Preeclampsia In Order Research Articles

The Effect of Preeclampsia on the Quality of Life of Children

Children who born to pregnant women with preeclampsia are at risk of having low physical and cognitive functions due to the influence of placental blood flow ischemia which affects children's neurodevelopment. The object of this research was to determine the effect of preeclampsia during pregnancy on the quality of life of children 2-4 years. The study used a retrospective cohort. The sample was 104 (consisted of 52 pregnant women with preeclampsia and 52 normal pregnant women), not suffering from chronic disease, taken randomly. Preeclampsia was assessed based on the diagnosis from medical records, while children’s quality of life was assessed using PedsQL. Data were analyzed by using logistic regression. The results showed preeclampsia has an effect on physical quality of children (p-value 0.03 <0.05), but did not affect the child's social and emotional function. Children born to mothers with preeclampsia are at 5.9 times the risk of having low physical quality compared to children born to normal maternal pregnancies. Early efforts are needed to stimulate children born to mothers who suffer from Preeclampsia in order to obtain optimal quality of life and physical function.

Management and Prevention of Pre-Eclampsia in Nigeria.

This research paper analyses the management and prevention of pre-eclampsia in Nigeria. Although efforts have been made to reduce outcomes due to pre-eclampsia, it still rears its head in the form of high maternal and perinatal morbidity and mortality. The aim of this review was to identify the main obstacles, gaps, and interventions related to the prevention and management of pre-eclampsia in order to be fully knowledgeable of the magnitude of the issue at the national level, to assess if current government policies are adequate and to recommend solutions. A search was performed on online databases and it was completed with hand searches related to the subject matter. Screening tests for early detection of pre-eclampsia are hardly available in Nigeria as many hospitals rely on the history of previous and current pregnancies, blood pressure monitoring and urinalysis-proteinuria. The administration of low-dose aspirin, antihypertensive drugs and magnesium sulphate, coupled with calcium in calcium deficit regions, was recommended. The main barriers to the wider implementation of these strategies are inadequacy of the antenatal care services in providing appropriate care, lack of resources and trained personnel, high healthcare costs, and low antennal care attendance. Improving education and awareness, use of low-cost screening modalities and low-dose aspirin can be deployed in developing countries to curb pre-eclampsia.

Прогнозування і профілактика прееклампсії при багатоплідній вагітності після допоміжних репродуктивних технологій

