Preeclampsia In Third Trimester Research Articles

Comparison of Placental Location on Ultrasound in Preeclampsia and Normotensive Pregnancy in Third Trimester.

Hypertensive disorders in pregnancy account for 15%-20% maternal and 20%-25% perinatal mortality. There is interest in predicting preeclampsia (PE) early in pregnancy to reduce PE and its subsequent complications. There is no cheap and easily available, reliable predictor for PE. Some studies have shown that the lateral location of placenta is associated with adverse pregnancy outcomes due to PE. The lateral placenta is yet to be proven as a strong predictor of PE to initiate preventive measures. Placental localization can be easily done on routine ultrasonography during pregnancy. In the light of these observations, a prospective study was done to study any association between PE and placental location by ultrasound in third trimester. Research Question: Is there any association between placental location on ultrasound and preeclampsia in third trimester? The objective is to study association between location of placenta and preeclampsia and compare placental location in normotensive pregnancies with that in PE in third trimester. A prospective comparative, case-control, observational study was conducted in the Department of Obstetrics and Gynecology at North DMC Medical College and Hindu Rao Hospital, Delhi, India, from August 2019 to April 2020. The study population included 200 pregnant women with singleton pregnancy in third trimester, without any medical disorders such as diabetes mellitus, hypertension, renal disease, cardiac disease, and coagulation disorder or smoking. One hundred women had preeclampsia and 100 were normotensive controls. Ultrasound was done after filling F form as per the Government of India guidelines to rule out sex determination, and placenta was localized by ultrasound. Placenta was classified as central when it was equally distributed between the right and left sides of the uterus irrespective of anterior, posterior, or fundal position and lateral when 75% or more of the placental mass was on one side of the midline. Placental location was compared in hypertensive and normotensive pregnancies. Out of the total 200 women, 152 (76%) had central and 48 (24%) had lateral placenta. Ninety-two percent of controls and 60% of cases had central placenta. Forty percent of cases and only 8% normotensive women had lateral placenta. Lateral placenta was five times more frequent in presence of PE as compared to normotensive controls. Out of 152 women with central placenta, 92 (60.5%) women were normotensive but with lateral placenta, only 8 (16.7%) had normal blood pressure. PE was present in 83% of women with lateral placenta and in only 39.47% with central placenta. This difference was statistically significant as P < 0.0001 as per Chi-square test. This reflects a significant association between lateral position of placenta and occurrence of PE. As per odds ratio (0.1304) patients without lateral placenta had 90% protection against preeclampsia. Central placenta is more common than lateral placenta. Lateral placenta is seen five times more frequently among hypertensive women and this difference is statistically significant. The absence of lateral placenta provides 90% protection against PE but the severity of PE was not affected by placental location..

Calcium supplementation dose and vegetable intake determine preeclampsia

Preeclampsia is one of the cause of high maternal mortality rates. Risk factors for preeclampsia include a lack of nutrients such as vitamin A, calcium, sodium and potassium. Calcium intake in pregnant women is not only obtained from calcium supplementation, but also obtained from consumed foods such as vegetables. to analyzed the relationship between calcium supplementation dose and vegetable intake with preeclampsia in third trimester of pregnant women. observational analytic used a prospective cohort design. A total of 65 third trimester pregnant women participated in the study in Bantul, Yogyakarta. The calcium supplementation dose was obtained through interview using a questionnaire, while vegetable intake was obtained through the food frequency and food recall 2x24 hours. 16 third trimester pregnant women experienced preeclampsia. The mean calcium dose consumed per day was 476.2 mg. The average intake of vegetables per day for pregnant women was 250.9 gr. Kaplan-Mier with the log rank method states that there was a significant difference between calcium supplementation dose (p=0.007) and preeclampsia. There was a significant difference between vegetable intake (p=0.007) and preeclampsia. there was a significant relationship between calcium supplementation dose and vegetable intake with preeclampsia in third trimester pregnant women.

Thyroid Hormones Pattern in Preeclampsia.

