Higher Incidence Of Preeclampsia Research Articles

Kidney biopsy during pregnancy: a difficult decision. A case series reporting on 20 patients from Mexico.

Kidney biopsy is a routine procedure in the diagnosis of kidney disease, but during pregnancy it carries potential adverse effects for both mother and child, aside from the challenges of obtaining adequate tissue samples. Nevertheless, a precise diagnosis is necessary when specific and potentially toxic treatments are to be used during pregnancy. The present report presents our experience with regard to the usefulness and safety of kidney biopsies during pregnancy. Retrospective analysis of clinical indications, complications, histopathological diagnoses, and treatment of patients who had kidney biopsies done at a single academic center during gestation weeks 11-30 between January 2015 and January 2019. Kidney biopsies were carried out in 20 pregnant patients with nephrotic proteinuria. Biopsy was adequate in all patients. The histological diagnoses included focal segmental glomerulosclerosis (collapsing, tip and perihiliar varieties), membranous lupus nephropathy, diabetic nephropathy, and IgA nephropathy. Treatment was associated with reduction of proteinuria in 17 patients and reduction of serum creatinine in 9 out of 11 patients who had serum creatinine ≥ 1mg/dl at the time of biopsy. There was one major bleeding complication that required transfusion of one unit of blood. There was a high incidence of preeclampsia, preterm delivery, and low birth weight despite appropriate kidney disease therapy. Kidney biopsy may be done during pregnancy when therapeutic decisions depend on a precise pathologic diagnosis.

P-362 The association between pregnancy-test day serum progesterone in IVF pregnancies and obstetrical complications

Abstract Study question Is there an association between pregnancy-test day serum progesterone level in IVF pregnancies and late gestational complications? Summary answer Low serum progesterone on pregnancy diagnosis day is independently associated with a higher prevalence of preeclampsia. What is known already Low first trimester arbitrary serum progesterone is associated with early pregnancy complications such as ectopic pregnancies and miscarriages. IVF pregnancies are associated with higher prevalence of obstetrical complications such as preterm birth, preeclampsia and small for gestational age. Different patient and treatment parameters such as age, diagnosis, peak blood Estradiol level, endometrial thickness, fresh or frozen embryo transfer are associated with obstetrical complications. Progesterone is a potent immunomodulator that can affect the inflammatory pathway and trophoblast invasion. Little is known about the association between early pregnancy progesterone level and obstetrical complications, with conflicting results. Study design, size, duration A cohort study reviewing fertility and delivery files of all singleton live births from successfully treated infertile patients, who underwent ovarian stimulation, IVF and fresh embryo transfer in a tertiary medical center between 2008 and 2018. Participants/materials, setting, methods Serum progesterone concentration was measured with the first serum hCG on 4 + 0 gestational week (14 days after oocyte retrieval) under luteal support with vaginal progesterone. Pregnancy-test day serum progesterone was categorized in quartiles. The prevalence of obstetrical complications including gestational diabetes mellitus, preterm birth, preeclamsia, small for gestational age, post-partum hemorrhage and neonatal ICU hospitalization was compared between the four groups. Confounders were adjusted for by multivariate analysis. Main results and the role of chance 719 singleton live births were included. The four serum progesterone quartiles were: Q1:3-44 nmol/L(n = 180); Q2:45-107 nmol/L(n = 180); Q3:108-223 nmol/L(n = 178); Q4:225-808nmol/L(n = 181). Patients with lower progesterone levels (Q1) had significantly more IVF treatments, lower peak estradiol level, fewer mature follicles and frozen embryos. The incidence of preterm labor, gestational diabetes mellitus, small-for-gestational-age, post-partum hemorrhage, placental abruption or neonatal ICU administration did not differ between the groups. Patients with lower serum progesterone had higher incidence of preeclampsia (9.44% in Q1, 2.78% in Q2, 2.81% in Q3 and 3.31% in Q4, P = 0.0046). On multivariate analysis, controlling for age, gravidity, treatment number, number of oocytes, peak follicular estradiol and progesterone, Q1 progesterone level was independently associated with an increased risk of preeclampsia (estimated OR = 3.27 95% CI 1.455-7.299). Limitations, reasons for caution Retrospective design, vaginal progesterone luteal support administration. Wider implications of the findings Low serum progesterone on pregnancy diagnosis day in gestations resulting from fresh ET is associated with a significantly higher prevalence of preeclampsia, possibly because of aberrant placentation and vascular development. This association is important for the obstetrical management, preeclampsia risk assessment, and administration of preventive therapy. Trial registration number not applicable

