Diagnostic Criteria For Preeclampsia Research Articles

Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature.

Pregnancy after kidney transplantation (KTx) is considered to have a high risk of non-negligible complications for the mother, the allograft, and the offspring. With an increased incidence of these pregnancies over the past decades, transplant nephrologists and specialized obstetricians face increasing challenges, with scarce literature regarding long-term outcomes. We retrospectively collected data from all women with at least one live birth pregnancy after KTx who were followed at our tertiary hospital between 2000 and 2021 to study maternal, graft and fetal outcomes. Ten patients underwent 14 live birth pregnancies after KTx. Preponderant maternal complications were stage 1 acute kidney injury (43%), urinary tract infections (UTI, 43%), progression of proteinuria without diagnostic criteria for preeclampsia (29%), and preeclampsia (14%). Median baseline serum creatinine at conception was 126.5 µmol/L [median estimated glomerular filtration rate (eGFR) 49 mL/min/1.73m2], and eGFR tended to be lower than baseline at follow-ups. Overall, there was no increase in preexisting or occurrence of de novo donor-specific antibodies. No graft loss was documented within the 2-year follow-up. There were nine premature births (64%), with a median gestational age of 35.7 weeks. The median birth weight, height, and head circumference were 2,560 g, 45.5 cm, and 32.1 cm, respectively. These measurements tended to improve over time, reaching a higher percentile than at birth, especially in terms of height, but on average remained under the 50th percentile curve. Overall, pregnancies after KTx came with a range of risks for the mother, with a high prevalence of cesarean sections, emergency deliveries, UTI, and preeclampsia, and for the child, with a high proportion of prematurity, lower measurements at birth, and a tendency to stay under the 50th percentile in growth charts. The short- and long-term impact on the allograft seemed reassuring; however, there was a trend toward lower eGFR after pregnancy. With these data, we emphasize the need for a careful examination of individual risks via specialized pre-conception consultations and regular monitoring by a transplant nephrologist and a specialist in maternal-fetal medicine during pregnancy. More data about the long-term development of children are required to fully apprehend the impact of KTx on offspring.

Possible additional criteria for the diagnosis of preeclampsia with severe features.

Preeclampsia is a disorder affecting multiple organ systems. Preeclampsia with severe features may prompt consideration of delivery. The diagnostic criteria for preeclampsia with severe features, while focusing upon maternal cardiopulmonary, neurological, hepatic, renal and haematological systems, vary considerably in international practice guidelines. In the absence of alternative causes, severe hyponatraemia, pleural effusions and ascites, and abrupt severe maternal bradycardia are proposed as possible additional criteria for the diagnosis of preeclampsia.

The impact of fetal growth restriction in diagnosing preeclampsia on the severity of maternal features.

We aimed to assess the impact of fetal growth restriction (FGR) as a diagnostic criterion for preeclampsia (PE) on the severity of maternal preeclamptic features by comparing it with other diagnostic criteria for PE, maternal organ dysfunction. We performed a retrospective cohort study of singleton pregnancies. Based on the status at diagnosis, PE cases preceded by FGR without maternal organ dysfunction (Group F; n = 28) and those preceded by maternal organ dysfunction without FGR (Group M; n = 87) were analyzed. Group F had an earlier PE diagnosis (32.5 ± 4.9 vs. 36.7 ± 3.5 weeks, p < 0.01) and delivery (33.7 ± 4.5 vs. 37.5 ± 3.1 weeks, p < 0.01) than Group M. No significant differences in maternal morbidities were observed between the groups, including severe hypertension (75.0 vs. 60.0%), need for intravenous antihypertensives (42.9 vs. 48.3%) or magnesium sulfate (60.7 vs. 54.5%), or a composite of major maternal complications (17.9 vs. 21.8%). When limited to early-onset PE diagnosed before 34 weeks of gestation (17 and 17 cases in Group F and M, respectively), the frequencies of maternal morbidities (severe hypertension: 70.6 vs. 52.9%, intravenous antihypertensives: 35.3 vs. 35.3%, magnesium sulfate: 58.8 vs. 47.1%, major complications: 29.4 vs. 23.5%) and the duration from diagnosis until delivery (11.2 ± 14.7 vs. 16.5 ± 21.7 days) were comparable between two groups. Our results suggest that the presence of FGR on PE diagnosis is associated with the development of severe maternal symptoms as much as that of maternal organ dysfunction at diagnosis, and it may be reasonable to include FGR in PE diagnostic criteria.

