Preeclamptic Group Research Articles

Study of Fetal Outcome in Preeclampsia and Eclampsia Syndrome

Background: Preeclampsia and eclampsia syndrome is one of the commonest medical disorders of females. The neonatal outcome is different from the normal pregnancy due to this disorder. It includes- stillbirth, low birth weight, asphyxia, and prematurity.Objective: The objective of the study was to determine the fetal outcomes in different groups of preeclampsia and eclampsiasyndrome.Materials and Methods: This cross-sectional observational study was conducted in the Department of Pathology, (BIRDEM) General Hospital, Dhaka, from July 2019 to June 2021. The study comprised 138 clinically diagnosed preeclampsia and eclampsia syndrome cases from the Department of Gynecology & Obstetric of BIRDEM and DMCH. Out of 138 cases, there were 42 cases of mild preeclampsia (mild PE), 62 were of severe preeclampsia (severe PE), and 33 were eclampsia. Relevant data and pregnancy outcome (neonatal birth weight, maturity, Apgar score, and stillbirth), were observed and recorded in a predesigned data collection sheet and statistical analyses were carried out. Ethical practice was ensured in every step of the study.Results: Among 138 cases, the mean birth weight was (2.12±0.57) kg, which was observed in the mild preeclamptic group, and the mean birth weight was (1.52±0.47) kg found in the eclamptic group. A low Apgar score (score˂7) was mainly observed in the severe PE (77.8%) followed by (84.8%) in eclampsia group. More than half of the cases were revealed stillbirth (54.4%) as the neonatal outcome in eclampsia group. A statistically significant difference was found among three groups regarding pregnancy outcome (neonatal birth weight, maturity, stillbirth, etc.).Conclusion: Majority of the fetal complications were related to the severity and duration of the preeclampsia and eclampsia syndrome. KYAMC Journal Vol. 14, No. 01, April 2023: 39-42

Role of preeclampsia on insulin-induced vasorelaxation

The objective of this project was to evaluate whether PE alters the vascular response to insulin. The physiological insulin resistance characteristic of pregnancy is increased in preeclamptic (PE) conditions. With the hypothesis that PE diminishes insulin vascular effects we used a conventional isolated aorta rings preparation to study insulin-induced relaxation on phenylephrin (Phe) pre-contracted vessels and Phe induced contraction in the presence or absence of insulin. Vessels were obtained from non-pregnant rats (NP) with subrenal aortic coarctation (SRAC), pregnant (P) and pregnant rats with SRAC (PE). Experiments were performed in thoracic or abdominal aorta rings with or without endothelium. The results show that PE increases the contractile response to Phe in the thoracic and abdominal aorta compared to P (PE vs P p<0.01). Incubation with insulin did not modify the thoracic or abdominal aorta Phe induced contraction of any of the three groups with and without endothelium.On the other hand, insulin induced relaxation was more evident in vessels with endothelium and was decreased both in the thoracic and the abdominal aorta of PE group (PE vs P p<0.01; PE vs NP-CARS p<0.01).In conclusion, PE decreases endothelium-dependent insulin-induced relaxation suggesting PE deteriorates insulin-PI3K-NO pathway. Funding: Consejo Nacional de Ciencia y Tecnología(CONACyT) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Morphometric Analysis of Placental Terminal Villi, Capillaries, and Intervillous Space in Normal and Pre-Eclamptic Pregnancies

Background: The placenta reflects the prenatal problems that are linked to high perinatal morbidity and mortality both macroscopically and microscopically. A pregnancy syndrome called pre-eclampsia has terrible consequences for both the mother and the unborn child. It may result in more frequent inductions of labor, fetal growth limitation, respiratory issues in newborns, increased admission rates to neonatal critical care units, and an elevated risk of perinatal or fetal death. To understand the relation of preeclampsia and fetal growth identification of its effects on various components of the placenta is mandatory hence the current study was designed to evaluate the Placental Terminal Villi, Capillaries, and Intervillous Space in Normal and Pre-eclamptic Pregnancies. Methodology: It was a cross sectional study, carried out on 50 samples of placentas, out of which 25 were preeclamptic and 25 were normal. The placentas were recruited after cesarean session, processed as per guidelines and were analyzed for histopathological examination. The set inclusion criteria were Registered cases of Pre-eclampsia, Blood Pressure ≥ 140/90 mmHg, Parity 0 – 4, Age of mother (25 – 35) Years., Gestational Age (36 – 42) Weeks, Mode of delivery Cesarean Sections. The set exclusion criteria were known hypertensive patients, and patient diagnosed with other chronic illnesses. Results: Number of terminal villi, Transverse diameter of terminal villi (μm), Intervillous space (μm), and Transverse diameter of terminal villous capillaries decreased significantly (p=0.001) in preeclamptic group however, Number of terminal villous Capillaries were found to be increased in preeclamptic group (p=0.001). Conclusion: Preeclampsia leads to more significant alterations in placental structure compared to normal pregnancies, emphasizing the importance of early detection and management of this condition to improve maternal and fetal outcomes. Keywords: Pregnancy, preeclampsia, terminal villi, Intervillous space, terminal villous Capillaries

