Diagnosis Of Preeclampsia Research Articles

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

Association of third-trimester N-terminal pro-brain natriuretic peptide levels and pre-eclampsia development

Abstract Background Pre-eclampsia shares numerous risk factors with cardiovascular diseases and is associated with postpartum cardiovascular complications. Natriuretic peptides, outside pregnancy valid biomarkers for detecting subclinical cardiac dysfunction, are typically elevated at the time of pre-eclampsia diagnosis. However, their role before disease manifestation is still puzzling. Aims To assess whether third-trimester natriuretic peptide levels are associated with a diagnosis of pre-eclampsia in pregnant individuals. Methods This study measured NT-proBNP levels in third-trimester samples of 1454 pregnant individuals prior to disease manifestation. Pre-eclampsia was diagnosed using the American College of Obstetrics and Gynecology (ACOG) criteria. Linear regression analyses were performed, and multivariable adjustments were done for age, body mass index (BMI), preexisting hypertension, diabetes, and chronic kidney disease. Odds ratios were calculated per doubling of NT-proBNP levels. Results Of the 1454 individuals, 118 (7.6 %) developed pre-eclampsia. The median week of gestation for blood sampling was 29.0 (IQR 28.4 – 29.4) in both groups (p = 0.68). Individuals with pre-eclampsia manifestation had higher BMI, were more often nulliparous, and had lower placental growth factor levels (all p < 0.01). Higher NT-proBNP levels were associated with a lower risk of pre-eclampsia, which persisted after controlling for confounders (adjusted odds ratio (OR), 0.84; 95 % CI, 0.70 - 1.00). This inverse relationship was particularly pronounced in cases of late-onset pre-eclampsia, defined as onset after 34 + 0 weeks of gestation. Specifically, for preterm pre-eclampsia between weeks 34 + 0 and 36 + 9, the adjusted OR was 0.78 (95 % CI, 0.56-1.09), and for term pre-eclampsia at or after week 37 + 0, the adjusted OR was 0.77 (95 % CI, 0.61 - 0.95). Conversely, a positive association was observed between NT-proBNP levels and the occurrence of early-onset pre-eclampsia < 34 + 0 weeks, with an adjusted OR of 1.69 (95 % CI, 1.00 - 2.91). Causal mediation analyses indicated that the association between higher BMI and pre-eclampsia mediated only a minor fraction (11.5 % [95 % CI, 4.3 % - 36.0 %, p < 0.01]) of the observed association. Conclusion These findings reveal the complex interplay between third-trimester NT-proBNP levels and the risk of pre-eclampsia. They unravel an inverse association for late-onset disease but a contrasting positive correlation for early-onset cases in temporal proximity to NT-proBNP assessment. The latter may reflect acute physiological responses to pre-eclampsia nearing diagnosis. However, the inverse relationship observed for later manifestations underscores the importance of further research to dissect the underlying pathophysiological mechanisms, which suggest cardiovascular maladaption to pregnancy prior to pre-eclampsia manifestation.

The role of pentraxin 3 and cathepsin B levels in pregnancies complicated by preeclampsia

Objective The objective of this study was to compare the levels of cathepsin B and pentraxin 3 in maternal serum of pregnant women with preeclampsia in the second trimester, to ascertain the impact of these levels on maternal and fetal outcomes, and to present a comprehensive analysis of the combined effects of cathepsin B and pentraxin 3 levels. Methods This prospective case-control study was conducted at Bursa Yuksek Ihtisas Training and Research Hospital between 1 January 2022 and 31 December 2022. The study included 78 pregnant women diagnosed with preeclampsia and 78 healthy pregnant women in the second trimester, between the ages of 18 and 45. Once a diagnosis of preeclampsia was established, maternal serum samples were obtained from the pregnant women prior to the initiation of any therapeutic intervention. Once all samples had been collected, the values for cathepsin B and pentraxin 3 were determined using the ELISA method. Results The results demonstrated a statistically significant elevation in the levels of pentraxin 3 (p = 0.008) and cathepsin B (p = 0.005) in pregnancies affected by preeclampsia when compared to those deemed healthy. Moreover, pentraxin-3 (p = 0.007) and cathepsin B (p = 0.002) were found to be significantly elevated in severe preeclampsia compared to mild preeclampsia. A comparison of the groups with and without HELLP syndrome revealed no statistically significant difference between the two groups. The ROC analysis revealed that the Cathepsin B 7.04 cut-off value was statistically significantly associated with the prediction of preeclampsia in all cases, with a sensitivity of 78.2% and a specificity of 47.4% (p = 0.005, AUC = 0.631). Conclusion The levels of CB and PTX3 may be employed as biomarkers to facilitate the early diagnosis of PE during the second trimester. Furthermore, these biomarkers may prove to be promising for the prediction of PE severity.