Reducing laboratory costs through rational testing in suspected pre-eclampsia

The current electronic laboratory order set at Epsom and St Helier University Hospitals NHS Trust for suspected pre-eclampsia includes a full blood count, urea and electrolytes, liver function, gamma-glutamyltransferase and...

PLACENTAL HEMODYNAMIC ASSESSMENT IN WOMEN WITH SEVERE PREECLAMPSIA IN SECOND- AND THIRD-TRIMESTER PREGNANCY BY 3D POWER QUANTITATIVE DOPPLER ULTRASOUND

Objective: The present study analyzed the fetal–placental hemodynamic parameters in women with severe preeclampsia in second- and third-trimester pregnancy with a view to developing effective predictive indicators for preeclampsia and providing support for the prenatal clinical treatment of preeclampsia. Materials and Methods: From January 2015 to January 2019, 160 pregnant women diagnosed with severe preeclampsia at Xiangyang First People’s Hospital were recruited as the study group. The diagnostic criteria for preeclampsia were in accordance with the guidelines of the International Society for the Study of Hypertension in Pregnancy (ISSHP). A sample of 160 healthy pregnant women with normal blood pressure were selected as the control group. The GE Voluson E8 and E10 four-dimensional (4D) ultrasonic diagnostic instruments and the three-dimensional (3D) power Doppler in angio-quantitative mode were used to measure the hemodynamic parameters of the placenta, left uterine artery (LUA), right uterine artery (RUA), middle cerebral artery (MCA), umbilical artery (UA), and ductus venosus (DV) in the two groups. The above parameters were analyzed statistically using SPSS 22.0. Results: The systolic/diastolic velocity ratio (S/D), pulsatility index (PI), and resistance index (RI) of the MCA in the study group were lower than those of normal subjects of the same gestational age (P &lt; 0.05). These parameters in the UA were higher in the study group than those in normal subjects (P &lt; 0.05). The ratios between the peak ventricular systolic velocity and the peak atrial systolic velocity (S/A), pulsatility index for the vein (PIV), pre-load index (PLI), and peak velocity index for the vein (PVIV) in the DV were significantly different between the study and normal groups (P &lt; 0.05). The placental vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were lower in the study group than those in normal subjects of the same gestational age (P &lt; 0.05). There were good correlations between VI, VFI and RUA, PI, with correlation coefficients of −0.697 and −0.702, respectively. FI was the indicator that had the highest diagnostic efficacy for severe preeclampsia. The predictive sensitivity of the FI with a cut-off value of 34.92 was 96.3%, and the corresponding specificity was 86.9%. Conclusions: Placental FI had the highest predictive efficacy for severe preeclampsia and provides a reliable quantitative indicator and data support for preeclampsia management. 3D power quantitative Doppler ultrasound provides a novel avenue for the study of severe preeclampsia.

The impact of the definition of preeclampsia on disease diagnosis and outcomes: a retrospective cohort study