The Inter-Trimester Variation and Prognostic Value of Creatinine, Cystatin C and Uric Acid in Preeclamptic Patients: A Retrospective Study

Background: This study aimed to evaluate the clinical significance of maternal serum creatinine, cystatin C, and uric acid levels in relation to fetal death in pregnant women with preeclampsia. Methods: This retrospective study evaluated 708 women with preeclampsia, and 738 healthy pregnant women were selected as control. Medical records were reviewed to collect obstetric, neonatal, and biochemical data, including creatinine, cystatin C, and uric acid concentrations. Results: Maternal serum creatinine, cystatin C, and uric acid concentrations were significantly higher in the preeclamptic group than in the control (p < 0.05). Preeclamptic women in the fetal death group had significantly higher creatinine levels during their second and third trimesters, and higher uric acid concentrations throughout the pregnancy compared to the fetal survival group. Preeclamptic patients were divided into four groups based on quartiles of uric acid levels. The overall fetal survival rate in patients with upper-quartile uric acid concentrations was significantly lower than those with low uric acid levels during pregnancy. Multivariate logistic regression analysis revealed that uric acid concentration was a significant risk factor for fetal death in the first and second trimesters in the preeclamptic group (p < 0.05). Conclusions: In pregnant women with preeclampsia, fetal death was associated with upper-quartile uric acid concentrations in the first and second trimesters. Uric acid levels can be an indicator of fetal death in the early and middle stage of pregnancy.

Association between serum hypovitaminosis D and preeclampsia: A nested case-control study

Background: Preeclampsia is a major complication of pregnancy and a major cause of perinatal and maternal morbidity and mortality. Vitamin D deficiency has been implicated in the aetiology and pathophysiology of preeclampsia. However, there is no uniformity in the findings of previous studies on the association between vitamin D and preeclampsia. Aims and Objectives: The study is aimed at determining the association between preeclampsia and maternal vitamin D deficiency. Materials and Methods: This nested case-control study was conducted among 158 pregnant women (78 preeclamptic women and 80 controls) with singleton pregnancies. Case participants were women with preeclampsia. The controls were matched pregnant women without preeclampsia. Their serum vitamin D levels were determined. Statistics: Continuous data was analysed using T-test. The statistical significance was inferred at p- value ≤0.05. Results: The prevalence of hypovitaminosis D in our study was 7.0% overall. The proportion of women with hypovitaminosis D was not significantly different between preeclampsia group and control group (7.7% vs 6.3% respectively; p=0.76). The mean serum concentration of vitamin D in the preeclamptic group was lower than that in the control group, however, the difference was not statistically significant (118.8±17.4nmol/L vs 129.0±19.7nmol/L, p=0.17). There was a weak association between gestational age and the level of serum vitamin D in both groups (r= 0.062 and r= -0.13 respectively). Conclusions: Hypovitaminosis D is not significantly associated with preeclampsia when compared with control. However, there was a weak association between gestational age and the level of serum vitamin D in both groups.

Multiscale asymmetry reveals changes in the maternal short-term heart rate dynamics of preeclamptic women during labor.