Gestational diabetes mellitus in in-vitro fertilization pregnancies – Clinical and placental histological characteristics

We aimed to investigate obstetric and neonatal outcomes and placental histological findings in in vitro fertilization (IVF) pregnancies complicated by gestational diabetes mellitus (GDM) as compared to unassisted pregnancies. This was a retrospective cohort of deliveries at a single university affiliated center between 12/2008 and 01/2020. Included were singleton pregnancies complicated by GDM, for which placental histopathological examination was performed. Obstetric, neonatal and placental outcomes were compared between pregnancies following IVF and unassisted pregnancies. Placental lesions were categorized according to the "Amsterdam" criteria. Included were 688 deliveries with a diagnosis of GDM with placental examination - 69 IVF pregnancies (IVF group) and 619 unassisted pregnancies (control group). The IVF group was characterized by a significantly higher maternal age and higher rate of nulliparous women - 60.8% vs. 32.9%, p<0.001. There were no differences in GDM type between the study groups - about two thirds of cases were GDMA1 and on third GDMA2. A higher incidence of preeclampsia was noted in the IVF group - 17.3% vs. 9.3%, p=0.03, with no difference in cesarean deliveries and birthweight. IVF deliveries were characterized by a significantly higher rate of adverse neonatal outcomes - 18.8% vs. 8.8%, p=0.008, although this did not attain significance after adjustment to gestational age. No differences were noted in placental histology between the groups. GDM in IVF is associated with a significantly higher rate of adverse neonatal outcomes, as compared with non-assisted pregnancies complicated by GDM. Placental histology does not shed light on these clinical associations.

External validation of first trimester combined screening for pre-eclampsia in Brazil: An observational study.

To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE<37) and early 34(PE<34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. Screening performance and PE rates. Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE<37 and 18(1.1%) PE<34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE<34; an AUC of 0.8, DR of 59% for PE<37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE<37 to 67%. Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.

STUDY OF THE EFFECT OF GENERALAND REGIONALANESTHESIA ON FOETOMATERNAL OUTCOME IN WOMEN UNDERGOING CAESAREAN SECTION FOR SEVERE PREECLAMPSIA

INTRODUCTION Motherhood is the ultimate joy in a woman's life. Every woman craves for her own child. However, more than half a million 1 women die each year from pregnancy related causes across the globe. The United Nations Millennium Development Goals has placed maternal health as a basic human right, one that is integral to the core of the ght against poverty and inequality. The high incidence of preeclampsia and its complications makes its prevention and effective management important. AIMS AND OBJECTIVES To study the effect of anaesthetic technique in the foetomaternal outcome in severe preeclamptic patients undergoing caesarean section and determining any difference in the maternal and perinatal morbidity/mortality amongst those receiving either general or regional anaesthesia. MATERIALS AND METHODS Study Area: Eden Hospital, Critical Care Unit (CCU), Special Neonatal Care Unit (SNCU), and Neonatal Intensive Care Unit (NICU) of Medical College &amp; Hospital, Kolkata. Study Population: Mothers and babies of severe preeclamptic patient with 34 or more gestational weeks admitted in Eden Hospital, Medical College &amp; Hospital, Kolkata undergoing caesarean section formed our study cohort. Study Period: 18 months (from February 2012 till June 2013). RESULTS AND OBSERVATIONS The patients of severe preeclampsia were in the age group 18 to 30 years (93 %). Only 1.2 % were aged more than 40years. 5.8 % of patients were between the ages of 30 to 40 years. The age patterns were similar in both the groups receiving either spinal or general anaesthesia. SUMMARY AND CONCLUSION Severe preeclampsia mothers receiving general anaesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was signicantly higher with general anaesthesia. Spinal anaesthesia is safer alternative to general anaesthesia in severe preeclampsia with less post operative morbidity and mortality

Incidence of pre-eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta-analysis.

