Late Severe Preeclampsia Research Articles

Predictive value of the second-trimester fibronectin concentration for severe preeclampsia: A prospective nested case-control study in China.

To evaluate the value of the second-trimester fibronectin concentration, alone and in combination with other markers (e.g., mean arterial pressure, inhibin A), in the identification of women who subsequently develop severe preeclampsia. For this prospective nested case-control study, serum from pregnant women (gestational age 15-22 weeks) who underwent routine Down syndrome screening was analyzed. The women were tracked to delivery and assigned to the severe preeclampsia or control group, according to whether they developed severe preeclampsia. Each woman who later developed severe preeclampsia was paired with five healthy women with pregnancies of similar gestational age (± 1week). Fibronectin, inhibin A, human chorionic gonadotropin, placental growth factor, cysteine, and homocysteine concentrations were measured in 44 cases in the severe preeclampsia group and 220 cases in the control group. The body mass index and mean arterial pressure were calculated. All results were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve construction were conducted for markers differing significantly between two groups. The second-trimester fibronectin value was positively correlated with severe preeclampsia and predicted 67.7% of severe preeclampsia cases. The combination of fibronectin, inhibin A, and mean arterial pressure predicted 76.7% of severe preeclampsia cases; predictive values for combinations of fibronectin with mean arterial pressure or inhibin A were 75.4% and 74.6%, respectively. Combination with these other markers increased the predictive value of fibronectin. In addition, fibronectin was more powerful for the late severe preeclampsia and severe preeclampsia without fetal growth restriction subgroups. The second-trimester fibronectin concentration can be used to predict severe preeclampsia.

The Relationship between Amniotic Fluid Index (AFI) & Single Largest Vertical Pocket and Perinatal Outcome in Late Severe Preeclampsia

Backgound: the amniotic fluid is a clear fluid that surrounds the fetus, and produced in part by the amniotic cells, maternal blood during the first trimester of pregnancy and fetal urine and lung fluid during the second trimester of pregnancy. It serves as a cushion to the fetus allowing musculoskeletal development and protecting it from trauma. It also maintains temperature and has a minimal nutritive function. Evaluation of AFV through ultrasound measurement is an essential part in tests of fetal well-being (BPP), by measuring the AFI or the MVP. Objective: the aim of this study was to evaluate both AFI and single deepest pocket in patients with late severe preeclampsia, and to correlate both markers with different parameters of fetal outcome. Patients and Methods: the study was a prospective controlled study involving 100 women with severe preeclampsia >34w managed at Al Hussein University Hospital and Al Arish General Hospital with the following inclusion criteria, pregnant patients, age 18- 40 years old, with variable parity and a singleton living fetus >34 weeks gestation, and with severe preeclampsia. Results: the neonatal outcomes regarding meconium is more with AFI group than MVP group while the neonatal outcome regarding NICU, RDS & Neonatal death in both groups were similar with no evidence of a statistical difference between both techniques. Conclusion: we concluded that AFI had more significant statistical relationship with perinatal outcome, hence AFI appeared to be a better predictor of perinatal outcome in preeclamptics in late severe preeclampsia.

276. Risk factors for early and late severe preeclampsia

Introduction PE complicates 5–8% of pregnancies and is the leading cause of maternal death-about 60 000 women die from it every year around the world. It should be noted that to date, early (up to 34 weeks) and late (after 34 weeks) PE are seen as two completely separate units, rather than as different clinical forms of the same disease. Objective To study risk factors in women, whose pregnancy was complicated by severe preeclampsia with early and late debut. Methods A retrospective cohort study of 254 histories of pregnant women operated on for severe PE. Results and its discussion The early onset of preeclampsia was in women with multiple pregnancies (4.5%), with genetic thrombophilia (6.4%). Heavy PE with late onset was observed in obese women (23.2%). Primiparity, chronic arterial hypertension, kidney disease are the most common risk factors for severe PE, but do not have significant differences in women with early and late PE. In both early and late PE, the leading position was occupied by chronic arterial hypertension (33%). In contrast to early PE in obese women with late PE, 13.5% occurred. At early PE – disturbances of system of a hemostasis (genetic trombophilia) it is marked in 6,4% of observations. In 24.1% of cases, the somatic history was not burdened. The frequency of occurrence of PE in previous pregnancies did not have significant differences between the groups with early and late PE (11.2% and 12.6%, respectively). In the group of pregnant women due to IVF-the frequency of severe PE was 8.3%. Of these, 6.7% fell to early PE, 1.6% to late PE. In case of multiple pregnancies, the rate of development of severe PE reached 12.2%. Early debut up to 34 weeks is marked in 8,7%, late-3,5%.

