Preeclampsia In High-risk Women Research Articles

Comparison of 75 mg versus 150 mg aspirin for the prevention of preterm preeclampsia in high-risk women at a tertiary level hospital: study protocol for a randomized double-blind clinical trial

BackgroundHypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health, with substantial mortality and morbidity rates globally, particularly in developing countries. Pre-eclampsia (PE) accounts for a notable portion of maternal morbidity and mortality, with varied prevalence across regions within countries like India. Despite advancements, disparities in healthcare access persist, influencing outcomes. PE not only affects maternal health during pregnancy but also predisposes women to long-term cardiovascular complications, emphasizing the need for early screening and preventive measures.MethodsThis prospective randomized double-blind clinical trial aims to compare the efficacy and safety of 75 mg versus 150 mg aspirin for preventing preterm pre-eclampsia in high-risk women. Screen-positive women aged 18–45 years with singleton pregnancies between 12 and 16 weeks of gestational age will be enrolled. They will be randomized in a 1:1 ratio to receive either 75 mg or 150 mg of aspirin nightly until 37 weeks of pregnancy or earlier if preterm pre-eclampsia develops. Feto-maternal outcomes, including preterm pre-eclampsia incidence and neonatal and maternal complications, will be assessed. The sample size calculation based on expected proportions of preterm pre-eclampsia in both groups indicates a total of 370 participants (185 per group) accounting for 20% attrition.DiscussionThis prospective randomized double-blind clinical trial aims to compare the effectiveness and safety of two doses of aspirin (75 mg vs 150 mg) in preventing preterm pre-eclampsia in high-risk women. The potential implications of this study are significant, including the optimization of aspirin prophylaxis, the development of evidence-based guidelines, and comprehensive assessment of maternal and fetal outcomes. In conclusion, the results of this study have the potential to significantly impact clinical practice by enhancing maternal and perinatal health outcomes and contributing to evidence-based obstetric care.Trial registrationClinical Trials Registry-India CTRI/2023/12/060983. Trial was registered prospectively on 29 December 2023. Acknowledgement Number REF/2023/12/076358. https://acrobat.adobe.com/id/urn:aaid:sc:AP:15870322-f1f4-4460-900c-6e056ab83a44.

Prediction using serum glycosylated fibronectin and angiogenic factors of superimposed pre-eclampsia in women with chronic hypertension.

To compare the predictive performance for delivery with pre-eclampsia (PE) within 2 weeks of assessment in women with chronic hypertension at 24-41 weeks' gestation between serum glycosylated fibronectin (GlyFn) concentration, serum placental growth factor (PlGF) concentration and soluble fms-like tyrosine kinase-1 (sFlt-1) to PlGF concentration ratio. This was a prospective study of 104 women with a singleton pregnancy and chronic hypertension presenting at 24-41 weeks' gestation. Twenty-six (25.0%) cases developed superimposed PE within 2 weeks of sampling. We compared the predictive performance for superimposed PE between GlyFn, PlGF and the sFlt-1/PlGF ratio at a fixed screen-positive rate of approximately 10%. The median gestational age at sampling was 34.1 (interquartile range, 31.5-35.6)weeks and 84.6% (88/104) of cases were sampled at < 36 weeks. The predictive performance for superimposed PE of the three methods of screening was similar, with detection rates of about 23-27%, at a screen-positive rate of 11% and a false-positive rate of about 5%. Measurement of GlyFn is a simple point-of-care test that can be carried out without need for a laboratory and provide results within 10 min of testing. In this respect, it could potentially replace the angiogenic markers that are used currently in the prediction of imminent PE in high-risk women. However, neither GlyFn nor angiogenic factors are likely to improve the management of women with chronic hypertension because their predictive performance for superimposed PE is poor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women

Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women

Utility of uterine artery doppler indices for prediction of preeclampsia: A narrative review with systematic analysis