It has been proposed recently that pre-eclampsia (PE) may originate from maternal cardiac maladaptation rather than primary placental insult. As congenital heart disease (CHD) is associated with reduced adaptation to the hemodynamic needs of pregnancy, it is hypothesized that women with CHD have an increased risk of PE. The aim of this systematic review was to investigate the risk of PE in pregnant women with CHD. A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, Chinese or German, with no time restrictions, using databases such as PubMed, Web of Science and SCOPUS. Randomized controlled trials and observational studies (prospective or retrospective cohorts) of pregnant women with a history of CHD were sought. The main outcome was the incidence of PE (including eclampsia and HELLP syndrome). For quality assessment of the included studies, two reviewers assessed independently the risk of bias. For the meta-analysis, the incidence of PE in pregnancies (those beyond 20 weeks' gestation) was calculated using single-proportion analysis by random-effects modeling (weighted by inverse variance). Heterogeneity between studies was assessed using the χ2 (Cochran's Q), tau2 and I2 statistics. Subgroup analysis was performed, and meta-regression was used to assess the influence of several covariates on the pooled results. A total of 33 studies were included in the meta-analysis, including 40 449 women with CHD and a total of 40 701 pregnancies. The weighted incidence of PE was 3.1% (95% CI, 2.2-4.0%), with true-effect heterogeneity of 93% according to I2 , and no publication bias found. No difference was found in the weighted incidence of PE between studies including cyanotic CHD vs those excluding (or not reporting) cyanotic CHD (2.5% (95% CI, 1.6-3.4%) vs 4.1% (95% CI, 2.4-5.7%); P = 0.0923). Meta-regression analysis showed that the only cofactor that significantly influenced the incidence of PE in each study was the reported incidence of aortic stenosis; studies with a higher incidence of aortic stenosis had a higher incidence of PE (estimate: 0.0005; P = 0.038). We failed to demonstrate an incidence of PE above the expected baseline risk in women with CHD. This observation contradicts the theory of the cardiac origin of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center

Women with a history of preeclampsia have a higher risk of recurrent preeclampsia. This study sought to ascertain the relationship between the interbirth interval and the risk of recurrent preeclampsia and difference in angiogenic markers between the two groups. Data was collected from an ongoing cohort study of women with hypertensive disorders of pregnancy (HDP) enrolled at the admission to the labor and delivery floor. From this dataset, multigravida women with a prior diagnosis of preeclampsia were identified and compared to women with no prior history of preeclampsia. Of the 375 women with HDP who were predominantly African American, 245 were multigravida and 44 (18.0%) had a prior history of preeclampsia. Women with prior preeclampsia had an earlier gestational age of delivery, higher rates of preterm delivery and a higher incidence of preeclampsia with severe features (56.8% vs 29.8%) in the index pregnancy (p-values≤0.001) than those without. The median number of years between history of preeclampsia in previous pregnancy and current pregnancy was 6years (IQR 3, 8). Among patients with a prior history of preeclampsia, the interbirth interval was not associated with severe preeclampsia (p=0.60) and there was no difference in angiogenic factors between patients with a prior history of preeclampsia compared to those without. In this study, the duration of the interbirth interval was not identified as a risk factor of developing severe preeclampsia in a subsequent pregnancy and angiogenic factors are not a reflection of maternal predisposition to recurrent preeclampsia.

A Study of Incidence of Pre-Eclampsia in Relation to Maternal Age

Background: - Pre-eclampsia is a serious complication of pregnancy and contributes significantly maternalas well as perinatal morbidity and mortality. So this study is done to find if there exists any relationshipbetween maternal age and pre-eclampsia.Aim:- To study what age group is more prone to development of pre-eclampsia in normal pregnancies.Methodology:- 400 pre-eclamptic women in age group 18-42 years were included in the study. Cases aredivided according to different age group.Result:- Higher incidence of pre-eclampsia was observed in the age group 18-26 years followed by 35-42years.Discussion:- Age is found to be related to pre-eclampsia.Conclusion:- From this study, this can be concluded that age less than 25 years and age greater than 35 yearsare more prone to development of pre-eclampsia.

