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Roman-Lazarte V, Angela Roman L, Moncada-Mapelli E, Uribe-Cavero LJ, Luz Marcelo-Armas M. Clinical manifestations and complications of preeclampsia and eclampsia in populations residing at high altitudes and very high altitudes: A scoping review. Pregnancy Hypertens 2024; 36:101119. [PMID: 38461671 DOI: 10.1016/j.preghy.2024.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Preeclampsia and eclampsia are conditions that affect gestation, characterized by high blood pressure and direct organ damage, while geographical altitude directly affects cardiovascular physiology. The aim of this review is to identify the clinical manifestations and complications of preeclampsia in pregnant women at high and very high altitudes. METHODS A scoping review was conducted to assess the objective. A systematic search was performed on Pubmed, Web of Science, Embase, Scopus, Scielo, and Lilacs. Studies including pregnant women with preeclampsia or eclampsia at high altitudes and very high altitudes were included, excluding non-citable documents. Results were summarized in tables based on bibliographic data, methodological aspects, and key findings. RESULTS Eight documents meeting the inclusion and exclusion criteria were obtained. Seven studies focused on populations in Latin America, with the highest geographical altitude being 4380 m above sea level in the city of Cerro de Pasco, Peru. One report suggests a higher admission rate to the Intensive Care Unit and a higher frequency of HELLP syndrome. Functional cardiovascular changes were also observed. CONCLUSIONS There are few studies directly evaluating pregnant populations at high altitudes and very high altitudes experiencing preeclampsia and eclampsia. Complications may be more frequent at high altitudes and very high altitudes with clinically unobservable cardiovascular changes.
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Affiliation(s)
| | - Luz Angela Roman
- Sociedad Científica de Estudiantes de Medicina Daniel Alcides Carrion, Universidad Nacional Daniel Alcides Carrion, Cerro de Pasco, Peru
| | | | - Leonardo J Uribe-Cavero
- Sociedad Científica de Estudiantes de Medicina de Ica, Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga de Ica, Ica, Perú
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Sun WJ, Hu J, Zhang Q, Shan JM. Administration of corticosteroid therapy for HELLP syndrome in pregnant women: evidences from seven randomized controlled trials. Hypertens Pregnancy 2023; 42:2276726. [PMID: 37937841 DOI: 10.1080/10641955.2023.2276726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND HELLP syndrome, featuring hemolysis, elevated liver enzymes, and thrombocytopenia, is life-threatening disease of pregnancy that triggers comorbidities in both pregnant women and the fetus/newborn. This study provides an updated systematic review and meta-analysis of relevant studies to assess the therapeutic efficacy of corticosteroids in maternal and neonatal outcomes. METHODS Randomized control trials (RCTs) regarding the use of corticosteroids in the HELLP population from three electronic databases, including Ovid MEDLINE, Ovid EMBASE, andCochrane Central Register of Controlled Trials, were searched from database inception to 23 March 202323 March 2023. RESULTS A total of 485 patients treated with corticosteroids from 7 RCTs were included. Compared to placebo, corticosteroids therapy failed to significantly improve the maternal outcomes regard to maternal morbidity (RR = 1.36, 95%CI [0.45, 4.10]), eclampsia (RR = 1.16, 95%CI [0.76, 1.77]), acute renal failure (RR = 0.71, 95%CI [0.41, 1.22]), pulmonary edema (RR = 0.34, 95%CI [0.10, 1.15]) and oliguria (RR = 1.08, 95%CI [0.75, 1.54]). In addition, pooled data showed that it wasn't significant differences between corticosteroids therapy and placebo regarding neonatal outcomes. CONCLUSIONS This study compared the efficacy of corticosteroids in patients with HELLP syndrome, revealing that corticosteroids did not provide any significant benefit in clinical outcomes for pregnant women and newborns with HELLP. The conclusions of this study must be verified by a larger sample of high-quality RCTs.
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Affiliation(s)
- Wei-Jing Sun
- Department of Obstetrics and Gynecology, Yancheng Third People's Hospital, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
| | - Jing Hu
- Department of Obstetrics and Gynecology, Yancheng Third People's Hospital, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
| | - Qing Zhang
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, Jiangsu, China
| | - Jin-Mei Shan
- Department of Obstetrics and Gynecology, Yancheng Third People's Hospital, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
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Laskowska M, Bednarek A. Optimizing Delivery Strategies in Eclampsia: A Comprehensive Review on Seizure Management and Birth Methods. Med Sci Monit 2023; 29:e941709. [PMID: 37803822 PMCID: PMC10566307 DOI: 10.12659/msm.941709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 10/08/2023] Open
Abstract
Eclampsia seizure is an always serious and potentially fatal obstetric condition. Safe delivery in women with pregnancies complicated by eclampsia seizures is still one of the greatest challenges in perinatal medicine. Pregnancy should be terminated (childbirth) in the safest and least traumatic way possible. Attempting vaginal delivery can take place only exceptionally, in the event of possibly quick completion of childbirth with a stable state of the mother and the fetus. However, immediate labor via cesarean section is most often recommended. It is essential to maintain left lateral patient positioning during cesarean section. Regional anesthesia can be used only in conscious patients who are free from coagulopathy and from HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome to decrease the risk of aspiration and failed intubation attempts in preeclamptic or eclamptic women. For sudden, unexpected interventions, when a patient arrives at the hospital with an eclampsia seizure without lab results, general anesthesia can be the best option and should be performed by an experienced medical team of anesthesiologists, ready to perform difficult intubation. Magnesium sulfate is the drug that should be used first to stop eclamptic convulsions and prevent their recurrence. Intravenous antihypertensive drugs can stabilize elevated blood pressure (BP), preventing multiorgan failure and recurrent eclampsia seizure, and thus the prevention of maternal death. This article aims to review the management of seizures during pregnancy in women with eclampsia to ensure safe delivery.