Purpose - to assess the effectiveness of the implemented algorithm of treatment and preventive measures by analyzing the course of pregnancy, childbirth and the condition of newborns in multiple pregnancies after assisted reproductive technologies to assess of changes in biochemical markers of endothelial dysfunction in the detection of pre-clinical manifestations of preeclampsia in pregnant women with multiple pregnancies after the use of assisted reproductive technologies. Materials and methods. A prospective study of pregnant women with dichorionic diamniotic twins after assisted reproductive technologies was conducted: the Group І (main) - 35 pregnant women with twins who were offered a developed monitoring algorithm; the Group ІІ (control) 27 pregnant women who were monitored according to generally accepted methods of managing multiple pregnancies. Statistical processing of the research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 6.0”. Results. In the Group І 2 cases of moderate preeclampsia were found in 32 and 33 weeks of pregnancy (PLGF results - 63.2 pg/ml and 58.7 pg/ml, sFlt-1/PLGF ratio - 51.7 and 66.3). In the Group II 4 cases of preeclampsia were identified: 2 cases of moderate preeclampsia (PLGF - 74.1 pg/ml and 69.3 pg/ml, sFlt-1/PLGF ratio - 98.6 and 104.5); 2 cases of severe preeclampsia at 33 and 34 weeks (PLGF data - 44.1 pg/ml and 47.3 pg/ml, sFlt-1/ PLGF ratio 122.4 and 130.1) against the background of signs of gestational hypertension. Fetal growth retardation in the Group І was noted in 3 (8.6%) women (І stage - in 2 (5.7%) cases, II stage - in 1 (2.9%) case, III stage was not diagnosed), in the Group II - in 7 (25.9%) women (I stage - in 2 (7.4%) cases, II stage - in 4 (14.8%) cases, III stage - in 1 (3.7%) case). Fetal distress in the Group І was detected in 4 (11.4%) pregnant women (during pregnancy - in 1 (2.9%) case, during deliveries - in 3 (8.6%) cases); in the Group II - in 7 (25.9%) women (during pregnancy - in 5 (18.5%) cases, during deliveries - in 2 (7.4%) cases). Premature deliveries in the Group I was noted in 5 (14.3%) women (before 34 weeks of gestation - in 2 (5.7%) cases, after 34 weeks of gestation - in 3 (8.6%) cases); in the Group II - in 8 (29.6%) women (before 34 weeks of gestation - in 5 (18.5%) cases, after 34 weeks of gestation - in 3 (11.1%) cases). Premature detachment of a normally located placenta was detected in 2 (7.4%) women in the Group II, and in the Group I such cases were not recorded. Vaginal delivery was observed in 14 (40%) women in the Group I and 7 (25.9%) patients in the Group II; cesarean section - in 21 (60%) and 19 (70.4%) women, respectively. Combined delivery was performed in 1 (3.7%) woman of the Group II, and in the Group I - not recorded. Hypoxic-ischemic lesions were detected in 2 (5.7%) children from women of the Group I and in 4 (14.8%) children from mothers of the Group II. Adaptation disorders were noted in 5 (14.3%) cases in the Group I and in 8 (29.6%) cases in the Group II. Transfer to the second stage of treatment required 3 (8.6%) children from mothers of the Group I and 6 (22.2%) children from mothers of the Group II. Conclusions. The proposed algorithm of modern diagnostic and treatment-prophylactic measures made it possible to reliably reduce the frequency of development of preeclampsia, obstetric and perinatal complications and can be recommended for use in practical health care. The study of the anti-angiogenic factor sFlt-1 and the pro-angiogenic factor PLGF and their ratio is promising in the prediction and early diagnosis of preeclampsia in multiple pregnancies after assisted reproductive technologies. The use of Triage PLGF and sFlt-1/PLGF ratio should be widely implemented in the practice of obstetrician-gynecologists as a prognostic marker for early recognition of preeclampsia in order to reduce perinatal complications, both from the mother and the fetus. Based on monitoring the growth dynamics of the sFlt-1/PLGF ratio, it is possible to predict the early development of preeclampsia even without clinical symptoms, and to make a decision about the possibility of extending the pregnancy or the need for urgent delivery. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Intima-Media Thickness in Women with the History of Hypertensive Disorders of Pregnancy as a Risk Marker of the Occurrence of Cardiovascular Pathology in Advanced Reproductive and Perimenopausal Age

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis.
 The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age.
 Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women.
 Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia.
 Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

Two-year follow-up of infant and maternal outcomes after planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): A randomised controlled trial.

ObjectiveWe evaluated the best time to initiate delivery in late preterm pre‐eclampsia in order to optimise long‐term infant and maternal outcomes.DesignParallel‐group, non‐masked, randomised controlled trial.SettingForty‐six maternity units in the UK.PopulationWomen with pre‐eclampsia between 34+0 and 36+6 weeks of gestation, without severe disease, were randomised to planned delivery or expectant management.Main outcome measuresInfant neurodevelopmental outcome at 2 years of age, using the Parent Report of Children’s Abilities – Revised (PARCA‐R) composite score.ResultsBetween 29 September 2014 and 10 December 2018, 901 women were enrolled in the trial, with 450 women allocated to planned delivery and 451 women allocated to expectant management. At the 2‐year follow‐up, the intention‐to‐treat analysis population included 276 women (290 infants) allocated to planned delivery and 251 women (256 infants) allocated to expectant management. The mean composite standardised PARCA‐R scores were 89.5 (SD 18.2) in the planned delivery group and 91.9 (SD 18.4) in the expectant management group, with an adjusted mean difference of −2.4 points (95% CI −5.4 to 0.5 points).ConclusionsIn infants of women with late preterm pre‐eclampsia, the average neurodevelopmental assessment at 2 years lies within the normal range, regardless of whether planned delivery or expectant management was pursued. With the lower than anticipated follow‐up rate there was limited power to demonstrate that these scores did not differ, but the small between‐group difference in PARCA‐R scores is unlikely to be clinically important.