Placental and maternal sFlt1/PlGF expression in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) and preeclampsia (PE) are both characterized by endothelial dysfunction and GDM women have higher incidence of PE. The placenta plays a key role in PE pathogenesis but its contribution to PE during GDM remains unclear. Herein, we compared placental and maternal blood anti-angiogenic soluble fms-like tyrosine kinase-1 (sFlt1) and pro-angiogenic Placental Growth Factor (PlGF) expressions in GDM and GDM-PE pregnancies compared to controls (CTRL) and PE cases. Electrochemiluminescence immunoassays showed a significantly higher maternal blood sFlt1/PlGF values in GDM-PE relative to CTRL and GDM pregnancies. We reported that placental PlGF gene expression was significantly decreased in GDM, PE and GDM-PE relative to CTRL. However, PlGF protein levels were significantly increased in GDM and GDM-PE relative to CTRL and PE placentae. Finally, sFlt1 gene expression was significantly increased in PE relative to CTRL, GDM and GDM-PE placentae. In contrast, sFlt1 protein expression was significantly decreased in GDM-PE relative to CTRL, GDM and PE placentae. Finally, higher sFlt1/PlGF ratio in GDM-PE maternal blood suggest that sFlt1 overproduction is related to PE onset also in GDM pregnancies even though characterized by a less severe endothelial dysfunction in terms of angiogenic biomarkers.

Maternal folate, one-carbon metabolism and pregnancy outcomes.

Single nucleotide polymorphisms and pre‐ and peri‐conception folic acid (FA) supplementation and dietary data were used to identify one‐carbon metabolic factors associated with pregnancy outcomes in 3196 nulliparous women. In 325 participants, we also measured circulating folate, vitamin B12 and homocysteine. Pregnancy outcomes included preeclampsia (PE), gestational hypertension (GHT), small for gestational age (SGA), spontaneous preterm birth (sPTB) and gestational diabetes mellitus (GDM). Study findings show that maternal genotype MTHFR A1298C(CC) was associated with increased risk for PE, whereas TCN2 C766G(GG) had a reduced risk for sPTB. Paternal MTHFR A1298C(CC) and MTHFD1 G1958A(AA) genotypes were associated with reduced risk for sPTB, whereas MTHFR C677T(CT) genotype had an increased risk for GHT. FA supplementation was associated with higher serum folate and vitamin B12 concentrations, reduced uterine artery resistance index and increased birth weight. Women who supplemented with <800 μg daily FA at 15‐week gestation had a higher incidence of PE (10.3%) compared with women who did not supplement (6.1%) or who supplemented with ≥800 μg (5.4%) (P < .0001). Higher serum folate levels were found in women who later developed GDM compared with women with uncomplicated pregnancies (Mean ± SD: 37.6 ± 8 nmol L−1 vs. 31.9 ± 11.2, P = .007). Fast food consumption was associated with increased risk for developing GDM, whereas low consumption of green leafy vegetables and fruit were independent risk factors for SGA and GDM and sPTB and SGA, respectively. In conclusion, maternal and paternal genotypes, together with maternal circulating folate and homocysteine concentrations, and pre‐ and early‐pregnancy dietary factors, are independent risk factors for pregnancy complications.

Histopathological lesions and exposure to Plasmodium falciparum infections in the placenta increases the risk of preeclampsia among pregnant women

Preeclampsia (PE) is a placental disorder with different phenotypic presentations. In malaria-endemic regions, high incidence of PE is reported, with debilitating foeto-maternal effects, particularly among primigravid women. However, the relationship between placental pathology and Plasmodium falciparum infection in the placenta with PE is underexplored. Placentas from 134 pregnant women were examined after delivery for pathological lesions and placental malaria (PM). They comprised of 69 women without PE (non-PE group) and 65 women diagnosed with PE (PE group). The presence of placental pathology increased the risk of PE, with particular reference to syncytial knots. Placental malaria was 64 (48.1%) and 21 (15.8%) respectively for active and past infections and these proportions were significantly higher in the PE group compared to the non-PE group. Further multivariate analyses showed placental pathology (adjusted (aOR) 3.0, 95% CI = 1.2–7.5), active PM (aOR 6.7, 95% CI = 2.3–19.1), past PM (aOR 12.4, 95% CI = 3.0–51.0) and primigravidity (aOR 6.6, 95% CI 2.4–18.2) to be associated with PE. Our findings suggest that placental histological changes and PM are independent risk factors for PE particularly in primigravida. These findings might improve the management of PE in malaria-endemic regions.

