Pregnancy Induced Hypertension Cases Research Articles

A comparative study of serum lipids and lipoprotein- A levels of women with pregnancy induced hypertension (PIH) and normotensive pregnant women

Hypertensive disorders complicating pregnancy is the one of the most common medical problem of pregnancy. Worldwide, hypertensive disorders in pregnancy causes complication in about 10 -16% of pregnancies. High blood pressure in pregnant women is related with incidence of large placental infarct and decreased placental growth resulting in intra uterine fetal growth restriction and intrauterine death. Hypertension in pregnancy is diagnosed when blood pressure is 140/90 mm of hg or greater with proteinuria and edema after 20 week of gestation. Plasma lipid and lipoprotein (a) undergo both qualitative and quantitative changes during pregnancy. During the course of normal pregnancy, plasma triglycerides and cholesterol concentration rises by 200-400% and 25-50% respectively. An abnormal lipid profile is known to be strongly associated with atherosclerotic changes and has direct effect on endothelial dysfunction. In preeclampsia women, thromboxane rise more than in normotensive pregnant women. Increased lipid synthesis causes increase in PGI2:TXA2 ratio and plays a role in pathogenesis of pregnancy induced hypertension (PIH), hence the hyperlipidemia may be an important marker of toxemia of pregnancy.To asses and compare the serum levels of lipid and lipoprotein (a) in pregnant women with PIH and normotensive pregnant women.A study conducted on total of 100 pregnant patients (50 cases and 50 controls) selected according to inclusion and exclusion criteria. 3ml of venous blood was drawn to estimate the Serum Cholesterol, Serum Triglycerides, Serum HDL, Serum LDL, Serum VLDL, Serum Lipoprotein (a) levels in each subject. The data was analyzed results were expressed as Mean and standard deviation of various parameters in different group. P value < 0.05 is considered as significant. ROC curve analysis was done to assess maximum sensitivity, specificity and diagnostic efficiencyIn our study the mean ±SD values of total cholesterol, triglycerides, LDL, VLDL, Serum Lipoprotein (a) are statistically significant higher in PIH cases whereas HDL levels are low in cases when compared to controls.A high lipid profile levels is observed to be associate with preeclampsia thus, serum lipid concentration and serum Lipoprotein (a) levels may provide a useful marker for screening patients at risk for developing PIH.

Gross Changes of Placenta in Pregnancy Induced Hypertension and its Clinical Relevance: A Cross-sectional Study

Introduction: Placenta establishes connection between mother and foetus through umbilical cord. Pregnancy Induced Hypertension (PIH) is one of the most common complication of pregnancy. Gross study of placenta in PIH gives an insight into prenatal health of baby and mother, thereby preventing maternal as well as foetal morbidity and mortality. Aim: To study the gross changes of placenta in PIH cases with its clinical relevance. Materials and Methods: A prospective cross-sectional study was done at tertiary care hospital of Osmania and Gandhi Medical College, Telangana, India. The study was carried over for a period of six months (from October 2019 to March 2020) with a sample size of 50 placentae in PIH mothers aged between 20-35 years who were inpatients at the Obstetrics Department. They were followed until delivery. Postdelivery, the gross anatomy of the collected placentas was studied. Varied parameters of placenta, data of newborn and clinical picture of mother were compared with normal standards and statistically analysed by using Unpaired t-test. Results: Significant reduction of mean placental weight and mean foetal weight (p-value<0.0001) and significant increase in foetoplacental weight ratio was found. There was an average reduction of number of cotyledons by 23% in PIH cases when compared to normal placentae. An incidence of mean infarct areas of 9.6 and mean calcified areas of 13 were found on the maternal surface of placenta in PIH. An incidence of 68% of marginal type of placenta was observed in patients with PIH. Clinically, incidence of headache, pedal oedema, convulsions, visual disturbances and proteinuria were found. Conclusion: Gross study of placenta in PIH reflects maternal and foetal status and can be taken as confirmative evidence by radiologists to prevent Intra Uterine Growth Retardation (IUGR) and guide obstetricians during management of pregnant mother with PIH. Thereby, preventing the maternal and foetal morbidity and mortality.