It is known that acceleration and deceleration patterns in heart rate variability (HRV) are asymmetrically distributed in healthy subjects. Accordingly, novel approaches for assessing the asymmetrical properties of HRV, such as the multiscale asymmetry (MSA), have been applied in the perinatal field. To study the asymmetry of accelerations and decelerations of maternal short-term cardiac dynamics of thirty-six normotensive and preeclamptic women during labor/nonlabor by MSA analysis. The RR interval time series obtained from these participants were classified into four groups: normotensive (control) without labor C-NL, n= 10; control with labor C-L, n= 10; and two preeclamptic groups with absence or presence of labor P-NL, n= 6; and P-L, n= 10, respectively. Multiscale indices of heart rate asymmetry (HRA) such as Porta (P%), Guzik (G%) and Ehlers (E) were used to explore the changes of HRA in the normotensive and preeclamptic groups in the presence or absence of labor. The main result of this study shows that preeclamptic women manifest decreased magnitude of decelerations of heart rate dynamics compared to normotensive women indicated by G% and E. We speculate that a lower cardiac parasympathetic response may be manifested in preeclamptic women during labor/nonlabor compared to normotensive women. These observations represented a new insight into the autonomic cardiovascular regulation in preeclampsia, which could contribute to the perinatal field in the future.

Angiogenic Biomarker Placental Growth Factor (PLGF) in the Prediction and Diagnosis of Placental Dysfunction in Pre-eclampsia: A Cohort Study

Introduction: Pre-eclampsia (PE), a pregnancy induced hypertensive disorder affects approximately 8-10% of all pregnancies in developing countries. A highly sensitive and specific marker for diagnosis of PE is the need of the hour as diagnostic criteria are still based on non-specific clinical symptoms, ultrasound, and laboratory findings. Imbalance in the placental release of various angiogenesis regulatory factors to the maternal circulation is one of the significant contributors to its clinical manifestations. Low levels of pro-angiogenic biomarker Placental Growth Factor (PLGF) are detectable several weeks before clinical presentation of PE. Aim: To determine the association of serum levels of PLGF with PE in second and third trimester of pregnancy. Materials and Methods: A prospective cohort study was performed in a tertiary care hospital from December 2018 to November 2021, on 130 patients by dividing study participants into two groups: Pre-eclamptic cases, Normotensive controls. At enrollment in second trimester (24-28 weeks) and during third trimester (beyond 28 weeks) serum PLGF concentration was measured by using the Enzyme-linked Immunosorbent Assay (ELISA) kit method. Data was statistically analysed. Student’s t-test was used for comparing differences between study groups. The chi-square test was used to compare qualitative categorical data. Evaluation of the Area Under the Curve (AUC), diagnostic accuracy, sensitivity and specificity was done by Receiver Operating Characteristics (ROC) curve analysis done using software defined cut-off values. Results: Total of 115 patients were analysed in the present study with 55 patients in group 1(mean age: 25.83±3.27 years) and 60 patients in group 2 (mean age: 30.52±5.63 years) When compared with normotensive group PLGF levels were significantly lower in pre-eclamptic group with median 16.27 ng/mL versus 12.20 ng/ mL (p <0.001) in second and 14.05 ng/mL versus 10.50 ng/mL (p <0.001) in third trimesters respectively. ROC curve analysis using cut-off point of 14.91 ng/mL showed sensitivity 80%, specificity 96.7%, AUC 0.896, 95%CI:(0.832-.959) in second trimester and in third trimester at cut-off point of 13 ng/mL sensitivity 73%, specificity 96.7%, AUC 0.882 95% CI:(0.816-.948) was found. Conclusion: PLGF may be used as a biomarker for early prediction, diagnosis, and management of PE. It might serve as ideal discriminating biochemical markers of PE. In the near future, the clinical utility of disease specific angiogenic biomarker in early detection of PE might improve health outcomes by preventing adverse maternal and neonatal outcomes and serious complications.

Cord Blood Total WBC Count and Neutrophil Count Changes in Newborn of Preeclamptic Mother

