Adverse Outcomes In Women Research Articles

The role of angiogenic biomarkers and uterine artery Doppler in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome.

To evaluate the usefulness of the uterine artery mean pulsatility index (mPI-UtA) and the sFlt-1/PlGF ratio in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) for the prediction of placental dysfunction-related adverse outcomes (AO), namely pre-eclampsia (PE) and intrauterine growth restriction (IUGR), and for differential diagnosis between PE and SLE flares. Observational prospective cohort study of 57 pregnant women with SLE or APS. mPI-UtA and sFlt-1/PlGF ratio in maternal serum were obtained at four gestational age periods (11-14, 19-22, 24-29 and 32-34 weeks). Comparisons among pregnancies with normal outcome, SLE flare and AO were performed. Overall, we had 44 ongoing pregnancies (36 with SLE and 8 with APS) of which most (n = 35, 80%) were uncomplicated. The overall rate of AO was 9% (n = 4), that was diagnosed at a mean (SD) gestational age of 34.1 (7.5) weeks. Five SLE patients (14%) suffered a SLE flare. No differences for these markers were found between normal pregnancies and those affected by SLE flare. mUtA-PI values were significantly higher in the AO group when compared with normal and SLE flare groups, at 19-22 weeks (1.52, 0.95 and 0.76) and 32-34 weeks (1.13, 0.68 and 0.65), respectively. The sFlt-1/PlGF ratio was significantly higher in the AO group at 24-29 weeks (191.1, 3.1 and 9.2), respectively. Our preliminary results indicate that mPI-UtA and sFlt1/PlGF ratio may be useful to predict AO in women with SLE, and to make the differential diagnosis with a lupus flare.

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study.

To evaluate the association between blood pressure (BP) measurements and adverse outcomes in women with pre-eclampsia. A prospective cohort study of women with pre-eclampsia admitted to three South African tertiary facilities. BP was measured using the CRADLE Vital Signs Alert (VSA), incorporated with a traffic light early warning system; green: systolic BP <140 mmHg and diastolic BP <90 mmHg, yellow: systolic BP 140-159 and/or diastolic BP 90-109 mmHg (but neither is above the upper threshold), red: systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg. Maternal: death, eclampsia, stroke, kidney injury; process measures: magnesium sulfate use, Critical Care Unit (CCU) admission; perinatal: stillbirth, neonatal death, preterm delivery. Of 1547 women with pre-eclampsia (including 42 twin pregnancies), 33.0% of women triggered a red light on admission and 78.6% at their highest BP. Severe hypertension and adverse outcomes were common across yellow and red categories. Comparing admission red to yellow lights, there was a significant increase in kidney injury (OR 1.74, CI 1.31-2.33, trend test p = .003), magnesium sulfate use (OR 3.40, CI 2.24-5.18, p < .001) and CCU admission (OR 1.50, CI 1.18-1.91, p < .001), but not for maternal death, eclampsia, extended perinatal death or preterm delivery. The CRADLE VSA, with integrated traffic light early warning system, can identify women who are hypertensive, at increased risk of severe pre-eclampsia complications and in need of escalation of care. Women who triggered a red light were at increased risk of kidney injury, magnesium sulfate use and CCU admission.

Abstract 21201: Stent Length Remains an Important Risk for Recurrent Events in Women With or Without Diabetes Mellitus After New Generation DES PCI: From the WIN DES Collaboration