Effects of Sickle Trait on Incidence and Outcomes of Hypertensive Disorders of Pregnancy [13L

INTRODUCTION: Due to a paucity of research and conflicting results in the few published studies, effects of sickle cell trait (SCT) on the incidence &amp; severity of hypertensive disorders in pregnancy and potential adverse perinatal outcomes remain inconclusive. The objective of this research was to examine the risk of hypertensive disorders in pregnancy among SCT carriers compared to non SCT carriers in a single institution, in Flint, Michigan. METHODS: This is an IRB-approved, retrospective cohort study. Pregnant women admitted to Labor and Delivery at Hurley Medical Center over a 5-year period (between 06/01/2012 to 06/01/2017) were included if SCT status (presence or absence) was confirmed through laboratory analysis. RESULTS: The study included 3,986 patients. 279 patients were carriers of SCT (7%). Maternal age ranged from 13-46 years (mean=25.00, SD 5.12). The majority of our subjects were African American (76.4%, n=3044). 1047 patients were nulliparous (26.4%). Incidence of preeclampsia was higher among patients with SCT (3.9%, n=11) compared to noncarriers [(2.0%, n=75, P=.033, relative risk 1.9487 (95% CI 1.0472–3.6262)]. There was no statistical difference in the incidence of other hypertensive diagnoses among the two groups. There was no statistically significant difference in preterm delivery by SCT status (P=.311). CONCLUSION: In our study population, there was a higher incidence of preeclampsia in patients with SCT. However, we were not able to determine if SCT correlated with increased incidence of preeclampsia with severe features or eclampsia. Larger, multi-institutional studies would be required to determine if the SCT may impact severity of hypertensive complications in carriers.

Factors that influence adherence to aspirin therapy in the prevention of preeclampsia amongst high-risk pregnant women: A mixed method analysis.

BackgroundNon-adherence with medications in pregnancy is increasingly recognized and often results in a higher rate of preventable maternal and fetal morbidity and mortality. Non-adherence with prophylactic aspirin amongst high-risk pregnant women is associated with higher incidence of preeclampsia, preterm delivery and intrauterine growth restriction. Yet, the factors that influences adherence with aspirin in pregnancy, from the women’s perspective, remains poorly understood.ObjectiveThe study is aimed at understanding the factors, from the women’s perspective, that influenced adherence with prophylactic aspirin in their pregnancy.Study designA sequential-exploratory designed mixed methods quantitative (n = 122) and qualitative (n = 6) survey of women with recent high-risk pregnancy necessitating antenatal prophylactic aspirin was utilized. Women recruited underwent their antenatal care in one of three high-risk pregnancy clinics within the South Western Sydney Local Health District, Australia. The quantitative study was done through an electronic anonymous survey and the qualitative study was conducted through a face-to-face interview. Data obtained was analysed against women’s adherence with aspirin utilizing phi correlation (φ) with significance set at <0.05.ResultsTwo key themes, from the women’s perspective, that influenced their adherence with aspirin in pregnancy were identified; (1) pill burden and non-intention omission (2) communication and relationship with health care provider (HCP). Pill burden and its associated non-intentional omission, both strongly corelated with reduced adherence (Φ = 0.8, p = 0.02, Φ = 0.8, p<0.01) whilst the use of reminder strategies minimized accidental omission and improved adherence (Φ = 0.9, p<0.01). Consistent communication between HCPs and a good patient-HCP relationship was strongly associated with improved adherence (Φ = 0.7, p = 0.04, Φ = 0.9, p = <0.01) and more importantly was found to play an important role in alleviating factors that had potentials to negatively influence adherence with aspirin in pregnancy.ConclusionThis study identified factors that both positively and negatively influenced adherence with aspirin amongst high-risk pregnant women. Is highlights the importance in recognizing the impact of pill burden in pregnancy and the need to counsel women on the utility of reminder strategies to minimize non-intentional omission. Importantly, it emphasizes on the importance of a positive patient-HCP relationship through effective and consistent communication to achieve the desired maternal and fetal outcomes.