Introduction: Preeclampsia is a hypertensive disorder during pregnancy which may severely impact the health of mothers and their newborns. The newborn of preeclamptic mother should be carefully monitored and managed for the purpose of reducing perinatal mortality and morbidity. Aim of the Study: The aim of this study was to evaluate the changes in cord blood total count of WBC and absolute neutrophil count in newborn of preeclamptic mother. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood from each newborn was collected in EDTA tube after delivery and haematological test for total WBC count and absolute neutrophil count was done. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre-designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: In this study, the mean (±SD) maternal systolic blood pressure of the study group A and control group B were 173.00 ± 19.73 and 114.83 ± 11.72 mm Hg respectively. In this study, the mean (±SD) maternal systolic blood pressure was significantly (p<0.001) higher in group A in compared to group B. The mean (±SD) maternal diastolic blood pressure of the study group A and control group B were 108.33 ± 9.52 and 73.33 ± 9.07 mm Hg respectively. In this study, the mean (±SD) maternal diastolic pressure was significantly (p<0.001) higher in group A in comparison to that of group B. The mean (± SD) total count of WBC was 9.62 ± 1.86 × 103/µl and 17.38 ± 3.31 × 103/µl in group A and B respectively. In this study, the mean (±SD) total count of WBC was lower in group A in comparison to that of group B which was statistically significant (p<0.001). In this study, mean (±SD) Absolute Neutrophil Count (ANC) was 5.76±2.01 ×103/µl and 10.45±1.90 ×103/µl in group A and B respectively. In this study, the mean (±SD) absolute neutrophil count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.953) with total count of WBC in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.957) with total WBC count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (- 0.951) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (-0.953) with absolute neutrophil count in newborn of preeclamptic mother, which was statistically significant (p<0.001). Conclusion: The total WBC count and absolute neutrophil count in the cord blood of the newborn of preeclamptic mother were lower than those of healthy pregnant mother, but they were within the normal range, it can be inferred after studying the study's findings. These changes were significantly related to severity of maternal blood pressure.

A Study of Platelet Count and Mean Platelet Volume in Newborn of Preeclamptic Mother

Introduction: Pregnancy is a physiological process. Preeclampsia is the commonest complication during pregnancy. This condition might severely affect the health of mothers and their newborns. Newborn of mothers with preeclampsia are more liable for intrauterine growth retardation and may be delivered prematurely. Aim of the Study: The aim of this study was to evaluate the platelet count and mean platelet volume in newborn of preeclamptic mother. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood was collected from each newborn after delivery and was analyzed for Platelet count and mean platelet volume. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre- designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: The mean (± SD) platelet count was 164.77 ± 79.44 × 103/µl and 212.83 ± 54.04 ×103/µl in group A and B respectively. In this study, the mean (±SD) platelet count was lower in group A in comparison to that of group B which was statistically significant (p<0.001). The mean (± SD) platelet volume was 8.90±1.15 fl and 8.30±1.45 fl in group A and B respectively. In this study, the mean (±SD) platelet volume was higher in group A in comparison to that of group B which was not statistically significant. Maternal systolic blood pressure showed negative correlation (- 0.952) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal diastolic blood pressure showed negative correlation (- 0.960) with platelet count of newborn in preeclamptic mother, which was statistically significant (p<0.001). Maternal systolic blood pressure showed negative correlation (-0.973) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Maternal diastolic blood pressure showed negative correlation (-0.964) with mean platelet volume of newborn in preeclamptic mother, which was not statistically significant (p>0.05). Conclusion: From the findings of the study, it can be concluded that the platelet count of newborn of preeclamptic mother was significantly lower in comparison to newborn of healthy pregnant mother but they were within normal range. This difference was significantly related to severity of maternal blood pressure. But there was no statistically significant difference in mean platelet volume between the groups. There was no statistically significant relation of mean platelet volume to maternal blood pressure.

Evaluation of RBC Count and Haemoglobin Concentration in Newborn of Mother with and without Preeclampsia

Introduction: Preeclampsia (PE) is one of the commonest complications in pregnancy which is associated with perinatal mortality and morbidity. Early hematological screening of the newborn of preeclamptic mother may be helpful to diagnose and treat the newborn of preeclamptic mother for better pregnancy outcome. Aim of the Study: The aim of this study was to evaluate the RBC count and Haemoglobin concentration in newborn of mother with and without preeclampsia. Methods: This cross-sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. Total 60 newborns were included in this study. The subjects were divided into 2 groups. Group A (Study group): Thirty (30) newborns of preeclamptic mother and Group B (Control group): Thirty (30) newborns of healthy pregnant mother. The subjects were selected from Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka on the basis of exclusion and inclusion criteria. Five (5) ml. of cord blood was collected from each newborn after delivery and was analyzed for complete blood count. These parameters were estimated in the Department of Hematology, Dhaka Medical College Hospital, Dhaka. Data were collected in pre- designed structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s “t” test, Chi Square test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS for windows version 16.0. p value <0.05 was accepted as level of significance. Results: In this study, the mean (±SD) maternal systolic blood pressure of the study group A and control group B were 173.00 ± 19.73 and 114.83 ± 11.72 mm Hg respectively. In this study, the mean (±SD) maternal systolic blood pressure was significantly (p<0.001) higher in group A in compared to group B. The mean (±SD) maternal diastolic blood pressure of the study group A and control group B were 108.33 ± 9.52 and.............

