Healthy Normotensive Pregnant Women Research Articles

Evaluation of Ophthalmic Artery Doppler Parameters in Preeclamptic and Normotensive Pregnant Women.

Preeclampsia, whose pathophysiology is still not fully elucidated today, is a pregnancy-specific disease that affects most organ systems in pregnant women, including the central nervous system. In this context, we aimed to investigate the effects of preeclampsia on blood flow in the ophthalmic artery of the eye, which is considered a part of the central nervous system. This prospective, non-interventional cohort study was conducted between February 2022 and June 2022 at Umraniye Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey. Forty-six normotensive healthy pregnant women constituted the control group and 46 preeclamptic pregnant women constituted the preeclampsia group. Prenatal follow-up and delivery of the participants were carried out in our clinic. First, an obstetric ultrasound was performed on all participants with the same ultrasound device and the same clinician. Then, Doppler measurements of the ophthalmic artery of both eyes were made by the same clinician using the linear probe of the same ultrasound. Both groups were compared in terms of the first peak of systolic velocity (PSV), second PSV, pulsatility index (PI), PSV ratio, end-diastolic velocity (EDV), resistance index (RI), and systolic/diastolic ratio (S/D) measurements of the ophthalmic artery. RESULTS : The first PSV, second PSV, PSV ratio, and EDV were significantly higher in the preeclampsia group than in the control group (p=0.001, p<0.001, p=0.019, p<0.001, respectively). According to the receiver operating characteristic analysis, the second PSV with a cut-off value of 43.75 cm/s was the most powerful ophthalmic artery Doppler parameter in detecting preeclampsia with 63% sensitivity and 63% specificity. No significant difference was found between the early and late onset or mild and severe preeclampsia groups in terms of ophthalmic artery Doppler parameters. Although the number of participants was too small to draw a definitive conclusion, the second PSV seems to be the most powerful parameter for the detection of preeclampsia. Studies with larger series are needed to determine the usability of ophthalmic artery Doppler parameters in the routine clinical diagnosis of preeclampsia and follow-up of the disease.

Alterations in maternal cardiovascular parameters and their impact on uterine and fetal circulation in hypertensive pregnancies and fetal growth restriction

ObjectiveTo examine potential alterations in maternal cardiovascular parameters in hypertensive pregnancies with or without fetal growth restriction (FGR) in comparison to uncomplicated normotensive pregnancies, and to determine the correlation between maternal cardiovascular parameters and changes in umbilical and uterine artery circulation. Materials and methodsThis study enrolled 73 pregnant women starting from the 20th week of gestation, categorized into three groups: hypertensive conditions (pregnancy-induced hypertension, preeclampsia or eclampsia, n = 30), hypertensive conditions with FGR (n = 8) and a control group of healthy normotensive pregnant women (n = 35). All participants underwent echocardiography to assess cardiac output and calculate peripheral vascular resistance. Additionally, fetal biometric measurements and Doppler ultrasound examinations of the uterine and umbilical artery were performed. The results were standardized into gestational age-adjusted z-scores. ResultsThe mean pulsatility index (PI) of the uterine artery (1.36, p < 0.001) and umbilical artery PI z-scores (1.32, p < 0.001) showed significant increases in the hypertensive conditions + FGR group. Maternal cardiac output z-scores were notably lower in both the hypertensive + FGR group (−2.62, p = 0.001) and the hypertensive group (−2.49, p < 0.001). Peripheral vascular resistance was significantly elevated in the hypertensive + FGR group (7.43, p < 0.001) and the hypertensive group (6.06, p < 0.001). There was a positive correlation between maternal peripheral vascular resistance and uterine artery PI (R2 = 0.172; p = 0.0004), and a negative correlation between cardiac output and uterine artery PI (R2 = 0.067; p = 0.031). However, significant correlation between maternal cardiovascular parameters and umbilical artery PI was not identified. ConclusionsMaternal cardiac output exhibits a significant decrease whereas peripheral vascular resistance increases in hypertensive pregnancies, irrespective of the presence of FGR. Both uterine and umbilical artery PI notably increase when hypertensive pregnancies are accompanied by FGR. A positive correlation exists between maternal peripheral vascular resistance and uterine artery PI, as well as a negative correlation between maternal cardiac output and uterine artery PI. However, changes in maternal cardiovascular parameters do not exhibit significant correlations with umbilical artery PI.