Background: Hypertensive disorders complicating pregnancy are common. Preeclampsia and eclampsia are major causes of maternal morbidity and mortality, particularly in developing countries. With prompt recognition of symptoms and early diagnosis of preeclampsia can lead to improved maternal and neonatal outcomes. Although, numerous tests have been proposed for the prediction of preeclampsia, their results have been inconsistent. So, we focused our research to study the uterine artery doppler for predicting preeclampsia in high-risk women. Methodology: We conducted a search on Google Scholar and PubMed based on Medical Subject Heading terms preeclampsia and uterine artery Doppler ultrasound. The articles between 2016 and 2020 which were in English were taken into consideration. We performed a qualitative interpretation as an approach for extracting the data. Results: Majority of the studies showed raised pulsatility index as a good predictor of preeclampsia, although it was closely followed by uterine artery notching which is in the early diastolic period. Conclusion: The findings of our research suggest that uterine artery Doppler indices and early diastolic notch can be used as a tool for the prediction of preeclampsia with high confidence.

Informational needs related to aspirin prophylactic therapy amongst pregnant women at risk of preeclampsia - A qualitative study.

Despite being key to reducing the occurrence of pre-eclampsia in high-risk women, adherence to aspirin prophylaxis is low, reflecting multifactorial challenges faced by pregnant women. It is therefore important to understand the barriers and facilitators of aspirin adherence in pregnancy. This sub-analysis of a qualitative study conducted to better understand barriers and facilitators of aspirin adherence was set to describe informational needs related to aspirin use in pregnancy. A qualitative study was conducted with 14 postnatal women from North-East of England, who declared various levels of non-adherence to aspirin (0-5/7 prescribed). A thematic framework analysis of semi-structured interviews was used. Emerging themes associated with informational needs about aspirin use in pregnancy. Main themes identified a) Informational needs, b) Nature of the information seeking behaviour (active vs passive), c) Sources of information, d) Preferred format of information, e) Partners seeking knowledge. Not all women actively seek information; some choose not to pursue it as they find thinking of hypothetical risks disturbing. When information is accessed, women use a wide range of informational resources from scientific articles and National Health Services website to social media sources and word-of-mouth. Women admit that reading leaflets can be difficult, preferring to receive information in interactive ways. Although partners seek information about risks and risk reduction strategies, they are often not included in conversations with health care professionals. New interactive and accessible informational resources are needed to engage pregnant women and their partners in aspirin prophylactic therapy.

Role of Uterine Artery Doppler Ultrasound in Predicting Pre-Eclampsia in High-Risk Women.

Background and objectivePre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women.MethodologyThis was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery’s flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria.ResultsTwenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE.ConclusionAbnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Effective Aspirin Treatment of Women at Risk for Preeclampsia Delays the Metabolic Clock of Gestation.

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A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre‐eclampsia

A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre‐eclampsia

Screening of High-Risk Patient by Uterine Artery Doppler Analysis in The 1st Trimester to Predict Early Onset Pre-Eclampsia

Background: Preeclampsia (PE) is still a major obstetrical problem world-wide. First trimester prediction of PE is of great clinical importance, as it would allow clinicians to focus on high-risk groups and initiate prophylactic medical treatment. The first stage of pre-eclampsia begins in the first trimester by impaired placentation. High-resistant spiral arteries can be detected from the 11th week of gestation by uterine artery (UtA) Doppler examination. Objective: To assess the relationship between 1st trimester uterine artery pulsatility index (UtA PI) and the development of early onset PE.Patients and Methods: Prospective observational study was performed at Mansoura University Hospital. This study was conducted on 109 pregnant women who attended their routine antenatal care visits at the Outpatient Obstetrics and Gynecology Clinic of Mansoura University Hospital. Results: There were statistically high significant difference between both groups in the BMI (p = 0.003), and no statistically significant difference as regards the age, gravidity and gestational age (p > 0.05). Statistically significant difference was evident between two groups in the mean values of UtA PI (p = 0.028). The best cutoff value of UtA PI for the prediction of early onset preeclampsia was ≥ 2.03 with accuracy of 0.79, and that of BMI was ≥ 35 with accuracy of 0.93. Conclusion: This study revealed that first trimester uterine artery Doppler can be used as a reliable screening test for prediction of preeclampsia in high risk women. It is a reliable, noninvasive method of examining uteroplacental perfusion. Abnormal UA Doppler ultrasonography (elevated PI) in 11–14 weeks' gestation can predict pre-eclampsia.