25-Hydroxy Vitamin D Level and Its Correlation with Mean Platelet Volume in Preeclampsia.

Preeclampsia is one of the challenging complications of pregnancy, of which little is known about its etiology and pathogenesis. Many studies have shown higher mean platelet volume (MPV) in preeclamptic patients. Vitamin D deficiency is in association with larger-size platelets. Thus, we aimed to determine the correlation of vitamin D with MPV in preeclamptic patients. This prospective case-control study was conducted in two tertiary hospitals in Tehran, Iran. Overall, 85 preeclamptic pregnant women and 85 normotensive pregnant women were entered between 2017 and 2018. Serum vitamin D concentration (ng/ml) and MPV (femtoliter) were measured for all patients. MPV was significantly higher in the cases compared to controls (10.59±1.08 vs 8.10±0.95, P=0.0001). In addition, serum vitamin D level in the preeclamptic group was significantly lower in compare to the control group (17.79±11.03 vs 30.24±12.49; P=0.0001). In multivariate logistic regression analysis, high age of mother (OR: 1.13; 95% CI: 1.01-1.27; P=0.03), low level of serum vitamin D (OR: 0.93; 95% CI: 0.87-0.99; P=0.02) and high MPV (OR: 8.83; 95% CI: 4.17-18.67; P=0.0001) were independent predictors of preeclampsia. Moreover, a correlation analysis revealed that vitamin D levels correlated negatively with MPV (r= -0.41, P<0.0001). Low levels of vitamin D in preeclamptic pregnancy are associated with higher platelet activity and thrombosis. In fact, the increment of MPV level might be a potential pathway for adverse outcomes of pregnancy including preeclampsia in the context of vitamin D deficiency.

Malaria Parasite Infection is associated with Inflammatory and Endothelial Dysregulation in Preeclampsia

Abstract Introduction/Objective Previous Studies have associated Preeclampsia with alterations in inflammation and endothelial dysfunction . However the relationship between the pathway of this alteration and the Malaria infection in pregnancy remains underexplored, especially in malaria endemic regions like Nigeria where there is high incidence of preeclampsia. Methods/Case Report A comparative cross-sectional study was carried out among 260 pregnant women at term (18-45 years); comprising 100 preeclamptic with Malaria (PEM), 80 preeclamptic without Malaria (PE2) and 80 Normotensive, Non Malaria (Control), at Federal Medical Center Owerri, Nigeria. The groups were matched for maternal age, gestational age, gravidity and body mass index. Fasting serum lipids were analyzed by Enzymatic colorimetric method. Some Inflammatory and anti-angiogenic markers; Vascular Endothelial growth factor (VEGF), Plasminogen Activator inhibitor 1, Intracellular adhesion molecule, CRP. IL 6 and IL 8 were tested by Magnetic multiplex ELISA. Results (if a Case Study enter NA) There were significantly higher levels of Total Cholesterol, LDL and triglyceride among the 2 pre-eclamptic groups (PEM,PE2) compared to the normotensive nonmalaria group; P&amp;lt; 0.001, p=0.001, p=0.003 respectively, while HDL was decreased in the pre-eclamptic groups against the normotensive nonmalaria group (P = 0.024). PAI-1 and VEGF expressed significantly higher levels in the pre- eclamptic groups (PEM,PE2) compared to the normotensive nonmalaria group (P &amp;lt; 0.0001, P=0.000). Based on Malaria exposure, PAI-1, and IL8 were significantly elevated in PEM group (P &amp;lt; 0.0001) compared to the PE2 and normotensive nonmalaria group. There was no significant difference in the CRP and ICAM-I between the 2 preeclamptic groups (PEM and PE2). Conclusion These findings demonstrated that Malaria is associated with dysregulated inflammation and endothelia function, which may enhance the pathogenesis of Preeclampsia. Further studies on the predictive role of PAI-I in the pathophysiology and diagnosis of Malaria and preeclampsia is hence suggested.