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Affiliation(s)
- Marzena Laskowska
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland
| | - Anna Bednarek
- Department of Health Promotion – Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Samal S, Manoharan K, Jinson J, George M, Rao AA. Prediction of maternal and foetal outcomes among patients with preeclampsia using circulatory biomarkers (MMP-9 & ST2) - A prospective cohort study. Placenta 2023; 142:12-17. [PMID: 37591113 DOI: 10.1016/j.placenta.2023.08.062] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Preeclampsia is one of the major causes of maternal and foetal morbidity and mortality worldwide. Its complications include but are not limited to eclampsia, intracerebral haemorrhage and cardiovascular diseases in the later stages of life. The combination of clinical and risk variables and a panel of multiple biomarkers will help clinicians in risk stratification and prognostication of clinical outcomes among preeclamptic women. We evaluated MMP-9 (matrix metalloproteinase - 9) and ST2 (suppression of tumorigenicity 2) for utility as biomarkers and for predicting maternal and foetal outcomes in women with preeclampsia. METHODS This prospective cohort study involved 49 preeclamptic women and 80 healthy controls. Biomarkers were measured in plasma using ELISA. The patients were followed up to assess maternal and foetal outcomes. RESULTS The mean value of MMP-9 was 2.42 ng/mL in the preeclamptic group and 2.67 ng/mL in controls. The mean value of ST2 (1937.4 ± 747.81) in the preeclamptic group was high compared to the control group (1005.7 ± 683.6) and the difference was significant (P = 0.0001). The study population was divided into those with high and low MMP-9 and those with high and low ST2. Lower levels of MMP-9 seemed to be related to both early and late onset preeclampsia. The ROC (Receiver Operating Characteristic) curve did not show the ability to predict maternal and foetal outcomes. DISCUSSION Our study demonstrated that women with preeclampsia had low MMP-9 and high ST2 compared to healthy pregnant women. But neither of the biomarkers could predict complications of preeclampsia.
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Affiliation(s)
- Sunita Samal
- Department of Obstetrics & Gynaecology, Apollo Womens' Hospital, Thousand Lights, Chennai, Tamil Nadu, 600006, India
| | - Kaviya Manoharan
- Department of Clinical Pharmacology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpet, Tamil Nadu, 603203, India
| | - Juanna Jinson
- Department of Clinical Pharmacology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpet, Tamil Nadu, 603203, India
| | - Melvin George
- Department of Clinical Pharmacology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpet, Tamil Nadu, 603203, India.
| | - Aishwarya Anand Rao
- Department of Clinical Pharmacology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpet, Tamil Nadu, 603203, India
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Chawla N, Shah H, Huynh K, Braun A, Wollocko H, Shah NC. The Role of Platelet-Activating Factor and Magnesium in Obstetrics and Gynecology: Is There Crosstalk between Pre-Eclampsia, Clinical Hypertension, and HELLP Syndrome? Biomedicines 2023; 11:biomedicines11051343. [PMID: 37239015 DOI: 10.3390/biomedicines11051343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Clinical hypertension is a complex disease of the cardiovascular system that can affect the body's ability to physiologically maintain homeostasis. Blood pressure is measured as systolic pressure of the heart and diastolic pressure. When the systolic pressure exceeds values of 130-139 and diastolic exceeds 80-89, the body is in stage 1 hypertension. A pregnant woman with hypertension is predisposed to developing pre-eclampsia during gestation between the 1st and 2nd trimester. If the symptoms and changes in the mother's body are not controlled, this can progress to hemolysis, elevated liver enzymes, and low platelet count also known as HELLP syndrome. The onset of HELLP syndrome generally begins before the 37th week of pregnancy. Magnesium is one of the most used cations in clinical medicine with various implications in the body. With a critical role in vascular smooth muscle, endothelium, and myocardial excitability it is used in treatment of clinical hypertension, pre-eclampsia in gestational periods, and HELLP syndrome. Platelet-activating factor (PAF) is an endogenous phospholipid proinflammatory mediator that is released in response to various biological and environmental stressors. When released it causes platelets to aggregate, further exacerbating hypertension. The purpose of this literature review is to investigate the role that magnesium and platelet-activating factors have on clinical hypertension, pre-eclampsia, and HELLP syndrome while focusing on the interplay between these molecules.
