Preeclamptic Woman Research Articles

PREECLAMPSIA: Long-term Prognosis in Mother and their Children

Abstract: Pre-eclampsia is a type of hypertension that affects several organs during pregnancy. Preeclampsia, on the other hand, does not go away once the baby is born, but it can harm the mother and her children for years. A pre-eclamptic woman is at risk for cerebrovascular disease, cardiovascular disease, renal disease, and metabolic abnormalities later in life if she has pre-eclampsia. In research, children born to pre-eclamptic moms have had a variety of issues. These conditions are associated with cardiovascular, respiratory, neurological, and gastrointestinal issues later in life. The purpose of this study is to learn more about the long-term impact of pre-eclampsia on both mothers and children. Pregnancy and postpartum offer a unique window of opportunity for screening and intervention for both mother and child in the interests of health maintenance and disease prevention.

Pregnancy-Associated Cardiomyopathy (PACM) in a Preeclamptic Woman with Twin Pregnancy: A Case Report

Peripartální kardiomyopatie (peripartum cardiomyopathy, PPCM) není časté onemocnění; jedná se o typ dilatační kardiomyopatie postihující ženy v posledním měsíci těhotenství a v prvních pěti měsících po porodu. Tomuto onemocnění předchází podobné, označované jako těhotenská kardiomyopatie (pregnancy-associ- ated cardiomyopathy, PACM). Morbidita i mortalita v souvislosti s oběma onemocněními jsou vysoké. U žen s preeklampsií a vícečetným těhotenstvím existuje výrazně vyšší riziko rozvoje PACM/PPCM. Na oddělení urgentního příjmu se dostavila 40letá multipara ve 20. týdnu vícečetného těhotenství s kašlem, dyspnoe, výraznými bilaterálními chrůpky, otoky končetin, kardiomegalií, hypertenzí, proteinurií a s hodnotou ejekční frakce levé komory 26 %. Byla u ní stanovena diagnóza akutního otoku plic, PACM a preeklampsie. Těhotenství bylo ukončeno a byla zahájena farmakologická léčba srdečního selhání. Při PACM může být odklad diagnostického vyšetření spojen se závažnou morbiditou matek a mortalitou novorozenců. Případ poukázal na nutnost věnovat pozornost preeklampsii a vícečetnému těhotenství jako rizikovým faktorům; tyto ženy mohou být i kandidátkami monitorování funkce levé komory. Časné a vhodné řešení může zabránit rozvoji ireverzibilní PACM.

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted For Cesarean Section under Spinal Anaesthesia

Background: Spinal anesthesia is widely considered a technique of choice for cesarean delivery. But due to fear of sudden and extensive sympathetic blockade, spinal anesthesia may not be considered safe in severe preeclampsia. Objectives: The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), incidence of hypotension, phenyl ephrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Material and Methods: A total of 35 severe pre-eclamptic (BP > 160/110 mmHg) 3(Group A) and 35 healthy parturients (group B), meeting the inclusion criteria were included in the study. After preloading with 10 ml/kg of ringer lactate (RL) solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP LESS,THAN 30% of the baseline or a decrease in SBP to LESS THAN 100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine intravenously (i.v). Apgar score was noted 1 and 5 min after birth. Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (55.6% vs. 34.1%). The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P LESS THAN 0.0001) than that of pre-eclamptic group (48.3 ± 35). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (P LESS THAN 0.05). There was no statistical difference in the neonatal outcome and Apgar score in the study groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted For Cesarean Section under Spinal Anaesthesia

Background: Spinal anesthesia is widely considered a technique of choice for cesarean delivery. But due to fear of sudden and extensive sympathetic blockade, spinal anesthesia may not be considered safe in severe preeclampsia. Objectives: The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), incidence of hypotension, phenyl ephrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Material and Methods: A total of 35 severe pre-eclamptic (BP > 160/110 mmHg) 3(Group A) and 35 healthy parturients (group B), meeting the inclusion criteria were included in the study. After preloading with 10 ml/kg of ringer lactate (RL) solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP LESS,THAN 30% of the baseline or a decrease in SBP to LESS THAN 100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine intravenously (i.v). Apgar score was noted 1 and 5 min after birth. Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (55.6% vs. 34.1%). The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P LESS THAN 0.0001) than that of pre-eclamptic group (48.3 ± 35). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (P LESS THAN 0.05). There was no statistical difference in the neonatal outcome and Apgar score in the study groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.

