1
|
Biswas J, Khatun N, Bandyopadhyay R, Bhattacharya N, Maitra A, Mukherjee S, Mondal S. Optic nerve sheath diameter measurements using ultrasonography to diagnose raised intracranial pressure in preeclampsia: an observational study. J Turk Ger Gynecol Assoc 2023; 24:5-11. [PMID: 36919381 PMCID: PMC10019004 DOI: 10.4274/jtgga.galenos.2022.2022-3-3] [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: 03/16/2023] Open
Abstract
Objective To estimate the incidence of raised intracranial pressure (ICP) as evident by enlarged optic nerve sheath diameter (ONSD) by ocular ultrasound among patients with preeclampsia and its relationship to severity of disease. Material and Methods Sixty pregnant mothers with preeclampsia were compared to 30 normotensive, uncomplicated pregnant controls. For ONSD measurement, a 7-MHZ linear probe was used and three values from each optic nerve were taken and the mean of six values of both eyes was recorded. All study subjects were followed until seven days after delivery. Results Two cut off values (5.8 mm and 4.6 mm) were used to compare ONSD in severe and non-severe preeclampsia with that of healthy pregnant individuals. The incidence of raised ICP among severe preeclampsia above 5.8 mm and 4.6 mm cut-off were 43.3% and 90%, respectively, before delivery. ONSD was significantly elevated among preeclampsia subjects at both cut-off values at pre-delivery (p=0.004 for ONSD >5.8 mm and p<0.001 for ONSD >4.6 mm) compared to controls. There a significant association between presence of neurological manifestations and enlarged ONSD (p<0.001 for ONSD >5.8 mm and p=0.04 for ONSD >4.6 mm) before delivery. Conclusion Severe preeclampsia with neurological features was associated with increased ONSD, reflecting raised ICP. Further studies are needed to compare ONSD values with invasive ICP monitoring for better understanding of this relationship.
Collapse
Affiliation(s)
- Jhuma Biswas
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, India
| | - Nasima Khatun
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, India
| | - Rakhi Bandyopadhyay
- Department of Ophthalmology, Diamond Harbour Medical College and Hospital, West Bengal, India
| | - Namrata Bhattacharya
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, India
| | - Arghya Maitra
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, India
| | - Sayan Mukherjee
- Department of Obstetrics and Gynecology, Grant Government Medical College and Sir J.J. Group of Hospital, Maharashtra, India
| | - Swarnakamal Mondal
- Department of Obstetrics and Gynecology, Calcutta National Medical College and Hospital, Kolkata, India
| |
Collapse
|
2
|
Dines V, Suvakov S, Kattah A, Vermunt J, Narang K, Jayachandran M, Abou Hassan C, Norby AM, Garovic VD. Preeclampsia and the Kidney: Pathophysiology and Clinical Implications. Compr Physiol 2023; 13:4231-4267. [PMID: 36715282 DOI: 10.1002/cphy.c210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Preeclampsia and other hypertensive disorders of pregnancy are major contributors to maternal morbidity and mortality worldwide. This group of disorders includes chronic hypertension, gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and eclampsia. The body undergoes important physiological changes during pregnancy to allow for normal placental and fetal development. Several mechanisms have been proposed that may lead to preeclampsia, including abnormal placentation and placental hypoxia, impaired angiogenesis, excessive pro-inflammatory response, immune system imbalance, abnormalities of cellular senescence, alterations in regulation and activity of angiotensin II, and oxidative stress, ultimately resulting in upregulation of multiple mediators of endothelial cell dysfunction leading to maternal disease. The clinical implications of preeclampsia are significant as there are important short-term and long-term health consequences for those affected. Preeclampsia leads to increased risk of preterm delivery and increased morbidity and mortality of both the developing fetus and mother. Preeclampsia also commonly leads to acute kidney injury, and women who experience preeclampsia or another hypertensive disorder of pregnancy are at increased lifetime risk of chronic kidney disease and cardiovascular disease. An understanding of normal pregnancy physiology and the pathophysiology of preeclampsia is essential to develop novel treatment approaches and manage patients with preeclampsia and hypertensive disorders of pregnancy. © 2023 American Physiological Society. Compr Physiol 13:4231-4267, 2023.