Increased Intima-Media Thickness of Carotid and Femoral Arteries in Women with Early Preeclampsia

Background: Preeclampsia can increase the risk of cardiovascular diseases (CVDs) later in life. Also, increased intima-media thickness (IMT) of the carotid artery was introduced as an independent risk factor for CVDs. Objectives: This study aimed to evaluate and compare the IMT of carotid and femoral arteries between women with early preeclampsia and normotensive pregnant and nulligravid women. Methods: In this study, which was conducted between May 2019 and January 2020, three groups of women were evaluated: early-onset preeclamptic pregnant women, normotensive pregnant women, and nulligravid women. The IMTs of the common femoral artery, superficial femoral artery, common carotid artery, carotid bulb, and internal carotid artery were measured using B-mode ultrasound. Results: A total of 100 women were enrolled in each group. The means ± SD of age in preeclamptic, normotensive and nulligravid women were 27.78 ± 3.23, 27.16 ± 3.09, and 27.11 ± 2.95, respectively. The mean gestational age of the two pregnant groups was nearly 32 weeks. Based on the results, the mean systolic blood pressure, diastolic blood pressure, and arterial pressure were significantly higher in the preeclamptic group compared to the other groups (P &lt; 0.001). The mean IMT of both sides of the common carotid artery, carotid bulb, internal carotid artery, common femoral artery, and superficial femoral artery was significantly higher in the preeclamptic group compared to normotensive pregnant and nulligravid women (P &lt; 0.001). Conclusion: Preeclampsia was associated with the increased IMT of common and internal carotid arteries, as well as common and superficial femoral arteries. Therefore, IMT measurements in preeclamptic women can provide an opportunity to identify those who may benefit from early screening and preventive care to reduce the risk of CVDs in the future.

Female-specific reference values for blood pressure and its relationship with subclinical echocardiographic findings in women with a history of preeclampsia: the Queen of Hearts study

Abstract Introduction Hypertension is the most crucial modifiable risk factor for cardiovascular disease (CVD). Sex differences in what is considered optimal blood pressure (BP) might deviate from current sex-blinded guidelines for hypertension. In women, an obstetric history of preeclampsia relates to postpartum hypertension and substantially increases the risk of premature CVD. Purpose To establish female-specific reference values for BP in relatively young women and assess its association with subclinical aberrant echocardiographic findings in a high-risk female population. Methods Data was used from the Queen of Hearts study; a cross-sectional cohort study on early detection of heart failure among young women with a history of preeclampsia and a control group of low-risk healthy women with a history of uncomplicated pregnancy. The control group was used to non-parametrically establish reference values for BP (95th percentile). The association between the derived reference values and the risk of subclinical aberrant echocardiographic findings was evaluated in the former preeclamptic group using logistic regression. All women were admitted to a standardized cardiovascular assessment including transthoracic echocardiography and 30-minutes BP measurement. Subclinical echocardiographic findings included left ventricular (LV) hypertrophy (LVH), LV concentric remodelling (LCVR), diastolic dysfunction (DD) and impaired LV ejection fraction (LVEF, &amp;lt;55%). Results A total of 429 women in the healthy control group and 856 in the former preeclamptic group were included (44±8 and 38±8 years, respectively). In the healthy control group, 97.7% and 99.8% of women had a systolic (SBP) and diastolic BP (DBP) value below the European Society of Cardiology (ESC) guidelines for hypertension. Overall, the derived reference value for SBP and DBP in our control group was 133 and 82 mmHg, respectively. Age-specific reference curves are presented in Figure 1 and 2. In the subgroup of former preeclamptic women 10.4% and 14.6% had SBP and DBP levels above 133 mmHg and 82mmHg, respectively. In this group, the Odds Ratio (OR) for subclinical aberrant echocardiographic findings when having SBP ≥133mmHg was 5.3 (95% CI 2.3–12.3) for LVH, 1.4 (95% CI 0.6–3.2) for LVCR, 5.9 (95% CI 3.3–10.7) for DD and 1.3 (95% CI 0.3–6.0) for impaired LVEF. For DBP ≥82mmHg, the OR for LVH was 3.5 (95% CI 1.5–8.0), LVCR 1.3 (95% CI 0.6–2.7), DD 3.4 (95% CI 1.9–6.0) and impaired LVEF 1.5 (95% CI 0.4–5.3). Conclusions Upper limits for SBP and DBP values in current guidelines correspond with the value of less than 2% of women in our healthy (no pre-eclampsia) population. We derived new reference values with the upper limit corresponding with the upper 5th centile. Values above this level, even below decision limits for hypertension, are associated with abnormal subclinical cardiac function and geometry in a high-risk young female population. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH PREECLAMPSIA.

