Pregnancy-related Disease Research Articles

An Unknown Pregnancy Presenting as Vision Loss: A case report

Hypertensive retinopathy (HTR) secondary to preeclampsia can present similarly to non-pregnancy related HTR. Here, we report a case of a patient who presented to our eye clinic for decreased vision bilaterally. Ocular exam and imaging revealed large serous retinal detachments affecting the central macula along with massive intraretinal edema. Due to concern for systemic pathology, the patient was referred to the emergency department (ED), where her blood pressure was found to be 200/110 mmHg. The patient was discovered to be pregnant and diagnosed with preeclampsia with severe features in the third trimester. After delivery of the fetus, the patient had complete resolution of visual symptoms. Since pregnancy-related ophthalmic manifestations are generally mild and reversible, ophthalmologists do not usually consider pregnancy-related disease in patients who are not known to be pregnant. However, it is important to keep these complications on the differential with women of child-bearing age.

Analysis of the evolution of placental oxidative stress research from a bibliometric perspective.

Research on placental oxidative stress is pivotal for comprehending pregnancy-related physiological changes and disease mechanisms. Despite recent advancements, a comprehensive review of current status, hotspots, and trends remains challenging. This bibliometric study systematically analyzes the evolution of placental oxidative stress research, offering a reference for future studies. To conduct a comprehensive bibliometric analysis of the literature on placental oxidative stress to identify research hotspots, trends, and key contributors, thereby providing guidance for future research. Relevant data were retrieved from the Web of Science Core Collection database and analyzed using VOSviewer, CiteSpace, and the bibliometrix package. An in-depth analysis of 4,796 publications was conducted, focusing on publication year, country/region, institution, author, journal, references, and keywords. Data collection concluded on 29 April 2024. A total of 4,796 papers were retrieved from 1,173 journals, authored by 18,835 researchers from 4,257 institutions across 103 countries/regions. From 1991 to 2023, annual publications on placental oxidative stress increased from 7 to 359. The United States (1,222 publications, 64,158 citations), the University of Cambridge (125 publications, 13,562 citations), and Graham J. Burton (73 publications, 11,182 citations) were the most productive country, institution, and author, respectively. The journal Placenta had the highest number of publications (329) and citations (17,152), followed by the International Journal of Molecular Sciences (122 publications). The most frequent keywords were "oxidative stress," "expression," "pregnancy," "preeclampsia," and "lipid peroxidation." Emerging high-frequency keywords included "gestational diabetes mellitus," "health," "autophagy," "pathophysiology," "infection," "preterm birth," "stem cell," and "inflammation." Over the past 3decades, research has concentrated on oxidative stress processes, antioxidant mechanisms, pregnancy-related diseases, and gene expression regulation. Current research frontiers involve exploring pathophysiology and mechanisms, assessing emerging risk factors and environmental impacts, advancing cell biology and stem cell research, and understanding the complex interactions of inflammation and immune regulation. These studies elucidate the mechanisms of placental oxidative stress, offering essential scientific evidence for future intervention strategies, therapeutic approaches, and public health policies.

NOTUM-mediated WNT silencing drives extravillous trophoblast cell lineage development

Trophoblast stem (TS) cells have the unique capacity to differentiate into specialized cell types, including extravillous trophoblast (EVT) cells. EVT cells invade into and transform the uterus where they act to remodel the vasculature facilitating the redirection of maternal nutrients to the developing fetus. Disruptions in EVT cell development and function are at the core of pregnancy-related disease. WNT-activated signal transduction is a conserved regulator of morphogenesis of many organ systems, including the placenta. In human TS cells, activation of canonical WNT signaling is critical for maintenance of the TS cell stem state and its downregulation accompanies EVT cell differentiation. We show that aberrant WNT signaling undermines EVT cell differentiation. Notum, palmitoleoyl-protein carboxylesterase (NOTUM), a negative regulator of canonical WNT signaling, was prominently expressed in first-trimester EVT cells developing in situ and up-regulated in EVT cells derived from human TS cells. Furthermore, NOTUM was required for optimal human TS cell differentiation to EVT cells. Activation of NOTUM in EVT cells is driven, at least in part, by endothelial Per-Arnt-Sim (PAS) domain 1 (also called hypoxia-inducible factor 2 alpha). Collectively, our findings indicate that canonical Wingless-related integration site (WNT) signaling is essential for maintenance of human trophoblast cell stemness and regulation of human TS cell differentiation. Downregulation of canonical WNT signaling via the actions of NOTUM is required for optimal EVT cell differentiation.

