Management Of Severe Preeclampsia Research Articles

Continuous non-invasive hemodynamic monitoring in early onset severe preeclampsia

ObjectivesContinuous hemodynamic monitoring offers the opportunity to individualize management in severe preeclampsia (PEC). We compared cardiac output (CO) and total peripheral resistance (TPR) measured by bioreactance (NICOM), Clearsite™ Fingercuff [CS), and 3D-echocardiography (3DE). Study designThis prospective observational study included 12 pregnant patients with early PEC. CO and TPR were measured simultaneously by NICOM, CS, and 3DE antepartum and 1–2 days postpartum. Using 3DE as the standard, CS and NICOM interchangeability, precision, accuracy, and correlation were assessed. ResultsCompared to 3DE-CO, CS-CO was highly correlated (R2 = 0.70, p = <0.0001) with low percentage error (PE 29%) which met criteria for interchangeablity. CS-TPR had strong correlation (R2 = 0.81, p = <0.0001) and low PE (29%). While CS tended to slightly overestimate CO (bias + 2.05 ±1.18 L/min, limit of agreement (LOA) −0.20 to 4.31) and underestimate TPR (bias −279 ±156 dyes/sec/cm5; LOA −580 to 18.4) these differences were unlikely to be clinically significant. Thus CS could be interchangeable with 3DE for CO and TPR. NICOM-CO had only moderate correlation with 3DE-CO (R2 = 0.29, p = 0.01) with high PE (52%) above threshold for interchangeability. NICOM-CO had low mean bias (−1.2 ±1.68 L/min) but wide 95% LOA (−4.41 to 2.14) suggesting adequate accuracy but low precision in relation to 3DE-CO. NICOM-TPR had poor correlation with 3DE-TPR (R2 = 0.32, p = 0.001) with high PE (67%), relatively low mean bias (238 ±256), and wide 95% LOA (–655 to 1131). NICOM did not meet the criteria for interchangeable with 3DE for CO and TPR. ConclusionsClearsite Fingercuff, but not NICOM, has potential to be clinically useful for CO and TPR monitoring in severe preeclampsia.

Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia.

The treatment of preeclampsia is delivering women and extracting the placenta, but the Chinese Society of Obstetrics and Gynecology guidelines do not recommend the delivery of babies without severe features. The objectives of the study were to compare the effectiveness and safety of nifedipine and phytosterol in combination with nicardipine for the management of severe preeclampsia. Women (19-32 years; gestation age ≥ 30 weeks) with the complication of severe preeclampsia have received 10 mg of oral nifedipine (pregnant women received 10 mg of oralnifedipine, n = 112) or 1 mg/h intravenous nicardipine (pregnant women received 1 mg/h intravenous nicardipine (ND cohort), n = 115) or oral 10 mg nifedipine and 500 mg phytosterol (pregnant women received oral 10 mg nifedipine and 500 mg phytosterol (np cohort), n = 111) until 150/100 mmHg blood pressure was achieved. The time required to achieve the desired blood pressure control was 13 minutes shorter in the NP cohort compared to the NF (p < 0.0001, t = 11.605), and 3 minutes shorter compared to the ND (p < 0.0001, t = 2.79) cohorts. Stillbirths were reported in 14 (13%), 28 (24%), and 10 (9%) infants, and 13 (12%), 26 (23%), and 10 (9%) infants died from the NF, ND, and NP cohorts, respectively. The undesirable tocolytic effect was reported in 17 (15%) women of the ND cohort. Phytosterol with nifedipine has a synergistic or additive effect on the management of preeclampsia with fewer adverse outcomes.

Potential mechanism of transient receptor potential cation channel subfamilyV member1 combined with an ATP‑sensitive potassium channel in severe preeclampsia.