ROLE OF MATERNAL SERUM FIBROBLAST GROWTH FACTOR 21 LEVEL IN PREDICTION OF PREECLAMPSIA

Pregnancy complications resulting from hypertensive disorders are a serious problem that impact 2-10 % of all pregnanciesglobally. Preeclampsia is defi ned as new onset hypertension and proteinuria after 20 weeks of gestation which may be associated with other maternal organ dysfunction, such as liver or renal insuffi ciency, hematological or neurological complications, uteroplacental dysfunction and fetal growth restriction.Aim of the Work: Primary outcome is to determine the correlation between fi broblast growth factor 21 level and preeclampsia &amp; signifi cance of serum fi broblast growth factor 21 levels as a predictive tool for preeclampsia. Secondary outcome is to establish the relationship between maternal serum fi broblast growth factor 21 level and Maternal complictions: - Eclampsia (tonic clonic fi ts after 20 weeks with elevated blood pressure and proteinuria)- HELLP syndrome (hemolysis, elevated liver enzymes and low platelet occur as a complication of severe preeclampsia)- placental abruption (bleeding after 20 weeks gestation due to premature separation of a normally situated placenta)Patients and Methods: This was a Nested case-control study that was conducted on 90 primigravidas at Ain Shams University maternity hospital from April 2021 to April 2022. Ethical approval was obtained from the ethical committee at Ain- Shams university maternity hospital. Data was recruited from patient attending obstetric clinic at Ain Shams University Maternity Hospital. Blood samples were collected after 20 weeks to 28 weeks gestation. Patients was followed up until delivery and grouped according to development of preeclampsia.Random samples from 45 patients (group who develop PE) and 45 random samples from control group were assessed forfi broblast growth factor 21. Serum fi broblast growth factor 21 levels were measured by a commercially available enzyme- linked immunosorbent assay kit.Results: our study showed that there was a significant difference in FGF21 levels between the groups, patients withpreeclampsia having higher levels than controls, 15.9 % of patients with preeclampsia experienced maternal complicationscompared to none in the control group. Meanwhile, 18.2 % of patients with preeclampsia experienced fetal complicationscompared to 0 % in the control group.Conclusion: Serum FGF-21 levels are signifi cantly higher in preeclamptic pregnant women compared to healthy normotensive pregnant women. So, it can be used as a predictor for preclampsia and maternal complicationsFunding information: The article was written and published without any fi nancial support.Confl ict of interest disclosure: The authors of the article have noconfl ict of interest related to the publication of the article

Differences in neonatal outcomes between normal and preeclampsia complicated pregnancies

This study aims to explore potential variations in neonatal outcomes between pregnancies without complications and those complicated by preeclampsia within a tertiary gynecology and obstetrics center in Serbia. By focusing on neonatal outcomes, the research seeks to provide a nuanced understanding of how preeclampsia may impact the health and well-being of newborns in this specific medical setting. The investigation will shed light on any distinctive patterns or disparities in outcomes, contributing valuable insights to the broader understanding of maternal and neonatal health within the context of preeclampsia in the Serbian healthcare system. Material and MethodThis case-control study included 50 preeclampsia patients and 50 healthy normotensive pregnant women followed up in the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia. Neonatal outcomes in both groups were monitored until discharge from the hospital. Appropriate statistical tests were applied for experimental and clinical data analysis. ResultsCesarean Section was significantly more frequent in preeclampsia than in the normal pregnancy group. The mean gestational age of birth and Apgar scores were significantly lower in newborns of preeclamptic mothers than in healthy control (p < 0.001). Hospitalization was longer after preeclampsia-complicated pregnancies than uncomplicated controls. Admission to the neonatal intensive care unit, along with perinatal complications such as perinatal asphyxia, respiratory distress syndrome, neonatal convulsions, intracranial hemorrhage, jaundice, anemia, and infection, were significantly more common in the preeclampsia group than in the controls (p < 0.001). In the whole study group, only one newborn from a pregnancy complicated with early and severe preeclampsia had a lethal outcome. Discussion and ConclusionsThe incidence of Cesarean sections exhibited a noteworthy increase in pregnancies complicated by preeclampsia, contrasting with a reduction in both gestational age and Apgar Scores when compared to the group with normal pregnancies. This investigation underscores a significant elevation in overall morbidity rates among newborns born to mothers grappling with preeclampsia in comparison to those born from uncomplicated pregnancies. The findings emphasize the multifaceted impact of preeclampsia on perinatal outcomes, underscoring the importance of comprehensive care strategies to address the unique challenges posed by this complication during pregnancy.

