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Lee S, Lee HJ, Yu EH, Yoon HJ, Jo HB, Kim SC. Assessment of transcranial Doppler indices after MgSO 4 administration in severe preeclamptic women with neurologic symptoms. Arch Gynecol Obstet 2024; 310:461-467. [PMID: 38252305 DOI: 10.1007/s00404-023-07327-8] [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: 06/20/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To investigate the effect of intravenous MgSO4 on maternal cerebral hemodynamics as well as the association between altered Doppler indices of the ophthalmic arteries and ocular lesions in patients with preeclampsia. METHODS After each of the 15 included patients was diagnosed with preeclampsia, MgSO4 was infused followed by transcranial Doppler tests of the indices of the ophthalmic, anterior, middle, posterior cerebral, vertebral, and basilar arteries, followed by a second MgSO4 infusion. The peak, mean, diastolic velocity, and pulsatile and resistance indices of each artery were automatically measured during testing. Based on the emergent data, the cerebral perfusion pressure, resistance-area product, and cerebral flow index were calculated. RESULTS The cerebral perfusion pressure of the posterior cerebral arteries significantly decreased following the infusion of MgSO4 (p < 0.05). Before the infusion of MgSO4, cerebral perfusion pressure and cerebral flow index of the ophthalmic arteries were significantly increased (p < 0.05) in the preeclamptic pregnant patients with ocular lesions compared those without ocular lesions. After the infusion of MgSO4, the cerebral perfusion pressure and cerebral flow index of both ophthalmic arteries were slightly decreased, but the difference was not significant. CONCLUSIONS Altered Doppler indices following the infusion of MgSO4 suggest significant changes in the hemodynamics of the posterior cerebral and ophthalmic arteries that are particularly related to the neurological signs and symptoms of women with preeclampsia. These findings may improve the understanding of the mechanism of the cerebral complications of preeclampsia. Advancing comprehension of these underlying mechanisms is postulated to play a pivotal role in the mitigation of hypertensive encephalopathy associated with preeclampsia.
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Affiliation(s)
- Sul Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Hyun-Joo Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Eun-Hee Yu
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Hyung-Joon Yoon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Hyun-Been Jo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Seung-Chul Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 179 Gudeck-Ro, Seo-gu, Busan, 49241, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
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Janoudi G, Uzun (Rada) M, Boyd ST, Fell DB, Ray JG, Foster AM, Giffen R, Clifford TJ, Walker MC. Do Case Reports and Case Series Generate Clinical Discoveries About Preeclampsia? A Systematic Review. Int J Womens Health 2023; 15:411-425. [PMID: 36974131 PMCID: PMC10039711 DOI: 10.2147/ijwh.s397680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity. The management of preeclampsia has not changed much in more than two decades, and its aetiology is still not fully understood. Case reports and case series have traditionally been used to communicate new knowledge about existing conditions. Whether this is true for preeclampsia is not known. Objective To determine whether recent case reports or case series have generated new knowledge and clinical discoveries about preeclampsia. Methods A detailed search strategy was developed in consultation with a medical librarian. Two bibliographic databases were searched through Ovid: Embase and MEDLINE. We selected case reports or case series published between 2015 and 2020, comprising pregnant persons diagnosed with hypertensive disorders of pregnancy, including preeclampsia. Two reviewers independently screened all publications. One reviewer extracted data from included studies, while another conducted a quality check of extracted data. We developed a codebook to guide our data extraction and outcomes assessment. The quality of each report was determined based on Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and case series. Results We included 104 case reports and three case series, together comprising 118 pregnancies. A severe presentation or complication of preeclampsia was reported in 81% of pregnancies, and 84% had a positive maternal outcome, free of death or persistent complications. Only 8% of the case reports were deemed to be of high quality, and 53.8% of moderate quality; none of the case series were of high quality. A total of 26 of the 107 publications (24.3%) included a novel clinical discovery as a central theme. Conclusion Over two-thirds of recent case reports and case series about preeclampsia do not appear to present new knowledge or discoveries about preeclampsia, and most are of low quality.
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Affiliation(s)
- Ghayath Janoudi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Stephanie T Boyd
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Canadian Institute of Health Research, Government of Canada, Ottawa, ON, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- International and Global Health Office, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
- BORN Ontario, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Correspondence: Mark C Walker, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Box 241, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, Tel +1 613-798-5555 x76655, Email
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