Severe preeclampsia is one of the most serious obstetric diseases. However, the pathogenesis of the disease is not fully understood. In the present study, placental artery and blood serum was collected from patients with severe preeclampsia, as well as from normal pregnant women. The results of reverse transcription-quantitative (q)PCR, western blotting, and immunohistochemical staining revealed markedly decreased transient receptor potential cation channel subfamily V member 1 (TRPV1), ATP-sensitive potassium channel (KATP) subtype Kir6.1/SUR2B and endothelial nitric oxide synthase (eNOS) expression in severe preeclampsia tissue specimens compared with those in samples from normal pregnant women. The nitrate reduction method indicated lower NO levels in the tissue specimens and serum of patients with severe preeclampsia. Moreover, hematoxylin-eosin staining showed that the endothelial cell layer in the placental artery of patients with severe preeclampsia was notably damaged. To investigate the potential role of TRPV1-KATP channels in severe preeclampsia, HUVECs were used for in vitro experiments. The samples were divided into a control group, a TRPV1 agonist group (capsaicin) and a TRPV1 inhibitor group (capsazepine). qPCR and western blotting revealed that the relative gene and protein expression levels of TRPV1, Kir6.1, SUR2B and eNOS in the control group were significantly lower than those in the capsaicin group and considerably higher than those in the capsazepine group. Based on previous studies and the results of the present study, we hypothesized that impairment of the endothelial TRPV1-KATP channels results in decreased eNOS/NO pathway activity, which may be one of the mechanisms involved in severe preeclampsia. The increase in NO generation mediated by TRPV1-KATP may be a suitable target for the management of severe preeclampsia.

Comments on a Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia

Comments on a Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia

Labetalol versus Hydralazine in the Management of Severe Pre-Eclampsia at Tertiary Hospitals in a Low-Resource Setting: A Randomised Controlled Trial

Labetalol versus Hydralazine in the Management of Severe Pre-Eclampsia at Tertiary Hospitals in a Low-Resource Setting: A Randomised Controlled Trial

Pregnancy latency and fetal growth restriction in expectant management of severe pre-eclampsia

Pregnancy latency and fetal growth restriction in expectant management of severe pre-eclampsia

Maternal morbidity and pregnancy latency in expectant management of severe pre-eclampsia

Maternal morbidity and pregnancy latency in expectant management of severe pre-eclampsia

Expectant versus aggressive management of severe preeclampsia at 24–34 weeks of gestation

Expectant versus aggressive management of severe preeclampsia at 24–34 weeks of gestation

Role of CA-125 Level as a Marker in the Management of Severe Pre-Eclampsia.

Hypertensive disorders of pregnancy remain one of the leading causes of morbidity and mortality in maternal-fetal medicine worldwide, particularly in low-resource settings. Despite extensive research in the last decades, pre-eclampsia prediction and, thus, effective prevention remains an unsolved problem. Current evidence suggests that CA-125, an already recognised tumoral marker and, lately, a valuable severity marker of heart failure, can be used to evaluate pre-eclampsia severity and thus improve the identification and management of high-risk patients; Materials and Methods: This is a case-control study involving 100 pregnant patients over 25 weeks of gestation, grouped based on the severity of hypertension in gestational hypertension (n = 22), non-severe pre-eclampsia (n = 11), severe pre-eclampsia (n = 17), and a control group (normotensive) (n = 50). Clinical and biochemical parameters recommended by the international guidelines for evaluating hypertensive pregnant patients were gathered from every patient in addition to CA-125 levels. The correlation was analysed. Mean CA-125 levels increased with the severity of hypertension from a mean of 8.97 U/mL (±2.84) in the normotensive group to a mean of 21.23 U/mL (±11.18) in the severe pre-eclampsia group. Significant differences were observed between each group. The correlation of CA-125 levels with the assessed clinical and biochemical parameters showed positive correlations with MAP, 24 h proteinuria, and LDH values and negative correlations with platelet count, gestational age at birth, and birth weight Conclusions: The reported results support this marker's promising role as a severity marker and its potential to improve pre-eclampsia management allowing a better selection of high-risk patients, aiding in decision making related to hospitalisation and/or timing of birth. Further studies are needed to improve the accuracy of the obtained results, identify an accurate cut-off and an optimal time of measurement, and achieve standardisation in measuring the marker.

A Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia

A Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia

Amount of Proteinuria and Duration of Expectant Management in Severe Preeclampsia.

The aim of the study is to evaluate the association between the amount of proteinuria at the time of diagnosis of preeclampsia with severe features (severe preeclampsia [SPE]) and duration of expectant management (EM) and other perinatal outcomes. This is a retrospective cohort study of patients with SPE delivering live, non-anomalous singletons at 230/7 to 342/7 weeks' estimated gestational age (EGA) at a single tertiary center 2016 to 2018. Patients with proteinuria assessment (24-hour total urine protein or urine protein-to-creatinine ratio extrapolation) within 3 days of SPE diagnosis were included. Patients delivered for an indication other than SPE were excluded. Patients were categorized by amount of proteinuria (mg): none (≤300), mild (301-1,000), moderate (1,001-3,000), and massive (≥3,001). The primary outcome was the proportion of potential EM time achieved (%EM), i.e., days of EM divided by days from SPE diagnosis to 34 weeks. Secondary outcomes included delivery EGA, days of EM, and perinatal outcomes. Bivariable and multivariable analyses compared outcomes across groups. Of 295 patients included, 21% had no proteinuria, 33% mild, 19% moderate, and 27% massive. Groups differed by EGA at diagnosis, age, parity, chronic hypertension, and renal disease. %EM was not significantly different between groups (adjusted β coefficient 4.1 [95% CI -5.3, 13.5] for mild proteinuria vs. none, -4.1 [95% CI -14.9, 6.6] for moderate proteinuria vs. none, and -5.6 [95% CI -16.0, 4.7] for massive proteinuria vs. none). Increasing proteinuria was associated with earlier delivery EGA but only days of EM in the mild versus no proteinuria groups. There was no significant association between proteinuria and maternal composite morbidity, but patients with mild and massive proteinuria had higher odds of neonatal composite morbidities compared with no proteinuria. Among patients with SPE, proteinuria level was not consistently associated with duration of EM. However, patients with the greatest amounts of proteinuria may have worse neonatal and selected maternal outcomes. · Amount of proteinuria was not associated with the duration of expectant management.. · Greater proteinuria was associated with earlier delivery in severe preeclampsia.. · Massive proteinuria in preeclampsia was associated with select adverse maternal and neonatal outcomes..

Severe preeclampsia at the University Hospital Center of Mother and Child (UHCMC) in N’djamena: Epidemiology and prognosis

Introduction: Preeclampsia constitutes a public health problem in our region. According to the WHO, it is the third cause of maternal mortality after severe hemorrhages, infections and is responsible for morbidity and high fetal mortality. The aim of this study was to improve on the management of severe preeclampsia at the University Hospital Center of Mother and Child (UHCMC) in N’Djamena. Patients and methods: It was a prospective and descriptive survey of 3 years duration, from January 01st, 2017 to December 31st, 2019. Included in our study were, all patients admitted for severe preeclampsia and agreed to participate in the study. Epidemiological, clinical, therapeutic and prognostic studies were conducted. The data collected was analyzed using SPSS 18.0 software. Results: During the study period, 13599 pregnant and parturients were admitted to the Gynecology-Obstetrics department of the UHCMC, among whom 406 cases of severe preeclampsia, with a frequency of 2.9%. The patients were young (23.2 years), married (96.3%), primipara (61.3%), referred (64.3%) without antenatal care in 47.9% of cases. Functional signs were dominated by headaches with 34.0% of cases. The proteinuria was ≥ 3 crosses in 83.7% of cases. Patients had received magnesium sulfate in 98.3%, the delivery mode was cesarean in 64.0% of cases. Principal morbidity was eclampsia (40.8%) and fetal was prematurity (36.4%). Maternal lethality was 11.1% and fetal mortality was 19.9% cases. Conclusion: Severe preeclampsia is frequent in the UHCMC in N’Djamena. It is responsible for high maternal and fetal mortality. The practice of quality antenatal care, could prevent the occurrence of complications and improve the maternal-fetal prognosis.