Investigation of Toxoplasma gondii Seroprevalence in Preeclampsic Pregnant.

Toxoplasma gondii is the causative agent of toxoplasmosis and is a parasite of high medical importance with a wide host variety. Bacterial, viral, and parasitic infections during pregnancy may predispose women to pregnancy complications. Preeclampsia of unknown etiology causes special conditions such as systemic vascular endothelial damage due to insufficient trophoblastic invasion and abnormal placentation. There are data of an association between various maternal infections and preeclampsia/eclampsias. The aim of the study was to compare and analyze the relationship between the presence of anti-Toxoplasma IgM and anti-Toxoplasma IgG antibodies in pregnant women with pre-eclampsia and in normotensive healthy pregnant women who were in the control group. In this study, 176 pregnant women who applied to our hospital between January 2019 and December 2020 were included. 88 (50%) of the pregnant women had pre-eclampsia and 88 (50%) were normotensive. The presence of anti-Toxoplasma IgM and IgG antibodies in blood taken from pregnant women with pre-eclampsia and control group was investigated using ELISA. Because of the study, both groups were found to be seronegative in terms of anti-Toxoplasma IgM by ELISA. Anti-Toxoplasma IgG was found to be seropositive in 24 (27.3%) pregnant women with pre-eclampsia and 18 (20.5%) normotensive pregnant women. There was no statistically significant difference between the two groups in terms of anti-Toxoplasma IgM and anti-Toxoplasma IgG seropositivity (X2=0.289, p>0.05) (p<0.05). Because of the study, no statistically significant difference was found between pregnant women with pre-eclampsia and those with toxoplasmosis. It was thought that further studies should be conducted to discuss the hormonal, vascular, etc. factors occurring in the pathogenesis of preeclampsia of T. gondii effect of preparing the ground for the changes and to reveal the existence of a possible relationship between pre-eclampsia and T. gondii seropositivity.

The evaluation of maternal serum glycodelin level as a marker for the presence and severity of preeclampsia

Abstract Background: Preeclampsia (PE) is a common multisystemic disorder of pregnancy. Glycodelin is a glycoprotein belongs to the lipocalin superfamily. It acts as a regulator of immunosuppression activity, fertilization, implantation, and placentation. Objectives: To analyze serum glycodelin levels in PE and evaluate whether it correlates with the severity of the disease. Materials and Methods: A prospective case–control study included 60 women diagnosed with PE (subdivided into 30 pregnant women with mild PE and 30 pregnant women with severe PE) and 30 healthy normotensive pregnant women. Patient with multiple pregnancies, gestational trophoblastic diseases, in active labor, a history of medical diseases, or taking treatment were excluded from the study. Blood samples were taken for biochemical study; serum glycodelin levels were measured using an enzyme-linked immunosorbent assay. Results: Patients with PE had significantly higher mean glycodelin levels as compared to the normal group. The glycodelin level ≥37.9 ng/mL had 96.70% sensitivity, 100% specificity, and 98% accuracy for the prediction of PE. The mean glycodelin was significantly higher in severe PE (102.3 ± 51.3) as compared to mild PE (45.2 ± 7.3) in pregnant women (P &lt; 0.001). The glycodelin level ≥50.1 ng/mL had 86.7% sensitivity, 80% specificity, and 85% accuracy for the prediction of severe PE. Conclusions: Glycodelin is an appropriate marker for the diagnosis of PE and the categorization of disease according to severity.

Utilidad de la relación calcio/magnesio en el diagnóstico de preeclampsia

Objective: To establish the usefulness of the calcium/magnesium ratio in the diagnosis of preeclampsia. Methods: A case-control study was performed between January 2014 and June 2022 on patients who were treated at the Central Hospital “Dr. Urquinaona”, Maracaibo, Venezuela. A group of pregnant women with a diagnosis of preeclampsia (group A, cases) and a control group of pregnant women with maternal age and body mass index similar to the study group (group B, controls) were selected. Demographic characteristics, laboratory parameters, and serum calcium and magnesium concentrations were evaluated. Results: 515 pregnant women were selected, 257 in group A and 258 in group B. Patients in group A had lower serum calcium and magnesium concentrations compared to patients in group B. The calcium/magnesium ratio was also lower in group A than in group B. (p &lt; 0.0001). Analysis of the discriminatory ability of the calcium/magnesium ratio in the diagnosis of preeclampsia showed that the value of 3.44 had a value under the curve of 0.893 (95% confidence interval, 0.867–0.919) with a sensitivity of 66.3% (95%CI, 60.3%-71.8%), specificity 92.6% (95%CI, 88.7%-95.2%). The diagnostic accuracy was 79.4% (95% CI,75.7%–82.7%). Conclusion: The calcium/magnesium ratio is useful in the diagnosis of preeclampsia since its value is significantly lower, compared to healthy normotensive pregnant women.