Senescent Syncytiotrophoblast Secretion During Early Onset Preeclampsia.

Preeclampsia is a severe hypertensive disorder in pregnancy that causes preterm delivery, maternal and fetal morbidity, mortality, and life-long sequelae. Understanding the pathogenesis of preeclampsia is a critical first step toward protecting mother and child from this syndrome and increased risk of cardiovascular disease later in life. However, effective early predictive tests and therapies for preeclampsia are scarce. To identify novel markers and signaling pathways for early onset preeclampsia, we profiled human maternal-fetal interface units (fetal villi and maternal decidua) from early onset preeclampsia and healthy controls using single-nucleus RNA sequencing combined with spatial transcriptomics. The placental syncytiotrophoblast is in direct contact with maternal blood and forms the barrier between fetal and maternal circulation. We identified different transcriptomic states of the endocrine syncytiotrophoblast nuclei with patterns of dysregulation associated with a senescence-associated secretory phenotype and a spatial dysregulation of senescence in the placental trophoblast layer. Elevated senescence markers were validated in placental tissues of clinical multicenter cohorts. Importantly, several secreted senescence-associated secretory phenotype factors were elevated in maternal blood already in the first trimester. We verified the secreted senescence markers, PAI-1 (plasminogen activator inhibitor 1) and activin A, as identified in our single-nucleus RNA sequencing model as predictive markers before clinical preeclampsia diagnosis. This indicates that increased syncytiotrophoblast senescence appears weeks before clinical manifestation of early onset preeclampsia, suggesting that the dysregulated preeclamptic placenta starts with higher cell maturation resulting in premature and increased senescence-associated secretory phenotype release. These senescence-associated secretory phenotype markers may serve as an additional early diagnostic tool for this syndrome.

Research progress of exosomes in pathogenesis and treatment of preeclampsia.

Preeclampsia (PE) is a critical and severe disease in obstetrics, which seriously affects maternal and neonatal life safety and long-term prognosis. However, the etiology and pathogenesis of PE are complex, and no unified conclusion has been reached. The types and number of exosomes and their transport substances in PE patients changed. The study of exosomes in PE patients helps clarify the etiology, diagnosis, effective treatment, accurate monitoring, and prognosis. The published articles were reviewed. Exosomes may affect endothelial and vascular production and function, participate in maternal-fetal immune regulation, and transport substances such as miRNAs, lncRNAs, and proteins involved in the development of PE. Detection of the contents of exosomes can help in the early diagnosis of PE, and can help to improve PE by inhibiting the action of exosomes or preventing their binding to target organs. Exosomes may be involved in the development of PE, and exosomes can be used as markers for predicting the onset of PE and tracking the disease process and determining the prognosis, and exosomes have great potential in the treatment of PE.

Study Effect of Esomeprazole on the Treatment of Preeclampsia in Pregnant Women: A Double-Blind Clinical Trial Study