Calcemia, Vitamin D and seasonal influences in preeclampsia in Goma

Background: The etiology of preeclampsia remains less well known. It is noted that low vitamin D levels are associated with a high risk of preeclampsia (PE). Calcium (Ca2+) levels during pregnancy appear to be involved in pregnancy-induced hypertension. Recent studies indicate that serum calcium levels may have a role in preeclampsia. Vitamin D promotes absorption of proper concentration of calcium in the blood which helps to lower blood pressure. The complications associated with calcium deficiency during a normal pregnancy are numerous and have not been extensively studied in Goma. Objective: To assess blood calcium levels (ionic and total) in preeclamptic women and to analyse the seasonal influence on preeclampsia in Goma. Method: A prospective case-control study (without matching) of 190 pregnant women without cardiovascular or endocrine diseases for a case-control ratio of 1∶1 was conducted in six hospitals in Goma. Blood ionogram was performed by an automated system directly after blood sampling and vitamin D was measured using enzyme-linked immunosorbent method. Results: The mean ionised calcium level in preeclamptic woman was 1.24±0.16 mmol/L (0.48-1.59) compared to 1.27±0.17 mmol/L (0.88-2.30) in normal pregnant woman (p=0.214). A slight negative correlation between blood calcium and blood pressure was observed in pregnant women. Low vitamin D levels were associated with preeclampsia. Hypovitaminosis D in the preeclamptic group was more observed during the rainy season than during the dry season. Pregnancies complicated by PE were from fertilisations occurring during the rainy season while the dry season was characterised by a high admission of preeclamptics. Conclusion: The study found that preeclamptic women in Goma had hypocalcemia. There was also a weak negative correlation between blood pressure and serum calcium levels. The majority of preeclamptics were diagnosed during the dry season, while conception with a PE complication occurred during the rainy season. As this is a first study in this area for the Great Lakes region of Africa, a more in-depth study with a larger sample size is desired.

A STUDY OF PLATELET COUNT AND BLEEDING TIME IN THIRD TRIMESTER OF PREGNANCY WITH REFERENCE TO PRE-ECLAMPSIA.

BACKGROUND: - Pre-eclampsia is a serious complication of pregnancy and contributes signicantly maternal as well as perinatal morbidity and mortality. So an attempt was made to study the platelet count and bleeding time in cases of preeclampsia. AIM:-(1) To nd out the platelet count and bleeding time in pre-eclamptic woman. rd (2) To compare the values of platelet count and bleeding time in pre-eclamptics and normal pregnant woman in 3 trimester of pregnancy. METHODOLOGY:- 120 pregnant women in age group 18-42 years were included in the study of which 40 women were mild pre-eclamptic, 40 severe pre-eclamptic and 40 normal pregnant women in third trimester of pregnancy. RESULT:- Signicant decrease in platelet count and signicant increase in bleeding time was found between pre-eclamptic in comparison with the normal pregnant women. DISCUSSION:- Platelet count was found to decrease & Bleeding Time increase in pre-eclampsia CONCLUSION:- From this study,it was concluded that platelet count decrease and bleeding time incease with increase in severity of preeclampsia

Aldosterone hormone levels in preeclamptic women in comparison with normal pregnancy