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Affiliation(s)
- Nidhi Chawla
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Hinal Shah
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Kathleen Huynh
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Alex Braun
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Hanna Wollocko
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Nilank C Shah
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
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First-Trimester Screening for HELLP Syndrome—Prediction Model Based on MicroRNA Biomarkers and Maternal Clinical Characteristics. Int J Mol Sci 2023; 24:ijms24065177. [PMID: 36982251 PMCID: PMC10049724 DOI: 10.3390/ijms24065177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
We evaluated the potential of cardiovascular-disease-associated microRNAs for early prediction of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Gene expression profiling of 29 microRNAs was performed on whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time RT-PCR. The retrospective study involved singleton pregnancies of Caucasian descent only diagnosed with HELLP syndrome (n = 14) and 80 normal-term pregnancies. Upregulation of six microRNAs (miR-1-3p, miR-17-5p, miR-143-3p, miR-146a-5p, miR-181a-5p, and miR-499a-5p) was observed in pregnancies destined to develop HELLP syndrome. The combination of all six microRNAs showed a relatively high accuracy for the early identification of pregnancies destined to develop HELLP syndrome (AUC 0.903, p < 0.001, 78.57% sensitivity, 93.75% specificity, cut-off > 0.1622). It revealed 78.57% of HELLP pregnancies at a 10.0% false-positive rate (FPR). The predictive model for HELLP syndrome based on whole peripheral venous blood microRNA biomarkers was further extended to maternal clinical characteristics, most of which were identified as risk factors for the development of HELLP syndrome (maternal age and BMI values at early stages of gestation, the presence of any kind of autoimmune disease, the necessity to undergo an infertility treatment by assisted reproductive technology, a history of HELLP syndrome and/or pre-eclampsia in a previous gestation, and the presence of trombophilic gene mutations). Then, 85.71% of cases were identified at a 10.0% FPR. When another clinical variable (the positivity of the first-trimester screening for pre-eclampsia and/or fetal growth restriction by the Fetal Medicine Foundation algorithm) was implemented in the HELLP prediction model, the predictive power was increased further to 92.86% at a 10.0% FPR. The model based on the combination of selected cardiovascular-disease-associated microRNAs and maternal clinical characteristics has a very high predictive potential for HELLP syndrome and may be implemented in routine first-trimester screening programs.
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Abstract
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.
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van de Vusse D, Mian P, Schoenmakers S, Flint RB, Visser W, Allegaert K, Versmissen J. Pharmacokinetics of the most commonly used antihypertensive drugs throughout pregnancy methyldopa, labetalol, and nifedipine: a systematic review. Eur J Clin Pharmacol 2022; 78:1763-1776. [PMID: 36104450 PMCID: PMC9474278 DOI: 10.1007/s00228-022-03382-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/03/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Purpose
Antihypertensive drugs are among the most prescribed drugs during pregnancy. Methyldopa, labetalol, and nifedipine have been perceived safe to use during pregnancy and are therefore recommended in international guidelines for treatment of hypertension. In this review, we provide a complete overview of what is known on the pharmacokinetics (PK) of the antihypertensive drugs methyldopa, labetalol, and nifedipine throughout pregnancy.
Methods
A systematic search was performed to retrieve studies on the PK of methyldopa, labetalol, and nifedipine used throughout pregnancy. The search was restricted to English and original studies. The systematic search was conducted on July 27, 2021, in Embase, Medline Ovid, Web of Science, Cochrane Library, and Google Scholar. Keywords were methyldopa, labetalol, nifedipine, pharmacokinetics, pregnancy, and placenta.
Results
A total of 1459 unique references were identified of which title and abstract were screened. Based on this screening, 67 full-text papers were assessed, to retain 30 PK studies of which 2 described methyldopa, 12 labetalol, and 16 nifedipine. No fetal accumulation is found for any of the antihypertensive drugs studied.
Conclusion
We conclude that despite decades of prescribing methyldopa, labetalol, and nifedipine throughout pregnancy, descriptions of their PK during pregnancy are hampered by a large heterogeneity in the low number of available studies. Aiming for evidence-based and personalized dosing of antihypertensive medication in the future, further studies on the relationship of both PK and pharmacodynamics (including the optimal blood pressure targeting) during pregnancy and pregnancy-related pathology are urgently needed to prevent undertreatment, overtreatment, and side effects.
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Affiliation(s)
- Dylan van de Vusse
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Paola Mian
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sam Schoenmakers
- Obstetrics and Gynecology, Division Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willy Visser
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Obstetrics and Gynecology, Division Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Karel Allegaert
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jorie Versmissen
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Asadikalameh Z, Maddah R, Maleknia M, Nassaj ZS, Ali NS, Azizi S, Dastyar F. Bioinformatics analysis of microarray data to identify hub genes, as diagnostic biomarker of
HELLP
syndrome: System biology approach. J Obstet Gynaecol Res 2022; 48:2493-2504. [DOI: 10.1111/jog.15363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Zahra Asadikalameh
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecology and Obstetrics Yasuj University of Medical Sciences Yasuj Iran
| | - Reza Maddah
- Department of Bioprocess Engineering, Institute of Industrial and Environmental Biotechnology National Institute of Genetic Engineering and Biotechnology Tehran Iran
| | - Mohsen Maleknia
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
- Student Research Committee Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Zohre S. Nassaj
- Center for Health Related Social and Behavioral Sciences Research Shahroud University of Medical Sciences Shahroud Iran
| | - Neda Seyed Ali
- Shahid AkbarAbadi Clinical Research Development unit (SHACRDU) School of Medicine, Iran University of Medical Sciences Tehran Iran
| | - Sepideh Azizi
- Shahid AkbarAbadi Clinical Research Development unit (SHACRDU) School of Medicine, Iran University of Medical Sciences Tehran Iran
| | - Fatemeh Dastyar
- Department of Obstetrics and Gynecology, School of Medicine Bushehr University of Medical Sciences Bushehr Iran
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Adorno M, Maher-Griffiths C, Grush Abadie HR. HELLP Syndrome. Crit Care Nurs Clin North Am 2022; 34:277-288. [DOI: 10.1016/j.cnc.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hypertensive Disorders of Pregnancy. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fetal Cerebral Hemodynamic Changes in Preeclampsia Patients by Ultrasonic Imaging under Intelligent Algorithm. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4269308. [PMID: 35669649 PMCID: PMC9166994 DOI: 10.1155/2022/4269308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
Abstract
This study was aimed at evaluating the adoption value of ultrasound imaging features on fetal cerebral hemodynamics in preeclampsia patients based on the partial difference algorithm and the hybrid segmentation network (HSegNet) algorithm. Forty pregnant women with preeclampsia diagnosed by ultrasound examination were selected as the research objects, and another forty normal pregnant women were selected as the control. Then, by using the partial differential algorithm, the imaging of fetal cerebral hemodynamics in preeclampsia patients was enhanced and optimized, and the general clinical data and experimental results were collected. The results showed that the automatic labeling of fetal cerebral artery in fetal middle cerebral artery (MCA) hemodynamic images was realized by HSegNet algorithm model, and the final accuracy was 97.3%, which had a good consistency with the manual annotation of doctors. Education level was a protective factor for preeclampsia (odds ratio (OR) = 0.535). Body mass index (BMI) and family history of hypertension during pregnancy were independent risk factors for preeclampsia (OR = 1.286, and 2.774, respectively). MCA end-diastolic volume (EDV) of preeclampsia fetuses was higher than that of normal fetuses. The MCA systolic-diastolic ratio (S/D), the pulsatility index (PI), and the resistive index (RI) in the preeclampsia group were significantly lower than those in the normal pregnancy group. The results showed that MCA PI, MCA RI, and MCA S/D had certain predictive values for the occurrence of adverse pregnancy outcomes (P < 0.05). In summary, the intelligent algorithm-based fetal MCA hemodynamic ultrasound image in the study could effectively predict pregnancy outcomes of patients and provide certain theoretical support for the subsequent reduction of adverse pregnancy outcomes in patients with preeclampsia.