JUSTIFICATION OF CONTROL OF RECEVALESCENCE AND INDIVIDUAL REHABILITATION IN WOMEN WHO UNDERWENT SEVERE PREECLAMPSIA

Aim. Justification of control of reconvalescence and individual rehabilitation in women who underwent severe preeclampsia (PE). Materials and methods. A prospective, non-randomized, controlled, open-label, nosocomial study was conducted in the period of 2016-2017. 170 women participated: 100 women with severe preeclampsia (32 – with early, 68 – with late), 70 women with moderate preeclampsia. Inclusion criteria: pre-eclampsia, singleton pregnancy, which occurred spontaneously in the natural menstrual cycle. Exclusion criteria non-obstetric pathology, by competing with the severity of pre-eclampsia, multiple pregnancy without fetal cephalic presentation, pregnancy due to assisted reproductive technologies, obstetrical pathologies, necessitating premature delivery or emergency. Results. In 70% of women the gestational age was premature. 53% of women with PE were primiparous and primgravida. Due to the atypical course of PE the time interval from the suspicion of PE to its clinical verification and delivery could reach 35 days, on average – 5,88±8,76 days before being transferred to the perinatal center. Time spent in the Perinatal Center before delivery was 3.43±2.3 days for early PE, 1.9±2.28 days for the severe late PE and 3.29±2.36 days for mild PE, was comparable. In women with severe PE critical (urgent) dysfunction of the organ (s) were diagnosed: signs of moderate pulmonary hypertension, interstitial pulmonary edema, hydrothorax; stagnant phenomena of both lungs; moderate hydrocephalus; dilatation of the left atrium; diffuse changes in the liver, pancreas, kidney parenchyma; paranephric discharge; hydroperitoneum; hydrothorax; hydropericardium. Critical multiple organ disorders due to PE in combination with delivery by cesarean section after delivery demanded staying in the intensive care ward within 2.6±1.84 days in severe PE and 1.0±1.41 days in moderate PE (p>0.05). 24% of women with severe PE after delivery under the supervision of ultrasound performed a vacuum-aspiration of the contents of the uterine cavity. The maximum time spent in the Perinatal Center after delivery was 7.65±2.34 days (5-13 days). The outpatient visits to an obstetrician-gynecologist varied from the 7th to the 15th week after the delivery. In 26% of women changes remained in the fundus (retinopathy, retinal angiopathy) and 35% - neurological symptoms (encephalopathy) of varying severity. In 16% of women d arterial hypertension with values of diastolic pressure more than 90 mm Hg was preserve. Conclusion. It is necessary to ensure the rehabilitation of women who have undergone severe PE, not only after delivery in a perinatal center, but also at an outpatient stage under supervision of related specialists. In the presence of fertile plans, individualized pregravid and preconception preparation is required with consideration of the nature of the scar on the uterus undergone instrumental uterine evacuation, specialized supervision by related professionals.