Objective To assess the level of aldosterone hormone in preeclamptic pregnant woman and comparing it with normal pregnancy. Patients and methods A prospective case–control study that was conducted on 80 pregnant women with gestational age from 28 to 40 weeks and attended Al Zahraa University Hospital, Al Azhar University, in the period from December 2019 to December 2020. The selected participants were divided into two groups: group I (control group) (n=40), which included 40 normal pregnant women, and group II (n=40) (cases group), which is further subdivided into two subgroups: subgroup A (n=20): cases with mild preeclampsia, and subgroup B (n=20) cases with severe preeclampsia. Approximately 5 ml of venous blood was collected once from both study group and control group by antecubital venipuncture, using a sterile disposable syringe, without using elastic band tourniquet. Half of the amount collected was transferred immediately into commercially prepared concentration of ethylene diamine tetra-acetic acid containers. The remaining half was allowed to clot and the serum was obtained by centrifugation at 3000 rpm for 10 min or the remaining investigations including serum aldosterone concentration estimation by enzyme immunoassay. Results Regarding the serum aldosterone levels, there was a highly statistically significant difference among control, mild preeclampsia, and severe preeclampsia groups (P=0.003). The mean aldosterone of the study participants was 0.76, with SD of 0.27, and ranged from 0.2 to 1.39 in control group; 0.83, with SD of 0.13, and ranged from 0.59 to 1.06 weeks in mild preeclampsia group; and 1.10, with SD of 0.59, and ranged from 0.65 to 2.88 in severe preeclampsia group. Conclusion The aldosterone hormone may play an important role in the pathogenesis of elevated blood pressure in this pathological state and may be used in the prediction of the severity of preeclampsia.

Hepatic infarction in a pregnant woman with antiphospholipid syndrome and early pre-eclampsia: A case report

The aim of the present case report is to stress out the occurrence of hepatic infraction in pregnant women with antiphospholipid syndrome (APS) and the critical role magnetic resonance imaging (MRI) plays for the early diagnosis of rare complications of the disease. Here we report the case of a preeclamptic pregnant woman with APS in her 17th week of gestation, who experienced severe epigastric pain, followed by multiple episodes of vomiting and an episode of soft stools. Patient was submitted to MRI examination of the upper abdomen, where findings suggested hepatic infarction with subsequent deterioration of her general status. Therefore, she underwent termination of gestation. We conclude that pregnancy is a deteriorating factor of the disease and patient should be closely monitored, evaluated of any suspicious symptom or sign.

Metabolic syndrome and its risk factors in preeclamptic woman: A comparative study from Tertiary Care Hospital Pakistan.

Objectives: To determine the frequency of metabolic syndrome in pregnant patients with preeclampsia as compared to normal pregnancies. Setting: Gynae and Obstetrics Department Liaquat University of Medical and Health Sciences Jamshoro. Period: Six months, from 29 march 2015 to 29 September 2015. Study Design: Comparative cross sectional Study. Materials and Methods: One hundred and twenty antenatal and laboring women were included in this study in which sixty were preeclamptic women (case) and 60 normal women taken as control Groups. A Predesigned questionnaire was used to record anthropometric measurements, relevant history and clinical examination. Blood specimen was taken for analysis. Results: Rate of metabolic syndrome was four times (approximate of 3.4) more likely in preeclamptic groups as compare to normal women (control) [OR=3.5; 95%CI: 1.56 to 7.87]. Conclusion: In this study prevalence of metabolic syndrome was high in preeclamptic pregnant women as compare to normal. These cases have high risk for cardiovascular and metabolic diseases in later life. Interventions could be done to prevent these complications.

Is preeclampsia a risk for end-stage renal disease?

Little information is available about the risk of end-stage renal disease (ESRD) after preeclampsia. The review of Covella etal. demonstrated that former preeclamptic women have a significant risk of ESRD in the medium term. However, it is still unknown which preeclamptic woman are at higher risk for progressive kidney disease. After delivery, women who had preeclampsia, particularly those with persistent hypertension, symptomatic proteinuria, or microalbuminuria, should receive a regular checkup for kidney disease.