Background: Preeclampsia is one of the most serious complications of pregnancy, leading to various maternal and fetal complications. Objectives: This study aimed to determine the effect of oral esomeprazole in the treatment of preeclampsia in pregnant mothers. Methods: In this double-blind clinical trial, we compared oral esomeprazole with a placebo. The study population included 120 pregnant women with preeclampsia (60 in the esomeprazole 40 mg group and 60 in the placebo group) who were referred to Ba'ath Hospital in Sanandaj in 2023. Patient care and follow-up were conducted from the time of diagnosis of preeclampsia and inclusion in the study groups until delivery and the final condition of the baby. The outcomes investigated included prolongation of pregnancy and maternal, fetal, and neonatal outcomes. Results: The average delivery time in the esomeprazole group was 37.3 ± 1.2 weeks, compared to 37.5 ± 1.7 weeks in the placebo group, with no statistically significant difference (P = 0.75). The frequency of maternal outcomes, such as eclampsia, pulmonary edema, hemolysis, placental abruption, renal failure, hepatic hematoma, ascites, thromboembolism, and maternal death, was not statistically different between the esomeprazole and placebo groups, and no severe complications were observed in either group. Similarly, fetal outcomes, including intrauterine growth restriction (IUGR) and changes in fetal heart rate patterns, did not significantly differ between groups, with no instances of fetal or neonatal death observed. Additionally, neonatal outcomes, such as Apgar scores below 7, NICU admissions, mechanical ventilation, and other severe neonatal complications, were not significantly different between the two groups (P > 0.05). Although the esomeprazole group showed a lower frequency of adverse maternal, fetal, and neonatal outcomes compared to the placebo group, these differences were not statistically significant. Conclusions: The frequency of adverse maternal, fetal, and neonatal outcomes was lower in the esomeprazole group than in the placebo group for most variables, but the differences were not statistically significant. Therefore, it cannot be concluded with certainty that esomeprazole is ineffective in preventing or controlling preeclampsia.

Hemorrhagic hepatic infarction in a pregnant woman with severe preeclampsia: A case report

Introduction and importance: Severe preeclampsia is a medical condition that affects women during the last two trimesters of pregnancy. Hemorrhagic hepatic infarction is a hepatic complication and is rarely encountered in women with severe preeclampsia. This case report aims to present the characteristics of hemorrhagic hepatic infarction in a pregnant woman with severe preeclampsia. Case presentation: A 27-year-old pregnant woman with a 30-week gestation of amenorrhea was admitted with a blood pressure of 160/100 millimeters of Mercury (mm Hg), headaches, dizziness and oedema in the lower limbs. Clinical discussion: These complaints with clinical and paraclinical examinations led to the diagnosis of severe preeclampsia and she underwent an emergency cesarean section but 6 hours later, she presented with hypovolemic shock and this led to a new surgery. A surgery which made it possible to develop or discover a diffuse hepatic infarction with hemorrhagic infiltration of the gallbladder and the falciform ligament without active bleeding in the liver. Emergency management of preeclampsia was adopted and the postoperative course was simple with a good clinical outcome when the patient was discharged. Conclusion: Severe preeclampsia and hemorrhagic hepatic infarction are complications of pregnancy which require emergency treatment and above all these medical conditions require the termination of the pregnancy.

Understanding the role of soluble proteins and exosomes in non-invasive urine-based diagnosis of preeclampsia

Preeclampsia is a hypertensive disorder of pregnancy that can lead to stillbirth and preterm birth if not treated promptly. Currently, the diagnosis of preeclampsia relies on clinical symptoms such as hypertension and proteinuria, along with invasive blood tests. Here, we investigate the role of soluble proteins and exosomes in noninvasive diagnosing preeclampsia non-invasively using maternal urine and urine-derived exosomes. We quantified the levels of particles and the presence of TSG101 and CD63 in urine and urinary exosomes via the biologically intact exosome separation technology (BEST) platform. Then, we obtained higher levels of soluble proteins such as fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) from urine as it was than urinary exosomes. Compared to commercial blood tests, the sensitivity of the sFlt-1/PlGF ratio was found to be 4.0 times higher in urine tests and 1.5 times higher in tests utilizing urine-derived exosomes. Our findings offer promising possibilities for the early and non-invasive identification of high-risk individuals at risk of preeclampsia, allowing for comprehensive preventive management.