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Naqvi S, Hassnain S, Yousaf A, Muhammad S, Cabrera D. Postpartum HELLP syndrome complicated with large subcapsular liver hematoma. Proc (Bayl Univ Med Cent) 2022; 35:709-711. [DOI: 10.1080/08998280.2022.2072184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Syed Naqvi
- Department of Internal Medicine, University of Kentucky College of Medicine, Bowling Green, Kentucky
| | - Syed Hassnain
- Department of Internal Medicine, University of Kentucky College of Medicine, Bowling Green, Kentucky
| | - Amman Yousaf
- Department of Internal Medicine, McLaren Flint–Michigan State University, Flint, Michigan
| | - Shoaib Muhammad
- Gulab Devi Hospital, Lahore, Pakistan
- Department of Radiology, Salam Medical Complex, Lahore, Pakistan
| | - Diego Cabrera
- Department of Hematology/Oncology, University of Kentucky College of Medicine, Bowling Green, Kentucky
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[Vascular emergencies in pregnant patients : Peripartum hemorrhage, thromboembolic events and hypertensive diseases in pregnancy]. Anaesthesist 2021; 70:895-908. [PMID: 34495345 DOI: 10.1007/s00101-021-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 10/20/2022]
Abstract
In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. Close consultation between the specialist departments and knowledge of the area of responsibility are essential. In the case of acute bleeding the anesthesiologist is responsible for maintaining adequate circulatory conditions and management of hemostasis. Thromboembolic events require immediate anticoagulation and focused diagnostics. Thereby, both the fetal and the maternal risks must be weighed up. The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.
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Irene K, Amubuomombe PP, Mogeni R, Andrew C, Mwangi A, Omenge OE. Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study. BMC Pregnancy Childbirth 2021; 21:439. [PMID: 34167502 PMCID: PMC8228929 DOI: 10.1186/s12884-021-03875-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03875-6.
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Affiliation(s)
- Koech Irene
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya
| | - Poli Philippe Amubuomombe
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya. .,Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya.
| | - Richard Mogeni
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya
| | - Cheruiyot Andrew
- Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Ann Mwangi
- Department of Behavioural Sciences, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Orang'o Elkanah Omenge
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya.,Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
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16
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Oluwaseyi BE, Michael OA, Oluwafemi AE, David AB. Pregnancy associated coagulopathies in selected community hospitals in Southwest Nigeria. J Family Med Prim Care 2021; 10:1614-1620. [PMID: 34123901 PMCID: PMC8144756 DOI: 10.4103/jfmpc.jfmpc_1381_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/12/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Aim: Pregnancy is characterized by multiple changes in the coagulation system which occurs at different stages of the condition, representing one of the major triggers of maternal and foetal morbidity/mortality in the world during complicated incidences. This study determined the prevalence of coagulation disorders among pregnant women in Southwest Nigeria to buttress the need for prompt and accurate routine diagnosis of these disorders. Methods: Four hundred and five participants (405) attending some selected tertiary health facilities in Southwestern Nigeria were randomly recruited for the study, comprising two hundred and seventy (270) pregnant subjects and one hundred and thirty-five (135) apparently healthy age- and socio-economic status-matched non-pregnant women as controls. The platelet count was assessed; prothrombin time and activated partial thromboplastin time were assessed. Immunoturbidimetric and chromogenic techniques were also used to assess the level of D-dimer and activated protein C resistance. Results: Platelet count, PT and INR in all three trimesters were significantly (p < 0.05) reduced when compared to the non-pregnant control subjects. However, the level of circulating D-dimer was significantly (p < 0.05) increased in all three trimesters when compared with the control group, with observable steady increase in the second and third trimesters. Also, 13% of respondents had thrombotic predisposition and 14.8% with tendencies for consumption coagulopathy while 1.1% are APCr positive individuals. Conclusion: The study affirms the hypercoagulable state of pregnancy coupled with mild gestational thrombocytopenia which could be pointers to onset of coagulation disorders in some participants, subjects with coagulation profiles indicative of thrombotic tendencies and possible onset of consumption coagulopathy and the presence of activated protein C resistant in the region. A review of the coagulation monitoring strategies for pregnant women from primary care to include more definite assays and its proper implementation will immensely contribute to early diagnosis along with intervention for pregnancy associated coagulopathies in resource-limited settings.
