1
|
Kuder MM, Baird R, Hopkins M, Lang DM. Anaphylaxis in Pregnancy. Immunol Allergy Clin North Am 2023; 43:103-116. [PMID: 36410997 DOI: 10.1016/j.iac.2022.07.004] [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: 11/05/2022]
Abstract
Anaphylaxis in pregnancy is a rare event, but has important implications for the pregnant patient and fetus. The epidemiology, pathophysiology, diagnosis, and treatment all carry important considerations unique to the pregnant patient. Common culprits of anaphylaxis are primarily medications, particularly antibiotics and anesthetic agents. Diagnosis can be difficult given the relative lack of cutaneous symptoms, and normal physiologic changes in pregnancy such as low blood pressure and tachycardia. Apart from patient positioning, treatment is similar to that of the general population, with a focus on prompt epinephrine administration.
Collapse
Affiliation(s)
- Margaret M Kuder
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation.
| | - Rachael Baird
- Women's Health Institute, Cleveland Clinic Foundation
| | - Maeve Hopkins
- Women's Health Institute, Cleveland Clinic Foundation
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation
| |
Collapse
|
2
|
Abstract
This article serves to highlight both the common nature and severity of postpartum hemorrhage (PPH). Identification of etiologies and management of each is reviewed. In addition, the evaluation and administration of proper blood component therapies and massive transfusion are also explained to help providers become comfortable with early administration and delivery of blood component therapies.
Collapse
|
3
|
Campbell NE, Deer EM, Herrock OT, LaMarca BB. The Role of Different Lymphoid Cell Populations in Preeclampsia Pathophysiology. KIDNEY360 2022; 3:1785-1794. [PMID: 36514732 PMCID: PMC9717666 DOI: 10.34067/kid.0001282022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023]
Abstract
Preeclampsia (PE), new-onset hypertension during pregnancy, affects up to 10% of pregnancies worldwide. Despite being the leading cause of maternal and fetal morbidity and mortality, PE has no cure beyond the delivery of the fetal-placental unit. Although the exact pathogenesis of PE is unclear, there is a strong correlation between chronic immune activation; intrauterine growth restriction; uterine artery resistance; dysregulation of the renin-angiotensin system. Which contributes to renal dysfunction; and the resulting hypertension during pregnancy. The genesis of PE is thought to begin with insufficient trophoblast invasion leading to reduced spiral artery remodeling, resulting in decreased placental perfusion and thereby causing placental ischemia. The ischemic placenta releases factors that shower the endothelium and contribute to peripheral vasoconstriction and chronic immune activation and oxidative stress. Studies have shown imbalances in proinflammatory and anti-inflammatory cell types in women with PE and in animal models used to examine mediators of a PE phenotype during pregnancy. T cells, B cells, and natural killer cells have all emerged as potential mediators contributing to the production of vasoactive factors, renal and endothelial dysfunction, mitochondrial dysfunction, and hypertension during pregnancy. The chronic immune activation seen in PE leads to a higher risk for other diseases, such as cardiovascular disease, CKD, dementia during the postpartum period, and PE during a subsequent pregnancy. The purpose of this review is to highlight studies demonstrating the role that different lymphoid cell populations play in the pathophysiology of PE. Moreover, we will discuss treatments focused on restoring immune balance or targeting specific immune mediators that may be potential strategies to improve maternal and fetal outcomes associated with PE.
Collapse
Affiliation(s)
- Nathan E. Campbell
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Evangeline M. Deer
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Owen T. Herrock
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Babbette B. LaMarca
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi,Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
| |
Collapse
|
4
|
Mugerli S, Zupančič D, Rok Romih, Lučovnik M. Transmission electron microscopy demonstration of reduced endothelial glycocalyx in severe preeclampsia. Placenta 2022; 126:64-69. [PMID: 35779415 DOI: 10.1016/j.placenta.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/30/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Endothelial glycocalyx is a carbohydrate-rich layer lining the luminal side of blood vessels. Its damage was demonstrated in different groups of critically ill patients. Indirect evidence showed that endothelial glycocalyx degradation might be an important factor in pathophysiology of preeclampsia. The aim of our study was to demonstrate endothelial glycocalyx by transmission electron microscopy and to compare its amount in the omentum vessels of pregnant patients with severe preeclampsia and two control groups. METHODS Patients with severe preeclampsia who had a cesarean section were included in the study. Controls were healthy pregnant people at term with an elective cesarean section and non-pregnant patients of reproductive age who underwent laparoscopy for benign conditions. We performed omentum biopsies in all three groups. Samples were prepared for transmission electron microscopy using perfusion with ruthenium red. We measured the amount of endothelial glycocalyx attached to apical plasma membrane of endothelial cells as the area of glycocalyx observed with transmission electron microscope. RESULTS In the analysis we included nine patients from each group and demonstrated statistically significant difference in the amount of endothelial glycocalyx among the three groups (p = 0.018). Glycocalyx was significantly reduced in severe preeclampsia (median 1.90 μm2, interquartile range 0.80-4.1 μm2) compared to non-pregnant controls (median 14.34 μm2, interquartile range 3.80-73.32 μm2); p = 0.021. A trend towards reduced glycocalyx amount in preeclampsia vs. pregnant controls and pregnant controls vs. non-pregnant controls was observed but without statistical significance. DISCUSSION Compared to non-pregnant controls the endothelial glycocalyx was significantly reduced in pregnant patients with severe preeclampsia.
