Diagnosis Of Preeclampsia Research Articles

Evaluation of Conventional and Combined Doppler Parameters in Preeclampsia: Diagnostic and Prognostic Insights.

Background: The aim of this study was to examine the relationship between conventional and novel Doppler parameters, including cerebroplacental ratio (CPR), cerebral-placental-uterine ratio (CPUR), umbilical-to-cerebral ratio (UCR), and amniotic-to-umbilical-cerebral ratio (AUCR), with the diagnosis of preeclampsia (PE) and adverse neonatal outcomes in PE cases. Methods: This prospective case-control study was conducted at the Ankara Etlik City Hospital Perinatology Clinic between November 2023 and May 2024. The study population was divided into two groups: Group 1, consisting of 74 patients diagnosed with preeclampsia, and Group 2, consisting of 80 healthy control patients. Composite adverse perinatal outcomes (CANOs) include presence of at least one adverse outcome: 5th-minute APGAR score < 7, transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), need for continuous positive airway pressure (CPAP), need for mechanical ventilation, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, need for phototherapy, intraventricular hemorrhage (IVH), and neonatal sepsis. Results: The CPR, CPUR, and AUCR were significantly lower in the PE group compared to the control group, while the UCR was notably higher in the PE group. Among the combined ratios, the CPUR exhibited the highest diagnostic performance for both PE diagnosis and the prediction of CANOs. Additionally, while the UCR, CPR, and AUCR were significant for PE diagnosis, only AUCR demonstrated a significant association with the prediction of CANOs. Conclusions: Combined Doppler parameters, especially CPUR and AUCR, offer valuable insights into diagnosing PE and predicting CANOs. CPUR demonstrated the highest diagnostic accuracy, underscoring its potential utility in clinical settings.

Clinical Value of Renal Function Markers Combined with Blood Lipid Levels during Late Pregnancy to Predict Preeclampsia: A Retrospective Case-Control Study

Background: Preeclampsia (PE) is a common complication of pregnancy and there is currently a lack of valuable diagnostic and predictive methods for it. This study aimed to explore the association between renal function markers, blood lipid levels in late pregnancy and PE, then assess the combined predictive value for PE. Methods: This was a retrospective case-control study that selected 263 eligible patients in late pregnancy diagnosed with PE as the case group and 264 healthy parturients as the control group. All participants were hospitalized from January 2021 to December 2023. The levels of serum renal function [creatinine (Cr), uric acid (UA) and urea] and blood lipid [total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL)] were compared between two groups. Logistic regression analysis was used to explore the association between these indicators and PE. Then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of them for PE. p &lt; 0.05 was considered statistically significant. Results: Univariate analysis showed that the PE group had significantly higher levels of TG, Cr, UA, and urea than the control group [3.56 (3.01–4.38) mmol/L vs. 2.98 (2.50–3.42) mmol/L, 54.00 (47.00–62.00) μmol/L vs. 46.00 (42.00–51.00) μmol/L, 367.00 (305.50–425.00) μmol/L vs. 278.00 (244.00–306.00) μmol/L, 3.50 (2.75–4.40) mmol/L vs. 2.90 (2.60–3.55) mmol/L respectively]. Multivariable analysis showed that the serum TG [adjusted odds ratio (AOR) = 1.827 (95% confidence interval (95% CI) = 1.277–2.615)], Cr [AOR = 1.066 (95% CI = 1.028–1.106)] and UA [AOR = 1.016 (95% CI = 1.011–1.022)] were risk factors for PE (p &lt; 0.001). ROC curves revealed that areas under the curve (AUC) were 0.703 (95% CI = 0.658–0.747), 0.734 (95% CI = 0.691–0.777) and 0.822 (95% CI = 0.786–0.857) respectively. The AUC, sensitivity and specificity of the combination of TG, Cr and UA were 0.864 (95% CI = 0.833–0.896), 76.4%, and 84.8%. Conclusions: The increased levels of serum TG, Cr and UA imply greater possibility of PE, thus they are considered as the risk factors. And their combination has a certain predictive value for PE, which may offer a fresh, convenient and efficient method for the diagnosis and treatment of PE.

Antioxidant Properties of Albumin and Diseases Related to Obstetrics and Gynecology.