Combined prevention of fetal growth restriction based on determination of diagnostic markers

Due to the morbidity of mothers and newborns caused by fetal growth restriction (FGR) and preeclampsia, preventive measures should be taken, especially in women at high risk of developing these conditions. Many studies have been conducted on the prevention of FGR and preeclampsia in high-risk women, especially anticoagulants, aspirin, paravastatin, nitric oxide, microelements (L-arginine, folic acid, vitamins E and C, phytonutrients, vitamin D) and calcium.&#x0D; The aim is to improve perinatal consequences by preventing FGR in high-risk women.&#x0D; Materials and methods: A prospective study of 137 pregnant women in the period of 110–136 weeks was conducted at the Perinatal Center in Kyiv. Pregnant women were divided into 3 groups. The main group included 47 women at high risk of FGR who received therapy (low doses of aspirin, low molecular weight heparin (LMWH) and vitamin and micro elements drugs). The comparison group included 45 women who had a high risk of FGR but did not receive treatment. The control group consisted of 45 women who were not at risk of FGR. The frequency of FGR and placental dysfunction were analyzed as well as a fetal distress was analyzed ante- and intranatally.&#x0D; Results: Therapy with low doses of aspirin, LMWH and a complex preparation of vitamins and micro elements improves the course of pregnancy and gestational complications. In the main group FGR was detected in 8.5 %, in the comparison group – in 17.8 %, in the control group – 4.4 %. Placental dysfunction was detected in 13.3 % in the control group, and only 6.4 % in the main group that was close to the control group – 2.2 %. Similar tendencies were found for fetal distress ante- and intranatally.&#x0D; Conclusions: The proposed prophylactic measures can improve maternal outcomes by reducing the level of gestational complications in pregnant women with biochemical signs of risk of FGR development. In addition, these preventive measures can reduce the frequency of children births with growth restriction, which significantly reduces early neonatal and perinatal morbidity and mortality.

Association of glutamate cystein ligase (GCL) activity Peroxiredoxin 4 (prxR4) and apelin levels in women with preeclampsia

Preeclampsia is a common disease of pregnancy that is characterized by symptoms such as high blood pressure and proteinuria. Peroxiredoxin 4 (Prx4), is a protein with antioxidant properties which is produced in placenta and protects it from antioxidant stress and recurrent miscarriage. For regeneration of Peroxiredoxin 4 need to glutathione (GSH) and Glutamate-cysteine ligase (GCL) enzyme controls the pathway of glutathione regeneration. Apelin is a paired internal ligand with a G protein coupled receptor and is associated with angiotensin receptor (AT1) as a blood pressure regulator. This study was designed to evaluate GCL enzyme activity and Peroxiredoxin 4, glutathione and apelin levels in serum of women with preeclampsia. Thirty pregnant women with preeclampsia and 30 healthy pregnant women were enrolled in this study. All participants were diagnosed by clinical examination and confirmation by Obstetrician-Gynecologist. The GCL enzyme activity and concentration of Prx4 and apelin in serum samples were measured using ready-to-use non-competitive ELISA methods while glutathione level was determined using Ellman's reagent. The GCL enzyme activity and Prx4 level were significantly lower in preeclampsia compared with control group (p<0.05). In addition, marked reductions were observed in the concentrations of glutathione and apelin in preeclampsia compared to the healthy pregnant women (p<0.05). This study identified the role of the GCL and Prx4 system in preeclampsia disorder and may be one of the ways to prevent and reduce the risks of preeclampsia in high-risk women using diet control and stress reduction.