Collapse
Affiliation(s)
- Virginia Dines
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Sonja Suvakov
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Kavita Narang
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Coline Abou Hassan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander M Norby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Keepanasseril A, Subburaj SP, Nayak D, Bojja V, Chakkalakkoombil SV, Nair PP. Risk factors of intracranial haemorrhage in preeclampsia: a case–control study. Neurol Sci 2022; 43:6003-6010. [DOI: 10.1007/s10072-022-06286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
|
4
|
Li L, Li H, Xue J, Chen P, Zhou Q, Zhang C. Nanoparticle-Mediated Simultaneous Downregulation of Placental Nrf2 and sFlt1 Improves Maternal and Fetal Outcomes in a Preeclampsia Mouse Model. ACS Biomater Sci Eng 2020; 6:5866-5873. [PMID: 33320575 DOI: 10.1021/acsbiomaterials.0c00826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Preeclampsia has impacted 3-5% pregnancies among the world and its complications lead to both maternal and fetal morbidity and mortality. However, management of preeclampsia is limited. Nanoparticles targeting chondroitin sulfate A (CSA) can deliver drugs to placenta. Inactivation of soluble fms-like tyrosine kinase (sFlt-1) and nuclear factor-erythroid 2-like 2 (Nrf2) has been proved to alleviate preeclampsia and improve maternal and fetal outcomes. Carboxyl-polyethylene glycol-poly (d,l-lactide) (COOH-PEG5K-PLA8K), cationic lipid DOTAP, and siNrf2 and sisFlt-1 were used to construct the nanoparticles and conjugating peptides targeting CSA was fabricated to it. The expression levels of proteins and RNAs were estimated by qRT-PCR and Western blot assays. ELISA assays were performed to evaluate levels of circulating sFlt-1. The nanoparticles containing siNrf2 and sisFlt-1 are targeted to the placenta trophoblasts and downregulated the expression levels of Nrf2 and sFlt-1 as well as their downstream genes in the placental cells of model mice. Treatment of nanoparticles induced the expression of angiogenic factors in placenta. Knocking down Nrf2 and sFlt-1 synchronously alleviated the preeclampsia and increased the maternal and fetal outcomes in preeclampsia model mice. Nanoparticle-mediated simultaneous downregulation of placental Nrf2 and sFlt1 improved maternal and fetal outcomes in a preeclampsia mouse model.
Collapse
Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.,Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, Shandong 250025, China
| | - Hongyan Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Jing Xue
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Pengzheng Chen
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Qian Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Chunhua Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| |
Collapse
|
5
|
Schuster J, Cheng SB, Padbury J, Sharma S. Placental extracellular vesicles and pre-eclampsia. Am J Reprod Immunol 2020; 85:e13297. [PMID: 32619308 DOI: 10.1111/aji.13297] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
Pre-eclampsia is a hypertensive disease of pregnancy characterized by new-onset hypertension, with either proteinuria and/or organ dysfunction. Pre-eclampsia is a leading cause of maternal morbidity and mortality; however, the underlying cellular and molecular mechanisms are not well understood. There is consensus that the underlying mechanism(s) resulting in pre-eclampsia is centered around abnormal placentation, inadequate spiral-artery remodeling, and deficiency in trophoblast invasion, resulting in impaired maternal blood flow to the placenta and a release of signals and/or inflammatory mediators into maternal circulation triggering the systemic manifestations of pre-eclampsia. ER stress, resulting in impaired autophagy and placental release of aggregated proteins, may also confer systemic stress to maternal organs in pre-eclampsia. Extracellular vesicles (EVs), lipid-bilayer enclosed structures containing macromolecules including proteins, miRNA, and other important nucleotides, have been suggested to play an important role in this maternal-fetal communication. Circulating EVs are present in greater quantity in the plasma of pre-eclampsia subjects compared to normal pregnancy, and the placental derived EVs have been shown to have altered protein and RNA cargo. In this review, we will focus on EVs and their role in pre-eclampsia, specifically their role in immune responses, inflammation, altered angiogenesis, and endothelial dysfunction.