Albumin, the most abundant protein, contributes significantly to various physiological processes, indicating its multifunctional properties. It has drawn the attention of scientists and physicians because of its primary role in maintaining osmotic pressure and involvement in transporting numerous small molecules, including hormones, fatty acids, and drugs. A growing body of evidence has recently illustrated an additional aspect of albumin's antioxidant properties. Therefore, based on recent research findings, this review article delves into the molecular and biochemical aspects of albumin's antioxidative capabilities. We highlight the multifaceted significance of proteins in oxidative stress and their relation to pathologies in obstetrics and gynecology. In particular, we focused on preeclampsia, in which oxidative stress is closely involved in the pathogenesis, and renal dysfunction leads to increased albumin excretion into the urine, resulting in hypoalbuminemia. In addition, we discussed the role of albumin in preeclampsia pathogenesis, diagnosis, and patient prognosis. Understanding the antioxidant properties of albumin opens new avenues for therapeutic intervention and sheds light on novel strategies for combating preeclampsia associated with oxidative damage. In this study, we employed the PubMed database to search for articles that assessed the antioxidant properties of albumin, with a specific focus on obstetric diseases, particularly preeclampsia. The last update of the search was conducted in November 2024.

Profilin-1 levels in preeclampsia: Associations with disease and adverse neonatal outcomes.

Preeclampsia is a serious pregnancy complication requiring early detection to improve outcomes. Profilin-1 (PFN1), linked to vascular dysfunction, may serve as a biomarker for diagnosing preeclampsia and predicting adverse neonatal outcomes. The aim of this study was to determine the serum Profilin-1 levels in patients diagnosed with preeclampsia and to investigate its association with disease severity and adverse neonatal outcomes. A prospective cross-sectional study was conducted at Etlik City Hospital involving 40 women with preeclampsia and 40 healthy controls. Serum PFN1 levels were measured by ELISA and results were compared between groups. The results were compared between the groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of PFN1. Serum PFN1 levels were significantly higher in the preeclampsia group compared to controls (46.48 [30.23-60.29] vs. 26.41 [19.65-41.76], p<0.001). The ROC curve showed good diagnostic accuracy for PFN1 in detecting preeclampsia with an AUC of 0.741 (95% CI: 0.631-0.832, p<0.001), a sensitivity of 95% and a specificity of 42.5%. PFN1 levels were also associated with composite neonatal outcomes, with an AUC of 0.622 (95% CI: 0.520-0.716, p=0.042). PFN1 is a potential biomarker for the diagnosis of preeclampsia. However, further studies are needed to validate its role in predicting adverse neonatal outcomes and to improve its specificity for clinical use.

Short communication: Upregulation of hypoxia/reoxygenation-induced Shc3 by downregulated miR-455-5p, suppresses trophoblast invasion and is associated with placental inflammation and angiogenesis in preeclampsia.

Preeclampsia is characterized by insufficient invasion of extravillous trophoblasts and is a consequence of failed adaption of extravillous trophoblasts to changes in the intrauterine environment developing embryo. Specific miRNAs are implicated in the development of preeclampsia (PE). miR-455-5p is present at low levels in PE but its role is not known. Combining cell and molecular biology methods, we provide evidence of the function and mechanism of miR-455-5p action, and identify its potential target, Shc3, in PE. In vitro, when miR-455-5p was overexpressed in HTR-8/SVneo cells they migrated and invaded more rapidly under hypoxia/reoxygenation (H/R) than in either hypoxic or normoxic conditions. In contrast, apoptosis of HTR-8/SVneo was reduced in H/R. Shc3 was identified as a direct downstream target gene of miR-455-5p. Overexpression of Shc3 reversed the effect of miR-455-5p, promoting apoptosis and suppressing invasion and migration of HTR-8/SVneo under H/R. Shc3 was highly expressed in H/R, but its level was reduced in isolated hypoxic or normoxic environments. Furthermore, we showed Shc3 overexpression is involved in placental inflammation and angiogenesis inhibition. Finally, we showed that the downregulation of miR-455-5p in PE contributes to increased Shc3 in extravillous trophoblasts, thereby limiting extravillous trophoblast cell invasion. Elevated Shc3 is associated with placental inflammation and angiogenesis inhibition. Thus Shc3 serves as a potential biomarker for PE diagnosis and treatment.