Retinal vascular disorders during pregnancy: An observational study

Aim: To determine the prevalence and pattern of retinal vascular disorders in pregnant women. Materials and Methods: This hospital based, prospective observational study was conducted over a period of two years. Patients were selected from outpatient department and antenatal ward of Department of Obstetrics and Gynecology and outpatient department of Ophthalmology, SS Hospital, IMS, BHU, Varanasi. In all cases detailed obstetric history including age, gravida, gestational age, general and antenatal examination and relevant pathological investigations like blood sugar, blood urea, serum creatinine and urinary protein were carried out. After taking ocular history, detailed ocular examination including visual acuity and fundus examination under mydriasis with 1% tropicamide eye drop was carried out. All the findings were recorded on a data sheet and were analyzed using SPSS programme. The Chi-Square test was used to evaluate the association between the various antenatal factors and retinal vascular changes. Results: Of 210 patients 38.09% patients were primigravida and 28.57% were second gravida. 28.57% had pregnancy induced hypertension (PIH), 13.33 % had gestational diabetes mellitus, 12.38% had preexisting diabetes mellitus. Fundus abnormalities were observed in 110 (52.38%) cases among them commonest retinal pathology was hypertensive retinopathy 38 (34.55%) followed by diabetic retinopathy (32.73%), retinal vein occlusion (16.36%) and central serous chorioretinopathy (7.27%). Out of 60 cases of PIH 38 (63.33%) had retinal abnormalities. Retinal vascular disorders were seen in > 80% cases of severe pre-eclampsia and about 90% cases of eclampsia. Majority (68.42%) of PIH patient had grade I hypertensive retinopathy. The commonest retinal change was arterial attenuation (28.57%) followed by dot and blot hemorrhage (21.90%), A-V crossing changes (20.48%), hard exudates (19.05%), flame shaped hemorrhage (42.56%) and macular edema (18.10%). However in 5.71% cases papill

Hypo-magnesium and Hyperlipidemia Responsible for Hypertensive Status of Pregnant Women in Pakistani Population

Background/ Aim: Pregnancy induced hypertension (PIH) has been a leading cause of maternal mortality worldwide. It could be responsible for several complications like hemodilution, altered lipid metabolism and deficiencies of different minerals in body. Although the causes of Pregnancy induced hypertension (PIH) remains indistinct. The aim of our present study was to evaluate the changes in magnesium serum levels and lipid profile in hypertensive and normotensive pregnant women.
 Materials and Methods: An analytical case control study comprising 60 individuals was designed. From which 30 normotensive pregnant women served as control group (A) and 30 pregnancy induced hypertensive women served as case group (B). Patients with pre-existing hypertension were excluded.
 Results: The independent t-test was used for comparison of various parameters between group A and B. Triacylglycerol (TAG) and low density lipoprotein cholesterol (LDL-C) levels were significantly high in PIH (B) as compare to normotensive group (A). Mean serum values of TG were measured as (195.73 ± 70.28 vs 156.27 ± 55.60 mg dL-1) and LDL-C vs control (87.33 ± 37.74 vs 69.45 ± 28.58 mg dL-1) in PIH and normotensive groups respectively. HDL-C in PIH vs Control (47.40±1.12 vs 54.43 ±1.27 mg dL-1) and Mg+2 PIH vs control (1.36±0.07 vs 1.94±0.35 mg dL-1) were measured respectively. High density lipoprotein cholesterol (HDL-C) and magnesium Mg+2 levels were significantly reduced in PIH.
 Conclusion: The lower serum magnesium levels and abnormal lipids profile may indicate their possible role as risk factors in the development of PIH in pregnant women. Hence initial diagnosis of hypomagnesemia in PIH cases may help in minimizing the complications and development of new cure strategies.