The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, there remains controversy with regard to the implementation of broader definitions and the most appropriate definition of end-organ dysfunction. This study aimed to assess the impact of different diagnostic criteria for preeclampsia on rates of disease diagnosis, disease severity, and adverse outcomes and to identify associations between each component of the different diagnostic criteria and adverse pregnancy outcomes. We performed a retrospective cohort study of singleton pregnancies at Monash Health between January 1, 2016 and July 31, 2018. Within this population, all cases of gestational hypertension and preeclampsia were reclassified according to the International Society for the Study of Hypertension in Pregnancy 2001, American College of Obstetricians and Gynecologists 2018, and International Society for the Study of Hypertension in Pregnancy 2018 criteria. Differences in incidence of preeclampsia and maternal and perinatal outcomes were compared between the International Society for the Study of Hypertension in Pregnancy 2001 group and the extra cases identified by American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018. Outcomes assessed included biochemical markers of preeclampsia, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. Multiple logistic regression analysis was also performed to assess each component of the American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018 criteria and their associations with adverse maternal and perinatal outcomes. Of 22,094 pregnancies, 751 (3.4%) women had preeclampsia as defined by any of the 3 criteria. Compared with International Society for the Study of Hypertension in Pregnancy 2001, the American College of Obstetricians and Gynecologists 2018 criteria identified an extra 42 women (n=654 vs n=696, 6.4% relative increase) with preeclampsia, and International Society for the Study of Hypertension in Pregnancy 2018 identified an extra 97 women (n=654 vs n=751, 14.8% relative increase). The additional women identified by International Society for the Study of Hypertension in Pregnancy 2018 exhibited a milder form of disease with lower rates of severe hypertension (62.4% vs 44.3%; P<.01) and magnesium sulfate use (11.9% vs 4.1%; P<.05) and a trend toward lower rates of adverse maternal outcomes (9.8% vs 4.1%). These women also delivered at a later gestation, and their babies had a lower number of neonatal intensive care unit admissions and adverse perinatal outcomes. Objective features such as fetal growth restriction, thrombocytopenia, renal and liver impairment, and proteinuria were associated with an increased risk of adverse maternal and perinatal outcomes, whereas subjective neurologic features demonstrated poorer associations. Implementation of broader definitions of preeclampsia will result in an increased incidence of disease diagnosis. However, because women who exclusively fulfill the new criteria have a milder phenotype of the disease, it remains uncertain whether this will translate to improved outcomes.

Blood Pressure Changes in Adolescents with Preeclampsia: A Multicentre, Case-Control Study in Latin American Hospitals

ObjectiveTo determine the minimum blood pressure increases that would confirm or exclude, with the greatest predictive values, hypertensive disorders of pregnancy (HDP) in pregnant adolescents after 24 weeks gestation. MethodsWe conducted a case-control study of pregnant women aged ≤19 years with and without HDP. Using systolic and diastolic blood pressure increases, a predictive analysis was performed, and the area under the curve was calculated. ResultsThe cases and controls had systolic blood pressure increases of 45.3 ± 17.5 mm Hg and 6.4 ± 7.9 mm Hg, respectively (P = 0.001) and diastolic blood pressure increases of 30.8 ± 11.7 mm Hg and 3.5 ± 5.7 mm Hg, respectively (P = 0.001). Systolic and diastolic increases of ≥20 mm Hg showed the greatest sensitivity and specificity. A combined analysis showed that an increase of ≥20 mm Hg had a greater positive likelihood ratio of 35.4 (95% CI 22.4–55.9) and negative likelihood ratio of 0.10 (95% CI 0.07–0.13), with an area under the curve of 0.98 (95% CI 0.96–0.99). ConclusionsSystolic and diastolic blood pressure increases of ≥20 mm Hg must be considered in the diagnostic criteria for preeclampsia and gestational hypertension among pregnant adolescents past 24 weeks gestation.

Fetal growth restriction as a diagnostic criterion for preeclampsia.

