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Ma S, Zhu L, Zhou T, Qi T, Wang W. Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia. Open Life Sci 2023; 18:20220581. [PMID: 37250848 PMCID: PMC10224616 DOI: 10.1515/biol-2022-0581] [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: 12/08/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 05/31/2023] Open
Abstract
The treatment of preeclampsia is delivering women and extracting the placenta, but the Chinese Society of Obstetrics and Gynecology guidelines do not recommend the delivery of babies without severe features. The objectives of the study were to compare the effectiveness and safety of nifedipine and phytosterol in combination with nicardipine for the management of severe preeclampsia. Women (19-32 years; gestation age ≥ 30 weeks) with the complication of severe preeclampsia have received 10 mg of oral nifedipine (pregnant women received 10 mg of oralnifedipine, n = 112) or 1 mg/h intravenous nicardipine (pregnant women received 1 mg/h intravenous nicardipine (ND cohort), n = 115) or oral 10 mg nifedipine and 500 mg phytosterol (pregnant women received oral 10 mg nifedipine and 500 mg phytosterol (np cohort), n = 111) until 150/100 mmHg blood pressure was achieved. The time required to achieve the desired blood pressure control was 13 minutes shorter in the NP cohort compared to the NF (p < 0.0001, t = 11.605), and 3 minutes shorter compared to the ND (p < 0.0001, t = 2.79) cohorts. Stillbirths were reported in 14 (13%), 28 (24%), and 10 (9%) infants, and 13 (12%), 26 (23%), and 10 (9%) infants died from the NF, ND, and NP cohorts, respectively. The undesirable tocolytic effect was reported in 17 (15%) women of the ND cohort. Phytosterol with nifedipine has a synergistic or additive effect on the management of preeclampsia with fewer adverse outcomes.
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Affiliation(s)
- Shanduo Ma
- Department of Obstetrics and Gynecology, The First People’s Hospital of Lianyungang, No. 182 of Tongguan North Road, Haizhou District, Lianyungang, 222061 Jiangsu, China
| | - Limei Zhu
- Department of Clinical Laboratory, The First People’s Hospital of Lianyungang, Lianyungang, 222061 Jiangsu, China
| | - Tiantian Zhou
- Department of Obstetrics and Gynecology, The First People’s Hospital of Lianyungang, No. 182 of Tongguan North Road, Haizhou District, Lianyungang, 222061 Jiangsu, China
| | - Ting Qi
- Department of Obstetrics and Gynecology, The First People’s Hospital of Lianyungang, No. 182 of Tongguan North Road, Haizhou District, Lianyungang, 222061 Jiangsu, China
| | - Weijun Wang
- Department of Obstetrics and Gynecology, The First People’s Hospital of Lianyungang, No. 182 of Tongguan North Road, Haizhou District, Lianyungang, 222061 Jiangsu, China
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Terstappen F, Clarke SM, Joles JA, Ross CA, Garrett MR, Minnion M, Feelisch M, van Goor H, Sasser JM, Lely AT. Sodium Thiosulfate in the Pregnant Dahl Salt-Sensitive Rat, a Model of Preeclampsia. Biomolecules 2020; 10:biom10020302. [PMID: 32075042 PMCID: PMC7072460 DOI: 10.3390/biom10020302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
Abstract
Aberrant production of hydrogen sulfide (H2S) has been linked to preeclampsia. We hypothesized that sodium thiosulfate (STS), a H2S donor, reduces hypertension and proteinuria, and diminishes fetal growth restriction in the Dahl salt-sensitive (S) rat, a spontaneous model of superimposed preeclampsia. In addition to a control group (n = 13), two groups received STS via drinking water at a dose of 2 g (n = 9) or 3 g per kg body weight per day (n = 8) from gestational day (GD) 10 to 20. Uterine artery resistance index was measured (GD18), urinary protein excretion rate was determined (GD19), and blood pressure and fetal outcomes were evaluated (GD20). At 2 g, STS had no effect on preeclamptic symptoms or fetal outcome. At 3 g, STS reduced maternal hypertension (121.8 ± 3.0 vs. 136.3 ± 2.9), but increased proteinuria (89 ± 15 vs. 56 ± 5 mg/24h), and relative kidney weight (0.86 ± 0.04 vs. 0.73 ± 0.02%). Fetal/placental weight ratio was reduced (3.83 ± 0.07 vs. 4.31 ± 0.08) without affecting litter size. No differences in uterine artery flow or renal histological damage were noted across treatment groups. While these data suggest a promising antihypertensive effect that could imply prolongation of preeclamptic pregnancies, the unfavorable effects on proteinuria, kidney weight, and fetal/placental weight ratio implies that clinical implementation of STS is contra-indicated until safety for mother and child can be verified.
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Affiliation(s)
- Fieke Terstappen
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
- Department of Developmental Origins of Disease (DDOD), Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-757-7251
| | - Sinéad M. Clarke
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands;
| | - Courtney A Ross
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - Michael R. Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (M.M.); (M.F.)
- NIHR Southampton Biomedical Research Center, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (M.M.); (M.F.)
- NIHR Southampton Biomedical Research Center, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands;
| | - Jennifer M. Sasser
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA; (C.A.R.); (M.R.G.); (J.M.S.)
| | - A. Titia Lely
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands; (S.M.C.); (A.T.L.)