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted for Cesarean Section under Subarachnoid Block

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted for Cesarean Section under Subarachnoid Block

Comparison of serum calcium and magnesium between pre-eclampsia and normotensive pregnant women:a prospective stud

Background: A large percentage of maternal mortality is related to hypertensive disorders of pregnancy. The etiology of preeclampsia is uncertain with imbalance between vasoconstrictor and vasodilators leading to vasospasm and endothelial dysfunction. Magnesium and Calcium plays a role in vascular smooth muscle contraction and thus regulating blood pressure. Aim: We compared the serum level of Calcium and Magnesium of preeclamptic women with normotensive women at SRMS-IMS, Bareilly. Method: 30 preeclamptic patient between 18-35 years with BP>140/90mmHg and gestation age >30 weeks were selected. Blood sample were taken for serum calcium and magnesium level and the results were compared with 20 normotensives pregnant. Result: Mean serum Calcium and Magnesium level in preeclamptic woman was 9.00± 0.47 and 1.90±0.31 mg/dl, respectively. Mean serum Calcium and Magnesium in normal pregnant woman was 9.12±0.37 and 1.92±0.23mg/dl, respectively. There was statistically no significant difference with p value of 0.34 and 1.00, respectively. Conclusion: Serum Calcium and Magnesiumlevelwere observed to be same in preeclamptic and normotensive pregnant women.

Postpartum Magnesium Sulfate Overdose: A Multidisciplinary and Interprofessional Simulation Scenario.

This case is one of an eight-case multidisciplinary curriculum designed and implemented at the University of Ottawa by simulation educators with specialty training in obstetrics and gynecology (OB/GYN) and anesthesiology. Consultation with a nurse educator maintained the quality and relevance of objectives for nursing participants.The curriculum was prepared to train OB/GYN and anesthesiology residents and labor and delivery nurses to hone crisis resource management skills and to recognize and manage rare/critical medical events in an obstetrical setting. Obstetricians, anesthesiologists, and nurses often work together in acute, high-stakes situations and this curriculum provides a safe environment to practice team-based management of such emergencies.Over an eight-year period, this curriculum has been executed in scenario couplets in a four-year cycle to allow OB/GYN and anesthesiology residents exposure to all scenarios during a five-year residency, beginning in their second year. Prospective evaluative data has been positive. For example, over 90% of participants rated these simulations to be 5 out of 5 for “Was an effective use of my educational time” and “Will influence/enhance my future practice.”In this scenario, participants must evaluate and treat a postpartum preeclamptic woman who is being treated with magnesium sulfate for the purpose of seizure prophylaxis. The patient experiences magnesium sulfate toxicity and subsequent respiratory arrest. Any mannequin that can display vital signs can be used for this scenario.This simulation case includes a case template, critical actions checklist, debriefing guide, summary of key medical content, and an evaluation form for learners to provide feedback.

Preeclampsia: Association With Posterior Reversible Encephalopathy Syndrome and Stroke.

Pregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic stroke.1-3 Based on the estimate from eleven studies published between 1990 and January 2017, stroke is most common in the peripartum and postpartum periods.4 Stroke is estimated to affect 30 per 100,000 pregnancies. Some of the mechanisms underlying this increased risk include venous or arterial thrombosis due to estrogen-related hypercoagulability; cerebral hypoperfusion related to acute blood loss; cardioembolism due to peripartum cardiomyopathy; and endotheliopathy, vasospasm, and hypertensive intracerebral hemorrhage related to hypertensive disorders of pregnancy.2, 5-7 Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, and preeclampsia/eclampsia. Gestational hypertension is defined as a systolic blood pressure ≥ 140 mmHg or a diastolic blood pressure ≥ 90 mmHg in a previously normotensive woman at ≥ 20 weeks of gestation.8 Preeclampsia is distinct from gestational hypertension in that it additionally involves at least one of the following criteria: proteinuria, thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms (see Table 1). Preeclampsia can progress to eclampsia, which is characterized by seizure activity in a preeclamptic woman. Preeclampsia most commonly occurs during pregnancy and the peripartum period, although postpartum preeclampsia can occur.9, 10 Table 1 Diagnostic criteria for preeclampsia (derived from The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy).8

Loading Dose only versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-eclamptic Women

Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure. It is a randomized controlled trial conducted on 60 pregnant women with severe preeclampsia randomized into standard dose and loading dose only regimen. Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens, there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery. Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome.