Insulin resistance and pregnancy outcomes in gestational diabetes mellitus gravida complicated by chronic hypertension

Objective To analyze insulin resistance (IR) level and pregnancy outcomes in women with gestational diabetes mellitus (GDM) complicated by chronic hypertension (CHT). Methods This is a retrospective case-control study involving 2 457 singleton pregnant women complicated by GDM who received regular prenatal examinations and participated in the one-day-care clinic of GDM in Peking University First Hospital from January 1, 2014 to December 31, 2016. Clinical data were collected and homeostasis model assessment insulin resistance (HOMA-IR) was calculated. All subjects were divided into two groups: GDM with CHT group (CHT group, n=47) and GDM without CHT group (non-CHT group, n=2 410). Based on their pre-pregnancy body mass index (BMI), they were also grouped into normal pre-pregnancy BMI group (n=1 590) and overweight and obese group (n=863). Two-sample independent t test and Chi-square test were used to compared the age, HOMA-IR, pre-pregnancy BMI, weight gain during pregnancy and glucose levels between groups, and logistic regression model was used to analyze the effects of HOMA-IR on pregnancy outcomes. Results HOMA-IR (3.5±1.8 vs 2.6±1.5, t=-3.290), fasting plasma glucose [(5.4±0.5) vs (5.2±0.5) mmol/L, t=-3.005], pre-pregnancy BMI [(26.7±4.7) vs (23.3±3.4) kg/m2, t=-4.842] and the incidence of preeclampsia [14.9% (7/47) vs 2.5% (61/2 410), χ2=21.790] were significantly higher in GDM women with CHT than those without (all P 0.05). For pregnant women with normal pre-pregnancy BMI, HOMA-IR (3.0±1.5 vs 2.3±1.2, t=-2.217), fasting plasma glucose [(5.4±0.5) vs (5.1±0.5) mmol/L, t=-2.299] and the incidence of preeclampsia [2/14 vs 1.6% (26/1 576), χ2=6.545] were higher in the CHT group than the non-CHT group (all P 0.05). After adjusting for age, fasting plasma glucose, pre-pregnancy BMI and weight gain during pregnancy, the elevated HOMA-IR level increased the risk of preterm birth (OR=1.223, 95%CI: 1.093-1.369, P<0.001) in GDM women without CHT. Conclusions GDM gravida complicated by CHT have severe insulin resistance and a higher incidence of preeclampsia, but the risk of other pregnancy outcomes are not increased. Key words: Diabetes, gestational; Hypertension; Insulin resistance; Pregnancy outcome

Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia.

Intrahepatic cholestasis of pregnancy and preeclampsia are two major pregnancy complications. We aimed to investigate the association between intrahepatic cholestasis of pregnancy (ICP) and preeclampsia. Single-center retrospective study. Study group included 180 women (162 singletons and 18 twin gestations) who were diagnosed with ICP based on clinical presentation, elevated liver enzymes and bile acids. The reference group included 1618 women (1507 singletons and 111 twin gestations) who delivered during the study period, and were matched according to age, gravidity, parity and singleton or twin gestation. The incidence of ICP was 0.36%. The incidence of preeclampsia was higher in women with ICP compared to reference group (7.78% vs 2.41%, aOR, 3.74 95% CI 12.0-7.02, p < 0.0001), for either without-(3.89% vs 1.61%, aOR 2.83, 95% CI 1.23-6.5, p = 0.145) or with severe features (3.89% vs 0.80%, aOR 5.17 95% CI 2.14-12.50, p = 0.0003). For both singleton and twin pregnancies, overall preeclampsia rates were higher in the ICP group (5.56% vs 2.19%, aOR 2.91 95% CI 1.39-6.07 p = 0.0045; and 27.78% vs 5.41%, aOR 10.9 95% CI 2.16-47.19, p = 0.0033, respectively). Earlier diagnosis of ICP was associated with higher incidence of preeclampsia (31.1 ± 3.8 vs 34.86 ± 6.2 gestational weeks, p = 0.0259). The average time between ICP diagnosis and to the onset of preeclampsia was 29.7 ± 24days. ICP is associated with an increased risk for preeclampsia. We suggest intensified follow-up for preeclampsia in women with ICP, especially among those with early ICP presentation and twins' gestations.