Decidual Granulomas in Placenta: A unique finding in Preeclamptic Pregnancy

Abstract Introduction/Objective Decidual granulomatous inflammation is a rare finding in the placenta, scarcely reported in the literature. We present an unusual case of a young woman with severe preeclampsia and histological presence of decidual granuloma, involving the placental membranes. Methods/Case Report A 34-year-old female, Gravida 2 Para 1, with prior term vaginal delivery without significant history presented at 26 weeks and 6 days of gestational age with decreased fetal movements. Her home blood pressure was 170 mm of Hg systolic and on presentation, was consistently within the range of <a href=“tel:192- 197/94-97”>192-197/94-97</a> mm of Hg. Biophysical profile of the fetus was 2/10. Complete blood count showed leukocytosis with absolute neutrophilia and urinalysis revealed slight increase in urine protein/creatinine ratio. Clinical diagnosis of severe preeclampsia was made. After initial stabilization, the patient underwent Cesarean section resulting in a premature baby with an uneventful postoperative course. The placenta was sent for histopathological examination. Grossly, the placental disc showed unremarkable membranes with normal appearing fetal and maternal surfaces. Sectioning revealed a central 4.2 cm hemorrhagic area and six tan-white wedge-shaped nodules ranging from 0.8-1.8 cm, occupying approximately 5% and 40% of the maternal surface, respectively. Microscopic examination revealed patchy non-caseating granulomas limited to the decidua, patchy intra-placental hematomas, placental infarcts and chronic villitis. Other findings included scattered avascular villi, villous stromal vascular karyorrhexis, focally increased syncytial knots, and decidual arteriopathy. Gram stain, GMS and acid-fast stains yielded negative results, while immunohistochemical stain CD68 highlighted histiocytes in the granulomas. The final diagnosis of decidual granulomas including the aforementioned microscopic observations was made. Results (if a Case Study enter NA) NA Conclusion Though decidual granulomas are seen in association with infectious and rheumatologic disorders. They can also be observed in severe preeclampsia as in this setting; with unclear underlying pathogenesis, warranting a close follow-up of the newborn and the mother.

A rapid diagnostic technique based on metabolomics to differentiate between preeclampsia (PE) and chronic kidney disease (CKD) using maternal urine

Similar clinical manifestations between preeclampsia and chronic kidney diseases can lead to potential misdiagnosis. Therefore, it is crucial to investigate effective diagnostic approaches that can reduce misdiagnosis and ensure the well-being of pregnant women. In this study, urine samples collected from 44 individuals with preeclampsia, 37 individuals with chronic kidney disease, and 37 healthy pregnant women were analyzed using metabolomic and proteomic strategies to distinguish between these two diseases. A total of 15 small molecules were tentatively identified as biomarkers to differentiate these two diseases, including potential internally exposed drugs and their metabolites like labetalol and SN-38, metabolites of exogenous substances like 3-phenylpropyl glucosinolate, and endogenous substances related to metabolism such as isoglobotriaose and chitobiose. Metabolic differences between preeclampsia from healthy pregnant women, as well as the differences between chronic kidney disease and healthy pregnant women were also investigated. Major mechanistic pathways were investigated based on the combination of metabolomic and proteomic, amino acid metabolisms and folate metabolism play key roles in distinguishing preeclampsia and chronic kidney disease. Two patients who were initially diagnosed with chronic kidney disease were found to have a closer association with preeclampsia following metabolomic analysis. Subsequent clinical symptoms and manifestations further supported the diagnosis of preeclampsia, and one of patient's pregnancy was ultimately terminated due to severe preeclampsia. Results of this study contribute to a better understanding of the pathogenesis and clinical diagnosis of preeclampsia, offering insights that could potentially improve future diagnostic and management approaches.

Dynamic monitoring of the endothelium function in pregnant women at high risk of preeclampsia during pathogenetic prevention of its development