Oxidative stress markers and thrombomodulin plasma levels in women with early and late severe preeclampsia

BackgroundPreeclampsia (PE) is a pregnancy disease associated with oxidative stress and endothelial dysfunction. It can be classified according to the severity and onset-time of clinical symptoms (early PE:<34 weeks, late PE:≥34 weeks). MethodsWe evaluated markers of oxidative stress (thiobarbituric acid reactive substances-TBARs and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide)-MTT) and endothelial lesion (thrombomodulin-TM) in early (N = 24) and late severe PE(N = 22) and normotensive pregnant women(N = 26). ResultsMTT levels were higher in early sPE than in normotensive pregnancy (P = 0.03). No difference was found comparing late sPE versus normotensive pregnancy, and early sPE versus late sPE. TM levels were higher in early sPE comparing to late sPE women (P = 0.05), but no difference was found between early or late sPE versus normotensive groups. TBARs levels did not differ significantly among the three groups. These data suggest that endothelial lesion and the antioxidant status are more pronounced in early sPE. Moreover, lipid peroxidation might be an early event in PE, stimulating a compensatory antioxidant defense later in pregnancy. ConclusionsLongitudinal studies involving pregnant women with risk factors for PE development and including other methods for oxidative stress and endothelial lesion determination should be conducted in order to better evaluate the role of these processes in PE pathogenesis.

Expression of markers of endoplasmic reticulum stress-induced apoptosis in the placenta of women with early and late onset severe pre-eclampsia

ObjectivesEndoplasmic reticulum (ER) stress-induced apoptosis has been implicated in severe pre-eclampsia (SPE) and is characterized by the activation of three signaling pathways: PKR-like endoplasmic reticulum kinase (PERK), activating transcription factor 6 (ATF6), and inositol-requiring 1 (Ire1). This study was designed to investigate the role of ER stress in the pathogenesis of SPE. Materials and methodsPlacental tissues were collected from 32 women with normal pregnancies and two cohorts of women with early (n = 32) or late onset (n = 32) SPE. The expression of glucose-regulated protein 78 (GRP78), PERK, eukaryotic initiation factor 2 subunit a (eIF2α), activating transcription factor 6 (ATF4), ATF6, Ire1, CHOP (ClEBP homologus protein), and caspase 12 mRNA and protein in the placentas was analyzed using real-time reverse transcription-polymerase chain reaction and Western blotting, respectively. ResultsThe levels of GRP78, PERK, eIF2α, CHOP, ATF6, and caspase 12 mRNA and protein expression were significantly higher in the placentas of women with early and late SPE than in the control women, whereas there were no differences in ATF6 and Ire1 mRNA and protein. ConclusionER stress-induced apoptosis was important in the development of SPE, especially in early onset SPE and was probably due to the activation of the PERK signaling pathway.

Оценка иммуногистохимической экспрессии матриксной металлопротеиназы 9 типа и её ингибитора 1 типа в плацентарной ткани при поздней тяжелой преэклампсии

Оценка иммуногистохимической экспрессии матриксной металлопротеиназы 9 типа и её ингибитора 1 типа в плацентарной ткани при поздней тяжелой преэклампсии

Polymorphisms in endothelial nitric oxide synthase gene in early and late severe preeclampsia

Preeclampsia (PE) is characterized by hypertension and proteinuria, occurring after the 20th week of pregnancy in women who have had no previous symptoms. The disease progresses with generalized vasoconstriction and endothelial dysfunction. Clinically, it is important to diagnose the severe form of the disease (sPE), in which blood pressure and proteinuria are much higher. Recently, the gestational age (GA) of the onset of PE has led to the classification of this disease as early (GA <34 weeks) and late (GA ≥34 weeks). Several genetic polymorphisms affecting endothelial nitric oxide synthase (eNOS) levels or function were described, including G894T (Glu298Asp), VNTR b/a (variable-number 27-bp tandem repeat) and T-786C (promoter) polymorphisms. Thus, the aim of this study was to compare the distribution of G894T, VNTR b/a and T-786C polymorphisms and their haplotypes in Brazilian early and late sPE, as well as in normotensive pregnant. A total of 201 women were evaluated, 53 with early sPE, 45 with late sPE and 103 as normotensive pregnant women. The frequency of 894T allele was higher in late sPE vs normotensive pregnant, and 894TT genotype was higher in late sPE vs early sPE and normotensive pregnant. For VNTR b/a polymorphism, higher frequencies of aa genotype and a allele were observed in early sPE vs late sPE and normotensive pregnant. Besides, the frequency of haplotype T-b-C was higher in late sPE vs early sPE and normotensive pregnant. Considering the results found for eNOS polymorphisms, it is possible to suggest that the functional alterations induced by these two polymorphisms may influence the time of severe PE onset, although both alterations are putatively associated with low NO bioavailability. However, other studies are necessary to validate these findings and clarify this issue.