Factors associated with longer latency in expectant management of severe pre-eclampsia

Expectant management of pre-eclampsia with severe features (SPREX) is often considered if diagnosed < 34 weeks. We sought to identify antepartum factors associated with latency of ≥7 days (long latency) and latency ≥14 days (very-long latency) among patients undergoing expectant management of SPREX.

Diagnosis to Delivery Outcomes of Early Severe Preeclampsia

Expectant management of severe preeclampsia (sPEC) diagnosed at < 34 weeks remains individualized, with limited data available to counsel patients. Existing literature includes women with prior chronic hypertension (cHTN), who may have different underlying physiology. Our objective was to evaluate outcomes of women with early sPEC at our institution, comparing those diagnosed at earlier vs. later gestational age (GA).

Management of Severe Pre-eclampsia within 24hours Postpartum at a Tertiary Hospital in Lusaka, Zambia: A clinical Audit

The worldwide incidence of pre-eclampsia ranges between 2% and 5%. Due to its complications, preeclampsia remains a significant public health threat,especially in developing countries. The quality of care given to postpartum women with severe preeclampsia has implications on disease progression.We audited the immediate postpartum care given to women with severe pre-eclampsia at the Women and Newborn Hospital-University Teaching Hospitals, atertiary level hospital in Lusaka, Zambia. We retrospectively reviewed 170 patient's medical records for the period of January 2020 to July 2020 and audited their management based on the local standard guidelines for the management of severe pre-eclampsia.&#x0D; The total number of patients seen during the study period was 1,317. Of these, the total number with SPE was 170, giving a period prevalence of 12%. Allpatients were admitted to the Special observation unit, now Obstetrics intensive care unit (OICU). 12 SPE patient files had incomplete data; hence their information was not included in the analysis to maintain data quality. All 158 patients received antihypertensive drugs, MgSO₄, with only 35% having laboratory results available.We found that more than 85% of women received adequate care according to standard guidelines on most parameters, including magnesium sulphate administration; however, the laboratory tests were below standard as only 36% of these women had adequate investigations. These findings arepromising, indicating that high quality care is achievable in a low resource setting through clinical audits and completing the audit cycles with a focus on correcting identified gaps.

The Use of Magnesium Sulphate in the Management of Severe Preeclampsia and eclampsia in Bayelsa State, Nigeria

The Use of Magnesium Sulphate in the Management of Severe Preeclampsia and eclampsia in Bayelsa State, Nigeria

Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks.

ObjectiveTo compare maternal complications and describe neonatal outcomes in women with severe preeclampsia at ≤ 26+0 weeks in two countries with different management policies: expectant management (Brazil) versus termination of pregnancy (France).MethodsWe conducted a retrospective comparative study by reviewing the medical records of women with severe preeclampsia at ≤ 26+0 weeks, from January 2010 to June 2018, in two centers: Hospital das Clínicas da Faculdade de Medicina, in Sao Paulo, Brazil (where medical abortion is forbidden in this indication) and Hôpital Antoine-Béclère, Clamart, France (where medical termination is accepted). We collected information on maternal characteristics, laboratory tests, maternal complications and fetal and newborn characteristics. We used Student’s t-test and the Mann-Whitney U nonparametric test to compare quantitative variables, and Chi-square test or Fisher's exact test to evaluate the associations between the qualitative variables.ResultsThere was no between-group difference in maternal complications during hospitalization (p = 0.846). In Brazil, the rate of cesarean section was 66.7%, and 20% of patients had vertical incision. The rate of spontaneous fetal death was 35.6% and among the live-born infants 26.6% were discharged from hospital. In France, one patient had a cesarean section with vertical incision.ConclusionWhen comparing termination of pregnancy to expectant management in severe preeclampsia before 26 weeks, maternal complications were equivalent but maternal reproductive future might have been compromised in 20% of cases due to a higher risk of uterine rupture in subsequent pregnancies for patients having classic cesarean (vertical incision). 26.6% of children survived the neonatal period when pregnancy was pursued, however we lack information on their long-term follow-up.