An application of multiple logistic regression for identifying lipid profile changes towards assessing maternal and fetal outcomes

Background: The millennium development goals encourage governments to address and reduce various developmental issues, two of the important ones being maternal and child health. The one of the important causes of maternal mortality in India is pregnancy induced hypertension (PIH) and present study is to identify the relationship between disturbed lipid profile and preeclampsia its effect on fetal and maternal outcome.Methods: This was a descriptive cross-sectional study done on data of maternal care and outcomes from the NRI General Hospital, Guntur district in the year 2013. Multiple logistic regression analysis is applied and results are adjusted to covariates maternal age and gravida.Results: Systolic blood pressure, diastolic blood pressure of normal group (n=50) and PIH group (n=60) are 116.08±7.77, 76.08±4.93, and 165.66±16.8 105.5±14.07 respectively. Birth weights of infants in normotensives and PIH group are 2.85±0.33 and 1.93±0.659 respectively. Percentages of fetal and maternal complications in PIH group are 88.33% and 25%. Still births are present in 31.66% of PIH cases. Mean and SD of gestational age in weeks in normal and PIH groups are 37.92±1.94 and 34.36±3.44 respectively.Conclusions: The model showed significant association between the selected independent variable, covariates and outcomes. The study demonstrates that multiple logistic regression may be applied to medical data in developing predictor models which are useful in clinical settings.

The Influence of Various Smoking Categories on The Risk of Gestational Hypertension and Pre-Eclampsia.

The relationship between smoking and the risk of pregnancy-induced hypertension (PIH) is not clearly established. Therefore, we conducted an analysis of cigarette smoking in a Polish cohort of women, recruited in the first trimester of a single pregnancy in 2015–2016. We evaluated the women who subsequently developed PIH (n = 137) (gestational hypertension—GH (n = 113) and pre-eclampsia—PE (n = 24)), and the women who remained normotensive (n = 775). The diseases odds ratios (and 95% CI—confidence intervals) were calculated in a multivariate logistic regression. In the PIH cases (vs. normotensive women) we found more smokers (25.6% vs. 17.2%, p = 0.020) including smokers in the first trimester (14.6% vs. 4.8%, p < 0.001). The average number of cigarettes smoked daily per smokers in the first trimester was 11.2 (range 2–30), and the average number of years of smoking was 11.6 (range 2–25). The number of years of smoking was a stronger risk factor for GH and PE than the number of cigarettes/day. Compared to the women who have never smoked, smoking ever before pregnancy was associated with a higher GH risk (AOR = 1.68; p = 0.043), and with no effect on PE risk (OR = 0.97; p = 0.950). Smokers in the first trimester had a higher odds ratio of GH (AOR = 4.75; p < 0.001) and PE (OR = 2.60; p = 0.136). Quitting smoking before pregnancy (ex-smokers) was associated with a lower odds ratio of GH (AOR = 0.83; p = 0.596) and PE (OR = 0.33; p = 0.288). However, quitting smoking during pregnancy was associated with a higher risk of GH (AOR = 11.63; p < 0.0001) and PE (OR = 3.57; p = 0.238). After dissection of the cohort into pre-pregnancy body–mass index (BMI) categories, smoking in the first trimester was associated with the higher hypertension risk in underweight women (OR = 22.00, p = 0.024). Conclusions: The factors that increased the risk of GH and PE were smoking in the first trimester and (paradoxically and more strongly) smoking cessation during pregnancy. Our results suggest that women of childbearing potential should be encouraged to quit smoking before pregnancy.

Fetomaternal Outcome in Women with Pregnancy Induced Hypertension versus Normotensive Pregnancy