Gambaran Tingkat Pengetahuan Ibu Hamil tentang Pencegahan Preeklamsia

Pre-eclampsia is a disease with the signs of hypertension, proteinuria, and edema arising from pregnancy. There are 20 maternal mortality rates in Banyuwangi, most of the causes of maternal mortality are PEB / Eclampsia as many as 5 people (25%). This study aims to describe the level of knowledge of pregnant women about the prevention of preeclampsia in the Kalibaru Kulon Public Health Center Banyuwangi. This study uses a quantitative descriptive method. The variable in this study was the knowledge of pregnant women about the prevention of preeclampsia. The population in this study were 58 pregnant women who continued to visit every month at the Kalibaru Kulon Public Health Center Banyuwangi. The sampling technique used was accidental sampling, while the sample obtained in June 2020 was 37 samples. Data collection techniques using a questionnaire.The results of this study indicate that the level of knowledge of pregnant women about the prevention of preeclampsia in the Kalibaru Kulon Banyuwangi Health Center in 2020 is categorized as good as many as 35 people (95%). where respondents are knowledgeable, aged 21-40 years, elementary school education, work as a housekeeper and the number of parity> 2. It is advisable for pregnant women to be more active in seeking health information, especially about the prevention of preeclampsia in order to increase knowledge so that they can prevent and avoid unwanted things.

Preeclampsia: A Review of Early Predictors

Abstract Preeclampsia is a progressive, multi-system disorder of pregnancy associated with morbidity and mortality on both the mother and the fetus. Currently, research is directed at identifying early biomarkers of preeclampsia in order to predict its occurrence. This is important because it helps understand the pathophysiology of the disease, and thus, promises new treatment modalities. Although a clear understanding of the pathogenesis of PE remains elusive, the currently most accepted theory suggests a two-stage process. The first stage results in inadequate remodeling of the spiral arteries and leads to the second stage, whereby the clinical features of the syndrome are featured. In this review, we summarize the modalities that have been studies so far to predict preeclampsia. The use of uterine artery Doppler and several other biomarkers such as vitamin D, soluble fms-like tyrosine kinase 1/placental growth factor (sFLT1/PlGF) ratio, soluble endoglin, and a subset of T-lymphocytes has shown promising results. We are still at early stages in this advance, and no clear recommendations have been made about their clinical use to date. Further studies are still needed to improve screening strategies and evaluate the cost-effectiveness of any intervention.

SOCIO-DEMOGRAPHIC PROFILE IN PREECLAMPSIA

Background: Pre-eclampsia is a complex multisystem condition. It affects 3-5% of all prenancies.It is defined as new onset hypertension after twenty weeks of pregnancy plus involvement of at least one organ system-renal, hepatic, neurological, hematological, pulmonary or cardiac system or as utero-placental dysfunction
 Methods: This was a hospital based comparative analytical cross sectional study carried out over 2 years period from may 2019 in the Department of Obstetrics and Gynecology, SMS Medical College and attached hospitals, Jaipur.
 Results: The mean age of cases (27.36 ± 3.66 years) was higher than the controls (23.43 ± 3.23 years). There was not much difference in the distribution of subjects according to residence. In the study group 26 (57.78%) women belonged to urban areas and 19 (42.22%) belonged to rural areas whereas in the control group, 26 (62.22%) women belonged to rural areas and 17 (37.78%) belonged to urban areas. There were more primigravida in pre eclamptic group compared to the control group.
 Conclusion: Identification of risk factor in the antenatal period helps in early detection of women who are at high risk of developing pre-eclampsia in order to reduce maternal morbidity and mortality.
 Keywords: Preclampsia, Age, Gravida

FEATURES OF THE FUNCTIONAL STATE OF PLATELETS AT THE PRE-CLINICAL STAGE OF PREECLAMPSIA

The only effective method of treating pregnant women with developed preeclampsia is timely delivery, so it is an urgent task to establish predictors of preeclampsia in order to predict its development.The aim of the work is to evaluate the platelet link of the hemostasis system in the 2nd trimester of pregnancy in patients with preeclampsia that developed after 34 weeks of pregnancy, to establish informative markers for predicting the development of preeclampsia after 34 weeks of pregnancy A survey of 210 apparently healthy women of active reproductive age (18-34 years) was carried out. Patients with multiple pregnancies, autoimmune pathology, arterial hypertension, heart defects, varicose veins, diabetes mellitus, hereditary thrombophilia were excluded from the study. All patients received voluntary informed consent to use the survey data for scientific purposes. In 20 patients, the course of pregnancy was complicated by the development of moderate preeclampsia after 34 weeks of pregnancy, these patients constituted the main group. 190 women with physiological pregnancy made up the comparison group. The study of the state of the platelet link of the hemostasis system was carried out using a VS-3000 + hematological analyzer, the number of platelets, their average volume, the root-mean-square value of the spread of platelet sizes, and the percentage of megalothrombocytes were determined. At the preclinical stage of development of preeclampsia (at 20-22 weeks), a decrease in the number of platelets and an increase in functional activity in the form of an increase in the rate of platelet anisocytosis, the average volume of platelets and the number of megalothrombocytes were found in pregnant women of the main group. Determination of indicators of the state of the platelet hemostasis at 20-22 weeks of gestation can be used to predict the development of moderate preeclampsia after 34 weeks of gestation.