Regulatory role and molecular mechanism of METTL14 in vascular endothelial cell injury in preeclampsia.

Preeclampsia (PE) is a pregnancy-related disease characterized by vascular endothelial cell injury. This study aimed to investigate the role of methyltransferase-like protein 14 (METTL14) in vascular endothelial cell injury in PE. The PE cell model was established by treating human umbilical vein endothelial cells (HUVECs) with tumor necrosis factor-alpha (TNF-α) in vitro. METTL14 and forkhead box protein 1 (FOXP1) were silenced, and miR-34a-5p was overexpressed in HUVECs to evaluate their effects. HUVEC viability, apoptosis, and the levels of intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and endothelin-1 were measured. The N6-methyladenosine (m6A) modification of pri-miR-34a-5p was quantified. The interactions between miR-34a-5p, DiGeorge syndrome critical region 8, and m6A enrichment in miR-34a-5p were analyzed. The relationship between miR-34a-5p and FOXP1 was also verified. The results showed that the expressions of METTL14, FOXP1, and miR-34a-5p were determined. METTL14 expression was elevated in the TNF-α-induced HUVEC injury model. Silencing METTL14 improved HUVEC viability, inhibited apoptosis, and reduced endothelial inflammation. METTL14 promoted miR-34a-5p expression through m6A modification. Overexpression of miR-34a-5p or silencing of FOXP1 reversed the protective effects of METTL14 silencing on cell injury in the PE model. In conclusion, METTL14 mediated m6A modification to promote miR-34a-5p expression, leading to the inhibition of FOXP1 expression, which aggravated endothelial cell damage in the PE cell model.

A dynamic prediction model for preeclampsia using the sFlt-1/PLGF ratio combined with multiple factors

ObjectivePreeclampsia (PE) is a pregnancy-related multi-organ disease and a significant cause of incidence rate and mortality of pregnant women and newborns worldwide. Delivery remains the only available treatment for PE. This study aims to establish a dynamic prediction model for PE.MethodsA total of 737 patients who visited our hospital from January 2021 to June 2022 were identified according to the inclusion and exclusion criteria, forming the primary dataset. Additionally, 176 singleton pregnant women who visited our hospital from July 2022 to November 2022 comprised the verification set. We investigated different gestational weeks of sFlt-1/PLGF (soluble FMS-like tyrosine kinase-1, placental growth factor) ratio combined with maternal characteristics and routine prenatal laboratory results in order to predict PE in each trimester. Multivariate logistic regression was used to establish the prediction model for PE at different gestational weeks. The discrimination, calibration, and clinical validity were utilized to evaluate predictive models as well as models in external validation queues.ResultsAt 20–24 weeks, the obtained prediction model for PE yielded an area under the curve of 0.568 (95% confidence interval, 0.479–0.657). At 25–29 weeks, the obtained prediction model for PE yielded an area under the curve of 0.773 (95% confidence interval, 0.703–0.842)and 0.731 (95% confidence interval, 0.653–0.809) at 30–34 weeks. After adding maternal factors, uterine artery pulsation index(Ut-IP), and other laboratory indicators to the sFlt-1/PLGF ratio, the predicted performance of PE improved. It found that the AUC improved to 0.826(95% confidence interval, 0.748 ∼ 0.904) at 20–24 weeks, 0.879 (95% confidence interval, 0.823 ∼ 0.935) at 25–29 weeks, and 0.862(95% confidence interval, 0.799 ∼ 0.925) at 30–34 weeks.The calibration plot of the prediction model indicates good predictive accuracy between the predicted probability of PE and the observed probability. Furthermore, decision-curve analysis showed an excellent clinical application value of the models.ConclusionUsing the sFlt-1/PLGF ratio combined with multiple factors at 25–29 weeks can effectively predict PE, but the significance of re-examination in late pregnancy is not significant.