Diagnosis of preeclampsia using metabolomic biomarkers

ABSTRACT The diagnostic criteria for preeclampsia do not accurately reflect the pathophysiological characteristics of patients with preeclampsia. Conventional biomarkers and diagnostic approaches have proven insufficient to fully comprehend the intricacies of preeclampsia. This study aimed to screen differentially abundant metabolites as candidate biomarkers for preeclampsia. A propensity score matching method was used to perform a 1:1 match between preeclampsia patients (n = 70) and healthy control individuals (n = 70). Based on univariate and multivariate statistical analysis methods, the different characteristic metabolites were screened and identified. Least absolute shrinkage and selection operator (LASSO) regression analysis was subsequently used to further screen for differentially abundant metabolites. A receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of the metabolites. A total of 1,630 metabolites were identified and quantified in maternal serum samples. Fifty-three metabolites were significantly increased, and two were significantly decreased in preeclampsia patients. The area under the curve (AUC) of the model composed of isobutyryl-L-carnitine and acetyl-leucine was 0.878, and the sensitivity and specificity in detecting preeclampsia were 81.4% and 87.1%, respectively. There are significant differences in metabolism between preeclampsia patients and healthy pregnant women, and a range of novel biomarkers have been identified. These findings lay the foundation for the use of metabolomic biomarkers for the diagnosis of preeclampsia.

Allostatic Load and Oxidative Stress Markers in Women With Early- and Late-Onset Preeclampsia.

Allostatic load and oxidative stress (OS) markers differ in women with and without preeclampsia. However, there is no difference in allostatic load and OS markers between late-onset preeclampsia (L-OP) and early-onset preeclampsia (E-OP). This study aimed to compare the concentrations of allostatic load and OS markers in pregnant women with L-OP and E-OP. This was a comparative cross-sectional study. Women with single pregnancy and a diagnosis of preeclampsia were included. Women with multiple pregnancies and/or chronic hypertension were excluded. Group 1 included women with E-OP (n=16), Group 2 included women with L-OP (n=45), and Group 3 included women without preeclampsia (n=40). No statistical differences were found in maternal age, body mass index, or number of gestations. Arginase levels were higher in Group 1 compared to Group 2 (p = 0.04) and Group 1 compared to Group 3 (p = 0.01). Total antioxidative capacity was higher in Group 1 compared to Group 2 (p = 0.03) and Group 1 compared to Group 3 (p = 0.001). Malondialdehyde levels were higher in Group 1 compared to Group 2 (p = 0.001) and Group 1 compared to Group 3 (p = 0.001). Total sulfhydryl compounds were lower in Group 1 compared to Group 2 (p = 0.01) and Group 1 compared to Group 3 (p = 0.001). No differences were observed between study groups in allostatic load markers. Higher levels of OS markers were found in women with E-OP compared to women with L-OP and controls.

Approach to investigation and management of proteinuria in pregnancy.

Pregnancy leads to significant changes in renal physiology which results in increased in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for five to six months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. Clinicians should establish the level of excretory kidney function and the presence or absence of proteinuria at booking/diagnosis. A history of proteinuria, PET, and anti-hypertensive requirements in previous pregnancies is a helpful guide to what to expect in the current pregnancy. Maternal physiological adaptations mean that yet undiagnosed kidney disease is unmasked during pregnancy. New onset of proteinuria before 20 weeks' gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This CME was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.

Higher Trace Elements and Lower Fatty Acids Levels in Erythrocytes as Predictors of Preeclampsia