Currently, no unified set of criteria to classify preeclampsia (PE) exists. Further, no consensus has been reached whether fetal growth restriction (FGR) should be included in diagnostic criteria for PE. We examined the adequacy of including FGR in diagnostic criteria for PE. Singleton pregnancy patients who developed PE before 34weeks of gestation managed at a tertiary center between 2010 and 2016 were included. Patients were divided into two groups according to cause for PE diagnosis. In addition, those diagnosed with PE because of gestational hypertension (GH) and FGR were divided into two groups according to presence of proteinuria or organ dysfunction during the expectant management. Pregnancy prolongation from PE diagnosis. Of 69 PE patients, 18 (28.1%) were diagnosed as PE with GH and only FGR (F group). Pregnancy prolongation between PE diagnosis to delivery was longer in the F group than in PE cases with primary organ dysfunction (P group) (21 vs 10days, P=0.049). Of 18 patients in the F group, 12 (66.7%) subsequently had proteinuria or organ dysfunction (S group). The remaining 6 patients (33.3%) had no subsequent proteinuria or organ dysfunction (N group). There were no significant differences in prolongation of pregnancy from organ dysfunction onset to delivery between the S and P groups (10 vs 10days, P=0.36). Organ dysfunction onset may reflect PE progression more accurately than FGR onset. Further investigations on whether to include FGR into the diagnostic criteria for PE are needed.

Early- and Late-Onset Preeclampsia: A Comprehensive Cohort Study of Laboratory and Clinical Findings according to the New ISHHP Criteria.

Recently, the diagnostic criteria of preeclampsia have been changed. No studies are available in the literature that analyzed in detail the differences between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP), taking into account the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Thus, we sought to retrospectively investigate in detail the differences in clinical and laboratory outcomes between EOP and LOP diagnosed according to the ISSHP criteria. A retrospective cohort study was conducted in 214 women with singleton pregnancies and preeclampsia admitted to the Department of Obstetrics and Perinatology of the University Hospital in Kraków, Poland, from 2013 to 2017 (113 (52.8%) women with EOP and 101 (47.2%) women with LOP). Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery and neonatal data. Patients with preeclampsia accounted for 1.7% of the women who delivered during the study period. The EOP and LOP groups did not differ in the distribution of risk factors for preeclampsia. The most common risk factor was primiparity, which was observed in 72.0% of cases. Regarding the ISSHP diagnostic criteria, the two groups differed in the incidence of fetal growth restriction (p=0.0009), hemolysis (p=0.0416), and neurological complications (p=00342), which were found more often in the EOP group. In addition, the EOP group had more frequent occurrence of severe cardiorespiratory (p < 0.0001) and hematological (p=0.0127) complications, adverse fetoplacental conditions (p < 0.0001), and severe fetoplacental complications (p=0.0003). Children born to women with EOP had lower Apgar scores (p < 0.001) and higher rates of intraventricular hemorrhage (p < 0.0001), respiratory disorders requiring mechanical ventilation (p < 0.0001), and early (p=0.0004) and late sepsis (p=0.002). EOP differed from LOP in terms of maternal and perinatal adverse outcomes. The observed higher rates of fetoplacental adverse conditions and severe complications indicate a significant contribution of impaired placentation to the etiopathogenesis of EOP.

Relationship between LPA SNPs and inflammatory burden in patients with preeclampsia to address future cardiovascular risk

Objective The study tested whether cardiovascular corresponding LPA risk genotypes improve pre-eclampsia and coronary heart disease (CHD) risk prediction beyond conventional risk factors. Background Studies have shown that women specific risk factors for cardiovascular disease (CVD) have taken an attention recently. It might be possible to identify women who have the highest risk in developing CVD in their further lives. It is well-known that Lp(a) levels have an impact on increased risk of CVD which is affected by LPA gene. Further, LPA risk genotypes are not considered in cardiovascular risk prediction. Methods We have included 200 pregnant Turkish women into the study. We stratified the preeclamptic (PE) group: early (EOP) (28.7 ± 3.0 weeks) and late onset (LOP) (36.0 ± 1.4 weeks). 14 LPA SNPs were evaluated in the study. Rs9355296 and rs3798220 were found as independent risk factors for preeclampsia by logistic regression analysis. A positive correlation was found between rs9355296 and the diagnostic criteria of preeclampsia. Further rs9355296 G/* carriers have higher vascular inflammation rather than AA carriers. Conclusions The findings reveal that LPA genetic variability with high inflammatory response might be an indication of future cardiovascular events.