Objectives: To assess thyroid hormones pattern in preeclampsia in third trimester, in our Pakistani population (Punjab). Methods| It was a Comparative cross- sectional study. Thyroid hormones; namely thyrotropin (TSH), Total triiodothyronine (tT3), free triiodothyronine (fT3), Total thyroxine (tT4) and free thyroxine (fT4) were evaluated by enzyme linked immunoassay (ELISA) in 17 diagnosed preeclamptic subjects with 16 number of matched normotensive pregnant subjects. Data was entered in the form of a questionnaire and analyzed by using version SPSS 17. Results| In this study the mean TSH concentration was 100% higher in preeclamptic subjects as compared to normotensive pregnant subjects, whereas Mean of tT3, tT4, fT3 and fT4were lower when compared between healthy normotensive pregnant and preeclamptic women but no significant difference was seen between both the groups. Conclusion| This study shows statistically non-significant increase in TSH levels and decrease in total and free T3 and T4 levels of PE as compared to the normotensive pregnant subjects.

Role of Calcium in Hypertensive Disorders of Pregnancy Current Status of Research a Mini Review

Introduction: Some studies have revealed changes in blood/urinary calcium with inverse relationship between calcium intakes during pregnancy, incidence of preeclampsia. So researchers believe that calcium has a role in etiology of hypertensive disorders during pregnancy. With reduced incidence of preeclampsia after calcium supplementation. So prevention of HDsP and/or their severity are being attempted through oral calcium. Objective: To collect existing information about role of calcium in HDsP for translational program or if needed, research. Material Methods: Present article is based on literature search by available search engines like, Pubmed, Google, Update and others. Studies, reviews and short commentaries were looked into to get desired information. Serum urinary cellular calcium: Normally there is increase in intracellular calcium in pregnancy. It has been reported that this effect is exaggerated in preeclampsia due to significant increase in the membranous calcium content. Researchers also reported that preeclampsia in third trimester was associated with hypocalciuria due to increased tubular reabsorption of calcium. Urinary calcium excretion has been found to be reduced in severe preeclampsia, eclampsia, but decrease could not be used to identify severity of preeclampsia, or predict impending eclampsia. Problem seems to be at the cellular level, needs to be investigated further. Calcium supplementation: Some have reported incidence of preeclampsia greater in women given placebo, compared to calcium-treated, although difference was not significant. Also supplementing calcium in women at high risk of pre-eclampsia was likely to reduce incidence of disease. But others reported that extra calcium did not reduce number of women who suffered, however reduced severity of HDsP. Also smooth-muscle relaxation detected in calcium supplemented women might affect labour onset. Conclusion: There are reports of positive relationship and no effect on reduction in HDsP or their severity. In view of contradictory findings, in depth studies are required to investigate altered serum, urine and cellular calcium, in women with HDsP.

Utility of uterine artery Doppler and pulsatility index at 11-14 weeks of normal pregnancy in prediction of preeclampsia in third trimester

Introduction: Preeclampsia affects 5-8% of women in pregnancy and leading cause of maternal mortality. The present study was done to predict the development of preeclampsia in patients with uterine artery pulsatility index (PI) >1.71 and the presence of diastolic notch at 11-14 weeks of gestation belonging to low risk population. Methods: Women attending routine antenatal care were offered an early transvaginal ultrasound scan between 11-14 weeks including uterine artery doppler assessment. Mean PI and presence or absence of bilateral early diastolic notch was also noted. All patients were followed up to term for the development of preeclampsia. Results: Out of 100 patients, 22% developed preeclampsia of which 15 (68.18%) cases showed the presence of diastolic notch and 12 (54.54%) cases had PI >1.71 (p 1.71 (p 140mm of Hg at 11-14 weeks of gestation developed preeclampsia (p<0.05). Conclusion: Presence of diastolic notch and PI of >1.71 in uterine artery colour doppler at 11-14 weeks of gestation serves as a good predictor of preeclampsia at term, in pregnancies with no other associated risk factors.

Mineral levels in Women with Pre-Eclampsia in Third Trimester of Pregnancy

Background: Preeclampsia, a systemic illness of late pregnancy seen in approximately 6% of prim-igravid women, is an important cause of maternal and fetal morbidity. The levels of calcium and magnesium in pregnancy may implicate in the possible role in pregnancy induced hypertension (PIH). This study as-sessed serum Ca2+, Mg2+, Na+ and K+ levels in women with PIH. Materials and Methods: We evaluated se-rum potassium, sodium, magnesium and calcium levels in 100 normal pregnant women and 100 women with pre-eclampsia. Result: We found elevated serum potassium levels and reduced calcium, sodium and magnesium levels in pregnant mothers with preeclampsia. Conclusion: Lowered plasma or serum magnesi-um concentrations in pre-eclampsia may contribute to the development in hypertension in pregnancy. In addition, a disturbed Calcium homeostasis is observed in pre-eclampsia. Keywords: Pre-eclampsia, PIH, calcium, magnesium, sodium, potassium