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Affiliation(s)
- Bamisaye E Oluwaseyi
- Department of Biomedical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Okungbowa A Michael
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Akanni E Oluwafemi
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria
| | - Akinbo B David
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
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17
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Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group. Blood 2021; 136:2103-2117. [PMID: 32808006 DOI: 10.1182/blood.2020005221] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Pregnancy and postpartum are high-risk periods for different forms of thrombotic microangiopathy (TMA). However, the management of pregnancy-associated TMA remains ill defined. This report, by an international multidisciplinary working group of obstetricians, nephrologists, hematologists, intensivists, neonatologists, and complement biologists, summarizes the current knowledge of these potentially severe disorders and proposes a practical clinical approach to diagnose and manage an episode of pregnancy-associated TMA. This approach takes into account the timing of TMA in pregnancy or postpartum, coexisting symptoms, first-line laboratory workup, and probability-based assessment of possible causes of pregnancy-associated TMA. Its aims are: to rule thrombotic thrombocytopenic purpura (TTP) in or out, with urgency, using ADAMTS13 activity testing; to consider alternative disorders with features of TMA (preeclampsia/eclampsia; hemolysis elevated liver enzymes low platelets syndrome; antiphospholipid syndrome); or, ultimately, to diagnose complement-mediated atypical hemolytic uremic syndrome (aHUS; a diagnosis of exclusion). Although they are rare, diagnosing TTP and aHUS associated with pregnancy, and postpartum, is paramount as both require urgent specific treatment.
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18
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Pereira MM, Torrado J, Sosa C, Zócalo Y, Bia D. Shedding light on the pathophysiology of preeclampsia-syndrome in the era of Cardio-Obstetrics: Role of inflammation and endothelial dysfunction. Curr Hypertens Rev 2021; 18:17-33. [DOI: 10.2174/1573402117666210218105951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
:
Preeclampsia (PE) is a worldwide pregnancy complication with serious maternal and neonatal consequences. Our understanding of PE pathophysiology has significantly evolved over the last decades by recognizing that endothelial dysfunction and systemic inflammation, with an associated angiogenic imbalance, are key pieces of this still incomplete puzzle. In the present era, where no single treatment to cure or treat this obstetric condition has been developed so far, PE prevention and early prediction poses the most useful clinical approach to reduce the PE burden. Although most PE episodes occur in healthy nulliparous women, the identification of specific clinical conditions that increase dramatically the risk of PE provides a critical opportunity to improve outcomes by acting on potential reversible factors, and also contribute to better understand this pathophysiologic enigma. In this review, we highlight major clinical contributors of PE and shed light about their potential link with endothelial dysfunction and inflammation.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
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19
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Nyuydzefon B, Bonaventure J, Raissa Bifouna I, Agnes E. Complications of severe pre-eclampsia associated with acute intestinal intussusception—A case report. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Tran PL, Randria JM, Ratsiatosika AT, Winer A, Schweizer C, Omarjee A, Peretti V, Dumont C, Dennis T, Lazaro G, Robillard PY, Boukerrou M. Admission into intensive care unit in preeclampsia: a four-year population-based study in Reunion Island. J Matern Fetal Neonatal Med 2020; 35:4285-4290. [PMID: 33207978 DOI: 10.1080/14767058.2020.1849106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of our study was to study risk factors and complications associated with severe preeclampsia requiring intensive care unit (ICU) admission. METHODS Retrospective comparative study over a period from 1st of January 2015 to 1st of January 2019 in the University's maternity unit of South Reunion (Indian Ocean). Our sampling included all preeclamptic patients who delivered in the Southern part of the island. Patients admitted to intensive care unit (ICU) and those who remained in the maternity unit (controls) were reviewed. RESULTS Out of 482 preeclampsia cases, 94 women (19.5%) needed a transfer in ICU, of which only 21 (4.3%) needed invasive intensive care. Mean length of stay was 2.4 ± 2.1 days. ICU admission was associated with HELLP syndrome (OR 8.5 [4.9-14.9], p<.001), severe post-partum hemorrhage (OR 5.86 [1.29-26.70], p=.01) and early onset of preeclampsia (<34 weeks gestation), 2.97 [1.9-4.7], p<.001), leading to higher rate of C-section (OR 2.83 [1.67-4.78], p<.001). There were three patients with a history of eclampsia and no case of maternal death was reported. Fetal prognosis was much poorer in maternal ICU admissions than in controls, with outcomes including lower birth weight (1776 vs. 2304 g, p<.001) and higher perinatal morbidity (infant respiratory distress syndrome 3.70 [1.94-7.05], p<.001) and mortality (<.001). CONCLUSIONS Women needing invasive ICU represented 4.3% of preeclampsia cases. This experience is of interest for lower resource settings such as in countries like Madagascar where very intensive ICU means are very poor, but simpler ICU surveillance is possible. Fetal prognosis was poor though no maternal death was reported. Thus, a multidisciplinary approach of patients with preeclampsia should be encouraged; admission into ICU should be facilitated, as soon as any sign of severity and complications appears.