Preconception preparation for pregnancy

Background. Experience in high-risk obstetrics shows that a significant part of the determining factors affects the woman and the fetus before the first visit to the doctor. Improving a woman’s health before conception can improve her reproductive performance and reduce financial costs spent on obstetric medical aid.&#x0D; Objective. Describe the key concepts of preconception training.&#x0D; Materials and methods. Analysis of literature sources on this topic; own study involving 42 pregnant women (22 women with systemic lupus erythematosus (SLE), 20 women with congenital heart disease (CHD) and hypertensive complications of previous pregnancies), who were divided into two groups. Group 1 received routine drugs and L-arginine (Tivortin, “Yuria-Pharm”) in doses recommended for cardiac patients, and group 2 – only routine drugs.&#x0D; Results and discussion. The components of preconception programs include the individual responsibility of women throughout life, awareness of women, preventive visits, interventions on identified risks, pre-pregnancy examinations and pregnancy supervision, health insurance for low-income women, health programs and strategies, medical research, and the improvement of monitoring. Target groups of preconception include women with unfavorable obstetric history (premature birth, cessation of fetal development, cesarean section, stillbirth, multiple miscarriages, birth of children with birth defects, hypertensive complications of pregnancy) and chronic diseases (type 1 diabetes mellitus, SLE, antiphospholipid syndrome, severe cardiovascular pathology, arterial hypertension, pulmonary hypertension). An important role in the management of pregnant women belongs to the prevention of preeclampsia (PE). Administration of acetylsalicylic acid reduces the likelihood of PE by 10 % in low-risk pregnant women and by 25 % in high-risk pregnant women, but the drug should be started during gestation. The use of calcium (1000 mg) reduces the risk of PE in high-risk pregnant women by 37 %. Preconception preparation is especially important, because some processes, such as the implantation of placental structures, begin and end before a woman learns she is pregnant. Remodeling of the spiral arteries also begins in the early stages of pregnancy, so its correction after the confirmation of pregnancy is less effective than prevention before it occurs. E.E. Camarena Pulido et al. (2016) studied the role of L-arginine (5 tablets of 600 mg per day from the 20th week of gestation before delivery) in the prevention of PE in high-risk women. In the L-arginine group significantly fewer cases of PE (3/49 vs. 11/47 in the placebo group; p=0.01) and a lower incidence of preterm birth were detected. In the another study, pregnant women with chronic hypertension received oral L-arginine or placebo. In the arginine group, there was a lower need for antihypertensive drugs, as well as lower frequency of births before 34 weeks, PE and neonatal complications (Neri I. et al., 2010). In the own study, favorable obstetric results of Tivortin were found. The percentage of births at &gt;37 weeks in the Tivortin group among women with SLE was 90.9 %, and in the group of standard therapy – 50 % (p&lt;0.01), among women with CHD – 90 % and 75 % respectively; p&lt;0.05). No newborns with an Apgar score of &lt;7 were found in the Tivortin group. In the comparison group their number was 27.7 %. Laboratory studies have shown that there is a significant increase in endothelial progenitor cells in the Tivortin group.&#x0D; Conclusions. 1. Preconception preparation of pregnant women is a multifaceted set of measures. 2. A significant number of physiological and pathological processes occur in the early stages of pregnancy, so they can be influenced only in the preconception period. 3. The use of L-arginine during gestation reduces the risk of PE, premature birth and other complications in all women and especially in women with hypertension.

Correlation of thioredoxin reductase (TrxR) and nitric oxide synthase (NOS) activities with serum trace elements in preeclampsia