PERBEDAAN RERATA RASIO KALSIUM MAGNESIUM DAN RERATA RASIO NATRIUM KALIUM SERUM

The high incidence of preeclampsia and eclampsia causes the importance of early detection especially eclampsia which is the main cause of maternal morbidity and mortality and bad perinatal outcome. The etiology was unknown, but is related to changes in electrolyte status. Electrolytes such as calcium (Ca2+), Magnesium (Mg2+), sodium (Na+) and potassium (K+) play an important role in pre-eclampsia and eclampsia because they contribute significantly in vascular smooth muscle function. This study was done to analyze the differences in mean levels of calcium magnesium ratio and sodium potassium ratio of maternal serum in severe preeclampsia and eclampsia. We performed an observasional comparative with cross sectional study on 16 women with severe preeclampsia and 16 women with eclampsia who met the inclusion criteria and there were no exclusion criteria. The samples were recruited in Dr. M Djamil general hospital Padang, Solok District Hospital, and Pariaman District Hospital from May 2015 to January 2016. The levels of calcium serum were examined by atomic absorption spectrophotometry (AAS), magnesium levels were examined by enzymatic metode, sodium and potassium levels were examined by ion selection electrode (ISE). The differences in mean levels of calcium magnesium ratio and sodium potassium ratio between the two groups was analyzed by using independent t test. The mean levels of calcium magnesium ratio in severe preeclampsia was significantly higher than eclampsia. The mean levels of sodium potassium ratio in severe preeclampsia was significantly lower than eclampsia.Keywords: Calcium magnesium ratio, sodium potassium ratio, severe preeclampsia, eclampsia

Effects of factor v Leiden polymorphism on the pathogenesis and outcomes of preeclampsia

BackgroundFactor V Leiden polymorphism is a well-recognized genetic factor in the etiology of preeclampsia. Considering that Ghana is recording high incidence of preeclampsia, we examined if factor V Leiden is a contributory factor to its development and pregnancy outcomes.MethodsSTROBE consensus checklist was adopted to recruit eighty-one (81) consenting subjects after ethical clearance. Subjects were followed up till delivery to obtain outcomes of PE. Routine blood chemistry and proteinuria were done on all samples. Factor V Leiden was characterized by polymerase chain reaction and restriction fragment length polymorphism (RFLP). The data was captured as protected health information (PHI) and analyzed with SPSS version 22.ResultsOverall allelic frequencies found in FVL exon 10 were 0.67 and 0.33 for G and A alleles respectively. The FVL mutation was more in PE and hypertensive patients. Increased white blood cells, increased uric acid and a three – fold increment of AST / ALT ratio was observed in PE cases when stratified by FVL exons (exon 8 and 10). Significant differences were also observed between FVL and age, systolic blood pressure (SBP), diastolic blood pressure (DBP), liver enzymes, white blood cells (wbc), hemoglobin levels.ConclusionFVL mutation allele frequency was 0.33, a first report. The mutation was associated with increased uric acid, liver enzymes and blood cell indices suggestive of acute inflammation.