Second Trimester Maternal Serum Cystatin C Levels in Preeclamptic and Normotensive Pregnancies: A Small Case-Control Study

Background/Aims: Cystatin C (CC) is a marker of glomerular filtration rate (GFR) and is elevated in cases of established preeclampsia (PE). It also has widespread presence in extracellular space and high levels in PE might reflect placental ischemia. The aim of this study was to measure CC levels in the second trimester in women who subsequently develop PE and in those who remained normotensive. Methods: Maternal serum taken at time of the anomaly scan from 15 women was analysed for CC and creatinine levels. Six women later developed PE and 9 remained normotensive. Results: Cystatin C levels were significantly higher in women who developed preeclampsia (mean value 0.76 vs. 0.53 mg/L, p = 0.008). However, creatinine levels showed no statistical difference (mean value 76.1 vs. 65.5 umol/L, p = 0.066). The range of CC was 0.41–0.55 mg/L in normotensive pregnancies and 0.50–1.26 mg/L in pregnancies with PE. Conclusion: This small observational study showed that serum CC is raised as early as the second trimester in women who subsequently develop PE in third trimester. Larger studies are needed to evaluate the potential role of CC as an early marker for the prediction of PE.

Raised Serum TNF-Alpha, Blood Sugar and Uric Acid in Preeclampsia in third Trimester of Pregnancy

In preeclampsia, insulin resistance occurs but the exact cause is unknown. It is uncertain whether women destined to develop preeclampsia have preexisting insulin resistance or it is acquired with the development of the disease. Fasting blood samples were collected from 10 normal control pregnant women and from 30 cases of preeclampsia in the third trimester of pregnancy to measure circulating level of glucose, uric acid and tumor necrosis factor-alpha (TNF) concentrations. Preeclampsia was diagnosed as per standard guideline adapted from national high blood pressure education program working group. In control group (n=10) mean age was 25+/-3.71 years, mean sugar level was 86.73+/-13.06 mg/dl, uric acid level was 3.25+/-+/-.59 mg/dl and TNF-alpha level was 9.93+/-9.56 pg/dl. In preeclampsia group mean age was 25.56+/-3.96 years, mean sugar level was 93.46+/-18.6 mg/dl, uric acid was 6.00+/-1.64 mg/dl and TNF-alpha level was 67.66+/-61.83 pg/dl. Statistical analysis done using Kruskal Wallis's test showed significantly raised levels of TNF-alpha (p<0.001), uric acid (p<0.001) and blood sugar (p=0.201) in preeclampsia cases. In preeclampsia there was positive significant correlations of raised TNF-alpha with uric acid (p<0.005). Spearman's test for correlation showed positive correlation of TNF-alpha with blood sugar (p<0.043) in cases of preeclampsia. The findings suggest the involvement of cytokines (TNF-alpha) in preeclampsia and may have a role in gestational diabetes mellitus and insulin resistance. In the present study, there was positive association of raised level of TNF-alpha with blood sugar / and uric acid levels.

Platelet specific protein (?-thromboglobulin and platelet factor 4) in normal pregnancy and in pregnancy complicated by preeclampsia

Pregnancy is accompanied by significant alterations of platelet function. Platelet activity can be determined by measurement of plasma levels of secreted platelet proteins. In this study we determined plasma levels of beta-Thromboglobulin (beta-TG) and Platelet Factor 4 (PF4) simultaneously in 35 women with uncomplicated pregnancy and in 15 patients with preeclampsia in third trimester of gestation. Additionally, PF4 plasma levels were measured using a commercially available Radio Immunoassay (RIA) and an Enzyme Immunoassay (EIA) simultaneously and values obtained were compared. Platelet count and creatinine were in the normal range in both groups; however, significantly higher levels of beta-TG (P less than 0.0005) and PF4 (P less than 0.0001) were found in case of preeclampsia. High levels of platelet proteins emphasize the active role of the platelets in the alterations of hemostasis in cases of preeclampsia.