To investigate the changes in the microvascular structure of the retina and optic disk by comparing the optical coherence tomography angiography findings in preeclamptic patients with those in healthy pregnant women and healthy nonpregnant women and also to evaluate the preeclamptic patients after delivery by showing whether the changes are permanent or not. Fifty preeclamptic, 50 healthy pregnant, and 50 healthy nonpregnant women enrolled in three groups (preeclamptic pregnant women group, healthy pregnant women group, and nonpregnant women group; respectively). Patients in the preeclamptic pregnant women group were evaluated at three different time points including up to 3 hours before delivery (Group 1), 2, or 3 days after delivery (Group 2), and 6 weeks after delivery (Group 3), and compared with each other. All patients underwent a comprehensive ophthalmologic examination including optical coherence tomography angiography. Choriocapillaris blood flow area, deep foveal density, deep temporal density, deep nasal density, and radial peripapillary capillary inside disk density values were significantly lower in the preeclamptic pregnant women group than in the healthy pregnant women group. Deep foveal density and deep nasal density values were significantly higher in Group 3 than in Group 1 and 2, and deep temporal density was significantly higher in Group 3 than in Group 1. Optical coherence tomography angiography diagnosed decreased deep retinal capillary density values in the macula of patients with preeclampsia, but these results improved after delivery.

Blood-brain barrier leakage years after pre-eclampsia: dynamic contrast-enhanced 7-Tesla MRI study.

Pre-eclampsia is a hypertensive complication of pregnancy that is associated with an increased risk of long-term cardiovascular and cerebrovascular disorders. Although the underlying mechanism of persistent susceptibility to cerebral complications after pre-eclampsia remains largely unclear, impaired blood-brain barrier (BBB) integrity has been suggested to precede several cerebrovascular diseases. In this study, we aimed to investigate the integrity of the BBB years after pre-eclampsia. This was an observational study of premenopausal formerly pre-eclamptic women and controls with a history of normotensive pregnancy who underwent cerebral magnetic resonance imaging (MRI) at ultra-high field (7Tesla) to assess the integrity of the BBB. Permeability of the BBB was determined by assessing leakage rate and fractional leakage volume of the contrast agent gadobutrol using dynamic contrast-enhanced MRI. BBB leakage measures were determined for the whole brain and lobar white and gray matter. Multivariable analyses were performed, and odds ratios were calculated to compare women with and those without a history of pre-eclampsia, adjusting for potential confounding effects of age, hypertension status at MRI and Fazekas score. Twenty-two formerly pre-eclamptic women (mean age, 37.8 ± 5.4 years) and 13 control women with a history of normotensive pregnancy (mean age, 40.8 ± 5.5 years) were included in the study. The time since the index pregnancy was 6.6 ± 3.2 years in the pre-eclamptic group and 9.0 ± 3.7 years in controls. The leakage rate and fractional leakage volume were significantly higher in formerly pre-eclamptic women than in controls in the global white (P = 0.001) and gray (P = 0.02) matter. Regionally, the frontal (P = 0.04) and parietal (P = 0.009) cortical gray matter, and the frontal (P = 0.001), temporal (P &lt; 0.05) and occipital (P = 0.007) white matter showed higher leakage rates in formerly pre-eclamptic women. The odds of a high leakage rate after pre-eclampsia were generally higher in white-matter regions than in gray-matter regions. This observational study demonstrates global impairment of the BBB years after a pre-eclamptic pregnancy, which could be an early marker of long-term cerebrovascular disorders. © 2022 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Association of TNFSF11 rs2200287 and TNFSF11 rs2148072 gene polymorphisms in preeclampsia.

Various cytokines released by white blood cells like lymphocytes are linked to the immune system during pregnancy. The polymorphism of the TNFSF11 (rs2200287 and rs2148072) gene is related to the preeclampsia of pregnancy. This study was a prospective study involving 304 pregnant women with preeclampsia (n=152) and controls (non-preeclamptic pregnant women) (n=152). To investigate the rs2200287 and rs2148072 SNP's of TNFSF11 gene polymorphism by using the PCR-RFLP techniques. A significantly different genotype distribution of TNFSF11 (rs2200287 and rs2148072) polymorphisms were observed between the two groups, with the G allele of variant rs2200287 was highly significant in the preeclamptic group (P=0.000; .5814; OR=.5814; 95% CI=.4211-.8012). And the C allele of variant rs2148072 was also highly significant in the preeclamptic group (P=0.000; OR=.5076; 95% CI, .362-.71) in this study. The outcomes of the present study indicate that there was an association in TNFSF 11 (rs2200287 and rs2148072) gene polymorphism with preeclampsia compared to non-preeclampsia women.