BACKGROUND: Today, preclinical diagnosis of preeclampsia presents significant difficulties. In widespread practice, it is diagnosed based on existing clinical signs and laboratory and functional research methods. Most of them are invasive and expensive, which makes it difficult to use them in widespread clinical practice for diagnosis and, especially, for monitoring the effectiveness of therapy over the dynamics of the disease. It is known that the pathogenesis of preeclampsia can have two independent development paths, converging in a common resulting link — the formation of endothelial dysfunction. Methods for studying endothelial function include determining markers of its imbalance in blood samples and non-invasive functional tests. Non-invasive diagnosis of endothelial dysfunction using the EndoPAT test allows us to quantify endothelium-mediated changes in vascular tone during 5-minute occlusion of the brachial artery. AIM: The aim of this study was to evaluate the method for determining the endothelium function in the first, second and third trimesters of pregnancy during ongoing pathogenetic prevention of preeclampsia. MATERIALS AND METHODS: This interventional uncontrolled study of the effectiveness of preventing preeclampsia using non-invasive assessment of vascular endothelial dysfunction during pregnancy was conducted at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, St. Petersburg, Russia. The study involved 108 pregnant women at high risk of developing preeclampsia. All pregnant women underwent a cuff test to determine endothelial dysfunction using the peripheral arterial tonometry technique on the Endo-PAT 2000 device. The dynamic study was carried out in the first, second and third trimesters of pregnancy. As a result of the study, when endothelial dysfunction was detected [logarithmic transformation of reactive hyperemia peripheral arterial tonometry index (LnRHI) less 0.51], a complex glycosaminoglycan was additionally added to the basic prophylaxis with acetylsalicylic acid at a dosage of 250 MU (one capsule three times a day for eight weeks), then a cuff test was monitored after 6–12 weeks. Statistical analysis was performed using the IBM SPSS Statistics 20 software. All tests for significance were two-tailed, and differences were considered significant at p 0.05. RESULTS: Endothelial dysfunction was detected in the first trimester in 59 (55%) patients, then during ongoing complex therapy in the second trimester (n = 72) in 46 (64%) patients and in the third trimester (n = 46) in 4 (1%) patients. Moderate preeclampsia in the third trimester (35–39 weeks of gestation) developed in 28 (25.9%) patients out of 108. At the same time, at the start of the study, 15 patients with endothelial dysfunction received complex therapy, and 13 individuals only took acetylsalicylic acid. Among 46 patients who observed the dynamics of the entire pregnancy, only 4 (8.7%) women developed preeclampsia. After complex treatment prescribed based on the first trimester parameters, out of 36 patients who discontinued complex therapy and did not undergo a functional test subsequently, preeclampsia developed in 16 (44.4%) women. In the second trimester, out of 26 patients who stopped complex therapy, preeclampsia developed in 8 (30.8%) people. Thus, constant monitoring and complex therapy reduced the frequency of preeclampsia. In the group with a history of preeclampsia, the disease developed in 13 (39.4%) women. In the group with a high risk of preeclampsia according to the results of combined prenatal screening in the first trimester, with the exception of a history of preeclampsia (blood pressure test, placental growth factor level in the blood serum, lowest uterine artery pulsatility index value calculated to assess the individual risk of preeclampsia with a titer less than 1 : 100), preeclampsia occurred in 4 (13.3%) women. In the group with extragenital pathology associated with the risk of preeclampsia, including obesity, pregestational diabetes mellitus, chronic arterial hypertension, and chronic kidney disease, with the exception of a history of preeclampsia and a high risk of preeclampsia according to the results of perinatal screening, preeclampsia occurred in 11 (24.4%) women. In the high–risk groups for preeclampsia, we identified the highest-risk group, namely, one with the presence of preeclampsia in the anamnesis. CONCLUSIONS: The effectiveness of the functional method for determining endothelial dysfunction in the first, second and third trimesters of pregnancy during pathogenetic prevention of preeclampsia has been proven.

Maternal blood endometase level as a predictive biomarker for hypertensive disorders during pregnancy: a prospective cohort study

Preeclampsia (PE) occurs due to inadequate spiral artery/trophoblast remodeling in early pregnancy. Endometases are involved in the remodeling of spiral arteries and placental trophoblasts. This study aimed to investigate differences in blood endometase levels between pregnant women with hypertensive disorders (PE and gestational hypertension [GHT]) and healthy pregnant women and to evaluate whether plasma endometase values ​​could play a predictive role in PE or GHT diagnosis. A total of 90 pregnant women (n(PE) = 30, n(GHT) = 30, n(healthy pregnant) = 30) who presented at the hospital between December 2023 and May 2024 and were 26–32 years of age and > 20 weeks pregnant were included in the study. The endometase levels in all pregnant women were determined in maternal blood plasma via enzyme-linked immunosorbent assay. The endometase values were recalculated according to albumin values, and corrected endometase (cEndo) values were determined. No significant differences in blood endometase levels were observed between the groups (p > 0.05). The cEndo value was significantly lower in the PE and GHT groups than in the control group (p < 0.05). There was no statistically significant difference in the cEndo values between the PE and GHT groups (p > 0.05). A statistically significant negative linear relationship was detected between cEndo values and mean systolic blood pressure and mean diastolic blood pressure (p < 0.05). The cEndo values in the PE and GHT groups at early (≤ 32 weeks 3 days) and late pregnancy were compared, and no statistically significant difference was detected (p > 0.05). Maternal blood cEndo values may play a successful role in distinguishing hypertensive diseases of pregnancy (PE + GHT) from healthy pregnant women. cEndo does not play an effective role in the differential diagnosis between pregnant women with PE and those with GHT. Studies with larger patient populations are needed.