Collapse
Affiliation(s)
- Sara Mugerli
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Šlajmerjeva 4, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Daša Zupančič
- Institute of Cell Biology, Faculty of Medicine, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Rok Romih
- Institute of Cell Biology, Faculty of Medicine, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Šlajmerjeva 4, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| |
Collapse
|
5
|
Dai DM, Cao J, Yang HM, Sun HM, Su Y, Chen YY, Fang X, Xu WB. Hematocrit and plasma albumin levels difference may be a potential biomarker to discriminate preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy. Clin Chim Acta 2017; 464:218-222. [DOI: 10.1016/j.cca.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/21/2016] [Accepted: 12/01/2016] [Indexed: 11/30/2022]
|
6
|
Stewart RD, Nelson DB, Matulevicius SA, Morgan JL, McIntire DD, Drazner MH, Cunningham FG. Cardiac magnetic resonance imaging to assess the impact of maternal habitus on cardiac remodeling during pregnancy. Am J Obstet Gynecol 2016; 214:640.e1-6. [PMID: 26611998 DOI: 10.1016/j.ajog.2015.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/21/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is well known that the maternal cardiovascular system undergoes profound alterations throughout pregnancy. Interest in understanding these changes has led investigators to use evolving and increasingly sophisticated techniques to study these changes, most recently with 2-dimensional echocardiography. Despite its clinical utility, echocardiography has limitations, and cardiac magnetic resonance imaging (CMRI) has become increasingly used for evaluation of cardiac structure and function. OBJECTIVE We used CMRI to evaluate cardiac remodeling according to maternal habitus throughout pregnancy and postpartum. STUDY DESIGN This was a prospective, observational study of nulliparous women aged 18-30 years, without preexisting medical conditions, conducted from October 2012 through December 2014. Women were classified according to prepregnancy body mass index (BMI) as either normal (BMI 18.5-24.9 kg/m(2)) or overweight (BMI 25-35 kg/m(2)). All women underwent CMRI during 5 epochs throughout gestation: 12-16 weeks, 26-30 weeks, 32-36 weeks, at delivery, and 3 months' postpartum. Using left ventricular mass (LVM) as a marker of cardiac remodeling, the 2 cohorts were compared. RESULTS There were 14 normal-weight (BMI 22.2 ± 1.3) and 9 overweight (BMI 29.1 ± 2.0) women who participated in the study. Beginning at 26-30 weeks and continuing to delivery, LVM of both normal-weight and overweight women was significantly increased compared with the respective first-trimester studies for each cohort (P < .001). LVM of both cohorts returned to their index values by 3 months' postpartum. The geometric ratio of LVM to left ventricular end-diastolic volume was calculated, and both normal-weight and overweight women demonstrated concentric remodeling throughout gestation, however this resolved by 12 weeks' postpartum. CONCLUSION There is substantial cardiac remodeling during pregnancy with significant increases in LVM that are proportional to maternal size. Left ventricular geometric remodeling was concentric in both normal-weight and overweight women. All changes in cardiac remodeling resolved by 3 months' postpartum.
Collapse
|
7
|
Akinlaja O. Hematological Changes in Pregnancy - The Preparation for Intrapartum Blood Loss. ACTA ACUST UNITED AC 2016. [DOI: 10.15406/ogij.2016.04.00109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
8
|
Dubbs SB, Tewelde SZ. Cardiovascular Catastrophes in the Obstetric Population. Emerg Med Clin North Am 2015; 33:483-500. [DOI: 10.1016/j.emc.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
9
|
Abstract
Intrapartum hemorrhage is a serious and sometimes life-threatening event. Several etiologies are known and include placental abruption, uterine atony, placenta accreta, and genital tract lacerations. Prompt recognition of blood loss, identification of the source of the hemorrhage, volume resuscitation, including red blood cells and blood products when required, will result in excellent maternal outcomes.