Is there an association between calcium level and preeclampsia in pregnant women? A systemic review

Background: Pregnancy-induced hypertension is a diagnosis used to describe a wide spectrum of patients who may have only mild elevations in blood pressure or severe hypertension with various organ dysfunctions. Preeclampsia is a form of pregnancy-induced hypertension which is defined as the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Preeclampsia has been identified as the leading reason for maternal admission to the intensive care unit in the puerperal period. Trends of pregnancy-induced hypertension in low- and middle-income countries were increasing. The WHO recommend calcium supplementation as part of the antenatal care for the prevention of preeclampsia in pregnant women, particularly among those population where calcium intake low and at higher risk of developing hypertension.&#x0D; Methods: The data were searched electronically From Pub Med, Google Scholar, Cochrane database reviews and Google. Case-control, retrospective and prospective cohort and clinical trial and papers published in the English language was included. Out of 460 pieces of literature searched electronically, only 23 pieces of literature were used in this study. The other 435 references were not reviewed based on exclusion criteria. In this review 14 case-control studies, 2 cross-sectional studies, 1 longitudinal study, 2 clinical trials, and 4 reviews were included.&#x0D; Results: The age of the study participant’s ranges from 18-41, all study participant’s gestational age was greater than 12 wk. All studies used a diagnostic criteria for preeclampsia based on the following criteria: Blood pressure (BP) more than 140/90 and proteinuria &gt;300 mg/do in 24 hr or 1+ in dipstick urine sample Low levels of calcium have a significant association to preeclampsia as indicated in most studies.&#x0D; Conclusion: Most studies explored that calcium level was low among preeclampsia women. Inconsistencies of recruitment (for example some researcher recruit at 20 weeks of gestational age others in 28 weeks of gestational age) of participant's leads to inconclusive and biased findings in this review. For future researcher should focus on pathophysiology calcium and hypertension. And also it is better the country should give special attention to improve the dietary calcium intake of pregnant women. In the future scientists should better assess calcium level through multiple methods like dietary, clinical and biochemical method and also the impact of calcium on neonatal and maternal should be assessed

Manejo de la preeclampsia / eclampsia en el Instituto Nacional Materno Perinatal

La preeclampsia es una enfermedad de carácter progresiva e irreversible que afecta múltiples órganos y debido a que lesiona a la madre y al feto, es responsable de una proporción considerable de muertes maternas y perinatales. Complica el 3 al 22% de los embarazos y es la segunda causa de muerte materna en el Perú en el 2014 con el 38%, y la primera causa de muerte materna en el Instituto Nacional Materno Perinatal con el 43%. El espectro clínico de la preeclampsia varía desde formas leves a severas. Los criterios de diagnóstico de preeclampsia son hipertensión y proteinuria, sin embargo la proteínuria mayor de 5 grs ya no se considera como un criterio de preeclampsia severa. Se hace una revisión de los nuevos aportes en el manejo de la preeclampsia severa y eclampsia y en el manejo de una de sus complicaciones más graves como es la rotura hepática.

Preeklampsi: Maternal Risk Faktörleri ve Perinatal Sonuçlar

Background: Pre-eclampsia (PE) is the commonest hypertensive disorder in pregnancy. Adverse maternal and perinatal outcomes of pre-eclampsia are representing the big burden on national health system. Objectives: Is to identify the maternal risk factors of pre-eclamsia among pregnant women as well as to find out the maternal and perinatal outcomes of this problem. Methods: A prospective follow up study was conducted in Obstetrics &amp;amp; Gynecology Department (OGD) of Al-Zahraa Maternity and Pediatric Hospital (ZMPH) in Al-Muqdadia District in Diyala province from the period 1st of February 2017 to 31st of January 2018. The study sample comprised 60 pregnant women with pre-eclampsia and 60 healthy pregnant women as controls. The diagnosis of PE was established according to American College of Obstetricians and Gynecologists (ACOG) diagnostic criteria of PE. Results: Maternal risk factors related significantly to pre-eclampsia in comparison to controls were increased woman's age, obesity and primigravidity. There was a highly significant association between high cesarean section rates and pre-eclamptic women. A significant association was observed between neonates of pre-eclamptic women and low birth weight preterm birth , low Apgar score at 1 minute . low Apgar score at 5 minutes and admission to neonatal intensive care unit . Conclusion: The main maternal risk factors for pre-eclampsia are advanced reproductive age, obesity and primigravidity, while the common adverse maternal outcome is the cesarean section. The common perinatal outcomes of PE are low birth weight, prematurity, low Apgar scores at 1 &amp;amp; 5 minutes and high NICU admission.