The investigation of serum nectin-4 levels in patients with early onset preeclampsia

Aims: We aimed to investigate the level and predictive value of soluble nectin-4 in early onset preeclampsia (EOPE).&#x0D; Methods: Forty-three patients with EOPE and 41 healthy normotensive pregnant women participated in this prospective case-control study. The groups were matched for gestational age and gravidity. Serum nectin-4 levels were compared between groups. The ROC curve was drawn to show the predictive value of nectin-4 for EOPE. Patients were followed up until the end of labor, and perinatal outcomes were recorded.&#x0D; Results: The demographic characteristics of the two groups were similar. Serum nectin-4 level was significantly increased in EOPE cases compared to controls (226.46±119.6 ng/ml vs. 156.54±44.8 ng/ml, p=0.001). The ROC showed that at &gt; 160.938, the sensitivity and specificity were 67.44% and 82.93%, respectively [AUC:0.822, (CI:0.724 - 0.897), and (p&lt; 0.001)]. Significant inverse correlations were found between nectin-4 levels and poor obstetric outcomes.&#x0D; Conclusion: Maternal serum nectin-4 levels were significantly higher in patients with EOPE compared with controls. Increased nectin-4 levels may contribute to the development of EOPE through possible oxidative, immunological, and inflammatory mechanisms adversely affecting trophoblastic cells.

Association between endothelial nitric oxide synthase (eNOS) gene variants and nitric oxide production in preeclampsia: a case–control study in Ghana

Evidence suggests that a major cause of PE is endothelial dysfunction emanating from the reduced bioavailability of Nitric oxide (NO). Variants of endothelial nitric oxide synthase (eNOS) gene may lead to decreased NO levels. We explored the association between eNOS gene variants and nitric oxide levels among preeclamptic women in the Ghanaian population. This case–control study included 75 preeclamptic women and 75 healthy normotensive pregnant women attending antenatal care at the Nkawie-Toase Government Hospital, Ghana. A well-structured questionnaire was used to collect socio-demographic, obstetric and clinical data. Blood was obtained for DNA extraction; the gene variants were determined using PCR and RFLP. Preeclamptic women had significantly lower NO concentration compared to the normotensives (p < 0.0001) and was significantly different between VNTR variants (p < 0.0001). A significant difference in VNTR intron 4 distribution was also observed between the preeclamptic and normotensive women with 4c4c” (12.0%) and “4a4c” (1.3%) genotypes found predominantly in preeclamptic women (p < 0.0001). There was significantly higher distribution of “TC” genotype in preeclamptic women (44.0%) compared to normotensives (22.7%) (p = 0.019). However, possessing “4a4b” (cOR: 0.17, 95% CI 0.04–0.64) and “4b4b” (cOR: 0.09, 95% CI 0.02–0.38) significantly decreased the likelihood of experiencing preeclampsia by 83% and 91% respectively. Nitric oxide is reduced in preeclamptic women. NO levels in preeclampsia are altered by VNTR intron 4 variants but not T786C variants. Possessing VNTR intron 4 “4b” allele decreases the risk of PE while the “4c” allele increases the risk of PE. There is the need for eNOS variant screening and nitric oxide estimation among pregnant women for early prediction of women at risk of preeclampsia.

Middle Cerebral Artery Blood Flow Velocity During Normal Pregnancy.