A hypertensive disorder in pregnancy comprises one of the deadly triad along with hemorrhage and infection-that contributes greatly to maternal morbidity and mortality. The aim of this study was to compare the feto-maternal outcome in pregnancy induced hypertension with normotensive pregnant women. A cross sectional prospective study was conducted in Paropakar Maternity and Women's Hospital from 1st February 2018 to 1st May 2018. All pregnant women seeking help for hypertension during this period was included in the study and were followed up to six weeks of postpartum period. Total 40 patients were enrolled in each arm. The highest number of pregnancy induced hypertension cases was seen in age group 20-24years (32.5%) and were mostly primigravidas (60%). The commonest symptom in Pregnancy induced hypertension was headache 47.5 %. The mean hemoglobin value was 11.91 gm/dl, mean SGPT (Gestational hypertension 25.44 IU/L, preeclampsia 55.25 IU/L and eclampsia 32.17 IU/L) and mean platelet count was 1, 95,140 lakh/cumm in pregnancy induced hypertension. Mean prothrombin time in gestational hypertension was 13.78±0.7 seconds. Most common maternal complication was preterm labor and fetal complication was prematurity. The most common mode of delivery was vaginal. Pregnancy induced hypertension was more common in primigravida with young age group of 20-24 years and presented commonly with complain of headache. Preterm labor was the most common maternal complication similarly prematurity was the commonest fetal complication seen in pregnancy induced hypertension. Vaginal delivery was the commonest mode of delivery. Blood investigation showed significant thrombocytopenia in eclampsia and decreased prothrombin time in gestational hypertension.

Association of circulating saturated fatty acids with the risk of pregnancy-induced hypertension: a nested case–control study

Circulating saturated fatty acids (SFAs) have been associated with cardiovascular disease. However, little is known about the relationship of SFAs with the risk of pregnancy-induced hypertension (PIH). We conducted a nested case-control study to examine the associations between circulating SFAs and the risk of PIH. A total of 92 PIH cases were matched to 184 controls by age (±2 years) and infant sex from a birth cohort study conducted in Wuhan, China. Levels of circulating fatty acids in plasma were measured using gas chromatography-mass spectrometry. Conditional logistic regressions were conducted to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). Even-chain SFAs, including myristic acid (14:0) and palmitic acid (16:0), were positively associated with the risk of PIH [ORs (95% CIs): 2.92 (1.27, 6.74) for 14:0 and 2.85 (1.18, 6.89) for 16:0, % by wt]. In contrast, higher levels of very-long-chain SFAs, including arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0), were associated with a lower risk of PIH [ORs (95% CIs): 0.40 (0.17, 0.92) for 20:0, 0.30 (0.12, 0.71) for 22:0 and 0.26 (0.11, 0.64) for 24:0, μg/mL]. For odd-chain SFAs, including pentadecanoic acid (15:0) and heptadecanoic acid (17:0), no significant difference was observed. Our results provided convincing evidence that different subclasses of SFAs showed diverse effects on the risk of PIH. This suggests that dietary very-long-chain SFAs may be a novel means by which to prevent hypertension. Future studies are required to confirm these associations and elucidate the underlying mechanisms.

Prognostic significance of liver function tests and platelet indices in predicting maternal and fetal outcomes in pregnancy induced hypertension cases

Prognostic significance of liver function tests and platelet indices in predicting maternal and fetal outcomes in pregnancy induced hypertension cases

Placental pathology in different degrees of pregnancy induced hypertension

Introduction: Pregnancy induced hypertension (PIH), a well-known medical complication of pregnancy is potentially morbid for the foeto-maternal health. It is also responsible for perinatal morbidity and mortality due to its effects on the growing foetus. Objectives: The present study was undertaken to analyse the histomorphological and gross features of placenta in pregnancy induced hypertension in relation to severity of hypertension, age of the patient, parity and gestational age. Materials and Methods: The current study was done at Gandhi Hospital, Secunderabad, India on antenatal cases of PIH of varying degrees. The placentas of these patients following delivery were studied and statistic significance between different histologic findings and severity of PIH calculated. Results: Incidence of PIH was highest in women above 26yrs of age (42%) and was found to be almost equal in both multiparous (52%) and primiparous (48%) women. Foetal outcome was worst in severe PIH (IUGR of 28.8% and IUD of 17.85%). The gross abnormalities noted, retroplacental hematomas (42%) and small sized placentae (24%) were more often seen in severe PIH. The consistent histological changes observed include fibrinoid necrosis (86%), thickened basement membrane (74%), increased syncitial knots (72%), stromal fibrosis (54%), cytotrophoblastic proliferation (46%), intervillous haemorrhage (40%), and calcification (34%). Conclusion: The pathological changes in the placenta seen in PIH patients are almost equally prevalent irrespective of the parity. Cases with severe PIH displayed features of placental underperfusion more frequently than with mild to moderate PIH. Hence watchful individualized management of PIH helps reduce the incidence of complications and morbidity.