Ten-Year Review of the Postpartum Maternal Health Clinic at the Kingston Health Sciences Centre

ObjectivesThe postpartum Maternal Health Clinic (MHC) sees patients who have experienced pregnancy complications identified as pregnancy-related cardiovascular disease (CVD) risk indicators (hypertensive disorders of pregnancy, gestational diabetes, placental abruption, idiopathic preterm delivery, and intrauterine growth restriction) at 6 months postpartum for CVD risk screening. This project aimed to summarise the past 10 years of the MHC and identify trends in patient characteristics, patient CVD risk assessments, and clinic attendance over time. MethodsPatients included in this study have experienced 1 or more pregnancy-related CVD risk indicator(s) and have delivered between April 2011 and April 2021. MHC patient data and the Better Outcomes Registry Network database were utilised to compare eligible and participating patient data during clinically significant time periods. ResultsThe clinic has seen 1030 patients in the last 10 years and their characteristics have remained largely consistent. However, there has been an increase in the proportion of patients seen because of a hypertensive disorder and an increase in the proportion of patients with obesity, abnormal total cholesterol, and elevated fasting glucose. Additionally, CVD risk scores and the prevalence of metabolic syndrome have remained consistent over the years. Regarding the clinic’s outreach, patient eligibility for the MHC has been increasing while attendance has been decreasing over time. ConclusionsOverall, there remains a need to screen these patients for CVD risk and counsel them on risk reduction. There is also an opportunity to increase patient recruitment to improve attendance and to address the increased need for CVD risk screening and counselling in the community.

Characteristics and Outcomes of Coronavirus Disease- 2019 Among Pregnant Women in Saudi Arabia; a Retrospective Study.

Pregnancy-related coronavirus disease 2019 infection ranges from asymptomatic to very serious illness. This study aimed to determine the impact of the COVID-19 infection on pregnant women in the Jazan region of Saudi Arabia. Retrospective observational study of women who had COVID-19 positive test in pregnancy admitted in King Fahd Hospital, Abu Arish General Hospital, and Sabya General Hospital, Jazan, Saudi Arabia during the period between March 2020 and March 2022. Data were extracted from the patient's records. Frequency and percentage distributions were calculated for categorical variables. Descriptive studies and regression analysis were conducted to evaluate the association between selected variables and pregnancy outcomes. Of the 33 pregnant women with confirmed infection, the majority were in their second and third trimester, with approximately 42.4% requiring intensive care unit (ICU) admission and oxygen therapy. The most prevalent symptoms were high respiratory rate and low blood pressure, often accompanied by fever, cough, and shortness of breath. Live births resulted in 54.5% of the cases, while two maternal deaths were reported. Significant associations were found between the need for non-invasive ventilation and timing of infection (p = 0.026), the mode of delivery and timing of infection (p = 0.036), and the mode of delivery and body mass index (BMI) (p = 0.007). COVID-19 poses significant risks to pregnant women, particularly in the third trimester, and emphasized the importance of early identification of high-risk pregnancies, strategic planning, and enhanced monitoring during antenatal care.

Severe Early-Onset Intrahepatic Cholestasis of Pregnancy Following Ovarian Hyperstimulation Syndrome with Pulmonary Presentation after In Vitro Fertilization: Case Report and Systematic Review of Case Reports.

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease, usually presented in the third trimester with pruritus, elevated transaminase, and serum total bile acids. Evidence shows that it can be developed in the first trimester, more commonly after in vitro fertilization (IVF) procedures, with the presence of ovarian hyperstimulation syndrome (OHSS). A literature search was conducted in the PubMed/MEDLINE database of case reports/studies reporting early-onset ICP in spontaneous and IVF pregnancies published until July 2023. Thirty articles on early-onset ICP were included in the review analysis, with 19 patients who developed ICP in spontaneous pregnancy and 15 patients who developed ICP in IVF pregnancies with or without OHSS. Cases of 1st and 2nd trimester ICP in terms of "early-onset" ICP were pooled to gather additional findings. Proper monitoring should be applied even before expected pregnancy and during IVF procedures in patients with known risk factors for OHSS and ICP development (patient and family history), with proper progesterone supplementation dosage and genetic testing in case of ICP recurrence.