The present study aimed to evaluate resting middle cerebral artery (MCA) blood flow velocities using transcranial Doppler ultrasound (TCD) in healthy women at different stages of pregnancy, and to compare these velocities with those of normal controls. A total of 105 healthy normotensive pregnant women and 25 non-pregnant healthy controls were included in the study. We formed 3 groups according to gestational age: first trimester (7 to 13wk pregnant), second trimester (14 to 28wk pregnant), and third trimester (29 to 42wk pregnant). Age, body mass index, heart rate, arterial blood pressure, and hematological data were recorded and TCD was performed on the subjects. Regarding TCD, we evaluated the mean cerebral blood flow velocity, the peak systolic velocity, the end-diastolic flow velocity, S/D ratio, the pulsatility Index (PI) and the resistance Index (RI). The MCA mean blood flow velocities differed significantly among the groups (P<0.001) and were higher in the controls than those of the first trimester, second trimester, and third trimester groups (P<0.01, P<0.001, P<0.001 respectively). The MCA mean and peak blood flow velocities, and the PI and RI decreased significantly with advancing gestation. TCD is a noninvasive and non-toxic method of monitoring the adaptation of the maternal cerebral blood flow in pregnancy. The progressive decreases in the MCA mean and peak blood flow velocities, PI, and RI during gestation may be the result of chemical and neuronal factors. This study supports the need for additional studies using TCD to establish normative cerebral blood flow volumes throughout pregnancy.

Evaluation of Platelet Count’s Role in the Prediction of Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is the main pregnancy-specific disease that causes maternal and perinatal death. In recent years, active treatment of pre-eclampsia after 34 weeks of gestation has resulted in good maternal and perinatal outcomes, but the treatment of early-onset pre-eclampsia patients is still unsatisfactory. So the prediction of PIH has become a research hot spot. Therefore, this study attempted to evaluate if a change in platelet count during pregnancy can be used to predict the development of PIH. A comparative cross-sectional study was conducted among 30 healthy normotensive pregnant women and 30 women with PIH. Face-to-face interviews’ using a structured questionnaire and physical examination supplemented with laboratory investigations were used for data collection. Statistical data analysis was done using an independent t-test, linear regression, and one-way ANOVA. The ROC curve was used to determine the optimal cut-off point of platelet count for the prediction of the development of PIH. The mean platelet count in the case was found to be 154.87 (± 42.56) × 103/µL while in controls the mean platelet count was 273.47 (± 34.08) × 103/µL. The ROC analysis showed that platelet count < 225 × 103/µL was a cut-off point to differentiate whether the pregnant women develop PIH or not with a sensitivity of 96.7% and specificity of 90%. In conclusion, a decrease in platelet count was significantly associated with the development and severity of PIH.

Evaluation of Maternal Serum Homocysteine in Pre eclampsia

Background: Pre-eclampsia affects about 2–8% of all pregnancies. It is one of the leading causes of maternal and perinatal morbidity and mortality hyperhomocysteinemia is considered as a risk factor for endothelial dysfunction and vascular disease. The vascular changes induced by homocysteine are similar to those with pre-eclampsia. The aim of the study is to identify the relationship between maternal serum homocysteine level and the development of pre-eclampsia.Method and patient: A case control study that was carried out in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital in Kirkuk-Iraq, during the period of eight months from 1st of Feb. till 1st of October 2021. It included 80 pregnant women with singleton viable pregnancy, gestational age of > 20 weeks. They were divided into two groups: Case group included 40 pregnant women who had diagnosed as pre eclampsia (mild and severe) and control group included 40 healthy normotensive pregnant women. Patients with multiple pregnancy, history of medical disease or tacking treatment for hypertension were excluded from the study. Blood sample was taken from each woman for biochemical study, serum homocysteine level was measured using ELISA technique.Result: In this study, pregnant women with pre-eclampsia had significantly higher mean of serum homocysteine compared with controls. Homocysteine level > 8.95 μmol/l is a predictor for pre-eclampsia. Out of 40 women with pre-eclampsia, 42.5% were mild, while the remaining 57.5% were severe. Pregnant women with severe pre eclampsia had significantly higher mean of serum homocysteine compared to those with mild pre-eclampsia. The level of tested biomarkers and homocysteine was tested between the two study groups to assess their rule in pre eclampsia.Conclusions: Maternal serum homocysteine biomarker represents an early non-invasive marker for diagnosis of pre eclampsia and to name the disease according to the severity.