ABSTRACT Background Preeclampsia is a dangerous disease of pregnancy with symptoms such as high blood pressure and proteinuria. The nitric oxide synthase (NOS) enzyme produces nitric oxide (NO) as a mediator of vasodilation and need to calcium and zinc ions for activity. The thioredoxin reductase (TrxR) as an enzyme containing selenium has been neutralized the damaging effects of oxidants. In this study, our aim was to evaluate the activity of eNOS and TrxR enzymes and the amounts of calcium, zinc, and selenium elements in serum of women with preeclampsia. Material and Methods Thirty preeclampsia and 30 healthy pregnant women were enrolled in the study after clinical examination and confirmation by Obstetrician-Gynecologist. Venous blood samples were collected and the activity of NOS, TrxR enzymes, and the concentration of zinc, calcium, and selenium elements were measured in serum. Results The results of NOS and TrxR activities showed significant decreases in preeclampsia compared with control group (p < .05). In addition, concentrations of zinc, calcium, and selenium were markedly lower in preeclampsia compared to the healthy control group (p < .05). Conclusion This study identified the role of the NOS and TrxR activities in preeclampsia disorder and may be one of the ways to prevent and reduce the risks of preeclampsia in high-risk women using diet control and stress reduction.

Prevention of preeclampsia

Preeclampsia is an obstetric disorder that affects 3–8% of pregnant women and remains a leading cause of short- and long-term neonatal and maternal morbidity and mortality. Professional societies recommend the use of low dose aspirin to prevent preeclampsia in high-risk women. However, interest in prevention of this disease and better understanding of its pathophysiology have led to growing research on other agents. This review focuses on the main therapeutic agents evaluated or in use for preeclampsia prevention.

The role of biomarkers in predicting pre-eclampsia in high-risk women.

Background There are limited data on performance of biomarkers to predict pre-eclampsia (PE) in high-risk women. This study investigated the ability of FABP4, PAPP-A, PlGF, sFlt-1 and sEng to predict PE in a high-risk group. Methods Non-fasting samples were analysed at 11 + 0–13 + 6 (V1) and 19 + 0–21 + 6 weeks (V2) ( n = 195). Logistic regression models were determined. Area under (AUC) the receiver operating characteristic (ROC) curve analysis was performed. The added value of biomarkers to clinical characteristics for PE prediction was quantified using integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. Results Prevalence of PE was 12%. Lower concentrations of sFlt-1:PlGF (V1) and PlGF and PlGF:sEng (V2) were seen in women who developed PE. Controlling for baseline characteristics (V1), a doubling of sFlt-1 (pg/mL) (median 896.0, IQR 725.5–1097.0) and sFlt-1:PlGF (median 21.2, IQR 14.7–32.3) was associated with reduction in odds of PE (OR 0.20, 95% CI 0.06–0.65, P = 0.007 and OR 0.48, 95% CI 0.25–0.92, P = 0.04). Addition of sFlt-1 and sFlt-1:PlGF to baseline characteristics non-significantly improved AUC (0.74) (AUC 0.77, P = 0.40 and 0.76, P = 0.39). NRI and IDI analyses confirmed added clinical utility of sFlt-1 (NRI = 0.539, P = 0.01 and IDI = 0.052, P = 0.03). In V2, doubling of PlGF:sEng (median 71.9, IQR 47.0–102.8) was associated with reduction in the risk of PE (OR 0.56, 95% CI 0.35–0.98, P = 0.04). The addition of PlGF:sEng to baseline characteristics non-significantly improved AUC from 0.78 to 0.82 ( P = 0.25) and improved reclassification of cases (NRI = 0.682, P = 0.002). Conclusions Screening tests incorporating first trimester sFlt-1 and second trimester PlGF:sEng have potential to aid PE prediction in high-risk pregnancies.

Effect of Self-care Before and During Pregnancy to Prevention and Control Preeclampsia in High-risk Women.

Our aims to examine the factors influencing self-care for the prevention and control of preeclampsia in high-risk women. The current study is a review where the researcher browsed the available databases such as PubMed, Cochrane, Medline, Google Scholar, Medscape, and relevant research published between 1980 and 2016 were studied. To search for articles, relevant Medical Subject Heading keywords were first determined (Self-care, preeclampsia, prevention.) A total of 350 related articles were first selected, and the findings of 70 were used to compile the present article. The results of the study were classified under two general categories, including (1). Counseling and screening strategies and (2) self-care strategies for the prevention and control of preeclampsia in high-risk women. Screening women at risk for preeclampsia include measures such as measuring their blood pressure, checking for signs of depression, testing for thrombosis, taking a history of preeclampsia, providing preconception counseling about the appropriate age, time of pregnancy, and encouraging weight loss in obese women. This review showed a positive relationship between knowledge about self-care for preeclampsia and its control. The factors influencing preeclampsia self-care include making lifestyle changes, having a healthy diet, learning stress management, performing exercise and physical activities, taking antioxidants, dietary supplements, and calcium and adherence to aspirin and heparin regimens. There is a positive relationship between preconception counseling, screening women at risk for preeclampsia, self-care for the prevention, and control of preeclampsia.(1) Tweetable abstract self-care in high-risk women is strongly associated with prevention and control of preeclampsia.