Pregnant women's adherence to COVID-19 prevention practice and associated factors in Jinka Town, South Omo Zone, Southern Ethiopia, a community based cross-sectional study

Background Pregnancy-related coronavirus disease 2019 (COVID-19) transmission and infection rates have continued to be a top public health concern. Pregnant mothers also have a higher risk of developing serious illness, needing to be admitted to an intensive care unit, and needing mechanical ventilation. More than six million people died as a result of COVID-19 worldwide. The aim of this study was to assess the level of adherence to COVID-19 preventive practice among pregnant mothers in Jinka Town. Methods In Jinka, South Omo Zone, between January 1 and January 30, 2023, a cross-sectional study was conducted. Using a simple random sampling technique, 412 pregnant women were selected. Data were collected using a face-to-face interviewer-administered, pre-tested questionnaire. The data were entered using Epi-data version 3.1, and after being exported, were analyzed using SPSS version 25. Bivariate and multivariable logistic regression analysis was carried out to identify relevant components. An adjusted odds ratio and a 95% confidence interval were used to report the relationship between the covariates and the outcome variable. Results The percentage of participants who adhered to COVID-19 prevention measures was only 11.4% (95% CI: 8.5, 14.8). Mothers with at least a bachelor’s degree 3.71 (AOR=3.71, 95% CI=1.28, 10.73), a residency of 4.40 (AOR=4.40, 95% CI=1.96, 9.87), and a history of chronic illness of 4.30 (AOR=4.30, 95% CI=1.69, 10.93) were significantly associated with good adherence to COVID-19 prevention practices. Conclusions Only a very small percentage of pregnant women, according to this poll, adhere to COVID-19 preventative practices. In order to raise pregnant women’s awareness of COVID-19 preventive practices, it is crucial to use a variety of media for health education. Further, it is preferable to focus on urban living and give special attention to women without a formal education.

Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs

BackgroundThe increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. MethodsCanadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. ResultsA total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. ConclusionsResidents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.

Characteristics and Outcomes of Patients With Pregnancy-Related End-Stage Kidney Disease

The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney disease (ESKD). Little is known about characteristics and long-term outcomes of patients who develop pregnancy-related ESKD. To examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes. This was a cohort study of 183 640 reproductive-aged women with incident ESKD between January 1, 2000, and November 20, 2020, from the US Renal Data System and maternal data from births captured in the US Centers for Disease Control and Prevention publicly available natality data. Data were analyzed from December 2022 to June 2023. Pregnancy-related primary cause of ESKD, per International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes reported at ESKD onset by the primary nephrologist on Centers for Medicare and Medicaid Services form 2728. Multivariable Cox proportional hazards and competing risk models were constructed to examine time to (1) mortality, (2) access to kidney transplant (joining the waiting list or receiving a live donor transplant), and (3) receipt of transplant after joining the waitlist. A total of 341 patients with a pregnancy-related primary cause of ESKD were identified (mean [SD] age 30.2 [7.3]). Compared with the general US birthing population, Black patients were overrepresented among those with pregnancy-related ESKD (109 patients [31.9%] vs 585 268 patients [16.2%]). In adjusted analyses, patients with pregnancy-related ESKD had similar or lower hazards of mortality compared with those with glomerulonephritis or cystic kidney disease (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19), diabetes or hypertension (aHR, 0.49; 95% CI, 0.39-0.61), or other or unknown primary causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75). Despite this, patients with pregnancy-related ESKD had significantly lower access to kidney transplant compared with those with other causes of ESKD, including (1) glomerulonephritis or cystic kidney disease (adjusted subhazard ratio [aSHR], 0.51; 95% CI, 0.43-0.66), (2) diabetes or hypertension (aSHR, 0.81; 95% CI, 0.67-0.98), and (3) other or unkown cause (aSHR, 0.82; 95% CI, 0.67-0.99). Those with pregnancy-related ESKD were less likely to have nephrology care or have a graft or arteriovenous fistula placed before ESKD onset (nephrology care: adjusted relative risk [aRR], 0.47; 95% CI, 0.40-0.56; graft or arteriovenous fistula placed: aRR, 0.31; 95% CI, 0.17-0.57). In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population. Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.