Introduction: New Generation drug eluting stents (DES) have overcome the limitations of bare metal stents and first generation DES resulting in lower risk of ischemic events in women. Hypothesis: We sought to compare increasing total stent length per patient for 3-yr outcomes in DM and non-DM women after percutaneous coronary intervention (PCI) with new generation DES. Methods: The WIN-DES collaboration is a pooled database of women undergoing PCI with coronary stents in 26 randomized trials. We compared total stent length per patient treated with new generation DES in quartiles (Among DM - Q1: 8-18mm, Q2: 18-24mm, Q3: 24-38mm and Q4: 38+mm; among non-DM Q1: 8-18mm, Q2: 18-24mm, Q3: 24-36mm and Q4: 36+mm). 3-yr outcomes were analyzed in a time to event manner and adjusted using multivariable methods. Major adverse cardiovascular events (MACE) were defined as a composite of death, myocardial infarction (MI) or target lesion revascularization (TLR). Results: The study sample comprised 5403 patients, of which 31.8% (n = 1719) had DM. In both DM and non-DM groups, patients in Q4 had greater prevalence of B2/C type and calcified lesions with smaller stent diameter compared to others. 3-yr MACE increased from Q1-Q4 in DM and non-DM patients, albeit DM patients experienced higher event rates ( Figure ). After multivariable adjustment, findings were unchanged, and increasing stent length remained associated with greater risk of 3-yr MACE in DM (p-trend=0.003) and non-DM (p-trend &lt;0.0001) patients. No interaction was observed between DM status and stent length for any outcomes. Conclusions: Despite the use of new generation DES, increasing total stent length per patient was associated with greater risk of MACE in both DM and non-DM women undergoing PCI. Women with DM experienced worse outcomes, and a greater risk of TLR regardless of total stent length. Meticulous attention to stent optimization and post PCI pharmacotherapy is needed to mitigate long-term adverse outcomes in women.

What Is the Optimal Time to Retest Patients With a Urogenital Chlamydia Infection? A Randomized Controlled Trial.

Chlamydia trachomatis is a common, often recurring sexually transmitted infection, with serious adverse outcomes in women. Current guidelines recommend retesting after a chlamydia infection, but the optimum timing is unknown. We assessed the optimal retest interval after urogenital chlamydia treatment. A randomized controlled trial among urogenital chlamydia nucleic acid amplification test positive heterosexual clients of the Amsterdam sexually transmitted infection clinic. After treatment, patients were randomly assigned for retesting 8, 16, or 26 weeks later. Patients could choose to do this at home (and send a self-collected sample by mail) or at the clinic. Retest uptake and chlamydia positivity at follow-up were calculated. Between May 2012 and March 2013, 2253 patients were included (45% men; median age, 23 years; interquartile range, 21-26). The overall uptake proportion within 35 weeks after the initial visit was significantly higher in the 8-week group (77%) compared with the 16- and 26-week groups (67% and 64%, respectively, P < 0.001), and the positivity proportions among those retested were comparable (P = 0.169). The proportion of people with a diagnosed recurrent chlamydia infection among all randomized was similar between the groups (n = 69 [8.6%], n = 52 [7.4%], and n = 69 [9.3%]; P = 0.4). Patients with a recent urogenital chlamydia are at high risk of recurrence of chlamydia and retesting them is an effective way of detecting chlamydia cases. We recommend inviting patients for a re-test 8 weeks after the initial diagnosis and treatment.

EP16.10: Prediction of adverse outcomes in women with hypertensive disorders of pregnancy near term utilising the uterine artery pulsatility index

EP16.10: Prediction of adverse outcomes in women with hypertensive disorders of pregnancy near term utilising the uterine artery pulsatility index

Potential Utility of Placental Endocrine Biomarkers to Detect Adverse Outcomes in Women of Advanced Maternal Age

Potential Utility of Placental Endocrine Biomarkers to Detect Adverse Outcomes in Women of Advanced Maternal Age

Evaluating the Safety of Medication Exposures During Pregnancy: A Case Study of Study Designs and Data Sources in Multiple Sclerosis.