Incidence and Risk Factors of Pre-Eclampsia in the Paropakar Maternity and Women’s Hospital, Nepal: A Retrospective Study

This study aims to determine the incidence of pre-eclampsia and distribution of risk factors of pre-eclampsia at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. A retrospective study included 4820 pregnant women from 17 September to 18 December 2017. Data were obtained from the medical records of the hospital’s Statistics Department. Associations between the risk factors and pre-eclampsia were determined using logistic regression analysis and expressed as odds ratios. The incidence rate of pre-eclampsia in the study population was 1.8%. Higher incidence of pre-eclampsia was observed for women older than 35 years (Adjusted Odds Ratio, AOR)= 3.27; (Confidence Interval, CI 1.42–7.52) in comparison to mothers aged 20–24 years, primiparous women (AOR = 2.12; CI 1.25–3.60), women with gestational age less than 37 weeks (AOR = 3.68; CI 2.23–6.09), twins pregnancy (AOR = 8.49; CI 2.92–24.72), chronic hypertension (AOR = 13.64; CI 4.45–41.81), urinary tract infection (AOR = 6.89; CI 1.28–36.95) and gestational diabetes (AOR = 11.79; CI 3.20–43.41). Iron and calcium supplementation appear to be protective. Age of the mothers, primiparity, early gestational age, twin pregnancy, chronic hypertension, urinary tract infection and gestational diabetes were the significant risk factors for pre-eclampsia. Iron and calcium supplementation and young aged women were somewhat protective.

Obstetric outcomes in patients with primary thrombotic and obstetric antiphospholipid syndrome and its relation to the antiphospholipid antibody profile.

Introduction: Previous studies suggested different obstetric outcomes between patients with thrombotic or obstetric antiphospholipid syndrome, but the data are inconclusive. Aims: To investigate obstetric outcomes and their relation to the antiphospholipid antibody profile in primary thrombotic or obstetric antiphospholipid syndrome patients and compare those to a control population. Materials and methods: A retrospective single-centre study on a cohort of 30 pregnant women with primary antiphospholipid syndrome treated at Karolinska University Hospital Solna, Sweden between 2000 and 2016. The pregnancy outcomes were compared to the outcomes of all pregnancies in Stockholm County during the same period. Results: Preeclampsia (p < 0.001), low birth weight at delivery (p = 0.001), Apgar < 7 at 5 minutes (p < 0.001) and small infants (p < 0.001) were more common in antiphospholipid syndrome patients compared to controls. Obstetric antiphospholipid syndrome patients had a higher incidence of small infants (p = 0.023), lower birth weight (p = 0.013) and infants born with complications (p=0.004) compared to thrombotic antiphospholipid syndrome. Mothers with triple antibody positivity had a higher incidence of preeclampsia (p = 0.03), preterm delivery (p = 0.011), small infants (p=0.002) and infants born with complications (p = 0.012). Conclusions: Patients with primary antiphospholipid syndrome, especially those with obstetric antiphospholipid syndrome and triple antibody positivity, are at higher risk for adverse pregnancy outcomes, even under antithrombotic treatment. More frequent antenatal controls in high-risk patients can further improve outcomes.

Rounded intraplacental hematoma - A high risk placental lesion as illustrated by a prospective study of 26 consecutive cases

BackgroundA rounded intraplacental hematoma (RIH) is a recently delineated placental lesion. Following the observation of two cases of RIH in placentas associated with stillbirth in 2012, we postulated that RIHs were associated with a higher risk obstetric phenotype when compared to other lesions characteristic of maternal vascular malperfusion (MVM). We aimed to investigate this further by reviewing the associated maternal and fetal characteristics in a series of prospectively identified cases. MethodsPregnancies where a RIH was identified on placental examination were prospectively collected from February 2014–July 2016. Comparison was made with pregnancies with placental evidence of MVM but without RIH. Results26 placentas with a RIH were identified and 26 placentas with MVM were selected for comparison. There was a statistically significantly increased incidence of stillbirth in the RIH group as compared with the MVM-only group (p = 0.022). Also, pregnancies with RIHs had a lower maternal age (p = 0.041), decreased incidence of antenatally diagnosed growth restriction (p = 0.023), a trend to increased incidence of clinical abruption (p = 0.051) and heavier mean infant birthweight (p = 0.034). Both groups had a high incidence of pre-eclampsia, Caesarean section and preterm delivery when compared with the general population. DiscussionThis is the first study to prospectively identify and collect RIHs using standardised pathological criteria and more than doubles the number of reported cases to date. We present 2 comparable, high-risk cohorts but with a significantly increased incidence of stillbirth in those in which RIHs were seen. Further study of these lesions is justified with an emphasis on the potential for antenatal detection using ultrasound evaluation of placental texture.