Interleukin-6 contributes to myocardial damage in pregnant rats with reduced uterine perfusion pressure.

Preeclampsia is one of the most frequent and difficult illnesses in pregnancy, which jeopardizes both mother and fetus. There are several diagnostic criteria for preeclampsia. However, the preeclampsia-associated myocardial damage has not been described. In this study, we employed reduced uterine perfusion pressure (RUPP) to generate a rat model of preeclampsia for the evaluation of myocardial damage in late-gestation rats. The expressions of cardiac injury markers were analyzed by immunohistochemistry and ELISA. The arterial pressure and myocardial tissue velocities were also measured. The role of interleukin (IL)-6 in RUPP-associated myocardial damage was further explored. The results showed that RUPP rats had significant myocardial damage, as demonstrated by the high expressions of myoglobin, creatine kinase isoenzyme, cardiac troponin I, and brain natriuretic peptide. In addition, RUPP increased the mean arterial pressure and the early transmitral flow velocity to mitral annulus early diastolic velocity ratio (E/Ea). Furthermore, IL-6 deteriorated these abnormalities, whereas inhibition of IL-6 significantly relieved them. In conclusion, our study demonstrated that RUPP rats displayed myocardial damage in an IL-6-dependent manner.

OP 31 The effect of ethnicity on the performance of protein-creatinine ratio in the prediction of significant proteinuria in pregnancies at risk of or with established hypertension – An implementation audit and cost implications

Background The replacement of 24-h urine collection by protein-creatinine ratio (PCR) as one of the diagnostic criteria for pre-eclampsia has been recently recommended. However, the literature is conflicting and there are concerns on the impact of demographic factors on the performance of PCR as a screening tool. Methods This was an implementation audit of the introduction of PCR in a London Tertiary obstetric unit. Women with suspected pre-eclampsia (N = 476) were asked to complete a 24-h urine collection and an untimed urine sample for PCR calculation. Multivariate logistic regression was used to assess the independent predictors of significant proteinuria. Results In a pregnant population ethnicity and PCR are the main predictors of 300 mg or more of proteinuria in a 24-h urine collection. With a PCR cut-off of 30 mg/mmol, 41.4% and 22.9% of black and non-black women, respectively, would have been incorrectly classified as non-proteinuric. Sensitivity of 100% is achieved at cut-offs of 8.67 and 20.56 mg/mmol for black and non-black women, respectively. Applying these levels as a primary screening tool to inform for the need to perform a 24-h urine collection in 1000 women, it would lead to a financial saving of £2587 in non-black and to a loss of £2905 black women, respectively. Conclusions PCR has 100% sensitivity and is cost efficient in non-black pregnant women, at a cut-off of 20.5 mg/mmol, in the detection of more than 300 mg in a 24-h urine collection. However, in black pregnant populations the performance of PCR is both clinically and financially suboptimal. Download : Download high-res image (77KB) Download : Download full-size image Download : Download high-res image (133KB) Download : Download full-size image