BackgroundRegulatory agencies often request prospective, product-specific post-authorization pregnancy exposure registries to monitor safety during pregnancy, even though studies using existing health databases could also be employed.ObjectivesUsing multiple sclerosis (MS) as a case study, we evaluated various study designs and data sources previously used to study medication exposure in pregnancy.MethodsWe examined (1) strengths and limitations of study designs used for pregnancy safety studies in women exposed to MS-specific medications during pregnancy and (2) existing data sources used to conduct such studies in other disease areas. For the data sources identified, we contacted data custodians to determine the feasibility of assessing the risk of adverse outcomes in women with MS exposed to disease-modifying therapies (DMTs) during pregnancy.ResultsOf 43 MS-specific studies identified, most of which were prospective registries, very few, regardless of design and study population, produced timely and robust results for spontaneous abortions and major congenital malformations, considering study duration, achievement of target enrollment numbers, inclusion of internal comparators, and publication of results. Building on the successful use of existing healthcare databases to investigate drug safety during pregnancy in other disease areas, we identified 13 data sources that could be used to study intravenous DMT exposures in women with MS.ConclusionsProspective, treatment-specific registries have generally failed to deliver robust information. For this reason, other study approaches, in particular cohort studies using existing healthcare databases, should be considered for evaluating the safety of drug exposure in pregnancy, including in MS.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-017-0114-9) contains supplementary material, which is available to authorized users.

P 21 Clinical utility of sFlt1/PlGF in management of hypertensive pregnancies in India

Introduction Timing of delivery among women with hypertension remains a balance between prevention of adverse maternal/fetal outcomes and gestational age of delivery. Angiogenic biomarkers have been researched to accurately predict adverse outcomes in women with hypertension, however their use in routine clinical care has not been studied. Objectives To study the outcomes of hypertensive pregnancies with real time assessment and incorporation of knowledge of sFlt1/PlGF ratio performed in the third trimester. Material and methods It is a prospective descriptive cohort study done in a tertiary center in India for a planned total enrollment of 100 patients. Singleton pregnancies with chronic/gestational HTN between 28 to 37 weeks were enrolled.sFlt1/PlGF was measured in serum samples on Roche platform. The results were stratified as Screen negative, borderline positive or Screen positive as per the cut offs (Fig. 1). Patients with Screen negative results underwent conventional testing for maternal fetal wellbeing every 2 weeks along with testing of the sFlt1/PlGF ratio until 35 weeks gestation. Borderline positives underwent testing every week while patients with positive results underwent testing for maternal and fetal wellbeing twice weekly. Once tested positive, the ratio was not repeated. Beyond 37 weeks biweekly clinical surveillance was carried out in the screen negatives and a birth plan was given at 38 to 39 weeks. In the screen positives, the decision to deliver was to be based only on worsening clinical status. Results Data on 21 patients resulting in 54 samples was analysed. Results were compared to 21 contemporaneous pregnancies with HTN from previous years before the use of sFlt1/PlGF ratio. Use of sFlt1/PlGF ratio for monitoring resulted in reduction of deliveries less than 30 weeks, increase in deliveries beyond 37 weeks, delayed delivery in patients with fetal growth restriction resulting in reduction in neonatal intensive care unit stay. There were no cases of perinatal death, eclampsia or maternal death (Fig. 2). Conclusion Clinical extrapolation of sFlt1/PlGF values in hypertensive pregnancies may help prolong stable pregnancies beyond 37 weeks without increase in perinatal mortality. Larger studies need to be done to confirm these findings.

Nonmedical Use of Prescription Opioids among Pregnant U.S. Women

ObjectivesNonmedical use of opioids during pregnancy is associated with adverse outcomes for women and infants, making it a prominent target for prevention and identification. Using a nationally representative sample, we determined characteristics of U.S. pregnant women who reported prescription opioid misuse in the past year or during the past month. MethodsWe used data from the National Survey on Drug Use and Health (2005–2014) in a retrospective analysis. The sample included 8,721 (weighted n = 23,855,041) noninstitutionalized women, ages 12 to 44, who reported being pregnant when surveyed. Outcomes were nonmedical use of prescription opioid medications during the past 12 months and during the past 30 days. Multivariable logistic regression models were created to determine correlates of nonmedical opioid use after accounting for potential confounding variables. ResultsAmong pregnant women in the United States, 5.1% reported nonmedical opioid use in the past year. In adjusted models, depression or anxiety in the past year was strongly associated with past year nonmedical use (adjusted odd ratio [AOR], 2.15; 95% CI, 1.52–3.04), as were past year use of alcohol (AOR, 1.56; 95% CI, 1.11–2.17), tobacco (AOR, 1.72; 95% CI, 1.17–2.53), and marijuana (AOR, 3.44; 95% CI, 2.47–4.81). Additionally, 0.9% of U.S. pregnant women reported nonmedical opioid use in the past month. Past year depression or anxiety and past month use of alcohol, tobacco, and marijuana each independently predicted past month nonmedical use. ConclusionsCharacteristics associated with nonmedical opioid use by pregnant women reveal populations with mental illness and co-occurring substance use. Policy and prevention efforts to improve screening and treatment could focus on the at-risk populations identified in this study.