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Role of endogenous digitalis-like factors in the clinical manifestations of severe preeclampsia: a sytematic review. Clin Sci (Lond) 2018; 132:1215-1242. [PMID: 29930141 DOI: 10.1042/cs20171499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Endogenous digitalis-like factor(s), originally proposed as a vasoconstrictor natriuretic hormone, was discovered in fetal and neonatal blood accidentally because it cross-reacts with antidigoxin antibodies (ADAs). Early studies using immunoassays with ADA identified the digoxin-like immuno-reactive factor(s) (EDLF) in maternal blood as well, and suggested it originated in the feto-placental unit. Mammalian digoxin-like factors have recently been identified as at least two classes of steroid compounds, plant derived ouabain (O), and several toad derived bufodienolides, most prominent being marinobufagenin (MBG). A synthetic pathway for MBG has been identified in mammalian placental tissue. Elevated maternal and fetal EDLF, O and MBG have been demonstrated in preeclampsia (PE), and inhibition of red cell membrane sodium, potassium ATPase (Na, K ATPase (NKA)) by EDLF is reversed by ADA fragments (ADA-FAB). Accordingly, maternal administration of a commercial ADA-antibody fragment (FAB) was tested in several anecdotal cases of PE, and two, small randomized, prospective, double-blind clinical trials. In the first randomized trial, ADA-FAB was administered post-partum, in the second antepartum. In the post-partum trial, ADA-FAB reduced use of antihypertensive drugs. In the second trial, there was no effect of ADA-FAB on blood pressure, but the fall in maternal creatinine clearance (CrCl) was prevented. In a secondary analysis using the pre-treatment maternal level of circulating Na, K ATPase (NKA) inhibitory activity (NKAI), ADA-FAB reduced the incidence of pulmonary edema and, unexpectedly, that of severe neonatal intraventricular hemorrhage (IVH). The fall in CrCl in patients given placebo was proportional to the circulating level of NKAI. The implications of these findings on the pathophysiology of the clinical manifestations PE are discussed, and a new model of the respective roles of placenta derived anti-angiogenic (AAG) factors (AAGFs) and EDLF is proposed.
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Cournot M, Lairez O, Medzech B. [Preeclampsia: A challenge also for cardiologists]. Ann Cardiol Angeiol (Paris) 2018; 67:280-287. [PMID: 29786511 DOI: 10.1016/j.ancard.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/06/2018] [Indexed: 01/25/2023]
Abstract
Due to its short-term consequences on perinatal outcome, preeclampsia has been long regarded as an obstetrical disease, strictly confined to a management by OB/GYNs. It has been now widely accepted that preeclampsia is most a systemic inflammatory and systemic vascular disease during pregnancy and then a lifelong risk factor for subsequent cardiovascular event in women's life. The aim of this review is to propose an overview in the current state-of-art in definition, early identification and management of preeclampsia. We will also discuss the growing evidence that support that cardiologists must be fully involved in screening and prevention of preeclampsia during pregnancy and beyond in the subsequent medical follow-up of women who have experienced a preeclampsia.
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Affiliation(s)
- M Cournot
- Services de cardiologie et de gynécologie-obstétrique, centre hospitalier Gabriel Martin, Saint-Paul, France; Inserm, UMR 1188 Diabète athérothrombose thérapies Réunion Océan Indien (DéTROI), université de La Réunion, Saint-Denis de La Réunion, France.
| | - O Lairez
- Department of cardiology, Rangueil university hospital, Toulouse, France
| | - B Medzech
- Services de cardiologie et de gynécologie-obstétrique, centre hospitalier Gabriel Martin, Saint-Paul, France
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Ulubaşoğlu H, Bakay K, Güven D. Relation with postpartum maternal morbidity of different types of anesthesia in preeclamptic patients. Hypertens Pregnancy 2017; 37:25-29. [PMID: 29157041 DOI: 10.1080/10641955.2017.1402923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effect of different anesthesia types administered to patients with preeclampsia on postoperative maternal morbidities. METHODS Medical records of pregnant women complicated with preeclampsia delivered by cesarean from January 2010 to December 2016 in our clinic were retrospectively reviewed. RESULTS There was not a statistically significant difference between patients receiving spinal anesthesia and general anesthesia in terms of additional parenteral analgesic requirement at postoperative period (p = 0.520). The length of stay in hospital and δHb (preoperative hemoglobin value minus postoperative hemoglobin value) were not different between spinal anesthesia and general anesthesia groups (p = 0.140 and 0.648, respectively). The rate of postoperative antihypertensive medication requirement was statistically significant in patients with severe preeclampsia who underwent general anesthesia (p = 0.009, x2 = 6.867, odds ratios = 4.276 (1.531-11.942)). The time passing to reach the first normal blood pressure level in patients with severe preeclampsia was 11.95 ± 9.11 h in patients with spinal anesthesia, 10.55 ± 4.95 h in patients with general anesthesia, and the difference was not statistically significant (p = 0.504). CONCLUSION The need for antihypertensive medication is greater in patients with severe preeclampsia receiving general anesthesia. There is a need for comprehensive, prospective, and randomized controlled trials to establish the relationship between postpartum morbidity and the different types of anesthesia.
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Affiliation(s)
- Hasan Ulubaşoğlu
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
| | - Kadir Bakay
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
| | - Davut Güven
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
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