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Affiliation(s)
- Phuong Lien Tran
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - José Mahenina Randria
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Arnaud Winer
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Chloé Schweizer
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Asma Omarjee
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Véronique Peretti
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Coralie Dumont
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Thomas Dennis
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | | | - Pierre-Yves Robillard
- Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Service de Réanimation néonatale, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island
| | - Malik Boukerrou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.,Faculté de médecine, Unité de formation et de recherche santé de la Réunion, Saint Denis, France
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21
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Arigita Lastra M, Martínez Fernández GS. [HELLP syndrome: controversies and prognosis]. HIPERTENSION Y RIESGO VASCULAR 2020; 37:147-151. [PMID: 32811776 PMCID: PMC7428701 DOI: 10.1016/j.hipert.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- M Arigita Lastra
- Departamento de Obstetricia y Ginecología. Hospital Universitario Doctor Peset, Valencia, España.
| | - G S Martínez Fernández
- Departamento de Obstetricia y Ginecología. Hospital Universitario Doctor Peset, Valencia, España
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22
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Enengl S, Mayer RB, Le Renard PE, Shebl O, Arzt W, Oppelt P. Retrospective evaluation of established cut-off values for the sFlt-1/PlGF ratio for predicting imminent delivery in preeclampsia patients. Pregnancy Hypertens 2020; 19:143-149. [DOI: 10.1016/j.preghy.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
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23
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Bradke D, Tran A, Ambarus T, Nazir M, Markowski M, Juusela A. Grade III subcapsular liver hematoma secondary to HELLP syndrome: A case report of conservative management. Case Rep Womens Health 2019; 25:e00169. [PMID: 31908974 PMCID: PMC6940712 DOI: 10.1016/j.crwh.2019.e00169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022] Open
Abstract
Subcapsular liver hematoma (SLH) is a rare condition that is associated with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A high level of suspicion, early diagnosis, and coordinated, intensive multidisciplinary management are necessary to monitor for serious complications and prevent death. Options include conservative management, hepatic resection, hepatic artery ligation and liver transplantation. This paper describes a 34-year-old woman with HELLP syndrome who developed a large grade III SLH that was managed conservatively.
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Affiliation(s)
- Daniel Bradke
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Ashley Tran
- Rutger's University New Jersey Medical School, Newark, New Jersey, United States of America
| | - Tatiana Ambarus
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Munir Nazir
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Maryann Markowski
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Alexander Juusela
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
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24
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Kocher Z, Hobbs V. Integrating Acupuncture for Preeclampsia with Severe Features and HELLP Syndrome in a High-Risk Antepartum Care Setting. Med Acupunct 2019; 31:407-415. [PMID: 31871530 DOI: 10.1089/acu.2019.1399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Acupuncture is known to reduce blood pressure (BP) in essential hypertension. Acupuncture has been used for addressing several issues in pregnancy, such as morning sickness, labor preparation, and turning breeches. To date, there are very few studies on the use of acupuncture for preeclampsia in high-risk pregnancy. Case: The subject of this single case report was a 35-year-old primipara, who developed preeclampsia with severe features and HELLP [Hemolysis, ELevated liver enzymes, Low Platelet count] syndrome at 27 weeks and 6 days of gestation. She was admitted to an antepartum high-risk hospital unit and was treated with acupuncture and acupressure for a 5-week duration. Results: This patient experienced a temporary reduction in blood pressure and was able to maintain her pregnancy until 34 weeks. The patient had a vaginal birth of a baby girl with Apgar scores of 8 and 9. Conclusions: By reducing the patient's BP, increasing her uterine blood flow, and providing renal protection and hepatoprotection, acupuncture was effective for increasing the length of gestation in a high-risk pregnancy to improve the viability of the baby.
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Affiliation(s)
- Zena Kocher
- Penny George Institute for Health and Healing, Abbott Northwestern Hospital, Minneapolis, MN
| | - Valerie Hobbs
- Postgraduate Doctoral Programs, American College of Traditional Chinese Medicine at the California Institute for Integral Studies, San Francisco, CA
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25
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 775] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Abstract
Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
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Affiliation(s)
- Graham J Burton
- Department of Physiology, Development & Neuroscience, University of Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, UK
| | | | - James M Roberts
- Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
| | - Ashley Moffett
- Centre for Trophoblast Research, University of Cambridge, UK
- Dept of Pathology, University of Cambridge, UK
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27
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Ghorbanpour M, Makarchian HR, Yousefi B, Taghipour M. Conservative Management of Postpartum HELLP Syndrome and Intraparenchymal Liver Hematoma; A Case Report. Bull Emerg Trauma 2019; 7:196-198. [PMID: 31198812 PMCID: PMC6555212 DOI: 10.29252/beat-070218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The HELLP syndrome is an important variant of pre-eclampsia which is known by triad of hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). Intraparenchymal liver hematoma is a rare and important complication of HELLP syndrome which is a life threatening condition. The incidence of intraparenchymal hematoma of the liver has been reported to vary from 1 in each 40,000 to 250,000 deliveries worldwide. Herein we report a case of intraparenchymal liver hematoma following HELLP syndrome. An 18 year- old woman with moderate to severe preeclampsia after delivery, presented with Right upper quadrant (RUQ) pain and tachycardia and significant drop in hemoglobin level. Ultrasonography revealed intraparenchymal liver hematoma. This finding was also confirmed by computerized tomography (CT)-scan. Conservative treatment was applied and the patient improved without need of any surgical intervention. Spontaneous hepatic hematoma should always be considered as a life threatening and important complication of HELLP syndrome during pregnancy and it can be managed conservatively in a hemodynamically stable patient.