PP077. New prognostic marker for the risk to develop early-onset preeclampsia

ESM-1 plays a role in the regulation of angiogenesis and is released by activated endothelial cells. To test the hypothesized that ESM-1 is increased in preeclampsia (PE). Plasma samples from high risk pregnancies divided in 23 healthy (CON), 11 severe early-onset PE (SE) and 7 severe late-onset PE (SL) pregnancies were collected at regular intervals between week 12 and birth. ESM-1 was measured by ELISA. (see figure) Between GA week 24 and birth, ESM-1 concentrations were significantly increased in both early and late preeclampsia compared to controls (Mann Whitney, p<0.05). Surprisingly, the concentration of ESM-1 also differed between the three groups at weeks 12 and 16. The ESM-1 concentration of healthy pregnancies (mean±SEM:1857±861pg/ml) and those that developed severe late-onset PE (1298±371pg/ml) are comparable, but in those pregnancies that develop severe early-onset PE, the concentration (410±355pg/ml) is significantly lower as compared with healthy pregnancies. ESM-1 concentrations are increased during early and late severe preeclampsia, which may be due to endothelial cell activation in these conditions. Interestingly, since ESM-1 is decreased at 12-16 weeks in patients that later on develop early onset severe PE, it might be a prognostic marker which can determine the risk of women to develop severe early-onset PE already as early as 12 to 16 weeks of gestation.

Maternal plasma concentrations of angiogenic/antiangiogenic factors in the third trimester of pregnancy to identify the patient at risk for stillbirth at or near term and severe late preeclampsia

To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) at 30-34 weeks of gestation can identify patients at risk for stillbirth, late preeclampsia, and delivery of small-for-gestational-age (SGA) neonates. A prospective cohort study included 1269 singleton pregnant women from whom blood samples were obtained at 30-34 weeks of gestation and who delivered at >34 weeks of gestation. Plasma concentrations of PlGF, sEng, and sVEGFR-1 were determined by enzyme-linked immunosorbent assay. The prevalence of late (>34 weeks of gestation) preeclampsia, severe late preeclampsia, stillbirth, and SGA was 3.2% (n = 40), 1.8% (n = 23), 0.4% (n = 5), and 8.5% (n = 108), respectively. A plasma concentration of PlGF/sEng <0.3 MoM was associated with severe late preeclampsia (adjusted odds ratio, 16); the addition of PlGF/sEng to clinical risk factors increased the area under the receiver-operating characteristic curve from 0.76 to 0.88 (P = .03). The ratio of PlGF/sEng or PlGF/sVEGFR-1 in the third trimester outperformed those obtained in the first or second trimester and uterine artery Doppler velocimetry at 20-25 weeks of gestation for the prediction of severe late preeclampsia (comparison of areas under the receiver-operating characteristic curve; each P ≤ .02). Both PlGF/sEng and PlGF/sVEGFR-1 ratios achieved a sensitivity of 74% with a fixed false-positive rate of 15% for the identification of severe late preeclampsia. A plasma concentration of PlGF/sVEGFR-1 <0.12 MoM at 30-34 weeks of gestation had a sensitivity of 80%, a specificity of 94%, and a likelihood ratio of a positive test of 14 for the identification of subsequent stillbirth. Similar findings (sensitivity 80%; specificity 93%) were observed in a separate case-control study. Risk assessment for stillbirth and severe late preeclampsia in the third trimester is possible with the determination of maternal plasma concentrations of angiogenic and antiangiogenic factors at 30-34 weeks of gestation.

P-047 Factor VII, factor VIIa and factor VIIa-antithrombin assessment in early and late severe preeclampsia

P-047 Factor VII, factor VIIa and factor VIIa-antithrombin assessment in early and late severe preeclampsia