Prediction of Preeclampsia and Intrauterine Growth Restriction in Low-risk Pregnancies in East Avenue Medical Center using Uterine Artery Doppler Velocimetry

Preeclampsia, which is defined as elevated blood pressure after 20 weeks of pregnancy in a woman whose blood pressure had been normal, remains the second most common cause of direct maternal deaths (0.83 per 100,000 cases) worldwide. At present, no effective prophylactic measures have been identified in the prevention of preeclampsia and other pregnancy complications such as intrauterine growth restriction. Therefore, proper antenatal care remains the most important part of prevention. Identifying each woman’s individualized risk can allow further antenatal surveillance to be directed to those women who are most likely to develop preeclampsia. Such care leads to early diagnosis and intervention, both in terms of maternal/ fetal monitoring and timing of delivery. In this study, uterine artery Doppler velocimetry in the mid-trimester will be analyzed, and its role in the prediction of later pregnancy complications (preeclampsia and intrauterine growth restriction) will be discussed. The aim of this study is to predict the risk for the development of adverse pregnancy outcomes on the basis of mid-trimester uterine artery Doppler velocimetry. Statistical analysis showed that preeclampsia occurred significantly more commonly in the group with an abnormal doppler result at 16-22 weeks of gestation, compared to pregnancies with normal doppler findings. That is 42.9% (3 out of 7) for abnormal doppler result versus 7.2% (2 out of 27) for those with normal doppler findings. However, none of the 34 evaluated cases developed intrauterine growth restriction. Abnormal uterine artery Doppler result at 16-22 weeks is associated with adverse pregnancy outcomes. In this study, it was well correlated with the development of preeclampsia. Hence, uterine artery Doppler can be used as a useful method for identifying high-risk pregnancies. Uterine artery pulsatility index (PI >1.45) can provide further information for the prediction of preeclampsia in order to conduct appropriate clinical interventions to avoid perinatal morbidity

Postpartum hepatic rupture and intestinal fistula associated with severe pre-eclampsia

Here, the authors present a case of severe pre-eclampsia complicated by postpartum HELLP syndrome. A 29-year-old pregnant woman with severe pre-eclampsia at 30 weeks of gestation was admitted to the present clinic with hypertension and proteinuria. A cesarean section was performed at 31+3 weeks of gestation due to fetal distress and a history of cesarean section. The postpartum period was uneventful until two days after the cesarean section, when the patient began to experience epigastric pain, nausea, and vomiting. Subsequent laboratory tests were consistent with HELLP syndrome. Development of hemoperitoneum led to the patient being conveyed to surgery whereupon the authors discovered a large hematoma. They also identified that the liver capsule had a 5-cm tear. Unfortunately, the patient was diagnosed with an intestinal fistula 12 days after surgery. They therefore recommend that caution should be exercised closely monitoring for new symptoms in patients with pre-eclampsia in order to detect the potential development of postpartum HELLP syndrome.

Myeloperoxidase is not a good biomarker for preeclampsia prediction

Myeloperoxidase is a proinflammatory enzyme found to be increased in patients with established preeclampsia but never investigated before the disease onset. Here we examined myeloperoxidase concentration and activity in plasma and urine samples from pregnant women who remained normotensive throughout pregnancy and those who developed preeclampsia in order to assess its potential to predict this disorder. Our sample consisted of 30 cases who developed preeclampsia (14 severe and 16 mild) and 57 controls who remained healthy throughout pregnancy, derived from the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA). Myeloperoxidase concentration were assessed using a commercial ELISA kit and enzymatic activity through tetramethylbenzidine oxidation. No statistical differences were found in myeloperoxidase levels nor activity between plasma or urine samples from controls, severe and mild cases. Myeloperoxidase did not seem to have a potential application for preeclampsia prediction.