BACKGROUND: Preeclampsia is one of the common causes of maternal death in Indonesia. Many studies only focus on the diagnosis and pharmacological treatment of preeclampsia. However, predictors of preeclampsia need to be observed to add more focus on the etiology and prevention of preeclampsia. The imbalances of trace elements and fatty acids play an important role in preeclampsia. Therefore, this study was conducted to evaluate the status of trace elements and fatty acids in preeclampsia patients as predictors of preeclampsia.METHODS: A cross-sectional study was conducted in 3 hospitals, and involving 40 pregnant women classified into severe preeclampsia and normotensive groups. Trace elements and fatty acids were measured in serum and erythrocytes using Inductively Coupled Plasma and Gas Chromatography-Mass Spectrometry. Serum and erythrocytes fatty acid levels' cut-off value, sensitivity, and specificity were analyzed using Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) value.RESULTS: Serum selenium, manganese, and iron levels were significantly different in the preeclampsia group than in the controls (p&lt;0.05). Of all the heavy metals, higher concentrations of cadmium, arsenic, lead, and mercury were found in preeclampsia groups compared to control. Linoleic acid showed the highest predictive value to increase severe preeclampsia with AUC of 0.8. The ratio of high omega-6/omega-3 increases the risk of preeclampsia.CONCLUSION: Selenium, manganese, iron, cadmium, arsenic, lead, and mercury levels are higher in the serum of preeclampsia patients. Almost all erythrocyte fatty acids were significantly higher in the control group compared to preeclampsia. Measurement of trace elements and fatty acids is needed as a predictor of preeclampsia. Erythrocyte fatty acids measurement is considered better than serum.KEYWORDS: trace elements, fatty acids, preeclampsia

Identification of hub genes, diagnostic model, and immune infiltration in preeclampsia by integrated bioinformatics analysis and machine learning

PurposeThis study aimed to identify novel biomarkers for preeclampsia (PE) diagnosis by integrating Weighted Gene Co-expression Network Analysis (WGCNA) with machine learning techniques.Patients and methodsWe obtained the PE dataset GSE25906 from the gene expression omnibus (GEO) database. Analysis of differentially expressed genes (DEGs) and module genes with Limma and Weighted Gene Co-expression Network analysis (WGCNA). Candidate hub genes for PE were identified using machine learning. Subsequently, we used western-blotting (WB) and real-time fluorescence quantitative (qPCR) to verify the expression of F13A1 and SCCPDH in preeclampsia patients. Finally, we estimated the extent of immune cell infiltration in PE samples by employing the CIBERSORT algorithms.ResultsOur findings revealed that F13A1 and SCCPDH were the hub genes of PE. The nomogram and two candidate hub genes had high diagnostic values (AUC: 0.90 and 0.88, respectively). The expression levels of F13A1 and SCCPDH were verified by WB and qPCR. CIBERSORT analysis confirmed that the PE group had a significantly larger proportion of plasma cells and activated dendritic cells and a lower portion of resting memory CD4 + T cells.ConclusionThe study proposes F13A1 and SCCPDH as potential biomarkers for diagnosing PE and points to an improvement in early detection. Integration of WGCNA with machine learning could enhance biomarker discovery in complex conditions like PE and offer a path toward more precise and reliable diagnostic tools.

Placenta location, a prognostic determinant for the incidence of preeclampsia

BackgroundPreeclampsia is one of the complications of pregnancy with uncertain etiology. Nevertheless, it is believed that the condition may arise due to abnormal trophoblastic invasion, resulting in vascular remodeling and increased resistance in the spiral arteries. It is assumed that the location of the placenta might have contributed to the formation of trophoblastic invasion and further placental supply. The current study aims to investigate the association of placental location with the incidence of preeclampsia.MethodsThe current case-control study was conducted on 206 primigravid pregnant woman undergone routine screening ultrasonography study between 14 and 26 gestational weeks to determine the location of the placenta (anterior, posterior, or lateral). The pregnant women were categorized as cases that met the criteria of high-risk for preeclampsia (n = 106) or the controls (n = 100).ResultsLogistic regression analysis identified increased age (OR: 1.047, 95% CI: 1.02–1.07, PPP-value = 0.033), BMI > 25 kg/m² (OR: 4.61, 95% CI: 1.02–10.02, PPP-value = 0.038), and anterior placental location (OR: 2.79, 95% CI: 1.08–9.43, PPP-value = 0.038) as significant predictors of preeclampsia. Posterior placental location was initially associated with preeclampsia (PPP-value = 0.049), but this association was not robust and may reflect random variation.ConclusionThis study identified anterior placental location, increased maternal age, and BMI above 25 kg/m² as significant predictors of preeclampsia. These findings suggest that healthcare providers should closely monitor pregnant women with anteriorly located placentas, advanced age, or elevated BMI. Regular blood pressure monitoring and urine protein screening for individuals with anterior placental location could facilitate early diagnosis and management of preeclampsia. While posterior placental location showed a potential association, it was less consistent, and further research is needed to confirm its role.