Influence of maternal overweight, obesity and gestational weight gain on the perinatal outcomes in women with gestational diabetes mellitus

To assess the associations between maternal body mass index (BMI) as well as gestational weight gain (GWG) and pregnancy outcomes in women with gestational diabetes mellitus (GDM). This is a retrospective analysis involving 832 nulliparous women complicated with GDM. Multivariate logistic and restricted cubic logistic regression were used to investigate the association of interest. Overall, 178 (21.4%) women were overweight or obese, and 298 (35.2%) exhibited excessive GWG. Compared with women of normal weight, high pre-pregnancy BMI resulted in a higher risk of cesarean section with an adjusted odds ratio of 1.95 (95% confidence interval being 1.29–2.96) for overweight group and 3.26 (1.57–6.76) for obese group. Similarly, the respective aORs were 4.10 (1.56–10.81) and 9.78 (2.91–32.85) for gestational hypertension, 2.02 (1.05–3.88) and 8.04 (3.46–18.66) for macrosomia, 2.14 (1.40–3.26) and 3.34 (1.69–6.60) for large for gestational age (LGA). Compared with adequate GWG, excessive GWG increased the incidence of cesarean section (1.60, 1.15–2.23) and macrosomia (1.94, 1.11–3.38), while inadequate GWG reduced the incidence of LGA (0.29, 0.17–0.51). High pre-pregnancy BMI and excessive GWG were associated with higher incidence of LGA, as well as other adverse outcomes in women with GDM. Narrower guidelines on GWG might offer extra safety benefit in gestational diabetic population.

Development and validation of prediction models for risk of adverse outcomes in women with early-onset pre-eclampsia: protocol of the prospective cohort PREP study

BackgroundEarly-onset pre-eclampsia with raised blood pressure and protein in the urine before 34 weeks’ gestation is one of the leading causes of maternal deaths in the UK. The benefits to the child from prolonging the pregnancy need to be balanced against the risk of maternal deterioration. Accurate prediction models of risks are needed to plan management.MethodsWe aim to undertake a multicentre prospective cohort study (Prediction of Risks in Early onset Pre-eclampsia (PREP)) to develop clinical prediction models in women with early-onset pre-eclampsia, for risk of adverse maternal outcomes by 48 h and by discharge. We will externally validate the models in two independent cohorts with 634 and 216 women. In the secondary analyses, we will assess risk of adverse fetal and neonatal outcomes at birth and by discharge.DiscussionThe PREP study will quantify the risk of maternal complications at various time points and provide individualised estimates of overall risk in women with early-onset pre-eclampsia to plan the management.Trial registrationISRCTN registry, ISRCTN40384046

N-terminal pro B-type natriuretic peptide and angiogenic biomarkers in the prognosis of adverse outcomes in women with suspected preeclampsia