Path Analysis on the Effects of Motivation and Other Factors on Midwives Performance of Preeclampsia Management in Malang, East Java

Background : The incidences of preeclampsia and eclampsia remain high worldwide. Preeclampsia and eclampsia remain a major cause (31.04%) of maternal mortality in East Java. It is essential to early detect preeclampsia in order to prevent mortality. Good performance of midwives in the management of preeclampsia may reduce maternal mortality attributable to eclampsia. It is hypothesized that motivation, leadership style, working atmosphere, insentive, skill, and training, all have impact on midwives performance. This study aimed to analyze the effects of motivation and other factors on midwives performance in preeclampsia management in Malang, East Java, using path analysis model. Subjects and M et hod : This was an analytic observational study with cross sectional design. The study was conducted in Community Helath Centers, Malang, East Java in September 2017. A total sample of 161 midwives were selected using total sampling technique. The endogenous variables were motivation and midwives performance. The exogenous variables were insentive, working atmosphere, leadership style, skill and training. The data were collected using a set of questionnaire and analyzed by path analysis. Results : Midwife performance were positively affected by working atmosphere (b= 0.11; SE=0.04; p= 0.004), leadership style (b= 0.06; SE= 0.02; p= 0.004), skill (b= 0.24; SE= 0.03, p<0.001), and motivation (b= 0.68; SE= 0.03; p<0.001). Motivation was positively afected by insentive (b= 0.25; SE= 0.09, p= 0.006), training (b= 0.89; SE= 0.28; p= 0.001), skill (b= 0.39; SE= 0.06; p<0.001), leadership style (b= 0.08; SE= 0.05; p= 0.110), and working atmosphere (b= 0.35; SE= 0.09; p<0.001). Conclusion : Midwives performance are positively affected by working condition, leadership, skill, and motivation. Keyword: preeclampsia, path analysis, motivation, midwives performance Correspondence: Nicky Danur Jayanti. Masters Program in Public Heath, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: nicky_daanty@yahoo.co.id Journal of Health Policy and Management (2017), 2(2): 137-146 https://doi.org/10.26911/thejhpm.2017.02.02.05

The Role of Adenomyosis in the Pathogenesis of Preeclampsia.

Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

Can the quantity of cell-free fetal DNA predict preeclampsia: a systematic review.

Previous studies have demonstrated an increase in the quantity of cell-free fetal DNA (cffDNA) before the onset of preeclampsia. It would be beneficial if the quantity of cffDNA predicted preeclampsia in order to implement preventative trials and strategies to decrease maternal and fetal morbidity. Our objective was to review the literature on using cffDNA levels as a predictor of preeclampsia. We performed a systematic review following the Meta-analyses and Systematic Review of Observational Studies guidelines. Included studies evaluated cffDNA levels in pregnant women before the clinical onset of preeclampsia. Thirteen studies met inclusion criteria. There was considerable heterogeneity between included studies, and all received a quality grade of C on the Grading of Recommendations Assessment, Development, and Evaluation scale. Of the 13 studies, 11 found an increase in cffDNA among pregnant women who subsequently developed preeclampsia. In addition, all four studies analyzing early-onset or severe preeclampsia found significantly elevated cffDNA levels prior to disease onset. Cell-free fetal DNA quantification is a promising marker for preeclampsia prediction, especially for the development of early-onset or severe preeclampsia. However, because of the heterogeneity in published studies, a precise conclusion about the statistical and clinical relevance cannot be made.

Increased expression levels of E-cadherin, cytokeratin 18 and 19 observed in preeclampsia were not correlated with disease severity