Management of severe preeclampsia in the puerperium: development and scenario validation for clinical simulation.

to develop and validate a scenario for clinical simulation in nursing education on the management of severe preeclampsia in the puerperium. methodological study in five stages (overview, scenario, scenario design progression, debriefing and assessment), developed from March to December 2019, involving 10 volunteers (one professor, five actors and four judges). Data were analyzed using descriptive statistics and Content Validation Index. the scenario was built from the definition of learning objectives that meet the needs of nursing education. From the completion of a Likert scale, by the judges in on-site validation, a Content Validity Index of 1.0 was reached, which indicates 100% agreement in the assessed items. the scenario was validated. It is expected that teaching by simulation will be expanded and that new studies of scenario validation will contribute to the preparation of future nurses, based on the most recent scientific evidence.

Transient cortical blindness at delivery-an unusual case report on posterior reversible encephalopathy syndrome

Background: Posterior reversible encephalopathy syndrome (PRES) is an unusual clinical entity seen associated with blood pressure (BP) fluctuations presenting with acute neurological symptoms. This is an unusual case of PRES due to severe preeclampsia, with clinical presentation of cortical blindness and hypertension, with absence of headache or seizures. Case Presentation: A primigravida, with no significant medical history, presented with significant proteinuria and worsening generalized itching and normotensive at 37 weeks 6 days of gestation. Due to elevated urate and raised urine protein induction of labor was planned. Ten minutes after vaginal delivery, patient reported sudden loss of vision with only being able to perceive light. She developed hypertension, hyperreflexia, and clonus. Aggressive management for severe pre-eclampsia was initiated. Her vision started improving as soon as her BP started normalizing. Imaging revealed the possibility of PRES with a superimposed focus of acute ischemia. She was discharged on antihypertensives and followed up by renal physicians. Within 2 months she recovered very well. Conclusion: This is an unusual case of PRES due to severe pre-eclampsia, with clinical presentation of only cortical blindness with absence of headache or seizures. Prompt recognition and aggressive management of severe pre-eclampsia resulted in resolution of symptoms.

Outcomes before and after Adopting Guidelines for Expectant Management of Severe Preeclampsia.

This study aimed to compare maternal and neonatal outcomes in women with severe preeclampsia before and after implementation of the American College of Obstetricians and Gynecologists (ACOG) taskforce hypertensive guidelines. Single-center retrospective cohort study of women with severe preeclampsia delivering live nonanomalous singletons 23 to 342/7 weeks from 2013 to 2017. In 2015, the ACOG guidelines for expectant management of severe preeclampsia were implemented at our institution. Based on this, patients were categorized as preguideline (January 2013-December 2015) or postguideline adoption (January 2016-December 2017). Primary outcomes included composite maternal morbidity and composite neonatal morbidity; secondary outcomes included composite components, length of stay, birth weight, and delivery gestational age. Groups were compared with Student's t-test, Chi-square, and Wilcoxon's rank-sum tests; adjusted odds ratios (aOR; 95% confidence intervals [CIs]) were calculated. Yearly composite outcomes were compared using the Cochran-Armitage trend test. We estimated a sample size of 250 per group would provide 80% power at α = 0.05 to detect a 50% reduction in neonatal morbidity from a baseline rate of 21.5%. From 2013 to 2017, a total of 543 women with severe preeclampsia were identified: 278 (51%) preguideline and 265 (49%) postguideline. Baseline characteristics were overall similar between groups. There were no significant differences in maternal (aOR = 0.96, 95% CI: 0.6-1.41) or neonatal (aOR = 0.88, 95% CI: 0.61-1.28) composite morbidity between groups. Furthermore, there were no differences in composite maternal or neonatal morbidity over time. Perinatal outcomes were similar before and after implementation of severe preeclampsia management guidelines at our institution. Studies to evaluate if benefits are limited to subsets of this population, such as earlier gestational ages, are needed. · Expectant management of severe preeclampsia has yet to be fully evaluated outside of trial conditions.. · We did not see a significant improvement in neonatal composite morbidity/mortality.. · We also did not see a worsened composite maternal morbidity/mortality..