BackgroundThis study compares the performance of the soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) ratio and the cardiac biomarker N-terminal pro-B type natriuretic peptide (NT-proBNP) in the prediction of adverse outcomes in women with suspicion of PE. MethodsA retrospective cohort study was conducted on women admitted at triage with signs and/or symptoms of PE (n=340). Serum levels of sFlt-1, PlGF and NT-proBNP were determined by an electrochemiluminescence immunoassay (Roche Diagnostics). The main outcomes were early- or late-onset PE and development of adverse outcome, defined as delivery within the first week since clinical presentation or fetal/early neonatal death. ResultsNT-proBNP concentrations (ng/L) were significantly increased in PE versus non-PE women, both at <34 (169 versus 34) and ≥34weeks of gestation (101 versus 49) (p<0.001). A cut-point of 70 showed sensitivities/specificities of 78/74% for early-, and 70/62% for late-onset PE; slightly lower than those offered by the sFlt-1/PlGF ratio or uric acid. The respective cut-points of 178 and 219 for sFlt-1/PlGF ratio and NT-proBNP, demonstrated similar performance in the prediction of adverse outcome, with sensitivity/specificity of 95/84% and 94/76%, respectively. ConclusionNT-proBNP and sFlt-1/PlGF ratio can be used to predict the development of an adverse outcome.

High-normal thyroid-stimulating hormone in euthyroid subjects is associated with risk of mortality and composite disease endpoint only in women.

IntroductionThe aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events.Material and methodsIn 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender.ResultsIn total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years’ follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07–3.82) and, much more strongly, the mortality risk, independently of fT4 increments.ConclusionsThe significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.

Choice of planned place of birth for women with diet-controlled gestational diabetes mellitus

Background: Women with diet-controlled gestational diabetes have been excluded from birthing in one midwife-led birth centre due to an assumed risk of complications. Aims: This study aimed to examine the rates of adverse outcomes for women diagnosed with gestational diabetes who have controlled their hypoglycaemia through dietary change, but who may be excluded from birthing in a midwife-led centre owing to risk of complications, to identify whether outcomes are the same for these women as for other low-risk women giving birth in one local maternity unit. Methods: Retrospective analysis was conducted of data on low-risk women giving birth at a maternity unit in the South East of England to compare the birth outcomes of women with or without gestational diabetes. Data were analysed in Microsoft Excel and presented as descriptive statistics. Findings: In 2014, a total of 164 out of 4032 women who gave birth at the maternity unit had gestational diabetes. Among these, 89 were controlled through diet alone. Data for 4 months in 2015 were also examined for 57 women with gestational diabetes. Conclusions: The mode of delivery and outcomes for the women in this cohort who remained normoglycaemic have been found to be in line with the general outcomes for all women at this hospital during the study period. The women diagnosed with gestational diabetes but well controlled on diet had similar outcomes to low-risk women giving birth at the maternity unit. The small sample size means further work is needed to confirm the findings, but indicates that the option of using the birth centre may be considered a reasonable alternative for these women.

H5. Second trimester vascular function parameters in women with chronic hypertension and their association with adverse maternal and perinatal outcomes

Introduction: Increased aortic systolic BP (SBPao), pulse wave velocity (PWVao) and augmentation index of the aorta (AIXao) are associated with increased cardiovascular morbidity. These measures may also be increased prior to the development of adverse maternal and perinatal outcomes. The aim of this study was to evaluate the association between haemodynamic parameters and adverse outcomes in women with chronic hypertension (CHT).Methods: Women recruited to the PANDA study (Pregnancy And chronic hypertension: NifeDipine versus lAbetalol as antihypertensive treatment) had Arteriograph (Tensio Med) readings taken while sitting. Brachial BP, central SBPao, AIXao and PWVao were measured between 12 and 23 + 6 weeks gestation. Pregnancy outcomes were recorded. Medians within each group were calculated and compared using the Mann–Whitney test.Results: Of the 70 participants; 24% developed superimposed preeclampsia (SPE), and there was a 19% incidence of SGA-3 (GROW customised birthweight below the third percentile).Conclusions: This study highlights interesting changes in vascular function in the second trimester in women with CHT, prior to the onset of superimposed pre-eclampsia or SGA-3. Assessing the impact of antihypertensive medication on these parameters may improve understanding of the mechanism of such treatments.