IntroductionPreeclampsia is a pregnancy-specific disorder and placental factor(s) contribute to the pathogenesis of preeclampsia. Turnover of villous trophoblast is affected by impaired placental perfusion in preeclampsia. Expression and localisation of cadherins and cytokeratins are involved in the pathogenesis of preeclampsia. However, studies describing the associations between cadherins and cytokeratins in preeclampsia are limited. The aim of this study was to investigate the expression of E-cadherin, N-cadherin, cytokeratin 18 and cytokeratin 19 in placentae from women with preeclampsia in order to determine whether their expression differs with disease severity. Methods29 preeclamptic placentae and 25 normotensive placentae were included in this study. The expression of E-cadherin, cytokeratin 18, cytokeratin 19 andN-cadherin was quantified by immunohistochemistry and western blotting. ResultsE-cadherin, cytokeratin 18 and cytokeratin 19 were expressed predominantly in the syncytiotrophoblast of the placenta and the expression of E-cadherin, cytokeratin 18 and cytokeratin 19 was significantly increased in preeclampsia compared to normotensive pregnancies. However, there was no significant difference in expression between severe preeclampsia and mild preeclampsia. In addition, there was no difference in the expression of N-cadherin between preeclampsic and normotensive pregnancies. DiscussionOur data demonstrated increased expression of E-cadherin, cytokeratin 18 and cytokeratin 19 in the syncytiotrophoblast of preeclamptic placentae, but this increase was not correlated with disease severity. ConclusionOur data suggests that E-cadherin and cytokeratins are involved in the pathogenesis of preeclampsia.

Including ethical considerations in models for first-trimester screening for pre-eclampsia

Recent efforts to develop reliable and efficient early pregnancy screening programmes for pre-eclampsia have focused on combining clinical, biochemical and biophysical markers. The same model has been used for first-trimester screening for fetal aneuploidies i.e. prenatal diagnosis (PD), which is routinely offered to all pregnant women in many developed countries. Some studies suggest combining PD and pre-eclampsia screening, so women can be offered testing for a number of conditions at the same clinical visit. A combination of these tests may be practical in terms of saving time and resources; however, the combination raises ethical issues. First-trimester PD and pre-eclampsia screening entail qualitative differences which alter the requirements for disclosure, non-directedness and consent with regard to the informed consent process. This article explores the differences related to the ethical issues raised by PD and pre-eclampsia in order to elucidate which factors are relevant to deciding the type of information and consent required in each context from the perspective of the ethical principles of beneficence and autonomy. Furthermore, it argues that ensuring respect for patient autonomy is context dependent and, consequently, pre-eclampsia screening and PD should be performed independently of one another.Pre-eclampsia is a complication of pregnancy that threatens the health of both mother and baby. It has recently been discovered that aspirin is an effective treatment of pre-eclampsia, but only if the mother starts taking aspirin before the 12th week of pregnancy. Presently, much research into the development of a method of screening for pre-eclampsia, similar to that currently used to detect Down’s syndrome during pregnancy, is underway. Some studies have suggested combining the Down’s syndrome and pre-eclampsia screening tests during the first trimester of pregnancy. There are good reasons for this as the time frame for testing is the same and some of the same components can be used in both tests. However, in this paper, we analyse the types of risk and benefits associated with both tests and we find that the type of information required for patients to give consent, and the type of consent required (written, verbal or implicit), are not the same. We find it problematic to combine these tests, and we recommend performing each test independently of the other.

PP086. The modern search for possible predictors of preeclampsia in the first trimester of pregnancy (preliminary study)

Preeclampsia is a major complication affecting at least 3-4% of all pregnancies and is globally responsible for approximately 50,000 maternal deaths annually. Currently the main cause of preeclampsia is a shallow placentation, with abnormal invasion of cytotrophoblasts and incomplete remodeling of placenta-supplying maternal uterine spiral arteries. However, up to 20weeks, these processes are asymptomatic, although they are accompanied by the release of various macromolecules in the bloodstream of the mother, which are potential biomarkers of disease, needed to detect. Much progress has been made in recent years towards first-trimester models using combined factors that will be of realistic use in clinical practice.The ability to predict the most severe forms of preeclampsia would allow closer surveillance and earlier intervention to improve pregnancy outcomes. To determine the significance of measuring the concentration of PlGF and sFlt-1 and their ratio in 11-13 weeks of pregnancy as early markers of preeclampsia. The study included 85 pregnant women in 11-13 weeks with subsequent uncomplicated pregnancy and 11 patients which developed various hypertensive disorders, four of them have developed severe (n=2) and mild (n=2) preeclampsia later. Concentrations of markers were determined on automated analyzers Cobas E411 (Hoffmann La Roche) using test kits Elecsys PlGF and Elecsys sFlt-1. In the first trimester the concentration of sFlt-1 in healthy pregnant women was 1618,0±18,2pg/ml, PlGF - 47,5±3,5pg/ml, the sFlt-1/PLGF ratio - 35,9±3,2. In the second trimester parameters were as follows: sFlt-1 - 1898,0±29,8pg/ml, PlGF - 208,0±11,0pg/ml, the sFlt-1/PLGF ratio-11,2±2,6. Two patients with severe preeclampsia had sFlt-1 concentration at 11-12 weeks of 2185 and 14923pg/ml, PlGF - 12,8 and 61.3pg/ml, the ratio sFlt-1/PLGF - 170,7 and 243.4. In two patients with mild preeclampsia, these figures were in 1700 and 2312pg/ml, 38.2 and 37,6pg/ml, 44,4 and 61,4, respectively. The optimal prediction biomarker does probably not exist. Our preliminary results confirm the feasibility of determining concentrations of sFlt-1 and PlGF, and their ratio in the 1st trimester of pregnancy to assess the risk of preeclampsia in order to reduce the frequency of obstetric complications and perinatal loss. Effective prediction of PE can be achieved at 11-13weeks' gestation. Further studies on the development and implementation a modified integrated screening program for early diagnosis of PE at 11-14weeks of gestation should be based on the assessment of maternal factors, biophysical, biochemical, and molecular genetic markers are needed. Better individualised patient prediction will allow us to target existing prevention, as it is, and to also develop new treatments in future.

