Diagnosis Of Preeclampsia In Women Research Articles

Urine Congo red test for the detection of preeclampsia in pregnant women presenting with suspected preeclampsia

Objectives To determine the predictive performance of the urine Congo red point-of-care test for the identification of preeclampsia in women presenting with suspected preeclampsia. Methods A prospective multi-center cohort study was conducted to include women with suspected preeclampsia (n = 244). The urine Congo red test was determined (score range 1–8). The diagnosis of preeclampsia was based on criteria proposed by The American College of Obstetricians and Gynecologists. The primary outcome was the predictive performance (sensitivity, specificity, negative and positive predictive values, as well as likelihood ratios) of the Congo red kit test for the diagnosis of preeclampsia. Results Fifty-four percent (131/244) of women with suspected preeclampsia subsequently developed preeclampsia. The sensitivity and specificity of the urine Congo red test were 49.6% and 94.7%, respectively, when using a cutoff for Congo red ≥4. The test had a significant positive correlation with the level of urine protein (Pearson correlation 0.61, p-value <.01). Intra- and inter-observer reliabilities were good (intra-class correlation coefficient and Cohen’s kappa coefficient of 0.88 and 0.75, respectively; p < .01). Conclusion The urine Congo red kit test has a high positive predictive performance for the identification of preeclampsia with high reproducibility. This test may be used as a bed side test to rule-in the diagnosis of preeclampsia in women presenting with suspected preeclampsia.

BLOOD BIOMARKERS TO PREDICT OF THE ONSET AND ADVERSE OUTCOMES OF PREECLAMPSIA : A SYSTEMATIC REVIEW

Background: Pre-eclampsia is one of the most common pregnancy complications, and a major cause of fetal and maternal morbidity and mortality globally. Diagnosis currently takes place in the third trimester based on clinical symptoms. This systematic review sought to determine the blood biomarkers that are associated with pre-eclampsia, and in particular, the biomarkers that could predict pre-eclampsia in early pregnancy. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 257 articles, whereas the results of our search on SagePub brought up 78 articles. The results of the search conducted for the last year of 2013 yielded a total 198 articles for PubMed and 54 articles for SagePub. In the end, we compiled a total of 5 papers, 4 of which came from PubMed and 1 of which came from SagePub. We included five research that met the criteria. Conclusion: PlGF and sFlt-1 are the most used in clinical practice, even if their specificity and sensitivity do not justify a default implementation into guidelines to screen all pregnant women. Their role is limited to rule-out a diagnosis of pre-eclampsia in women presenting with symptoms highly suggestive of the disease. Therefore, their current application is not useful for an early prediction of pre-eclampsia. Novel lines of research are needed to identify molecules able to detect pre-eclampsia in a timely manner and which have a predictive value high enough to justify the costs associated with routine measurements in the general pregnant population.

Diagnosis of preeclampsia in women with diabetic kidney disease

ABSTRACT Objective: assessing the incidence of preeclampisa (PE) in women with diabetic kidney disease (DKD) and analyzing the significance of clinical characteristics and changes in laboratory findings throughout the pregnancy on the onset of PE. Methods: the study included 79 patients with DKD. All patients had elevated urinary protein loss (30–299 mg/24 h) or proteinuria (≥300 mg/24 h) in the first trimester of pregnancy. PE was diagnosed in 22,8% patients with DKD. Results: women with proteinuria and/or proliferative retinopathy at the admission developed preeclampsia significantly more frequently than those without these findings. The degree of proteinuria was significantly associated with the risk of PE development in each trimester of pregnancy. Patients with chronic hypertension developed PE significantly more frequently than those who had no chronic hypertension. Conclusion: chronic hypertension and the degree of primary kidney injury and dysfunction are crucial determinants of PE development in women with DKD. Proteinuria seems to be the best renal predictive factors of PE.

Reproductive health and pregnancy in women with chronic kidney disease.

Chronic kidney disease (CKD) is associated with reduced fertility and an increased risk of adverse pregnancy outcomes. Rates of pre-eclampsia, fetal growth restriction and preterm delivery increase incrementally with the severity of CKD and proteinuria. Pre-pregnancy counselling can facilitate informed decision-making. Safe and effective contraception is required for women who wish to delay or avoid pregnancy. Pregnancy planning for women who wish to conceive involves appropriate substitution of known teratogens - including mycophenolate mofetil, angiotensin blockers and cyclophosphamide - and can aid optimization of disease control. However, pregnancy, which can occur in women with any stage of CKD, can exacerbate comorbidities such as anaemia, vitamin D deficiency and hypertension. Increased haemodialysis provision is associated with improved pregnancy outcomes for women on dialysis. Diagnosis of pre-eclampsia in women with CKD is complicated in patients with pre-existing hypertension and proteinuria but can be improved by the use of vasoactive biomarkers as well as placental and fetal Doppler ultrasound. Pregnancy data for newer drugs used in CKD are limited as pregnancy and CKD are common exclusion criteria for drug and intervention trials. Although prospective data may be available for older drugs, the use of most drugs in pregnancy is based on retrospective data and expert consensus.

P 41 Diagnostic biomarkers in women with CKD and superimposed pre-eclampsia

Introduction Chronic kidney disease (CKD) affects 3% of pregnant women and is associated with an increased risk of pre-eclampsia. Diagnosis of pre-eclampsia in women with CKD is complicated by pre-existing hypertension, proteinuria, and gestational changes in creatinine. A fall in placental growth factor may be a useful adjunct for the diagnosis of pre-eclampsia in women with CKD. Pathological mechanisms that link CKD and pre-eclampsia include endothelial dysfunction, complement dysregulation, kidney injury, and renin-angiotensin system activation. Objectives To quantify biomarkers of the endothelial glycocalyx, complement activation, kidney injury, and the renin-angiotensin system in women with CKD in pregnancy. 1. To evaluate diagnostic test performance for these biomarkers in pre-eclampsia superimposed on CKD. 2. To correlate discriminatory biomarkers with PlGF centile due to the absence of robust clinical diagnostic criteria for pre-eclampsia superimposed on CKD. Patients and methods A case-control cohort of 15 women with CKD and pre-eclampsia were matched for both gestation and stage of CKD with 45 women without pre-eclampsia. Active renin, angiotensinogen, tetrahydroaldosterone, hyaluronan, C3a, C5a, complement factor H, C5b-9 were quantified by ELISA. Intercellular adhesion molecule (I-CAM), Vascular cell adhesion molecule (V-CAM), P-selectin, E-selectin, kidney-injury-molecule-1 (KIM-1) and lipocalin-2 (NGAL) were quantified by Luminex performance assay. Results were correlated with placental growth factor (PlGF) centiles. Results Plasma hyaluronan, V-CAM and urinary C5b-9:creatinine were significantly higher in women with superimposed pre-eclampsia compared to women with CKD who did not develop pre-eclampsia (Figure 1:). Hyaluronan and V-CAM correlated strongly with PlGF centile (Figure 2). Plasma active renin was significantly lower in pre-eclampsia than controls but diagnostic distinction was lost after adjustment for the presence of chronic hypertension. Other biomarkers were not discriminatory. Conclusion Plasma hyaluronan, V-CAM and urinary C5b-9:creatinine may have potential as diagnostic markers for superimposed pre-eclampsia in women with CKD. A large validation study of these biomarkers is in progress. Download : Download high-res image (171KB) Download : Download full-size image Download : Download high-res image (220KB) Download : Download full-size image