The association between nitroglycerin use and adverse outcomes in women undergoing cesarean delivery in the second stage of labor

Objective: To identify predictors of hysterotomy extension in women undergoing cesarean delivery (CD) in the second stage of labor, and whether use of nitroglycerin (NTG) during CD has a protective effect.Methods: We conducted a retrospective cohort study of women undergoing CD in the second stage of labor from 2012 to 2015. Some women received NTG at the obstetrician’s request. Logistic regression was used to examine the relationship between second stage duration and NTG administration on maternal and neonatal outcomes.Results: Of the 391 women in the sample, 27% had an extension and 12% received NTG. Second stage ≥4 h was associated with a 2.14-fold higher risk of extension (95% CI 1.22–3.75), a 2.00-fold higher risk of hemorrhage (95% CI: 1.20–3.33) and 2.42-fold higher risk of blood transfusion during delivery hospitalization (95% CI: 0.99–5.91). Intravenous (IV) and sublingual-spray (SL-spray) NTG administration were not associated with an increased risk of hemorrhage or extension. SL-NTG was associated with 4.68-fold increased odds of 5-min Apgar <7 (95% CI 1.42–15.41) and 3.36-fold greater odds of NICU admission (95% CI 1.20–9.41).Conclusion: We found no evidence that NTG protects against extension, and SL-NTG use was associated with adverse neonatal outcomes. Clinical trials should be conducted to evaluate risk and benefits of NTG use.

Pelvic inflammatory disease: improving awareness, prevention, and treatment.

PurposePelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID.Recent findingsThe rates of adverse outcomes in women with PID are high and disproportionately affect young minority women. There are key opportunities for prevention including improving provider adherence with national screening guidelines for STIs and PID treatment recommendations and patient medication adherence. Nearly half of all eligible women are not screened for STIs according to national quality standards, which may increase the risk of both acute and subclinical PID. Moreover, in clinical practice, providers poorly adhere to the Centers for Disease Control and Prevention recommendations for treatment of PID. Additionally, patients with PID struggle to adhere to the current management strategies in the outpatient setting.ConclusionNovel evidence-based clinical and public health interventions to further reduce the rates of PID and to improve outcomes for affected women are warranted. We propose potential cost-effective approaches that could be employed in real-world settings.

Origins in the Womb: Potential Role of the Physical Therapist in Modulating the Deleterious Effects of Obesity on Maternal and Offspring Health Through Movement Promotion and Prescription During Pregnancy.

Maternal obesity and associated metabolic disease contribute to adverse outcomes in women and their offspring, and many of these outcomes have significant acute and chronic implications for both mother and neonate. Targeted movement (ie, physical activity or exercise training) during pregnancy has been shown to be safe and effective for improving many of these outcomes in women at a healthy weight and women who are obese. However, movement prescription and advice during pregnancy are often not addressed by health care providers; this situation creates a unique opportunity for physical therapists to use their expertise in movement with patients who are pregnant. The objective of this article is to briefly review the adverse maternal and neonatal outcomes associated with maternal obesity, the benefits of intentional maternal movement during pregnancy for women who are obese, the evidence-based guidelines for prescribing intentional movement during pregnancy for women who are obese, and the potential for physical therapists to become the driving force behind a necessary increase in movement levels in women who are pregnant. Physical therapists can play a significant role in encouraging movement in women who are healthy and women who have metabolic challenges during pregnancy and thus assist in combating the vicious cycle of obesity by improving maternal and offspring health.