247. Effect of aspirin on soluble Fms-like tyrosine kinase-1 levels and placental growth factor in women with suspected or confirmed preeclampsia

Background Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and decreased placental growth factor (PlGF) levels. Low-dose aspirin use is recommended for the prevention of preeclampsia in high-risk women, although its exact pathogenic mechanism remains unknown. Preclinical studies have shown that aspirin decreases sFlt-1 secretion in vitro. Our aim is to investigate whether aspirin use affects sFlt-1 and PlGF in women with confirmed or suspected preeclampsia. Methods A prospective cohort study was conducted involving 430 women. Of these women, 45 took aspirin for 10 to 32 (median 23) days before sFlt-1 and PlGF measurement. Measurements were only made once at study entry, between weeks 20 and 41 (median 33) weeks. Results Women using aspirin at study entry were compared to either all women not using aspirin, or given that sFlt-1 and PlGF alter with advancing gestation, to gestational age-matched women not using aspirin. We aimed at obtaining 2 gestational age-matched non-users for each individual drug user. Aspirin use tended to lower sFlt-1/PlGF ratio (p = 0.05), but this trend was mitigated when matched with gestational age-matched controls (p > 0.05). With regard to other drugs affecting sFlt-1, PPI use was associated with lower sFlt-1 levels both when compared with all non-PPI users and with 80 gestational age-matched controls. No sFlt-1/PlGF factor alterations were observed in women using ferrous fumarate or macrogol while, and as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower PlGF levels. The PPI use-associated decrease in sFlt-1 was independent of the application of aspirin or antihypertensive drugs. Rates of pregnancy complications for aspirin users were not different from non-aspirin users. Discussion Treatment with aspirin does not associate with lower sFlt-1 or altered PlGF levels. Larger studies are required to further elucidate the pathogenic role of aspirin in the prevention of preeclampsia.

Placental vascularization indices and prediction of pre-eclampsia in high-risk women

ObjectiveTo assess ability of first and second trimester Placental Vascularization Indices (PVIs) to predict pre-eclampsia (PE) in high-risk pregnancies. MethodPVIs derived from 3-Dimensional power Doppler imaging were measured at 11+0–13 + 6 (n = 194) and 19+0–21 + 6 weeks (n = 195). Logistic regression (LR) models used PE as the outcome. To quantify added value of PVIs to baseline characteristics in predicting PE, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices were calculated. ResultsOverall rate of PE was 12% (n = 26). Lower first trimester PVIs were seen in women with PE (mean, SD); Vascularization Index (VI,%): 10.0 (6.2) v 14.7 (7.6), P = 0.005, Flow Index (FI): 37.7 (9.1) v 42.9 (10.4), P = 0.03, Vascularization Flow Index (VFI): 3.8 (2.5) v 6.6 (4.0), P < 0.001). All first trimester PVIs predicted PE in LR models adjusted for covariates. IDI and NRI analyses confirmed added clinical utility of VI (IDI 0.05, P = 0.004; NRI 0.66, P < 0.001) and VFI (IDI 0.06, P = 0.004; NRI 0.53, P = 0.91). In the second trimester, FI was lower in women with PE (39.6 (9.1) v 44.4 (8.6), P = 0.01) and predicted PE in adjusted LR models (standardised OR 0.53, 95% CI 0.29–0.97, P = 0.04). FI discriminated between cases and non-cases of PE (IDI 0.04, P = 0.04). ConclusionFirst trimester placental vascularization indices (VI, FI and VFI) have the potential to predict PE in high-risk pregnancies, with FI remaining predictive in the second trimester.