OP.5B.06] CONCENTRIC LEFT VENTRICULAR REMODELING IS ASSOCIATED WITH EARLY ONSET PREECLAMPSIA IN WOMEN WITHOUT PREEXISTENT HYPERTENSION

Objective: Preeclampsia (PE) is a maternal complication characterized by hypertension and proteinuria that usually occurs after the 20th gestational week and resolves after delivery. PE is associated with persistent cardiac abnormalities and a high cardiovascular risk during the woman life. Early onset PE presenting before the 34th gestational week is a more severe form of disease, but its relevance on cardiac abnormalities in comparison to the forms with later onset is not clear. The aim of this study was to assess cardiac structure and function in women with PE without preexistent hypertension. Design and method: One month after delivery, the clinical and echocardiographic variables of 54 preeclamptic women (age 36 ± 6 y), 39% of which with early PE, was compared with a group of 54 normotensive (age 37 ± 6 y) and 15 hypertensive (age 41 ± 5 y) nonpregnant women who were matched for age and height. Results: Despite comparable antihypertensive treatment, women with early PE had lower 24-hour average systolic and diastolic blood pressure than those with late PE. Left ventricle (LV) relative wall thickness was significantly greater in women with early PE (0.39 ± 0.10) than in those with late PE (0.31 ± 0.07; p < 0.001) and normotensive (0.29 ± 0.05; p < 0.001) women, but not hypertensive women (figure). Women with early and late PE had comparably greater LV mass and worse diastolic function as assessed by the E/A ratio, isovolumic relaxation time, and tissue Doppler imaging, than normotensive woman. No differences in LV systolic function were observed between preeclamptic and normotensive woman. Conclusions: Women with early onset PE have more pronounced LV concentric remodeling than women with late onset PE. This observation could account for the greater cardiovascular risk of these patients and might prompt the use of antihypertensive drugs specifically acting on LV remodeling.

Placental bed apoptosis is increased in pregnant women with pre-eclampsia versus normotensive pregnant women

abstractWe hypothesised that apoptosis in the placenta is increased in pregnant women whose pregnancies were complicated by pre-eclampsia as compared to normal pregnant women. Biopsy samples were obtained by punch biopsy from placental beds in 15 pre-eclamptic and 15 normotensive pregnant women during cesarean section. Apoptosis in syncytiotrophoblasts, syncytial cluster, extravillous cytotrophoblast, and decidual and stromal cells were evaluated by caspase-3, bax and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) immunohistochemical methods. A significant involvement was observed via caspase-3 and TUNEL methods in the syncytiotrophoblasts, syncytial cluster and extravillous cytotrophoblast cells of the pre-eclamptic group versus normotensive group (p < 0.001). Caspase-3 method found significantly increased involvement in the pre-eclamptic group versus normotensive group (p < 0.001). Although bax method found significantly increased involvement in syncytiotrophoblasts in the pre-eclamptic group versus normotensive group (p < 0.001), no significant difference was found between the groups in terms of involvement of other cell groups (p > 0.05). Apoptosis in the placental bed is increased in pre-eclamptic woman.