Increased 8-OHdG in umbilical cord blood represents the risk of preeclampsia with Intra-Uterine Growth Restriction (IUGR)

Link of Video Abstract: https://youtu.be/VsAy9X8XIAk Background: Preeclampsia is a pregnancy-related disease involving multi-organs, characterized by increased blood pressure in the second trimester of pregnancy. Preeclampsia can have short-term and long-term consequences for the mother and the fetus, including intra-uterine growth restriction (IUGR). One of the markers of DNA damage due to oxidative stress due to endothelial dysfunction in preeclampsia is the increase in 8-OHdG levels in cord blood. This study aims to see an increase in 8-OHdG levels in preeclampsia. Methods: This study was a cross-sectional study with a total of 41 patients with preeclampsia and 41 patients with healthy pregnant women at Wahidin Sudirohusodo Hospital and its network. Samples were taken using the purposive sampling method according to the inclusion criteria. This 8-OHdG level was examined using the ELISA kit at the HUMRC laboratory of Hasanuddin University Hospital. The data is then processed statistically using SPSS. Results: This study found 6 patients with PE + IUGR, 31 with PE, and 41 without PE. The examination results of 8-OHdG levels found significant differences between the 3 groups PE + IUGR, PE, and normal pregnancies, which showed a significant relationship between elevated 8-OHdG levels and the incidence of PE accompanied by IUGR (p = 0.006) Conclusion: Elevated 8-OHdG levels are found in preeclampsia, especially in preeclampsia accompanied by IUGR.

Lack of association between the VEGFA gene polymorphisms and preterm birth in Korean women.

Preterm birth (PTB), a pregnancy-related disease, is defined as a birth before 37 weeks of gestation. It is a major cause of maternal mortality and morbidity worldwide, and its incidence rate is steadily increasing. Various genetic factors can contribute to the etiology of PTB. Vascular endothelial growth factor A (VEGFA) gene is an important angiogenic gene and its polymorphisms have been reported to be associated with PTB development. Therefore, we conducted a case-control study to evaluate the association between VEGFA rs699947, rs2010963, and rs3025039 polymorphisms and PTB in Korean women. A total of 271 subjects (116 patients with PTB and 155 women at ≥38 weeks of gestation) were analyzed in this study. The genotyping of VEGFA gene polymorphisms was performed using polymerase chain reaction- restriction fragment length polymorphism. No significant association between the patients with PTB and the control groups was confirmed. In the combination analysis, we found a significant association between PTB and VEGFA rs699947 CC-rs2010963 GG-rs3025039 CC combination (odds ratio, 3.77; 95% confidence interval, 1.091 to 13.032; p = 0.031). The VEGFA rs699947, rs2010963, and rs3025039 polymorphisms might have no genetic association with the pathogenesis of PTB in Korean women. However, the combination analysis indicates the possibility that VEGFA acts in PTB pathophysiology. Therefore, larger sample sets and replication studies are required to further elucidate our findings.

Death receptor 3 is involved in preeclampsia through regulating placental trophoblast cell physiology by inactivating the PI3K/AKT pathway.

Preeclampsia (PE) is a pregnancy related disease that affects about 5% of pregnancies. Death receptor 3 (DR3) expression is significantly elevated in both placental tissue and plasma of PEpatients. However, whether DR3 was involved in trophoblasts in pathogenesis of PE are not well elucidated. Our research was designed to illustrate the biological roles of DR3 in placental trophoblasts, as well as explain its relevant mechanisms. HTR-8/SVneo cells viability, migration, invasion, and apoptosis were assessed using MTT, Transwell assay, and flow cytometry analysis, respectively. Levels of DR3, PI3K, and AKT in HTR-8/SVneo cells were analyzed via reverse transcription-quantitative polymerase chain reaction assay. Western blot analysis was utilized to assess DR3, p-PI3K, p-AKT, PI3K, and AKT protein expression. Upregulation of DR3 obviously inhibited HTR-8/SVneo cells viability, migration, and invasion, as well as promoted HTR-8/SVneo cells apoptosis, as opposed to the control-plasmid group. We also found that DR3-plasmid enhanced cleaved-caspase3 expression, reduced p-PI3Kand p-AKT protein expression, and p-PI3K/PI3K or p-AKT/AKT ratio in HTR-8/SVneo cells. Importantly, IGF-1, a PI3K/AKT signaling pathway agonist, partially reversed the effects of DR3-plasmid on the cell viability, migration, invasion, apoptosis, and PI3K/AKT signal pathway in HTR-8/SVneo cells. DR3 was involved in PEthrough regulating placental trophoblast cell physiology via PI3K/AKT pathway, which might be a promising therapeutic target forPE therapy.