Placenta-specific epimutation at H19-DMR among common pregnancy complications: its frequency and effect on the expression patterns of H19 and IGF2

BackgroundH19 and IGF2 genes are imprinted and involved in regulating fetal and placental growth. The H19 differentially methylated region (DMR) is paternally methylated and maternally unmethylated and regulates the imprinted expression of H19 and IGF2. Epimutation at the H19-DMR in humans results in congenital growth disorders, Beckwith-Wiedemann and Silver-Russell syndromes, when erroneously its maternal allele becomes methylated and its paternal allele becomes unmethylated, respectively. Although H19 and IGF2 have been assessed for their involvement in pregnancy complications including fetal growth restriction (FGR) and pregnancy-induced hypertension (PIH)/hypertensive disorder of pregnancy (HDP) intensively in the last decade, it is still not established whether epimutation at the H19-DMR in the placenta results in pathogenic conditions in pregnancy. We aimed to assess the frequency of H19-DMR epimutation and its effects on the allelic expression patterns of H19 and IGF2 genes among normal and abnormal pregnancy cases.ResultsWe enrolled two independently collected sets of placenta samples from normal pregnancies as controls and common pregnancy complications, FGR and PIH (HDP). The first set consisted of 39 controls and 140 FGR and/or PIH cases, and the second set consisted of 29 controls and 62 cases. For these samples, we initially screened for DNA methylation changes at H19-DMR and IGF2-DMRs by combined bisulfite restriction analysis, and further analyzed cases with methylation changes for their allelic methylation and expression patterns. We identified one case each of FGR and PIH showing hypomethylation of H19-DMR and IGF2-DMRs only in the placenta, but not in cord blood, from the first case/control set. For the PIH case, we were able to determine the allelic expression pattern of H19 to be biallelically expressed and the H19/IGF2 expression ratio to be highly elevated compared to controls. We also identified a PIH case with hypomethylation at H19-DMR and IGF2-DMRs in the placenta from the second case/control set.ConclusionsPlacental epimutation at H19-DMR was observed among common pregnancy complication cases at the frequency of 1.5% (3 out of 202 cases examined), but not in 68 normal pregnancy cases examined. Alteration of H19/IGF2 expression patterns due to hypomethylation of H19-DMR may have been involved in the pathogenesis of pregnancy complications in these cases.

Histopathological study of placental changes associated with pre-eclampsia and eclampsia in a tertiary care centre of Puducherry

Histopathological study of placental changes associated with pre-eclampsia and eclampsia in a tertiary care centre of Puducherry - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/2456-9267.2019.0009, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

Thrombocytopenia in Pregnancy Induced Hypertension

Introduction Hypertension is a common clinical complication during pregnancy. About 18% of foetal deaths are associated with hypertensive disorders. Out of all the haematological changes that occur in Pregnancy Induced Hypertension (PIH), thrombocytopenia is the most common haematological abnormality found. Material & Method Study subjects include 70 women with diagnosed PIH (case) and 70 normotensive pregnant women (control). Platelet count was done. Result In PIH cases the low platelet count was seen as compared to normotensive pregnant women. In this study between mean blood pressure & platelet count no correlation was found in normotensive pregnant women but significant negative correlation was found in PIH. Conclusion We found significant negative correlation between mean blood pressure & platelet count in PIH.