Advancing diagnosis and early risk assessment of preeclampsia through noninvasive cell-free DNA methylation profiling

BackgroundAberrant embryo implantation and suboptimal placentation can lead to (severe) complications such as preeclampsia and fetal growth restriction later in pregnancy. Current identification of high-risk pregnancies relies on a combination of risk factors, biomarkers, and ultrasound examinations, a relatively inaccurate approach.Previously, aberrant DNA methylation due to placental hypoxia has been identified as a potential marker of placental insufficiency and, hence, potential (future) pregnancy complications. The goal of the Early Prediction of prEgnancy Complications Testing, or the ExPECT study, is to validate a genome-wide, cell-free DNA (cfDNA) methylation strategy to diagnose preeclampsia accurately. More importantly, the predictive potential of this strategy is also explored to reliably identify high-risk pregnancies early in gestation. Furthermore, a longitudinal study was conducted, including sequential blood samples from pregnant individuals experiencing both uneventful and complicated gestations, to assess the methylation dynamics of cfDNA throughout these pregnancies.A significant strength of this study is its enzymatic digest, which enriches CpG-rich regions across the genome without the need for proprietary reagents or prior selection of regions of interest. This makes it useful for the cost-effective discovery of novel markers.ResultsInvestigation of methylation patterns throughout pregnancy showed different methylation trends between unaffected and affected pregnancies. We detected differentially methylated regions (DMRs) in pregnancies complicated with preeclampsia as early as 12 weeks of gestation, with distinct differences in the methylation profile between early and late pregnancy. Two classification models were developed to diagnose and predict preeclampsia, demonstrating promising results on a small set of validation samples.ConclusionsThis study offers valuable insights into methylation changes at specific genomic regions throughout pregnancy, revealing critical differences between normal and complicated pregnancies. The power of noninvasive cfDNA methylation profiling was successfully proven, suggesting the potential to integrate this noninvasive approach into routine prenatal care.

Sensing Platform Based on Gold Nanoclusters and Nanoporous Anodic Alumina for Preeclampsia Detection.

Preeclampsia is a pregnancy-specific hypertensive syndrome recognized as the leading cause of maternal and fetal morbidity worldwide. Early diagnosis is crucial for mitigating its adverse effects, and recent investigations have identified endoglin as a potential biomarker for this purpose. Here, we present the development of a hybrid biosensor platform for the ultrasensitive detection of endoglin, aimed at enabling the early diagnosis of preeclampsia. This platform integrates the high surface area properties of nanoporous anodic alumina (NAA) with the unique optical characteristics of gold nanoclusters (AuNCs) to achieve enhanced detection capabilities. The NAA surface functionalized to promote attachment of AuNCs, which then was functionalized with specific antibodies to confer selectivity towards endoglin. Photoluminescence (PL) analysis of the biosensor demonstrated a linear detection range of 10-50 ng/mL, with a detection limit of 5.4 ng/mL and a sensitivity of 0.004 a.u./(ng/mL). This proof-of-concept study suggests that the NAA-AuNCs-based biosensing platform holds significant potential for the development of ultrasensitive, portable, and cost-effective diagnostic tools for preeclampsia, offering a promising avenue for advancing prenatal care.

Information Requirements of Clinical Decision Support Systems for the Diagnosis and Prediction of Preeclampsia

Background: Clinical decision support systems (CDSS) are valuable tools for diagnosing and predicting diseases. However, their effectiveness hinges on the quality of the information provided. Objectives: This study aimed to identify the information requirements for a CDSS designed to diagnose and predict preeclampsia. Methods: This applied study was conducted in 2024. A literature review was performed to identify relevant studies. Based on the findings, a questionnaire with a five-point Likert scale was developed and validated through the input of 22 experts in related fields. Data were analyzed using SPSS version 22, and the findings are presented in the text and tables. Results: Among 143 items identified, 115 were deemed essential for a CDSS to diagnose and predict preeclampsia. The information requirements were classified into eight main categories: Demographic information, medical history, laboratory data, pregnancy-related data, complications in other organs, medical examinations, warning signs, paraclinical data, and lifestyle. Conclusions: The findings of this study provide critical insights for developers of CDSS tailored to preeclampsia diagnosis and prediction. By addressing these information needs, such systems can significantly enhance the capabilities of women's health professionals, advancing timely diagnosis and prevention of preeclampsia.

Point-of-Care Tests for Preeclampsia: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.