Relationship between serum selenium deficiency and preeclampsia among pregnant women at the Rivers State university teaching hospital, Port Harcourt, Nigeria

Background: Preeclampsia is a multi-system disorder of pregnancy. It is associated with a significantly increased risk of maternal and fetal morbidity and mortality. Oxidative stress has been implicated. Selenium is a very important trace element in the synthesis of endogenous antioxidants which help to balance the effects of oxidative free radicals. This study sought to determine the relationship between serum selenium deficiency and preeclampsia among pregnant women. Method: A prospective case-control study was carried out on consenting preeclamptic (135) and normotensive (135) pregnant women in their second half of pregnancy. Blood samples were taken for serum selenium estimation and analyzed using Atomic Absorption Spectrophotometry (AAS). Their Socio-demographic information was collected through a structured proforma. Data were analyzed using SPSS version 20. A P-value of &lt; 0.05 was considered to be statistically significant. Results: There was no significant difference in characteristics between the two groups. The mean selenium level of the preeclamptic women (0.52 ± 0.31µmol/l) was significantly (P=0.001) lower than that of the normotensive women (0.73 ± 0.24µmol/l). Bivariate analysis showed that preeclamptic women were 3.6 times more likely to have a deficiency in selenium compared to normotensive women (OR=3.61; P=0.001; 95%CI: 2.13-6.10). No significant difference was noted in the serum level of selenium in patients with mild versus severe preeclampsia. Conclusion: This study showed that pregnant women with selenium deficiency were 3.6 times more likely to develop preeclampsia compared to healthy normotensive pregnant women. However, there was no significant difference between levels in mild compared to severe preeclamptic women.

Thyroid status in pregnant women with pregnancy induced hypertension – A case control study

Introduction: Pregnancy induced hypertension (PIH) is an important cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. PIH is more frequently associated with elevated TSH (Thyroid-stimulating hormone). Thyroid dysfunction plays an important role in the development of gestational hypertension. However, this relationship remains unclear. The study was performed to evaluate the thyroid status in pregnant women with PIH and normal pregnant women. Methodology: This was a hospital based observational case control study done in Dr M K Shah Medical College, Ahmedabad. Total 100 pregnant women were included, out of them 50 PIH women were included in the case study group and 50 normotensive healthy pregnant women were included in the control group. After taking written consent, thyroid profile (TSH, free T3 and free T4) were measured in all 100 subjects. Results: Women with PIH had higher TSH levels and lower free T3 and free T4 as compared to normotensive pregnant women. There was a significant association between hypothyroidism and PIH cases. There was a significant positive correlation between TSH and systolic BP (r=0.42) and diastolic BP (r=0.52). Conclusion: PIH women are at greater risk of decreased thyroid function. Therefore, PIH women should be monitored for thyroid levels regularly.

Maternal tumour necrosis factor-alpha levels in preeclamptic pregnancies in Lagos, South-West Nigeria.

This study aimed to assess the association between maternal serum levels of TNF-α and preeclampsia. An analytical cross-sectional study involving 45 women diagnosed with preeclampsia and 45 healthy normotensive pregnant women matched for age, and gestational age at enrolment. Venous samples were collected from each participant after informed consent was obtained. Serum TNF-α level was determined using the human TNF-α competitive enzyme-linked immunosorbent assay (ELISA) technique with ELISA Kit. Hypothesis testing was done using the Chi-square test for categorical variables, the independent samples t-test and the Kruskal-Wallis test for numerical variables. All significances were reported at P<0.05. The median concentrations of TNF-α in women with preeclampsia of varying severity were significantly higher than those with normotensive pregnancies (P=0.001). The median level of TNF-α was also significantly higher in patients with severe features of preeclampsia than in those without. The estimated cut-off levels of serum TNF-α were 15.6ng/mL and 26.4ng/mL respectively for the development and severity of preeclampsia. Maternal serum TNF-α level in preeclamptic patients is strongly correlated with systolic and diastolic BP, serum uric acid and alkaline phosphatase levels, proteinuria, and platelet count (P<0.05). We can infer from this study that increased maternal serum levels of TNF-α may play a significant role in the pathogenesis of preeclampsia. We recommend further validation of these findings with a more robust longitudinal characterization of maternal serum TNF-α profiles in pregnancy through a well-designed prospective cohort study.

Serum immunoglobulins, C-reactive protein, and trace element level in preeclamptic Nigerian subjects.