132 Evaluation of the fullpiererse maternal and fetal outcomes in women with hypertensive disorders of pregnancy

Introduction The fullPIERS model is an instrument of simple evaluation and low-cost that uses clinical variables to stratify pregnant women with preeclampsia at high risk for adverse outcomes. However, differentiating high-risk patients amongst the variety presentations of hypertension disorders of pregnancy (HDP), not only preeclampsia, represents a daily challenge for obstetricians. Objectives The aim of this study is to evaluate the use of the fullPIERS model as a predictor of maternal and fetal adverse outcomes in women with hypertensive disorders of pregnancy. Methods This is a prospective cohort ongoing at the obstetric unit of a teaching hospital in Porto Alegre, Brazil. Pregnant women, after 20 weeks of gestation, admitted to the hospital with systolic blood pressure ⩾ 140 and/or diastolic blood pressure ⩾ 90 mmHg were enrolled. Women in active labor at the moment of hospital admission were excluded. The worst clinical and laboratory data from the first 48 hours after admission were recorded. Development of maternal and perinatal outcomes was observed for 14 days. Classification into HDP categories (gestational hypertension, preeclampsia, chronic hypertension and chronic hypertension with superimposed preeclampsia) was completed after delivery. Results • Until this moment, seventy-nine women were included to the study. Thirteen (16.5%) with gestational hypertension, 44 (55.5%) with preeclampsia, 11 (14%) with superimposed preeclampsia and 11 (14%) with chronic hypertension. • Thirty three (42%) women had at least one adverse outcome. Elevated liver enzymes was the most common adverse outcome, occurring in 28 (35%) women. • The group with gestational hypertension had a significant lower incidence of adverse maternal outcomes (2 cases, 15%) when compared to preeclampsia (20 cases, 45.5%) (p 0.05) and superimposed preeclampsia patients (6 cases, 54.5%) (p 0.05). There were no differences comparing development of adverse outcomes between preeclampsia and superimposed preeclampsia groups, or comparing the chronic hypertensive group (5 cases, 45.5%) with any of the other groups. • Twelve (15%) newborns were admitted to intensive care unit and four (5%) neonatal deaths occurred. Women with preeclampsia and superimposed preeclampsia had more perinatal adverse outcomes when compared to other groups (p 0.009). • The fullPIERS model did not demonstrate association with the development of maternal adverse outcomes during the 14 days of follow-up. On the other hand, fullPIERS model predicted adverse fetal outcomes within 14 day of eligibility (AUC ROC 0.73, 95% CI 0.56-0.89). The classification accuracy of fullPIERS was fair. Using a predicted probability of 0.16 as a threshold, fullPIERS obtained a specificity of 80% and a negative predictive value of 90%, whereas correctly classified 54% of women who subsequently had events as being at high risk. Conclusions In our study, fullPIERS model could not predict maternal adverse outcomes within 14 days of hospital admission in women with different categories of HDP. However, we demonstrated that fullPIERS had a reasonable discrimination predicting fetal adverse outcomes in the same period. The main limitation of this study is the small sample size, especially in view of the broad spectrum of pregnant women with elevated blood pressure included. Nonetheless, the elevated rate of adverse outcomes in our sample corroborates to the need for studies that can be generalized to the women with HDP presenting with different features at obstetric units.

Prevalence of comorbidities and their influence on complications and outcomes of coronary bypass surgery for coronary heart disease in gender perspective

Aim. To study prevalence of cardiovascular, respiratory, urinary tract and gastrointestinal comorbidity for the improvement of prediction of complications and adverse outcomes in coronary bypass surgery in patients with coronary heart disease, incl. gender differences. Material and methods. We observed 127 patients (73,2% — males, 26,8% — females), operated for ischemic heart disease in Altai regional clinical hospital. Mean age at the moment of surgery was 58,9±6,3 y.o. Bypass operation was done as indicated, under on-pump conditions with pharmaco-cold cardioplegy. Results. Comorbidity index by Charlson (CIС) was 4,7 [4,1-5,3] points; in men — 3,6 [3,2-4,1], in women — 5,2 [4,7-5,6] (p5) у for women — 58,8% vs 36,6% (р=0,04). CIC correlated with the following operation complications: heart failure required inotropes for >5 days (r=0,73); perioperation myocardial infarction (r=0,71); acute disorder of brain circulation confirmed by computed tomography (r=0,56); heart rhythm disorders: atrial fibrillation, paroxysmal ventricular tachycardia (r=0,52); respiratory failure led to prolonged artificial ventilatory support >5 days. (r=0,48). Conclusion. CIC shows gender differences and is characterized by higher risk of adverse outcomes in women: survival 70 y.o., heart failure, diabetes, chronic kidney disease (≥III stage) and duration of on-pump period.