Evaluation of diastolic left ventricular energy loss in patients with pregnancy-induced hypertension using vector flow mapping

Objective To quantify the diastolic average energy loss (EL) of left ventricle in patients with pregnancy-induced hypertension (PIH) by vector flow mapping (VFM) technique and explore the clinical significance of EL in evaluating left ventricular diastolic function in patients with PIH. Methods Fifty-seven cases of singletonic PIH in late pregnancy (PIH group) and 38 cases of the third trimester normal singleton pregnancy (control group) were enrolled in this study. VFM were used to analyze the total average energy loss (ELt) and average energy loss at the basal level (ELb), the papillary muscle level (ELp), and the apical level (ELa) in isovolumic relaxation, rapid filling, mid-diastol and atrial systole phases, and the differences between the two groups were compared. The correlation between ELt and E/e in both groups were analyzed. Results In PIH group, ELt, ELb, ELp and ELa in the mid-diastolic and atrial systolic phases were significantly higher than those in control group (all P<0.01); ELt, ELp, ELa in isovolumic diastolic phase and ELt, ELb and ELa in fast filling phase were higher than those in control group (all P<0.05). There was a positive correlation between ELt and E/e in isovolumic diastolic phase, rapid filling phase and atrial systolic phase in PIH group (r=0.326, 0.386, 0.403; all P<0.05). There was a positive correlation between the ELt of fast filling and atrial systolic phases and E/e in control group (r=0.498, 0.371; all P<0.05). Conclusions Increased left ventricular diastolic flow EL in PIH patients reflects the abnormal intraventricular hemodynamic changes, and it is related to left ventricular diastolic function parameters for the quantitatively evaluation of PIH patients, and might be feasible to reveal the extent and mechanism of left ventricular diastolic dysfunction. Key words: Vector flow mapping; Pregnancy-induced hypertension; Ventricular function, left; Energy loss

Histopathological findings of pregnancy-induced hypertension: histopathology of early-onset type reflects two-stage disorder theory.

The placental tissues of pregnancy-induced hypertension (PIH) patients exhibit multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. However, these findings are not observed in all cases of PIH; thus, the significance of these changes in PIH is still unclear. We studied the frequency of histopathological changes of placental tissue in the subgroups of PIH, such as mild and severe PIH and early-onset (< 34weeks) and late-onset (≥ 34weeks) PIH. One hundred seven cases of PIH diagnosed at the Shinshu University Hospital, Matsumoto, Japan, between 2008 and 2014 were collected. PIH includes preeclampsia and gestational hypertension. The pathologic changes evaluated in the placenta were multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. Placental tissues of patients with early-onset PIH demonstrated acute atherosis resulting from the incomplete remodeling of the spiral arteries and distal villous hypoplasia and increased syncytial knots reflecting placental hypoxia/ischemia much more frequently than those with late-onset PIH (all p < 0.001). The frequencies of multiple infarctions did not show a statistical difference between early-onset PIH and late-onset PIH. Moreover, there were no significant differences in the frequencies of histopathological features of placental tissue between mild PIH and severe PIH. Early-onset PIH exhibited histopathological changes of placental tissue consistent with the two-stage disorder theory more frequently than late-onset PIH. These findings support the idea that early-onset PIH and late-onset PIH are distinct entities or different extremes of the PIH spectrum.

COMPARATIVE STUDY OF CORD BLOOD HEMATOLOGICAL PROFILE OF NEONATES BORN TO MOTHERS WITH AND WITHOUT PREGNANCY-INDUCED HYPERTENSION: A PROSPECTIVE CASE–CONTROL STUDY