Prenatal diagnosis

Ultrasound screening is the most important contribution for prenatal detection of fetal developmental disorders. The time period between 11 and 14 weeks has proved to be the most suitable for detecting the majority of aneuploidies, a great number of malformations, the differentiation between mono- and dichorionic twin pregnancies and the early assessment of maternal pregnancy risks such as pre-eclampsia in order to start prophylactic treatment. The period between 18 and 22 weeks is used for the detection of structural fetal abnormalities. For this purpose a great number of clearly defined sonographic planes have to be visualized and electronically stored. The main task for the sonographer in the third trimester is to determine fetal and placental position and to detect fetal growth disorders. Using fetal Doppler studies allows determination of the optimal time and mode of delivery. In the case that a particular fetal malformation requires post-natal treatment, the mother can be transferred before birth to the most appropriate hospital. With the aforementioned sonographic techniques most of the major fetal and maternal problems can be detected on time and effective steps for a solution be taken.

Study of Glucose-6-phosphate Dehydrogenase (G6PD) Status in Preeclampsia

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the common enzymopathy and may be one of the risk factor for complicated pregnancy. Objectives : To measure erythrocyte G6PD level in pregnant women with preeclampsia in order to observe this enzyme status and also to measure Hb, TC of RBC, serum bilirubin, reticulocyte count to observe hemolytic status. In addition, to correlate this enzyme level with all these hematological parameters in order to find out any relationships among them. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2008. For this, 30 pregnant women with preeclampsia, age ranged from 20 to 34 years during their third trimester (>24th weeks) were studied (group B). They were selected from the Obstetric and Gynae Out Patient Department (OPD) of BSMMU and Bangladesh Medical College Hospital (BMCH) of Dhaka City. For comparison age matched 30 apparently normal pregnant women of the same gestational age (control group - group A) were also studied. They were selected by personal contact. Erythrocyte G6PD level was measured by Spectrophotometric method using kit of Randox. Serum bilirubin, hemoglobin concentration, total count of RBC and reticulocyte count were measured by standard laboratory techniques. For statistical analysis ANOVA, independent sample t test, Chi-square test and Pearson's correlation coefficient test were performed by using SPSS for windows version-12 as applicable. Results: In this study, erythrocyte G6PD level was significantly lower in preeclampsia in comparison to that of control but their percentages of involvement was not statistically significant. In addition, hemoglobin concentration and RBC count were significantly lower and serum bilirubin and reticulicyte count were significantly higher in the study group than those of control group. On the other hand, erythrocyte G6PD level was positively correlated with hemoglobin concentration and total count of RBC while negatively correlated with serum bilirubin and reticulocyte count and all these relationships were statistically significant in the study group. Conclusion: Therefore, this study revealed that presence of G6PD deficiency associated with hemolysis in preeclampsia may act as a contributory factor for the development of this complicated pregnancy. Key words: G6PD; preeclampsia DOI: 10.3329/bsmmuj.v2i2.4758 BSMMU J 2009; 2(2): 56-60