8501 Adrenal Incidentaloma In A Pregnant Woman Diagnosed With Preeclampsia

Abstract Disclosure: V.P. Vargas-Abonce: None. I.M. Hernandez-Riveros: None. J. Vasquez-Vasquez: None. F.D. Martínez-Sánchez: None. J.L. Hernandez-Castillo: None. A. Pretel Gutiérrez: None. T.G. Jaramillo-Salazar: None. M.E. Rodriguez García: None. E.K. Tenorio-Aguirre: None. Introduction: An adrenal incidentaloma is a tumor detected on imaging conducted for reasons other than suspected adrenal disease. Whether an incidentaloma should be addressed during pregnancy has not been discussed since this condition is very uncommon. The correct diagnosis and treatment of a functional adrenal tumor has significant implications for maternal-fetal morbidity and mortality. Case Presentation: A 25-year-old woman at 37 weeks of gestation presented to the obstetric emergency department with a headache accompanied by tinnitus and dizziness. Arterial blood pressure at admission was 180/120 mmHg, and biochemical urinary analysis showed proteinuria. A diagnosis of preeclampsia was made, and an emergency cesarean section was performed due to fetal bradycardia. A live single neonate was delivered with an Apgar score of 5/9 at 1 and 5 minutes respectively. During surgery, the patient's arterial blood pressure persisted at 190/110 mmHg despite treatment with 20 mg intravenous hydralazine. At her admission to the intensive care unit, an esmolol infusion was indicated, but the patient further presented tachypnea and tachycardia. A chest Angio tomography ruled out pulmonary thromboembolism, but imaging of the abdomen revealed a right adrenal mass of 6 cm with a heterogeneous enhancement in the arterial phase. Considering the clinical evolution and the findings in tomography, a pheochromocytoma was suspected. The antihypertensive treatment was switched from labetalol to prazosin, achieving control of blood pressure and clinical improvement. The patient was discharged after five days to continue the approach of an incidentaloma. Contrast-enhanced abdominal MRI reported a 9 cm right adrenal mass with a heterogeneous center and hypointense areas suggestive of necrosis. Plasma-free metanephrine was reported at 128 pg/mL (reference value &amp;lt;100 pg/mL) and normetanephrine at 3976 pg/mL (reference value &amp;lt;126 pg/mL). A right adrenalectomy was scheduled. Conclusion: In the workup of an incidentaloma, suggestive characteristics of malignancy in TC, and functional evaluation guided by the patient's clinical manifestations must be addressed concurrently. In this case, the presence of an adrenal incidentaloma larger than 4 cm with &amp;gt;10 HU in a pregnant woman diagnosed with preeclampsia who had an inadequate response to the standard treatment led to the consideration of a probable pheochromocytoma as a secondary cause of hypertension, which influenced the change of antihypertensive treatment to alpha-adrenergic blockade, followed by patient clinical improvement. Although the presence of a pheochromocytoma is much less common than preeclampsia as a cause of hypertension in pregnancy, a misdiagnosis can increase maternal morbidity and mortality by up to 15%. After adequate treatment of the obstetric emergency, the approach to incidentaloma in pregnancy is recommended. Presentation: 6/3/2024

Calcium carbonate supplementation for the prevention of preeclampsia in high-risk pregnant women: a randomized clinical trial protocol