Collapse
Affiliation(s)
- Jessica Schuster
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Shi-Bin Cheng
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - James Padbury
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Surendra Sharma
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA
| |
Collapse
|
6
|
Gill M, Motta-Mejia C, Kandzija N, Cooke W, Zhang W, Cerdeira AS, Bastie C, Redman C, Vatish M. Placental Syncytiotrophoblast-Derived Extracellular Vesicles Carry Active NEP (Neprilysin) and Are Increased in Preeclampsia. Hypertension 2019; 73:1112-1119. [PMID: 30929513 DOI: 10.1161/hypertensionaha.119.12707] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
NEP (neprilysin) is a widely expressed membrane-bound metalloprotease, which binds and cleaves a variety of peptides including vasodilators, natriuretics, and diuretics. Higher levels of NEP result in hypertension-a cardinal feature of the placental disease preeclampsia. Syncytiotrophoblast-derived extracellular vesicles (EVs), comprising microvesicles and exosomes, are released into the peripheral circulation in pregnancy and are postulated as a key mechanism coupling placental dysfunction and maternal phenotype in preeclampsia. We aimed to determine whether higher levels of active NEP are found in syncytiotrophoblast-derived EVs in preeclampsia compared with normal pregnancy. Using immunostaining and Western blotting, we first demonstrated that NEP levels are greater not only in preeclampsia placental tissue but also in syncytiotrophoblast-derived microvesicles and exosomes isolated from preeclampsia placentas ( P<0.05, n=5). We confirmed placental origin using antibody-coated magnetic beads to isolate NEP-bound vesicles, finding that they stain for placental alkaline phosphatase. NEP on syncytiotrophoblast-derived EVs is active and inhibited by thiorphan ( P<0.01, n=3; specific inhibitor). Syncytiotrophoblast-derived microvesicles, isolated from peripheral plasma, demonstrated higher NEP expression in preeclampsia using flow cytometry ( P<0.05, n=8). We isolated plasma exosomes using size-exclusion chromatography and showed greater NEP activity in preeclampsia ( P<0.05, n=8). These findings show that the placenta releases active NEP into the maternal circulation on syncytiotrophoblast-derived EVs, at significantly greater levels in preeclampsia. NEP has pathological roles in hypertension, heart failure, and amyloid deposition, all of which are features of preeclampsia. Circulating syncytiotrophoblast-derived EV-bound NEP thus may contribute to the pathogenesis of this disease.
Collapse
Affiliation(s)
- Manjot Gill
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Carolina Motta-Mejia
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Neva Kandzija
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - William Cooke
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Wei Zhang
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Ana Sofia Cerdeira
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Claire Bastie
- Department of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom (C.B.)
| | - Christopher Redman
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Manu Vatish
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| |
Collapse
|
7
|
Kane SC, Dennis AT, Da Silva Costa F, Kornman LH, Cade TJ, Brennecke SP. Optic nerve sonography and ophthalmic artery Doppler velocimetry in healthy pregnant women: an Australian cohort study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:531-539. [PMID: 31087684 DOI: 10.1002/jcu.22735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Maternal ocular sonography offers a window into cerebrovascular and intracranial pressure changes in pregnancy. This study aimed to determine the Doppler velocimetric variables of the ophthalmic artery, and the mean diameter of the optic nerve sheath (ONSD), in an Australian cohort of healthy pregnant women. METHODS A prospective observational cohort study of healthy women with uncomplicated singleton pregnancies in the third trimester was undertaken in a tertiary maternity service. A single prenatal ultrasonographic examination was performed on all participants, with a postnatal examination performed on a subgroup with uncomplicated deliveries. RESULTS Fifty women were examined at a mean gestation of 35 weeks. The mean ± SD Doppler variables in the ophthalmic artery were peak systolic velocity (PSV) 41.89 ± 13.13 cm/s, second peak velocity 20.63 ± 8.97 cm/s, end diastolic velocity 9.29 ± 5.13 cm/s, pulsatility index 1.97 ± 0.53, resistive index 0.78 ± 0.07, peak ratio (second peak velocity/PSV) 0.49 ± 0.12, while the mean ONSD was 4.34 ± 0.4 mm. None of these variables had a demonstrable relationship with gestation or mean arterial pressure (MAP), nor did the sheath diameter have a relationship with any of the Doppler variables. CONCLUSIONS The ocular sonographic variables observed in this population are similar to those reported in other cohorts. No clear relationship could be identified in this cohort between ophthalmic artery Doppler variables and the ONSD, and between each of these variables and gestation or MAP.