Monitoring intra-abdominal pressure for early detection of preeclampsia among pregnant women

Background: Elevated intra-abdominal pressure (IAP) is commonly present in critically ill patients. Where the trigger mechanism of preeclampsia is related to increase abdominal hypertension. Aim: Monitoring the intra-abdominal pressure for early detection of preeclampsia among pregnant women. Design: A quasi-experiment clinical practice research. Methods: a sample of 60 pregnant women divided into an intervention group included a total of 30 patients diagnosed with preeclampsia and 30 normotensives as a control group. Setting: The study conducted at obstetric ICU and emergency unit, woman's Health Hospital, Upper Egypt. Results: There is a statistically significant difference between intra-abdominal pressure and preeclampsia and its clinical feature. The risk factors' effects on intra-abdominal pressure, such as age and gravidity, have no statistically significant relationship. Conclusions: The study confirms that the range of intra-abdominal pressure in the preeclamptic group significantly higher than the normotensive group, and there is a positive correlation between elevated IAP and preeclamptic complications. Relevance to clinical practice: Applied continuous nursing monitoring of intra-abdominal pressure for all critical patients in the obstetric field is an essential part of nursing care to avoid abdominal compartment syndrome and organ complications.

Study the relationship between long non-coding RNA (CCAT1) expression and CDK4 expression levels in Egyptian patients with preeclampsia

BackgroundMaternal and perinatal mortality is caused by a variety of factors, including preeclampsia. PE's onset and progression may be influenced by lncRNAs. The effect of long non-coding RNA (lncRNA) Colon cancer-associated transcription factor 1 (CCAT1) expression in the placenta of preeclampsia patients on preeclampsia progression was the focus of this investigation. ObjectivesThe aim of the current study is to check if the levels of expression of Colon cancer-associated transcription factor 1 (CCAT1) and Cyclin-dependent protein kinase 4 (CDK4) are associated with preeclampsia vulnerability and biogenesis. Subjectsand methods: This work included the participation of 160 people. Eighty of the patients had preeclampsia. The control group included 80 normal pregnant women. The two groups were almost of the same age. A thorough clinical examination was performed in all groups (including taking a detailed history, concentrating on parity, age and previous background of diabetes or hypertension). The expression levels of CCAT1 and CDK4 in placental tissue were determined using a real-time q PCR technique. ResultsExpression levels of CCAT1 and CDK4 differed significantly between the study groups. preeclamptic patients having the highest level of CCAT1in comparison with control group, However, preeclamptic patients having lower level of CDK4 than controls. There was a strong negative association between CDK4 expression level and DBP, SBP, creatinine, urea and CCAT1 level of expression in the preeclamptic group, whereas there was a positive correlation between CCAT1 level of expression and DBP, SBP, urea and creatinine in patients group. ConclusionBased on the findings of this study, it is possible that CCAT1 and CDK4 expression levels could be used to aid in the diagnosis and biogenesis of preeclampsia.

Angiogenic factors and histomorphological alterations encountered in preeclamptic placentae

Background:Preeclampsia complicates 10% of pregnancies in the developed world. Alteration in angiogenic factors occurs in preeclampsia which leads to chronic hypoxic changes in placenta.Aim:To assess the histomorphological changes and expression of angiogenic factors in placenta of preeclamptic patients in comparison to normal placenta.Design: Cross sectional analytical study.Materials&amp; Methods: This study was conducted from October 2013 to August 2015 and included 53 placenta from preeclamptic patients and 53 placenta from healthy pregnant women. Histomorphological changes were studied in the placenta. Expression of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-1 (VEGFR-1) in the placental villi were evaluated using immunohistochemistry (IHC).Statistical analysis: Done using IBM-SPSS 21.0. ‘p’ value &lt; 0.05 was taken as significant.Results: In our study, 92.5% of preeclamptic group were in the age group of 21 to 34 years and 62.3% of them had placental weight of less than 500 grams.