Background: The neonates born to mothers with pregnancy-induced hypertension (PIH) are prone to have abnormalities in their umbilical cord blood hematology. However, the exact pattern of the derangements and their clinical correlations has not been defined. Objectives : The purpose of this study is to compare the hematological profile of cord blood of neonates born to mothers with and without PIH (gestational hypertension, pre-eclampsia, and eclampsia), and to evaluate short-term clinical outcomes in the two groups. Methods: A prospective case–control study was done on cord blood of 155 neonates born to mothers with PIH (cases) and compared with that of 155 neonates born to normotensive mothers (controls). 2 ml cord blood was collected at birth and was analyzed for - hemoglobin (Hb), various red cell indices including nucleated red blood cell (NRBC), reticulocyte count, total leukocyte count (TLC), differential leukocyte count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet count, and cord blood smear examination. The cases and controls were followed up during their hospital stay for the clinical outcome. Results: The mean red cell distribution width, NRBC, and reticulocyte count in cases were 14.64±2.14%, 11.18±2.33/100 white blood cells (WBCs) and 5.18±0.49% as compared with 11.84±0.78%, 4.32±1.32/100 WBCs, and 3.83±3.59% in controls (p 1 (1.64), with a significant increase in mortality as compared to controls. Conclusions: PIH increased the RR of sepsis (although not significantly) and mortality rate in the neonate, which can be related to cord blood hematological profile findings of leukopenia, absolute neutropenia, and thrombocytopenia, and increased NRBC count.

Influence of serum HMW adiponectin level in patients with pregnancy-induced hypertension syndrome on the occurrence of eclampsia in secondary pregnancy.

In the present study, we studied the influence of serum high-molecular weight adiponectin (HMWA) levels in patients with pregnancy-induced hypertension (PIH) on the occurrence of eclampsia in secondary pregnancy and its related mechanisms. In total, 130 patients who were diagnosed with PIH for the first time were selected for this study; the median interval of the secondary pregnancy was 28.5 months. The serum HMWA and leptin levels both times were detected, and the insulin resistance indexes (HOMA-IR) were calculated. The serum inflammatory indexes in the secondary pregnancy included interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and the oxidative stress indexes included methane dicarboxylic aldehyde (MDA) and oxidized low-density lipoprotein (ox-LDL) levels. The expression levels of adiponectin receptor 2 and cyclooxygenase-2 (COX-2) in placental tissue were detected. In secondary pregnancy, there were a total of 20 cases of eclampsia (15.38%), including 2 cases of mild PIH, 8 cases of moderate PIH and 10 cases of severe PIH; differences were statistically significant when compared to patients without eclampsia (p<0.001). The serum HMWA levels in patients with severe PIH in the first pregnancy were significantly lower than those in patients with mild and moderate PIH, and the serum levels in patients with mild PIH were the highest. The leptin levels in patients with severe PIH were significantly higher than those in patients with mild and moderate PIH, and the leptin levels in patients with mild PIH were the lowest (p<0.05). The HMWA levels in patients with eclampsia in the secondary pregnancy was significantly lower than those in patients without eclampsia, and the leptin levels in patients with eclampsia were significantly increased. The HMWA levels in patients with eclampsia in the secondary pregnancy were lower than that in the first pregnancy, whereas the leptin levels were higher than that in the first pregnancy (p<0.05). HOMA-IR, IL-6, TNF-α, MDA and ox-LDL levels in patients with eclampsia were significantly higher than those in patients without eclampsia (p<0.05), and the adiponectin receptor 2 and COX-2 expression levels in the placental tissue were significantly higher than those in patients without eclampsia (p<0.05). Therefore, the serum HMWA levels are closely related to the occurrence of eclampsia in PIH patients in secondary pregnancy, and it influences insulin resistance, inflammatory response and oxidative stress response, which is correlated with increased adiponectin receptor 2 and COX-2 protein expression in placental tissue. Consequently, HMWA may be an important target for the intervention of preventing eclampsia for PIH patients in secondary pregnancy.

The effect of Preeclampsia on some biochemical parameter

This survey research to identify the effect of preeclampsia, alterations in renal function, electrolyte and water metabolism are common findings. To evaluate the usefulness of urine calcium and phosphorus levels as a marker of severity in preeclampsia. Our study was carried at the Hospital of Maternity and pediatrics in Aldiwanyia city from 1/1-30/6 -2011 . The total number of all cases 96, among them 20 women with normal pregnancy , 25 cases with hypertension , 20 cases with mild preeclampsia , 31 cases with sever preeclampsia .Every patient was send for urinary calcium and phosphate were determined by the Kramer-Tisdall and phosphomolibidic acid method, respectively. In the Results There was significant decrease in excretion of calcium and phosphorus in sever preeclampsia[p&lt; 0.001,p&lt; 0.01] respectively as a result of decrease glomerular filtration rate. While in mild cases and pregnancy induced hypertension cases there’s no significant change.Conclusion: Urine calcium and phosphorus level is significant determinant of severity of preeclampsia and may be considered as usefulness marker for predicting the level of renal impairment.