Preeclampsia is a common condition associated with significant maternal and foetal complications. The diagnosis of preeclampsia is based on clinical criteria, with recent introduction of angiogenic markers as an aid to clinical triage. Several biomarkers are now available in a point-of-care test format, which provide swift results to support clinical decision-making. To determine sensitivity and specificity of available point-of-care tests used for preeclampsia prediction. Systematic searches of databases (PubMed/Medline, Ovid Embase) from inception till May 2024 were done to identify relevant studies. we included studies reporting on the diagnostic test accuracy of any point-of-care test for short-term prediction of preeclampsia in the second or third trimester. Data were extracted using pre-designed template, and statistical analysis was performed to pool sensitivity and specificity and a hierarchal summary receiver operating characteristic curve model was used. Quality of included studies and risk of bias were assessed following the QUADAS-2 tool. We identified 17 studies that met the inclusion criteria, six of which described the use of glycosylated fibronectin, five with Congo red, two with placental growth factor (PlGF) and one study each investigated nephrin, misfolded protein, CD44/FKBPL ratio and inositol phosphoglycan-P. Meta-analysis was possible only for glycosylated fibronectin with a pooled sensitivity of 0.80 (95% CI: 0.51-0.94) and a specificity of 0.84 (95% CI: 0.71-0.93). Five studies were included in meta-analysis, all of which had a low risk of bias on the QUADAS assessment. These findings suggest that the point-of-care glycosylated fibronectin testing might be beneficial in clinical triage for preeclampsia in an at-risk population.

Impact of inter-twin growth discordance on preeclampsia: based on ultrasonic estimated fetal weight.

A retrospective cohort study with 4396 twins who registered before 13 gestational weeks and delivered between January 2013 and December 2020 at Shanghai First Maternity and Infant Hospital, China, was conducted to clarify causal associations between inter-twin estimated fetal weight discordance and preeclampsia. Ultrasound measurements of fetal biometry were collected until the confirmation of preeclampsia diagnosis or the termination of pregnancy (when preeclampsia did not occur). Inter-twin discordance was divided into binary variables using cut-offs of 10%, 15%, and 20%. The associations between inter-twin discordance and preeclampsia were analyzed using generalized estimating equations and group-based trajectory modeling methods. The incidence of preeclampsia was 13.9%, among which 21.8% of cases were diagnosed at early onset and 55.3% at a severe stage. Inter-twin discordance based on estimated fetal weight during pregnancy was positively associated with preeclampsia. The associations were robust and constant by treating the discordance as continuous and binary. Two groups, the stable trajectory group, including 92% of participants, and the changing trajectory group, including 8% of participants, were divided according to the group-based trajectory models. Compared with the stable trajectory group, the risk of developing preeclampsia in the changing trajectory group increased by 50.3% (OR = 1.502, 95%CI: 1.073, 2.105). Subgroup analysis showed positive association primarily in early-onset preeclampsia (OR: 3.859, CI: 2.293, 6.494) and severe preeclampsia (OR: 1.896, CI: 1.264, 2.844) subgroups. These findings can provide a direction to reduce the incidence of preeclampsia in twin pregnancies, considering growth discordance as a high-risk factor in clinical practice.

The 36-week preeclampsia risk by the Fetal Medicine Foundation algorithm is associated with fetal compromise following induction of labor.