P 30 Clinical characteristics of patients whose preeclampsia status changes

Introduction By definition, elevated blood pressure is central to preeclampsia (PE) diagnostics. However, blood pressure varies with many factors, including physical activity, hydration, and stress. Degree of proteinuria, another finding diagnostic of PE, may also fluctuate due to dipstick test inaccuracy, hydration level, and specimen collection technique. Thus, a PE diagnosis made according to current criteria does not always accurately represent the final clinical picture. Objectives To compare the clinical profiles of 1) women who receive a PE diagnosis but later cease to fulfill the diagnostic criteria for PE, 2) women who cycle between diagnostic groups, and 3) women who consistently fulfill the diagnostic criteria for PE. Patients and methods The PEACH (PreEclampsia, Angiogenesis, Cardiac dysfunction and Hypertension) study is an ongoing longitudinal prospective study being conducted at two hospitals in Copenhagen. Approximately 300 women presenting to the obstetrics departments of these hospitals with signs or symptoms of PE have already been recruited and followed to the end of pregnancy with serial blood tests and repeated cardiac function measurements obtained using the USCOM-1A device. We compare clinical variables (e.g. blood pressure at multiple time points, dipstick proteinuria, symptoms, pre-pregnancy body mass index, age) and USCOM-derived cardiac function measurements (stroke volume, cardiac output, systemic vascular resistance and their indexed values) across groups of women with varying clinical courses. Results and conclusion We present clinical and hemodynamic profiles for PEACH women who can consistently be classified as having PE and those who cannot. It is not unusual for a woman who initially meets the criteria for PE to later stabilize and be re-classified with gestational hypertension or no hypertensive disorder at all; others continue to have blood pressure fluctuations around the levels considered diagnostic for PE. Women who initially present with hypertension and proteinuria but later appear to become non-preeclamptic are an interesting group of patients whose management presents a challenge. A new diagnostic paradigm is urgently needed; however, until PE diagnosis is revolutionized, it may be beneficial to add a temporal component to the current criteria.

Fetal Hypotrophy Is an Important Marker in Diagnosis of Preeclampsia in Pregnant Patients After Solid Organ Transplantation.

BACKGROUND The purpose of this study was to use a multidisciplinary approach to define the importance of fetal growth disturbances in pregnant patients after renal or liver transplantation in diagnosis and treatment of preeclampsia. MATERIAL AND METHODS We assessed 108 pregnancies in patients with renal or liver transplants. Statistical analysis included Pearson's chi-square test and Fisher's exact test. RESULTS In the renal transplant (RTR) group, preeclampsia was diagnosed in 40% according to ISSHP. In the liver transplant (LTR) group, ISSHP guidelines allow this diagnose in 14.6% of patients. Intrauterine fetal hypotrophy occurred in 53.3% of RTR patients with clinical symptoms of preeclampsia and in none of stabile patients. Premature delivery rate was 40% in patients with hypotrophy and only in 15.5% without. For LTR patients, hypotrophy was diagnosed in 16.4% patients with clinical symptoms of preeclampsia and in 12.7% of stabile patients. Premature delivery rate was 14.5% in patients with hypotrophy and in 14.5% without. CONCLUSIONS Fetal hypotrophy is strongly associated with premature delivery and risk of preeclampsia in pregnancies after renal transplantation. There is a need for including ultrasound findings in diagnostic criteria of preeclampsia. Fetal growth monitoring may help in prediction of premature delivery in these group.

Transthoracic echocardiography in women with preeclampsia

Recent literature on the role of transthoracic echocardiography in the management of women with preeclampsia is reviewed with emphasis on recommendations for its use in the life-threatening complications of acute pulmonary edema, chest pain, and hemorrhage. The diagnostic criteria for preeclampsia are closer to reaching international consensus with most guidelines now removing the mandatory requirement for proteinuria. Hemodynamic findings using transthoracic echocardiography in women with untreated preeclampsia include normal or increased cardiac output, normal or increased contractility, a nondilated left ventricle, diastolic dysfunction, increased pericardial effusions, and increased left ventricular mass. Echocardiography is recommended as a diagnostic and monitoring tool for acute hemodynamic complications of preeclampsia, such as acute pulmonary edema, significant arterial hypertension, and chest pain. Despite this there has been limited uptake of transthoracic electrocardiography into routine clinical practice in women with preeclampsia. The role of transthoracic echocardiography in the management of women with preeclampsia is emphasized by international groups. Research into the hemodynamics in preeclampsia, which demonstrates preserved ejection fraction, and diastolic dysfunction highlights its utility and acceptability by pregnant women with preeclampsia. Training of obstetric anesthesiologists in echocardiography is necessary to enable more widespread implementation of this important technology.