ارزیابی نقش مارکرهای سرمی و سونوگرافی داپلر شریان رحمی در پیشگویی پره‌اکلامپسی در سه ماهه دوم بارداری: یک مطالعه مرور سیستماتیک

مقدمه: پره­اکلامپسی، شایع‌ترین عارضه طبی در بارداری است. با توجه به پاتوفیزیولوژی و اتیولوژی پیچیده پره‌اکلامپسی، طیف وسیعی از مارکرها بررسی شده‌اند که علاوه بر ارزش پیشگویی، شناسایی این عوامل ممکن است مکانیسم روشنی برای پاتوژنز پره­اکلامپسی فراهم کند. مطالعه مروری حاضر با هدف ارزیابی نقش چهار مارکر سرمی و سونوگرافی داپلر شریان رحمی در پیشگویی پره­اکلامپسی در سه ماهه دوم بارداری انجام شد. روش‌کار: در این مطالعه مروری جهت یافتن مطالعات مرتبط، در بازه زمانی 2000 تا 2017 از پایگاه­های اطلاعاتی SID، Weily online library،Elsevier ، Scopus، Pubmed و همچنین موتور جستجوی Google Scholar استفاده شد. برای دستیابی به تمامی مقالات به زبان انگلیسی و فارسی مورد نظر از کلید واژه­های فارسی شامل: BHCG، اینهیبین A، اکتیوین A، آلفا فتوپروتئین، مارکرهای سرمی، سونوگرافی داپلر شریان رحمی، سه ماهه دوم و پیشگویی پره­اکلامپسی و کلید واژه­های انگلیسی شامل: serum markers،Uterine artery Doppler ultrasonography، Preeclampsia prediction، Second trimester، AFP، β-HCG، Activin A، Inhibin A با همه ترکیبات احتمالی این کلمات استفاده شد. یافته‌ها: نتایج مطالعات مختلف بیانگر این مسئله بودند که هیچ یک مارکرهای مورد مطالعه شامل اکتیوین A و اینهیبین A، β-HCG و AFP به تنهایی قدرت پیشگویی پره­اکلامپسی را با حساسیت و ویژگی بالا فراهم نمی‌کنند، اما سونوگرافی داپلر شریان رحمی در سه ماهه دوم بارداری را می­توان به عنوان یک تست غربالگری برای پیشگویی پره­اکلامپسی در زنان پرخطر به‌کار برد. نتیجه‌گیری: مهم‌ترین استراتژی‌های پیشگویی پره‌اکلامپسی شامل: مشخصات فردی، سونوگرافی شریان داپلر و بیومارکرها می­باشند و هیچ‌یک از این مارکرها به تنهایی قدرت پیشگویی پره­اکلامپسی را با حساسیت و ویژگی بالا فراهم نمی‌کنند.

The Use of Pulse Wave Velocity in Predicting Pre-Eclampsia in High-Risk Women

In this study, we evaluated the diagnostic utility of pulls wave velocity (PWV) alone or in combination with other diagnostic markers in predicting pre-eclampsia (PE) on high-risk women. Pregnant women at high risk for PE were recruited between 32 and 36 weeks of gestation period. This study is the first in Romanian and shows that PWV may be a potentially promising predictor of early-onset PE in women at high risk for PE. All these patients were treated and were instructed according to the ESC/ESH guidelines regarding hypertensive patients. Statistical analysis was performed using the Chi-square, a Mann-Whitney test, Pearson correlation, and linear regression tests.After we ran several test the main conclusions are that there is a positive correlation between the para-clinics data (creatinine, Esbach proteinuria) and the pulls wave velocity for aorta (PWVao). The risk for preeclampsia is increasing if the body mass index (BMI) of the patients is higher than the average value (BMI]26) or if the patient is a smoker.