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Affiliation(s)
- Manouchehr Ghorbanpour
- Department of Surgery, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Hamid Reza Makarchian
- Department of Surgery, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Babak Yousefi
- Department of Surgery, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Mehrdad Taghipour
- Department of Surgery, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
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28
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Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Routine Complete Blood Count Components in HELLP Syndrome: A Matched Case Control Study. ACTA ACUST UNITED AC 2019; 55:medicina55050123. [PMID: 31072037 PMCID: PMC6572204 DOI: 10.3390/medicina55050123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 01/29/2023]
Abstract
Background and objective: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are new readily available inflammatory markers that have been analyzed in pregnancy-induced hypertensive disorders such as preeclampsia. Studies on the NLR/PLR ratio in hemolysis, elevated liver enzymes, low-platelet count (HELLP) syndrome are limited in the current literature. We compared NLR/PLR and other complete blood count (CBC) components between women with HELLP syndrome and women with healthy pregnancies. Methods: We conducted a retrospective matched case–control study at a tertiary care hospital in NY (USA) in the time frame between January 2016 and December 2018. The study compared pregnant women with HELLP syndrome (cases) to women with healthy pregnancies in the third trimester (controls), matched by age, body mass index (BMI), parity, and race. Patient with preeclampsia, infection, and fever were excluded. Venous blood samples were obtained as part of the routine work-up at admission for delivery, which included a CBC. The main outcomes were NLR and PLR. The secondary outcomes were hemoglobin, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), neutrophils, lymphocytes. Results: There were 14 patients in each group. They were matched by age, race, BMI, and parity. NLR (5.8 vs. 3.6, p-value = 0.002) and neutrophil count (10.7 vs. 6.8, p-value = 0.001) were higher in women with HELLP compared to controls. PLR (34 vs. 130.2, p-value < 0.001) and platelet count (71 vs. 223, p-value < 0.001) were lower in the study group compared to controls. Conclusions: NLR was higher, and PLR was lower in women with HELLP syndrome. These inflammatory markers can be incorporated into the diagnostic algorithm for HELLP syndrome. Future studies are needed to evaluate their ability to predict HELLP syndrome.
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Arora A, Kumar A, Anand AC, Puri P, Dhiman RK, Acharya SK, Aggarwal K, Aggarwal N, Aggarwal R, Chawla YK, Dixit VK, Duseja A, Eapen CE, Goswami B, Gujral K, Gupta A, Jindal A, Kar P, Kumari K, Madan K, Malhotra J, Malhotra N, Pandey G, Pandey U, Puri RD, Rai RR, Rao PN, Sarin SK, Sharma A, Sharma P, Shenoy KT, Singh KR, Singh SP, Suri V, Trehanpati N, Wadhawan M. Indian National Association for the Study of the Liver-Federation of Obstetric and Gynaecological Societies of India Position Statement on Management of Liver Diseases in Pregnancy. J Clin Exp Hepatol 2019; 9:383-406. [PMID: 31360030 PMCID: PMC6637074 DOI: 10.1016/j.jceh.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to pregnancy, those coincidental with pregnancy, and preexisting liver diseases exacerbated by pregnancy. A rapid differential diagnosis between liver diseases related or unrelated to pregnancy is required so that specialist and urgent management of these conditions can be carried out. Specific Indian guidelines for the management of these patients are lacking. The Indian National Association for the Study of the Liver (INASL) in association with the Federation of Obstetric and Gynaecological Societies of India (FOGSI) had set up a taskforce for development of consensus guidelines for management of patients with liver diseases during pregnancy, relevant to India. For development of these guidelines, a two-day roundtable meeting was held on 26-27 May 2018 in New Delhi, to discuss, debate, and finalize the consensus statements. Only those statements that were unanimously approved by most members of the taskforce were accepted. The primary objective of this review is to present the consensus statements approved jointly by the INASL and FOGSI for diagnosing and managing pregnant women with liver diseases. This article provides an overview of liver diseases occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and the recommended treatment options.