BackgroundPreeclampsia (PE) is a significant cause of maternal mortality worldwide, affecting 2% to 8% of pregnancies. The World Health Organization recommends the use of low-dose acetylsalicylic acid (100 mg of aspirin) and 1.5 to 2 g of calcium carbonate during pregnancy to prevent PE. However, robust evidence supporting the efficacy of calcium supplementation is still needed. This study aims to assess the efficacy of calcium carbonate in preventing preeclampsia in high-risk pregnant women.MethodsA triple-blind, randomized clinical trial will be conducted at an outpatient clinic in Brazil between May 2024 and March 2026. Pregnant women at high risk of developing preeclampsia and with low dietary calcium intake will be randomly assigned to one of three groups: one group will receive calcium carbonate capsules (commercially available in Brazil) along with 100 mg of aspirin; the second group will receive calcium carbonate derived from Crassostrea sp. along with 100 mg of aspirin; and the control group will receive a placebo alongside 100 mg of aspirin. The primary outcome is the diagnosis of preeclampsia during pregnancy, while secondary outcomes evaluate maternal and fetal health indicators.DiscussionThis trial seeks to generate evidence on the efficacy of calcium carbonate in preeclampsia prevention, with a focus on comparing industrial calcium carbonate with calcium carbonate sourced from Crassostrea sp., a more sustainable alternative.Trial registrationThe study was approved by the Research Ethics Committee of the Federal University of Sergipe and registered in the Brazilian Registry of Clinical Trials (ReBEC), under the ID RBR-7hqhj3y. Registered on November 16, 2023.

Role of circular RNAs in preeclampsia (Review).

Preeclampsia (PE) is a hypertensive disorder of pregnancy characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, which affects 3-8% of pregnant individuals worldwide each year. Prevention, diagnosis and treatment of PE are some of the most important problems faced by obstetrics. There is growing evidence that circular RNAs (circRNAs) are involved in the pathogenesis of PE. The present review summarizes the research progress of circRNAs and then describes the expression patterns of circRNAs in PE and their functional mechanisms affecting PE development. The role of circRNAs as biomarkers for the diagnosis of PE, and the research status of circRNAs in PE are summarized in the hope of finding novel strategies for the prevention and treatment of PE.

Proteomic Profiles of Maternal Plasma Extracellular Vesicles for Prediction of Preeclampsia.

Preeclampsia is a heterogeneous syndrome of diverse etiologies and molecular pathways leading to distinct clinical subtypes. Herein, we aimed to characterize the extracellular vesicle (EV)-associated and soluble fractions of the maternal plasma proteome in patients with preeclampsia and to assess their value for disease prediction. This case-control study included 24 women with term preeclampsia, 23 women with preterm preeclampsia, and 94 healthy pregnant controls. Blood samples were collected from cases on average 7 weeks before the diagnosis of preeclampsia and were matched to control samples. Soluble and EV fractions were separated from maternal plasma; EVs were confirmed by cryo-EM, NanoSight, and flow cytometry; and 82 proteins were analyzed with bead-based, multiplexed immunoassays. Quantile regression analysis and random forest models were implemented to evaluate protein concentration differences and their predictive accuracy. Preeclampsia subgroups defined by molecular profiles were identified by hierarchical cluster analysis. Significance was set at p < 0.05 or false discovery rate-adjusted q < 0.1. In preterm preeclampsia, PlGF, PTX3, and VEGFR-1 displayed differential abundance in both soluble and EV fractions, whereas angiogenin, CD40L, endoglin, galectin-1, IL-27, CCL19, and TIMP1 were changed only in the soluble fraction (q < 0.1). The direction of changes in the EV fraction was consistent with that in the soluble fraction for nine proteins. In term preeclampsia, CCL3 had increased abundance in both fractions (q < 0.1). The combined EV and soluble fraction proteomic profiles predicted preterm and term preeclampsia with an AUC of 78% (95% CI, 66%-90%) and 68% (95% CI, 56%-80%), respectively. Three clusters of preeclampsia featuring distinct clinical characteristics and placental pathology were identified based on combined protein data. Our findings reveal distinct alterations of the maternal EV-associated and soluble plasma proteome in preterm and term preeclampsia and identify molecular subgroups of patients with distinct clinical and placental histopathologic features.

Can Peripheral Arterial Tonometry and Biomarkers Help Identify Women Who Will Have Progressively Worsening Hypertensive Disorders of Pregnancy?