OP 18 Comparing the sflt-1/plgf ratio with other biomarkers as a predictive test for pre-eclampsia – A clinical audit

Introduction The recently published PROGNOSIS study (NEJM 2016 374:1:13–22) demonstrated the sFlt-1/PlGF ratio biomarker test to have significant clinical utility as a stand-alone predictive investigation for the assessment of patients with suspected pre-eclampsia (PE). Before implementation of the sFlt-1/PlGF test into routine local practice, clinical superiority and cost-effectiveness compared to current alternate investigations for the evaluation of patients with suspected pre-eclampsia must be demonstrated. Objective To compare the test characteristics of investigations currently utilised in the assessment of suspected pre-eclampsia with the sFlt-1/PlGF ratio in a retrospective audit of such cases managed in a pregnancy day care centre (PDCC) setting in a tertiary perinatal centre in Melbourne, Australia. Methods The audit was performed over 4 months at the Royal Women”s Hospital, Melbourne, Australia. Patients included in the audit were greater than 20 weeks gestation and were admitted to the PDCC following an initial observation of hypertension. Four repeat one-hourly blood pressure measurements were taken for each patient. Urine protein-creatinine ratio (PCR), blood platelets, hepatic enzymes (ALT, ALP, GGT), haemoglobin (Hb) and the sFlt-1/PlGF ratio investigation were performed. The test characteristics of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for each investigation. Results 197 women were included in the audit. Of these, 67 were classified as normal, 72 as pregnancy-induced hypertension (PIH), 52 as PE and 6 as HELLP syndrome cases. Normal and PIH cases were combined into a ”non-PE” group for control analysis. PE and HELLP cases were combined for ”PE” case analysis. The prevalence value for PE utilised in analysis was 29.4%. Based on the investigation result nearest to delivery, test characteristics for each investigation were calculated (Fig. 1). The sFlt-1/PlGF ratio biomarker demonstrated the best negative predictive value with 94.07%. Conclusion This audit validates the superiority of the sFlt-1/PlGF ratio biomarker test in the prediction of PE compared with current alternate investigations in an Australian pregnancy day care setting. Download : Download high-res image (205KB) Download : Download full-size image

Clinical study on the association between pregnancy-induced hypertension and insulin resistance.

The aim of the present study was to explore the association between pregnancy-induced hypertension (PIH) and insulin resistance (IR). A total of 50 cases of PIH and 50 healthy pregnant women with a similar gestational age were enrolled. The hyperinsulinemic-euglycemic clamp technique was used to evaluate the degree of IR and all 100 subjects were divided into an IR and a non-IR group accordingly. Subsequently, the correlation between the systolic or diastolic blood pressure was assessed; furthermore, a homeostasis model assessment of IR (HOMA-IR), a HOMA of the insulin sensitivity index (HOMA-ISI) and a HOMA of β cell function (HOMA-β%) were performed. Moreover, the effect of IR on PIH was assessed and the protein expression of insulin receptor substrate (IRS)-1, phosphorylated (p)-IRS-1, AKT and p-AKT were detected in the placental plasma by western blot analysis. The results showed that in the PIH group, the p-IRS-1/IRS-1 and p-AKT/AKT ratios were decreased compared with those in the control group. Blood flow parameters, including perfusion index, retinal resistive index and systolic maximum velocity/end-diastolic velocity ratio in the IR group were higher, while time averaged velocity was lower compared with that in the non-IR group. Furthermore, the HOMA-ISI and HOMA-β% were decreased, while the HOMA-IR was increased in the PIH group compared to that in the control group; alongside the blockage of the insulin signaling pathway, these factors may therefore cause PIH. The present study may provide novel therapeutic approaches for PIH.