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Objectives To study adverse outcomes associated with definitions of preeclampsia and compare them to patients not meeting diagnostic criteria for preeclampsia. Methods A multicenter, prospective, observational study was conducted on women with suspected preeclampsia (PE). Patients were managed by local protocol, and final diagnoses were adjudicated by independent panel. Subjects were classified as Traditional PE (TrPE) with both hypertension and proteinuria, or eclampsia or HELLP syndrome (ACOG 2012); Nonproteinuric PE (NpPE) with severe gestational hypertension (BP >160/110) or mild hypertension plus ⩾1 severe feature (ACOG, 2013); or No diagnosis (NoD). Adverse outcomes included preterm birth (PTB), SGA, IUFD, neonatal demise (NND), and severe maternal adverse outcomes (MAO - abruption, renal failure, pulmonary edema, fatty liver, TTP, DIC, stroke, and retinal detachment). Comparisons tested with Chi square, α = 0.05. Results A total of 757 subjects with signs or symptoms of PE were enrolled Table 1 ). 96 had chronic hypertension or mild gestational hypertension. As compared to TrPE, women with NpPE experienced similar rates of all adverse outcomes. Subjects with NoD also had similar rates of IUFD, NND, and MAO. However, women with NoD experienced lower rates of PTB p Conclusions Among patients with suspected preeclampsia before 35 weeks, the risks of severe adverse outcomes are elevated, even for those who fall outside current clinical diagnostic categories. Patients without a diagnosis, however have fewer preterm deliveries and SGA babies. Diagnostic criteria for preeclampsia poorly predict severe adverse outcomes, and may contribute to preterm delivery. Disclosures D. Woelkers: None. J. Barton: None. P. von Dadelszen: None. B. Sibai: None.

SFLT1/PIGF angiogenic relationship in the experimental model of preeclampsia induced by sympathetic activation in the mouse (679.5)

It has been reported that angiogenic factors involved during pregnancy, are altered during the pathogenesis of preeclampsia. Despite some conflicting results, the majority of studies indicate an increase of soluble factor‐like tyrosine kinase 1 (sFlt‐1) with reduced placental growth factor (PIGF). However, many doubts still prevail about the angiogenic response and its relation to this disease. The purpose was to determine plasma levels of sFlt‐1 and PIGF in healthy pregnant CD1 mice (n = 7 / duplicate) and a group of pregnant mice subjected to chronic cold stress (Walking on cold platform 0°C/20 min/day) for 11 days (from day 7 to 17), a validated model for experimental preeclampsia in rats. Results: the group subjected to cold stress showed decreased levels of sFlt‐1 in respect to control group (ct 7137±487 &lt; st 9742±846 pg/mL; p&lt;0.001 Student t). PIGF levels increased significantly with stress (ct 3.88±1.5 &lt; st 40.20±4.2 pg/mL; p&lt;0.001 Student t). Besides we quantified plasma glucose levels, which increased in a non significant in the stress group (163±44 ct &lt; st 174.6 ± 54 mg/dL). Moreover, stressed mice showed a non significant decrease in weight at 17 day of gestation (53.1 ± 4.4 ct &gt; st 51.9±8.3 g). These data may indicate that the results are polarized to a sympathetic nervous system response. In our work, the angiogenic factors behaved contrary to several reports. This could be due to release of Neuropeptide Y by sympathetic activation. This compound has been related to cause pro‐angiogenic effects. These may indicate that the diagnostic criteria of preeclampsia, not necessarily are associated with endothelial and / or angiogenic dysfunction.