Previous studies demonstrated that placental dysfunction leads to intrapartum fetal distress, particularly when an abnormal pattern of angiogenic markers is demonstrated at 36 weeks of gestation. Prediction of intrapartum fetal compromise is particularly important in patients undergoing induction of labor due to different indications for delivery, as this can be a useful in optimizing the method and timing of the induction. To examine whether the risk of preeclampsia assessed by the Fetal Medicine Foundation (FMF) algorithm (derived from a combination of maternal risk factors, mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase-1), associates with the risk of intrapartum fetal compromise requiring cesarean delivery, in a population of singleton pregnancies undergoing labor induction for various indications. Retrospective analysis on prospectively collected data from women with singleton pregnancies undergoing routine assessments at 35+0 to 36+6 weeks of gestation at King's College Hospital (London, UK). The study outcome was the rate of fetal compromise requiring cesarean delivery, examined in relation to the risk of preeclampsia assessed at 36 weeks by the FMF algorithm. Patients undergoing spontaneous labor and prelabor cesarean deliveries were excluded. Five risk categories for preeclampsia were created based on the 36 weeks FMF algorithm: A:˃1/2; B:1/2 -1/5; C: 1/5-1/20; D:1/20-1/50 and E:˂1/50. Based on the reason for induction, we created five categories: premature rupture of membranes; post-term (˃41 weeks), preeclampsia, fetal growth restriction (estimated fetal weight ˂5th centile), preeclampsia and fetal growth restriction. A multinomial logistic regression was used to assess the risk of fetal compromise across the FMF risk categories and accounting for all delivery outcomes (spontaneous or operative vaginal delivery and urgent cesarean delivery for fetal compromise, failure to progress or other reasons), allowing accurate and generalizable risk assessment of fetal compromise. Of 45,375 screened pregnancies, 26,597 (58.6%) had spontaneous onset of labor, 6529 (14.0%) underwent elective pre-labor cesarean delivery, and these were excluded from the analysis; 12,249 were included, of which 182 had a gestational age at birth ≤37 weeks and 1,444 had fetal compromise (crude risk 11.8%). The rate of vaginal delivery in the study population was 69.4%. The rates of fetal compromise in the five induction categories were: 9.7% (premature rupture of membranes), 13.5% (post-term), 14.8% (preeclampsia), 17.2% (fetal growth restriction), and 23.4% (preeclampsia and fetal growth restriction). Cases with vs without intrapartum fetal compromise had higher mean PE risk (1/45 vs. 1/81; p-value < 0.001). The risk of cesarean delivery for fetal compromise increased with: i) advancing gestational age (each week increase at 35-40 weeks: +1%; at 41-42 weeks: +5%); ii) nulliparity +7-10% vs multiparity iii) higher FMF risk of preeclampsia (from the low-risk <1/50 to the high-risk category ≥1/2: +18%; with greater effect for higher preeclampsia risk). In this study population, the rates of fetal compromise were lower with diagnoses of preeclampsia and rupture of membranes and higher with fetal growth restriction (alone or in combination with preeclampsia) and post-term. This study points out the clinically useful association of the 36 weeks FMF risk for preeclampsia with fetal compromise after labor induction. The combination of preeclampsia risk by the 36 weeks FMF method and major delivery indications significantly associates with intrapartum fetal compromise requiring cesarean delivery and may be used to optimize labor induction.

Proposed Utilization of PlGF-Based Diagnostic Testing for Suspected Preeclampsia in Québec: Insights From an Expert Panel Discussion.

Prompt diagnosis of preeclampsia is key to ensure appropriate management and reduce associated adverse outcomes. Placental growth factor (PlGF)-based biomarkers have been shown to be safe and effective diagnostic tools for preterm preeclampsia, and their use is recommended by most recent Canadian guidelines. The present report summarizes an expert panel discussion that led to the development of a proposed utilization algorithm for PlGF-based diagnostic testing for suspected preeclampsia in Québec. In addition to recommendations on who, why, when to test and how to interpret and respond to the test, considerations for optimizing clinical testing relevance were suggested.

Pregnancy and Postpartum Experiences of Women Diagnosed with Preeclampsia: A Qualitative Study

Objective: The aim of this study is to determine the pregnancy and postpartum experiences of women diagnosed with preeclampsia. Methods: The study was conducted with a qualitative design. Data were collected through face-to-face or online interviews using a semi-structured form with 18 women who gave birth with a diagnosis of preeclampsia in the first six months following delivery at a university hospital in Istanbul. The findings were analyzed using content analysis. Results: The mean age of the participants was 30.1±4.1 years. 61.1% of the participants had preterm delivery, 88.8% stayed in the hospital for 2-6 days, and the mean duration after delivery was 90.3±44.6 days. Participants were diagnosed with preeclampsia at an average of 28.5±3.8 weeks. Five themes were identified as a result of qualitative interviews: “reaction to the diagnosis of pre-eclampsia”, ‘postpartum effects of pre-eclampsia’, ‘information gathering’, ‘social support’ and ‘lifestyle changes and pregnancy intention’. Conclusion: The diagnosis of PE affects women’s experiences during pregnancy and the postpartum period. The results indicate that women needed professional assistance with a multidisciplinary approach during this period.

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.