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Key Words
- ABCB4, ATP-binding cassette subfamily B member 4
- AFLP, Acute fatty liver of pregnancy
- ALF, Acute liver failure
- ALP, Alkaline phosphatase
- ALT, Alanine transferase
- ART, Antiretroviral therapy
- AST, Aspartate aminotransferase
- BCS, Budd-Chiari syndrome
- CT, Computerized tomography
- DIC, Disseminated intravascular coagulation
- DNA, Deoxyribonucleic acid
- DPTA, Diethylenetriamine pentaacetic acid
- ERCP, Endoscopic retrograde cholangiopancreatography
- FDA, Food and Drug Administration
- FOGSI, Federation of Obstetric and Gynaecological Societies of India
- GGT, Gamma-glutamyl transpeptidase
- GI, Gastrointestinal
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- HBIG, Hepatitis B immune globulin
- HBV, Hepatitis B virus
- HBeAg, Hepatitis B envelope antigen
- HBsAg, Hepatitis B surface antigen
- HCV, Hepatitis C virus
- HELLP syndrome
- HELLP, Hemolysis, elevated liver enzymes, low platelet count
- HG, Hyperemesis gravidarum
- HIV, Human immunodeficiency virus
- HV, Hepatic vein
- ICP, Intrahepatic cholestasis of pregnancy
- INASL, Indian National Association for the Study of Liver
- IVF, In vitro fertilization
- LFT, Liver function test
- MDR, Multidrug resistance
- MRI, Magnetic resonance imaging
- MTCT, Mother-to-child transmission
- NA, Nucleos(t)ide analog
- PIH, Pregnancy-induced hypertension
- PT, Prothrombin time
- PUQE, Pregnancy-Unique Quantification of Emesis
- PegIFN, Pegylated interferon
- RNA, Ribonucleic acid
- TAF, Tenofovir alafenamide
- TDF, Tenofovir disoproxil fumarate
- TIPS, Transjugular intrahepatic portosystemic shunt
- UDCA, Ursodeoxycholic acid
- UGI, Upper gastrointestinal
- ULN, Upper limit of normal
- acute fatty liver of pregnancy
- hyperemesis gravidarum
- intrahepatic cholestasis of pregnancy
- liver diseases in pregnancy
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Affiliation(s)
- Anil Arora
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil C. Anand
- Kalinga Institute of Medical Sciences, KIIT University, Bubaneswar, India
| | - Pankaj Puri
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subrat K. Acharya
- Kalinga Institute of Medical Sciences, KIIT University, Bubaneswar, India
| | - Kiran Aggarwal
- Department of Obstetrics and Gynecology, LHMC & Associated Hospitals, New Delhi, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Yogesh K. Chawla
- Kalinga Institute of Medical Sciences, KIIT University, Bubaneswar, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Bhabadev Goswami
- Department of Gastroenterology, Guwahati Medical College, Assam, India
| | - Kanwal Gujral
- Institute of Obstetrics and Gynecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anoop Gupta
- Delhi IVF and Fertility Research Centre, New Delhi, India
| | - Ankur Jindal
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Patparganj, New Delhi
| | - Krishna Kumari
- Max Cure Suyosha Woman & Child Hospital, Hyderabad, India
| | - Kaushal Madan
- Max Smart Super Speciality Hospital, Saket, New Delhi, India
| | | | | | - Gaurav Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uma Pandey
- Dept of Obstetrics & Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ratna D. Puri
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ramesh R. Rai
- Department of Gastroenterology, NIMS Medical College and Hospital, Jaipur, India
| | - Padaki N. Rao
- Department of Hepatology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Shiv K. Sarin
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Aparna Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Praveen Sharma
- Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Koticherry T. Shenoy
- Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Thiruvananthapuram, India
| | - Karam R. Singh
- Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
| | | | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Skaadel H, Bruserud Ø. Thrombotic complications in adult patients with severe single coagulation factor or platelet defects – an overview. Expert Rev Hematol 2019; 12:119-128. [DOI: 10.1080/17474086.2019.1570126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hanne Skaadel
- Section for Hematology, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Øystein Bruserud
- Section for Hematology, Department of Clinical Science, University of Bergen, Bergen, Norway
- Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
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31
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Morgan J, Della Torre M, Whelan AR, Rodriguez SM, DiGiovanni LM. A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome. AJP Rep 2019; 9:e84-e87. [PMID: 31041116 PMCID: PMC6424812 DOI: 10.1055/s-0039-1681028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.
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Affiliation(s)
- Jessica Morgan
- Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
| | - Micaela Della Torre
- Division of Maternal-Fetal Medicine, Department Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
| | - Anna R. Whelan
- Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
| | - Sophia M. Rodriguez
- Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
| | - Laura M. DiGiovanni
- Division of Maternal-Fetal Medicine, Department Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois
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Raguema N, Zitouni H, Ben Ali Gannoun M, Benletaifa D, Almawi WY, Mahjoub T, Lavoie JL. FAS A-670G and Fas ligand IVS2nt A 124G polymorphisms are significantly increased in women with pre-eclampsia and may contribute to HELLP syndrome: a case-controlled study. BJOG 2018; 125:1758-1764. [PMID: 30066360 DOI: 10.1111/1471-0528.15412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated the association between the Fas-670A/G and the Fas ligand FasL IVS2nt 124 A/G polymorphisms and the risk of pre-eclampsia and its complications. DESIGN A case-controlled study. SETTING University Hospitals in most areas of Tunisia. POPULATION We recruited 300 pregnant women who developed pre-eclampsia and 300 age-matched healthy pregnant women from the same hospital. METHODS Genotyping of Fas-670A/G and the FasL IVS2nt 124A/G gene polymorphisms were conducted using polymerase chain reaction-restriction fragment length polymorphism among our cohort. MAIN OUTCOME MEASURES Fisher's exact test was used to compare the statistical differences between groups for categorical variables and Student t tests were used for continuous variables. RESULTS The frequency of the Fas-670G gene variant was significantly increased in women with pre-eclampsia (42%) compared with control women (30%; P < 0.001). Also, a statistically significant difference was obtained in the distribution of the FasL IVS2nt 124G gene variant when comparing women with pre-eclampsia (43%) with controls (30%; P < 0.001). Interestingly, we found that the carriage of Fas-670G was associated with increased liver enzymes, suggesting an increased prevalence of the haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, a pre-eclampsia complication. CONCLUSION The Fas-670G and FasL IVS2nt 124G polymorphisms are associated with a higher risk of pre-eclampsia and its complications. TWEETABLE ABSTRACT Polymorphisms in the Fas and FasL genes are associated with increased risk of pre-eclampsia and HELLP syndrome.
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Affiliation(s)
- N Raguema
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Jarzouna- Bizerte, Tunisia.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
| | - H Zitouni
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Jarzouna- Bizerte, Tunisia
| | - M Ben Ali Gannoun
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Jarzouna- Bizerte, Tunisia
| | - D Benletaifa
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - W Y Almawi
- Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - T Mahjoub
- Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - J L Lavoie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
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