Posterior reversible encephalopathy syndrome in postpartum woman: a case report

Posterior reversible encephalopathy syndrome (PRES) also known as reversible posterior leukoencephalopathy syndrome (RPLS) is a neurotoxic state that occurs secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. PRES has been accompanied by a number of medical conditions such as hypertensive encephalopathy, preeclampsia, eclampsia, acute or chronic renal diseases, hemolytic uremic syndrome, use of cytotoxic and immunosuppressant drugs, blood transfusion, and electrolyte disturbances1. Clinical and radiological features of PRES include headache, encephalopathy, seizures, cortical visual changes, and parieto-occipital white matter edema visualized on neuroimaging modalities. An association between eclampsia and PRES was first described by Hinchey et al in 19962. Low magnesium levels can augment PRES(3). The diagnosis is typically made clinically, with supportive findings on magnetic resonance imaging of the brain. The treatment of PRES depends on the underlying cause. Prompt recognition and treatment are crucial to avoid the permanent damage leading to sequelae and even mortality. Many cases resolve within 1–2 weeks of controlling the blood pressure and eliminating the inciting factor. PRES may recur in about 5-10% of cases3. In this case report, we present a pre-eclamptic pregnant woman presented with acute loss of vision and elevated blood pleasure due to PRES without seizures after delivery (which is an uncommon complication of preeclampsia.)

Comparison of the Hemodynamic Alterations in Normotensive and Preeclamptic Pregnant Woman Posted for Cesarean Section Under Subarachnoid Block

Introduction: Anesthesia for cesarean section in a patient with preeclampsia is far more complicated than an otherwise normal pregnancy for several reasons. Apart from the risks of high incidence of intrauterine growth restriction, fetal distress and prematurity, there are risk of increased perioperative morbidity due to altered hemodynamics Material and methods: This study was conducted on 100 booked pregnant woman of ASA physical status I and II (Normotensive) or III (Preeclamptic), between 19 to 30 years of age, carrying a live, mature, healthy, single fetus posted for elective cesarean section. Patients were counseled during preoperative examination and 50 normotensive and 50 preeclamptic patients were recruited for this study after obtaining informed consent from each of the patient in their own language. Result and Analyses: In this study, the authors found significant differences in SBP, DBP and MAP at different point of times in both the groups. One probable explanation of this may be the use of invasive arterial blood pressure monitoring in place of non-invasive monitoring unlike other studies. Also the preoperative blood pressure values were significantly different in both the groups. More phenylephrine consumption was noted in the normotensive group. Conclusion: subarachnoid block in preeclampsia patients associated with better perioperative hemodynamic stability, less hypotension, less vasopressor consumption and more gradual blood pressure changes.

HIF-1 Alpha and Placental Growth Factor in Pregnancies Complicated With Preeclampsia: A Qualitative and Quantitative Analysis.

The pathophysiology of preeclampsia is not clearly understood worldwide. Hypoxia inducible factor 1α (HIF-1α) is thought to be the preliminary factor for the hypoxic conditions prevailing in preeclampsia, which causes imbalance in the expression of angiogenic proteins. A proangiogenic protein, placental growth factor (PIGF), is reported to be dysregulated in preeclampsia. Therefore, this study focuses on the investigation of HIF-1α and PIGF in preeclamptic conditions and a possible molecular association between them. Placental tissue (n = 45 + 45) and serum samples (n = 80 + 80) of preeclamptic patients and healthy control were collected and processed for the analysis of HIF-1α and PIGF by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). In preeclamptic group, the significant nuclear and cytoplasmic expression of HIF-1α was noticed in syncytiotrophoblast (P = 0.0001) but in control placenta, it was localized to cytoplasm (P = 0.0001). The intensity of PIGF expression was lower in syncytiotrophoblast cytoplasm (P = 0.0001) in preeclamptic cases as compared with control. Also, the significant upregulated concentration of HIF-1α and downregulated PIGF was observed in serum samples of preeclamptic woman (P = 0.0001). Thus, there was a significant direct negative correlation between HIF-1α and PIGF both at tissue and serum level (P < 0.01). The direct inverse association between HIF-1α and PIGF in serum and placental tissues may be responsible for the low oxidative stress and endothelial dysfunction, leading to the pathogenesis of preeclampsia.