The mechanism involved in the pathogenesis of preeclampsia (PE) remains uncertain, and the research into a better understanding, its possible prediction, and subsequent prevention continues. This study evaluated changes in serum immunoglobulins (IgG, IgA, and IgM), C-reactive protein, and trace elements (Zn, Cu, and Mn) in preeclamptic, normotensive pregnant, and non-pregnant females. The study was conducted among 150 subjects consisting of 50 preeclamptic subjects, 50 healthy normotensive pregnant women in their third trimester, and 50 non-pregnant women, all within the same age bracket. The serum concentration of the immunoglobulins and C-reactive protein were measured using standard immunoturbidimetric methods, whereas the trace elements were assayed using the atomic absorption spectrophotometric method. Serum IgG and IgM levels were observed to be significantly lower (P < 0.05) in preeclamptic subjects (101.22 ± 4.44 and 769.43 ± 1.43 mg/dl), respectively, when compared to the normotensive pregnant women (123.87 ± 1.81 and 881.71 ± 2.80 mg/dl), respectively. There was a non-significant difference in immunoglobulin A levels between the groups (P > 0.05). The C-reactive protein was significantly higher, whereas the trace elements were significantly lower (P < 0.05) in preeclamptic subjects compared to the normotensives. There was a positive correlation between the immunoglobulin G and Zn levels (r = 0.334; P = 0.046) and also between immunoglobulin G and C-reactive protein levels (r = 0.340; P = 0.043) and a negative correlation between systolic blood pressure and manganese levels in preeclamptic subjects (r = -0.375; P = 0.024). This study therefore reveals significantly lower levels of immunoglobulins and trace elements among the preeclamptic subjects. These micronutrient deficiencies and low levels of immunoglobulins could be risk factors for the development of high blood pressure and PE.

Protein S and protein C in preeclamptic pregnant women

Background and purpose: Deficits of protein C and protein S are associated with an increased incidence of thrombotic disorders. The aim of the present study was to determine the levels of the mentioned natural coagulation inhibitors in women with preeclampsia and in a 6-months followup period after delivery.Materials and methods: This case-control clinical study included 55 pregnant women (cases) with preeclampsia and 50 healthy normotensive pregnant women (controls) in tertiary perinatal centre. Protein C levels were determined photometrically using a chromogen substrate, and protein S levels were determined using the clot method and optic detection.Results: There were no significant differences in protein C and protein S levels between women with preeclampsia and healthy pregnant women; however, six months after delivery protein S levels were significantly lower in women with preeclampsia as compared to healthy peers, whereas protein C levels did not differ significantly.Conclusion: Possible long-term cardiovascular morbidity should be assessed in preeclampsia women.

CAN PLACENTAL HISTOPATHOLOGICAL LESIONS BE A GUIDE TO MATERNAL AND NEONATAL OUTCOMES IN PATIENTS WITH PREECLAMPSIA?

Objective: The aim of this study was to investigate the predictive role of massive perivillous fibrinoid deposition (MPFD), syncytial knots, and accompanying histopathological features of placentas of preeclampsia (PE) on maternal and neonatal outcomes. Matherials and methods: A retrospective clinicopathological study was conducted in a tertiary unit. In the study, 51 pregnant women admitted with PD and 55 normotensive healthy pregnant women matched for age and gestational age were compared. Information regarding clinical characteristics, neonatal findings, and placental properties such as syncytial knots, vascular structure density, placental area, volume, and weight) was retrieved. Results: Massive perivillous fibrinoid deposition, syncytial knots and decreased vessels in terminal villi were significantly frequent in the PE group compared to the controls. However, these histopathological findings were not associated with clinical and neonatal outcomes. Conclusions: Syncytial knot and perivillous fibrin deposition are significant microscopic findings of preeclampsia. However, the presence and amount of fibrin deposition were not correlated with perinatal outcome.

Evaluation of maternal ophthalmic artery Doppler indices and its correlation with fundoscopic changes in normotensive and pre-eclamptic pregnancies: A comparative study

Background: Preeclampsia is a multisystem disease characterized by the development of hypertension after 20 weeks of gestation in a previously normotensive woman with the presence of proteinuria, severity leading to target organ injury, including liver, kidney, heart, lungs, brain and pancreas. We evaluated the ophthalmic artery Doppler indices (PSV, EDV, PI, RI) in normotensive and in pre-eclampic pregnancies and correlated the Doppler indices changes with fundoscopic findings. Materials and methods: Orbital Ultrasonography was performed on the pregnant women who developed high blood pressure after 20 weeks of gestation and on the normal pregnant women as control and the Doppler indices of ophthalmic artery were determined. Fundoscopic examination of the patients was done with direct ophthalmoscope. Hypertensive Retinal changes observed in both eyes were taken as positive findings. Results: The study showed that PSV, RI and PI and S/D ratio were reduced in pre-eclampic patients when compared with healthy normotensive pregnant women while EDV was increased in pre-eclampic patients when compared with healthy normotensive pregnant women. Statistically significant relationship among Doppler parameters namely PSV, EDV, PI, RI, S/D values between normotensive and pre-eclampic patients was noted. Fundoscopic changes were noted among sever pre-eclampsia patients. Conclusions: Ophthalmic artery Doppler Ultrasonography can detect pre-eclampsia in early stages when compared to fundoscopy and is a cheap, noninvasive, readily available, safe, and reliable tool for evaluation of the central hemodynamic changes in normal pregnancy, and even more so in PE.