Collapse
Affiliation(s)
- James M Alexander
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA.
| | | |
Collapse
|
10
|
Kojima T, Yamada T, Yamada T, Morikawa M, Cho K, Minakami H. Unusual clinical course of preeclampsia heralded by generalized edema. J Obstet Gynaecol Res 2013; 39:1538-40. [DOI: 10.1111/jog.12080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Takashi Kojima
- Department of Obstetrics; Hokkaido University Graduate School of Medicine
| | | | - Takashi Yamada
- Department of Obstetrics; Hokkaido University Graduate School of Medicine
| | | | | | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine
| |
Collapse
|
11
|
|
12
|
Yamada T, Koyama T, Furuta I, Morikawa M, Yamada T, Minakami H. Association of antithrombin activity with plasma aldosterone concentration and plasma renin activity in pregnant women. Hypertens Pregnancy 2013; 32:96-103. [PMID: 23273069 DOI: 10.3109/10641955.2012.751995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To test the hypothesis that the blood antithrombin (AT) activity is correlated with the plasma aldosterone concentration (PAC), the plasma renin activity (PRA), and/or the PAC-to-PRA ratio during the late stage of pregnancy. METHODS The AT activity, PAC, and PRA were determined within 7 days prior to delivery in 47 women, consisting of 30 normotensive and 6 hypertensive women with singleton pregnancies and 11 normotensive women with twin pregnancies. RESULTS The median values of the 47 women were 86% of the normal activity level for the AT activity, 442 pg/mL for the PAC, 3.7 ng/mL/h for the PRA, and 108 pg/mL per ng/mL/h for the PAC-to-PRA ratio. Women with an AT activity ≤86% had a significantly lower PRA and a higher PAC-to-PRA ratio than women with an AT activity >86% (3.5 ± 3.0 vs. 6.6 ± 4.7 ng/mL/h for PRA, p = 0.008; 156 ± 109 vs. 97 ± 46 pg/mL per ng/h for PAC-to-PRA ratio, p = 0.021). The AT activity was significantly correlated positively with the PRA and negatively with the PAC-to-PRA ratio. CONCLUSIONS The existence of a common pathophysiological background between a reduced AT activity and a reduced PRA during the late stage of pregnancy was suggested.
Collapse
Affiliation(s)
- Takashi Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | |
Collapse
|
13
|
Koyama T, Yamada T, Furuta I, Morikawa M, Yamada T, Minakami H. Plasma Aldosterone Concentration and Plasma Renin Activity Decrease during the Third Trimester in Women with Twin Pregnancies. Hypertens Pregnancy 2012; 31:419-26. [DOI: 10.3109/10641955.2012.690057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Lee J, Romero R, Dong Z, Lee DC, Dong Y, Mittal P, Chaiworapongsa T, Hassan SS, Kim CJ. Glycogen phosphorylase isoenzyme BB plasma concentration is elevated in pregnancy and preterm preeclampsia. Hypertension 2012; 59:274-82. [PMID: 22215716 PMCID: PMC3488461 DOI: 10.1161/hypertensionaha.111.177444] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 11/21/2011] [Indexed: 11/16/2022]
Abstract
Glycogen phosphorylase is a key enzyme in glycogenolysis. Released with myocardial ischemia, blood concentration of glycogen phosphorylase isoenzyme BB (GPBB) is a marker of acute coronary syndromes. Pregnancy imposes metabolic stress, and preeclampsia is associated with cardiac complications. However, plasma GPBB concentration during pregnancy is unknown. This study was conducted to determine maternal plasma GPBB concentration in normal pregnancy and in preeclampsia. Plasma samples from 6 groups (n=396) were studied: nonpregnant and pregnant women with normal term delivery, term and preterm preeclampsia, and term and preterm small-for-gestational-age neonates. GPBB concentration was measured with a specific immunoassay. Placental tissues (n=45) obtained from pregnant women with preterm and term preeclampsia, spontaneous preterm delivery, and normal term delivery were analyzed for potential GPBB expression by immunoblotting. Median plasma GPBB concentration was higher in pregnant women than in nonpregnant women (38.7 versus 9.2 ng/mL; P<0.001), which remained significant after adjusting for age, race, and parity. Maternal plasma GPBB concentrations did not change throughout gestation. Cases of preterm (but not term) preeclampsia had higher median plasma GPBB concentrations than gestational age-matched normal pregnancy cases (72.6 versus 26.0 ng/mL; P=0.001). Small-for-gestational-age neonates did not affect plasma GPBB concentration. GPBB was detected in the placenta and was less abundant in preterm preeclampsia than in preterm delivery cases (P<0.01). There is physiological elevation of plasma GPBB concentration during pregnancy; an increase in maternal plasma GPBB is a novel phenotype of preterm preeclampsia. It is strongly suggested that these changes are attributed to GPBB of placental origin.
Collapse
Affiliation(s)
- JoonHo Lee
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zhong Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Deug-Chan Lee
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Yi Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Pooja Mittal
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
15
|
Tejera E, Areias MJ, Rodrigues AI, Ramõa A, Nieto-Villar JM, Rebelo I. Relationship between Heart Rate Variability Indexes and Common Biochemical Markers in Normal and Hypertensive Third Trimester Pregnancy. Hypertens Pregnancy 2011; 31:59-69. [DOI: 10.3109/10641955.2010.544802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|