This study aimed to (1) evaluate whether endothelial dysfunction, as measured by peripheral arterial tonometry (PAT) indices and biomarker (soluble fms-like tyrosine kinase-1 [sFLT], brain natriuretic peptide [BNP]) levels at 34 weeks gestation, can predict progression from nonsevere to severe hypertensive disorders of pregnancy (HDPs); and (2) develop a clinical risk model for prediction of progression from nonsevere to severe HDP. We prospectively enrolled patients with a singleton gestation carrying a nonsevere HDP diagnosis. Forty-five participants were enrolled for PAT evaluation and serum collection between 340/7 and 366/7 weeks. PAT indices (e.g., Augmentation Index normalized to a heart rate of 75 bpm [AI75]) and biomarker concentrations were assessed at enrollment. The primary outcome was progression from a nonsevere diagnosis in the late preterm period to a diagnosis of preeclampsia with severe features or superimposed preeclampsia. Statistical analyses included two-sample t-tests, Fisher's exact tests, and multivariate modeling. Thirteen subjects (30%) progressed to severe disease. No significant differences in mean PAT indices between the outcome groups were found. We found a significant difference in mean sFLT values between the two groups (p = 0.02, area under the curve [AUC] of 0.609), but not in mean BNP values. An endothelial dysfunction index (presence of fetal growth restriction, "high" AI75, and positive systolic blood pressure slope) discriminated between progression and nonprogression (p = 0.03, AUC of 0.707). sFLT level was a marker of progression from nonsevere to severe HDP. Further, a novel endothelial dysfunction index discriminated between progression and nonprogression to severe disease with good performance. · HDPs are important causes of morbidity and mortality.. · The sequelae of HDPs are not limited to pregnancy.. · Developing accurate tools to predict severe HDPs is of great clinical importance.. · Our index shows promising performance for predicting progression from nonsevere to severe HDPs..

A Systematic Review of Complications Following Pre-eclampsia.

Most pregnancies are low-risk. However, sometimes women develop pre-eclampsia. The incidence varies based on different studies (Havers-Borgersen et al., 2023, 10.1136/jech-2023-220829).Pre-eclampsia is characterized by elevated blood pressure, protein in the urine, and excessive swelling and occurs after 20 weeks of pregnancy though in the case of severe symptoms, all may not be required for diagnosis (Bajpai et al., 2023). Many strategies exist to identify women with pre-eclampsia and to treat it. There are known immediate risks to both the mother and fetus. Some of these risks extend beyond the immediate postpartum period. Much less is known regarding the long-term risks. Therefore, the purpose of our study was to conduct a systematic review of the long-term complications related to pre-eclampsia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to guide this systematic review. PubMed, CINAHL, Medline, Scopus, PschINFO, and Google Scholar were used to identify relevant articles. We focused on articles published within the last 5 years. Search terms were pre-eclampsia and complications, pregnancy-induced hypertension and complications, long-term complications of pre-eclampsia, and long-term follow-up of pre-eclampsia. Two hundred and fifty-eight articles were identified; further analysis identified 91 that seemed relevant. After a thorough review, 19 articles were deemed relevant to identify complications women experience following pre-eclampsia. Cardiovascular disease is a major long-term risk. Early-onset pre-eclampsia contributes the greatest risk. Health promotion interventions that target women following a diagnosis of pre-eclampsia are needed. Inadequate knowledge exists to guide efforts to prevent long-term sequelae from pre-eclampsia.

Predictive Ability of Ratio of Soluble FMS Like Tyrosine Kinase-1 and Placental Induced Growth Factor (sFlt-1/PIGF) in Diagnosis of Preeclampsia: A Case Control Study.

Predictive Ability of Ratio of Soluble FMS Like Tyrosine Kinase-1 and Placental Induced Growth Factor (sFlt-1/PIGF) in Diagnosis of Preeclampsia: A Case Control Study.

Evaluation of the Effectiveness of Training Using Simulation Equipment and Simulators for Midwives of Maternity Hospitals

For the purpose of professional growth and assignment of qualification categories in the profile "Obstetrics" additional professional education (advanced training programs and professional retraining programs) and training in simulation centers are included. The results of the effectiveness of the training of midwives of maternity hospitals in the specialty "Obstetrics" on the topic "Development of practical skills of the algorithm of actions in the diagnosis of moderate and severe preeclampsia in a pregnant woman and a woman in labor in a maternity hospital" in the federal accreditation center of the Far Eastern State Medical University are presented.