Collapse
Affiliation(s)
- Stefan C Kane
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Ultrasound Service, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alicia T Dennis
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Anaesthesia, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Victoria, Australia
| | - Fabrício Da Silva Costa
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Departamento de Ginecologia e Obstetricia, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Estado de São Paulo, Brazil
| | - Louise H Kornman
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
- Ultrasound Service, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Thomas J Cade
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Shaun P Brennecke
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
8
|
Abstract
Acute complications of preeclampsia contribute substantially to maternal and fetal morbidity and mortality. The considerable variation in onset, clinical presentation, and severity of this hypertensive disease that is unique to pregnancy creates challenges in identifying risk factors for clinical deterioration. Delivery of the fetus remains the only definitive treatment for preeclampsia. Surveillance of signs and symptoms and laboratory parameters consistent with progression in severity requires an appreciation of the dynamic and progressive nature of the disease. This article provides a comprehensive overview of the pathophysiology of preeclampsia, setting the foundation for discussion of management priorities for acute complications that pose the greatest risks to maternal health.
Collapse
Affiliation(s)
- Patricia M Witcher
- Patricia M. Witcher is Clinical Outcomes Manager, Women's Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA 30342
| |
Collapse
|
9
|
Tolefac PN, Awungafac NS, Minkande JZ. Spontaneous haemorrhagic stroke complicating severe pre-eclampsia in pregnancy: a case report in a resource-limited setting in Cameroon. BMC Pregnancy Childbirth 2018; 18:506. [PMID: 30587133 PMCID: PMC6307190 DOI: 10.1186/s12884-018-2157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral haemorrhage is a rare complication of preeclampsia during pregnancy associated with a high morbidity and mortality. Compared with the non-pregnant women stroke rates are relatively rare during pregnancy. CASE PRESENTATION We report the case of a 32-year-old female Cameroonian gravida 4 para 3 who presented at 34 weeks of gestation with sudden onset of right sided hemiplegia associated with headache, blurred vision and a blood pressure of 182/126. Cerebral CT scan confirmed a left parietal spontaneous haemorrhage. Emergency caesarean delivery was done and the recovery uneventful. CONCLUSION This case highlights the importance of good neurological examination in pregnant women presenting with neurological symptoms as well as the place of multidisciplinary management in severe life threatening conditions.
Collapse
Affiliation(s)
- Paul Nkemtendong Tolefac
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Mbalmayo District Hospita, Mbalmayo, Cameroon
| | | | | |
Collapse
|
10
|
Kane SC, Brennecke SP, da Silva Costa F. Ophthalmic artery Doppler analysis: a window into the cerebrovasculature of women with pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:15-21. [PMID: 27485824 DOI: 10.1002/uog.17209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 05/27/2023]
Affiliation(s)
- S C Kane
- University of Melbourne, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - S P Brennecke
- University of Melbourne, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - F da Silva Costa
- University of Melbourne, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
- Perinatal Services, Monash Health, Clayton, Victoria, Australia
- Monash Ultrasound for Women, Clayton, Victoria, Australia
| |
Collapse
|
11
|
Magnesium in obstetric anesthesia and intensive care. J Anesth 2016; 31:127-139. [PMID: 27803982 DOI: 10.1007/s00540-016-2257-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.
Collapse
|
12
|
Dag ZO, Isik Y, Turkel Y, Alpua M, Simsek Y. Atypical eclampsia and postpartum status epilepticus. Pan Afr Med J 2015; 20:17. [PMID: 25995814 PMCID: PMC4431409 DOI: 10.11604/pamj.2015.20.17.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/31/2014] [Indexed: 12/03/2022] Open
Abstract
Preeclampsia is an entity that may present from 20th week of gestation up to 48 hours postpartum and is associated with hypertension and proteinuria. Eclampsia is emergence of convulsions pre-eclampsia in pregnant women with signs and symptoms. Recent studies showed that in some women, preeclampsia and even eclampsia may occur without hypertension or proteinuria. Here, we present a case of 26 years old women who had an uneventful pregnancy until 30 weeks' of gestation. She had only proteinuria in laboratory tests and was diagnosed as status epilepticus in early postpartum period. Preeclampsia and eclampsia is related with serious fetal and maternal morbidity and mortality and may present with atypical course. The awareness of atypical cases of preeclampsia enhances early diagnosis and management which are critical to avoid feto-maternal complications.
Collapse
Affiliation(s)
- Zeynep Ozcan Dag
- Department of Obstetrics and Gynecology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Yuksel Isik
- Department of Obstetrics and Gynecology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Yakup Turkel
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Murat Alpua
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Yavuz Simsek
- Department of Obstetrics and Gynecology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| |
Collapse
|