population of French patients who had preeclampsia and/or HELLP syndrome, incidence and risk factors of IUGR to isolate specific characteristics of these women. PATIENTS AND METHODS We studied 578 pregnant women treated for preeclampsia or HELLP syndrome according to the presence or absence of IUGR (database compiled since 1996). Comparisons between the groups were done with Wilcoxon test (quantitative data) or Fisher's exact test (qualitative data). RESULTS We found that pre-eclampsia appeared earlier and was more severe in the group with IUGR. In addition foetal issues were more defavorable when IUGR was associated with preeclampsia. CONCLUSION Combination of IUGR and pre-eclampsia or HELLP syndrome is a criterion of severity for both the mother and the fetus. Our data do not allow distinguishing physiopathological mechanism to explain these differences.
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Affiliation(s)
- C Geyl
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - E Clouqueur
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - J Lambert
- Service de biostatistique et information médicale, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Subtil
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - V Debarge
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; EA 4489, environnement périnatal et croissance, IMPRT IFR 114, faculté de médecine université Lille-2, rue Paul-Duez, 59045 Lille cedex, France
| | - P Deruelle
- Pôle d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; EA 4489, environnement périnatal et croissance, IMPRT IFR 114, faculté de médecine université Lille-2, rue Paul-Duez, 59045 Lille cedex, France.
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Farag MK, Maksoud NAE, Ragab HM, Gaber KR. Predictive value of cystatin C and beta-2 microglobulin in preeclampsia. JOURNAL OF GENETIC ENGINEERING AND BIOTECHNOLOGY 2011. [DOI: 10.1016/j.jgeb.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Turck M, Carles G, El Guindi W, Helou G, Alassas N, Dreyfus M. [Sixty-nine consecutive cases of eclampsia: prodromes and circumstances]. ACTA ACUST UNITED AC 2011; 40:340-7. [PMID: 21353400 DOI: 10.1016/j.jgyn.2011.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 01/10/2011] [Accepted: 01/13/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To specify clinical and biological characteristics of patients developing eclampsia, and identify atypical eclampsia without prior signs and symptoms of severe preeclampsia. PATIENTS AND METHODS This was a retrospective observational study conducted from January 1996 to December 2008 in a maternity type IIB in French Guiana. Data of patients who experienced eclampsia were collected from obstetric records. RESULTS Sixty-nine patients were selected among 21,525 patients who delivered during this period, corresponding to a prevalence of 3.2 ‰. The average patient age was 21 years (range from 12 to 45 years). Sixty-six percent of patients were nulliparous. The gestational age was greater than 37 weeks of gestation for 62% of patients, between 26 and 37 weeks of gestation for 36% and less than 26 weeks of gestation for 2% of patients. Two thirds of the patients had been examined less than a month before the eclamptic seizure, blood pressure was normal in 62% of cases. Seventy-four percent of patients had at least one Doppler study of the uterine and umbilical arteries velocimetry, the Dopplers studies were normal in 78% of cases. The eclampsia occurred in ante-, peri- and post-partum in 59, 6 and 35% of the cases, respectively 10% of patients were hospitalized for preeclampsia at the time of eclamptic seizure. Less than 10% of patients developed HELLP syndrome. One patient had died of aspiration pneumonia. Newborns had a mean birth weight over 2500 g in 88% of cases. During the follow-up period, 41% of the patients had subsequent pregnancies with 62% without hypertension, 24% complicated by recurrent gestational hypertension, 24% by preeclampsia and 4% by eclampsia. DISCUSSION AND CONCLUSION In a majority of the patients in our study, eclampsia was the main manifestation, and only 10% were preceded by severe preeclampsia. These results are comparable to recent studies, which found in their series that 40 to 60% of eclampsia manifested without preeclamptic prodromi. Eclampsia can occur after an unremarkable pregnancy, in women without risk factors, and then it is hardly predictable. Prenatal follow-up must be very cautious paying attention to any markers such as intermittent hypertension, functional symptoms or appearance of proteinuria.
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Affiliation(s)
- M Turck
- Service de gynécologie obstétrique, centre hospitalier de l'Ouest Guyanais, 16, boulevard du Général-Leclerc, BP 245, 94393 Saint-Laurent-du-Maroni, France.
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Valera MC, Parant O, Vayssiere C, Arnal JF, Payrastre B. Physiologic and pathologic changes of platelets in pregnancy. Platelets 2010; 21:587-95. [PMID: 20873962 DOI: 10.3109/09537104.2010.509828] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Platelets are key players in haemostasis and thrombus formation. Defects affecting platelets during pregnancy can lead to heterogeneous complications, such as thrombosis, first trimester miscarriage and postpartum haemorrhage. The incidence of complications is increased in women who have heritable platelet function disorders. Modifications of platelet count or platelet functions during normal pregnancy and preeclampsia will be summarized and the management of pregnant women with heritable platelet function disorders will be discussed.
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Affiliation(s)
- Marie-Cecile Valera
- INSERM U858, I2MR, Equipe 9, CHU Rangueil, BP 84225, 31432 Toulouse cedex 4, France
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Okafor UV, Efetie ER, Igwe W, Okezie O. Anaesthetic management of patients with pre-eclampsia/eclampsia and perinatal outcome. J Matern Fetal Neonatal Med 2009; 22:688-92. [DOI: 10.1080/14767050902994473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Le Guern V, Pannier E, Goffinet F. Lupus érythémateux systémique et grossesse. Presse Med 2008; 37:1627-35. [DOI: 10.1016/j.lpm.2008.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/09/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022] Open
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Schneider KTM. [What does the obstetrician expect from the internist during prenatal care?]. Internist (Berl) 2008; 49:799-804. [PMID: 18509614 DOI: 10.1007/s00108-008-2068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cooperation between the obstetrician and the physician for internal medicine is especially needed when a pregnant woman suffers from complex medical diseases. This contribution focuses on the special circumstances of maternal treatment also considering the fetal state with the following examples: drugs in the first trimester, cardiac diseases, pregnancy-induced hypertension, HELLP syndrome, gestational and type I diabetes, thrombosis, pulmonary diseases, infections, and treatment of cancer during pregnancy. Special obstetric requests to the physician are: keeping in close contact, avoiding recommendations for the mode of delivery, avoiding overtreatment of hypertensive disorders as well as intensifying the surveillance including the creation of preventive schedules for pregnant women with an increased risk of developing metabolic syndrome in their later life.
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Affiliation(s)
- K T M Schneider
- Abteilung für Perinatalmedizin, Technische Universität München, Ismaningerstrasse 22, 81675 München, Deutschland.
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