Complement Activation Drives Progression of Pre-Eclampsia to HELLP Syndrome

Background: Pre-eclampsia is a hypertensive disorder of pregnancy that affects about 5% of all pregnancies; however, its pathogenesis remains poorly understood. About 1% of pre-eclampsia cases will progress to a severe form termed HELLP syndrome characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet counts. We have previously shown that abnormal activation of complement is a driver of disease in a subset of patients with HELLP syndrome (Vaught et al. 2016 and 2018). Based on these studies, we proposed that germline variants in complement regulatory genes predispose to HELLP in the setting of pregnancy, a complement amplifying event. However, whether complement dysregulation correlates to disease severity in HELLP syndrome is unclear. In addition, the contribution of complement activation to the onset or severity of pre-eclampsia remains unknown. We hypothesized that patients with pre-eclampsia harboring complement gene variants are at increased risk for progression to HELLP syndrome and worse maternal and fetal outcomes due to dysregulation of the complement system.Methods: In this prospective cohort study, patients with the pregnancy-associated hypertensive disorders including HELLP or pre-eclampsia were enrolled after diagnostic validation with the Tennessee and ACOG classification criteria, respectively. In total, 24 women with HELLP and 42 women with pre-eclampsia were enrolled and followed through their hospital course and compared with 47 healthy normotensive pregnant women. Both maternal and fetal clinical outcomes were recorded. Delivery before estimated gestational age < 23 weeks was considered previable, and intra-uterine fetal death (IUFD) was characterized as death of the fetus in utero during the pregnancy. Targeted sequencing of 13 genes known to regulate the alternative complement pathway was performed, and non-synonymous, heterozygous germline variants with a minor allele frequency less than 0.01 were identified. A functional assay for complement activation, the modified Ham assay (mHam), was performed in a subset of cases with available serum samples. The mHam is based on the principle that a cell line lacking surface complement regulators is susceptible to complement mediated cell death; non-viable cells > 20.5% is considered a positive test.Results: The frequency of rare germline variants in the HELLP cohort was 45.8%, comparable to a well-established complement mediated disease (aHUS, Table 1). By comparison, the frequency of germline variants in the pre-eclampsia and control cohort was 28.6% and 23.4%, respectively. Of the 14 patients with sera available to perform the mHam, 57% of HELLP syndrome patients had a positive mHam as compared to 0% of the controls (p = incalculable). Among patients with HELLP syndrome, those with a complement gene variant were more likely to have a poor clinical outcome compared to those without a variant. Specifically, 3/11 patients with variants versus 1/13 patients without variants were diagnosed at a previable stage and/or experienced IUFD (p = 0.19). There was no difference in the rate of HELLP onset after 28 and 34 weeks between the two groups. Notably, when comparing the cohort of HELLP patients harboring variants to the cohort without, patients with variants had higher rates of acute renal failure, hypoxia, and ICU care, but a lower frequency of blood transfusions (Table 2).Conclusion: Patients with HELLP syndrome harbor rare germline variants in complement genes at a greater frequency than controls (p = 0.05) and a similar frequency to aHUS, a known complement mediated disease. HELLP syndrome patients also carry mutations at a higher frequency than women with pre-eclampsia (p = 0.16) who have a similar rate of variants as controls. This suggests that complement gene variants predispose to progression of pre-eclampsia to HELLP syndrome where the gene variant and pregnancy provide a first and second ‘hit’ similar to other complement disorders. Patients with rare complement-associated variants are also more likely more susceptible to severe disease manifestations. [Display omitted] DisclosuresChaturvedi: UCB: Other: Advisory board participation; Sanofi Genzyme: Other: Advisory board member; Alexion: Other: Advisory board member; Dova: Other: Advisory board member; Argenx: Other: Advisory board member.