Enhanced sugeno fuzzy inference system with fuzzy AHP and coefficient of variation to diagnose cardiovascular disease during pregnancy

Accurate prediction of cardiovascular disease (CVD) risks during pregnancy is vital for preventing and treating life-threatening condition. Existing research has explored fuzzy inference systems and machine-learning techniques for predicting cardiovascular disease risks. However, these models have not explicitly addressed pregnancy-related cardiovascular disease. This study proposes a novel hybrid system that combines the fuzzy analytic hierarchy process (fuzzy-AHP), coefficient of variation (CV) and Sugeno fuzzy inference system with the optimized rule to diagnose cardiovascular disease during pregnancy. The study considers 12 cardiovascular disease risk factors and involves an experienced cardiac clinician and gynaecologist in determining their contributions. Fuzzy-AHP is employed for assigning weights to risk factors and distributing them among sub-risk factors based on their relative contributions. The coefficient of variation is utilized for calculating the weights of the strings, while the nearest neighboring method is employed to cluster the potential strings. The obtained rules are incorporated into the Sugeno fuzzy inference system to compute the output of CVD during pregnancy. The system’s performance is evaluated using an online clinical dataset of 1015 maternal health risks, performance measures, receiving operating system, and statistical analysis. The hybrid system detects cardiovascular disease with 98.71% accuracy, 98.73% sensitivity, and 98.91% precision. This suggest that the proposed technique could be an accurate and valuable tool for predicting cardiovascular disease risks during pregnancy in clinical settings.

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Inflammatory Marker in Preeclampsia: A Scoping Review

Background: Preeclampsia (PE) is characterized as pregnancy-related hypertensive disease with unclear pathophysiology but causes tremendous fetomaternal death. Some predisposing factors considered to be responsible are statistical characteristics, hereditary and factors in the environment should purpose local abnormalities in activation of cytogenic elements along with integrins, matrix metalloproteinases, cytokines, and foremost histocompatibility complex molecules mainly responsible for reduced blood supply to placenta and fetus, trophoblastic cellular apoptosis and abnormal placentation. Aim: In the current scoping review (ScR), the detection of PE using neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as an inflammatory marker which is easily available at primary health system. Methodology: The subject’s relevant researches were found using an ScR format from database searches in PubMed and Google Scholar. Out of 179 articles 10 fulfilled inclusion criteria which were systematically reviewed and underwent meta-analysis to highlight the knowledge gaps and further additional case–control study done in tertiary care center. Conclusion: Maternal NLR and PLR resulting from whole blood cell count is an easily available and routinely performed test, obtained as cost-benefit biomarkers for the early prediction of hypertensive disorders of pregnancy.

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management.

Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy.

Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution.

Pre-eclampsia (PE) is a pregnancy-related disease, causing significant threats to both mothers and babies. Numerous studies have identified the association between PE and renal dysfunction. However, in clinical practice, kidney problems in pregnant women are often overlooked due to physiologic adaptations during pregnancy, including renal hyperfiltration. Recent studies have reported serum creatinine (SCr) level distribution based on gestational age (GA) and demonstrated that deviations from the expected patterns can predict adverse pregnancy outcomes, including PE. This study aimed to establish a PE prediction model using expert knowledge and by considering renal physiologic adaptation during pregnancy. This retrospective study included pregnant women who delivered at the Wonju Severance Christian Hospital. Input variables, such as age, gestational weeks, chronic diseases, and SCr levels, were used to establish the PE prediction model. By integrating SCr, GA, GA-specific SCr distribution, and quartile groups of GA-specific SCr (GAQ) were made. To provide generalized performance, a random sampling method was used. As a result, GAQ improved the predictive performance for any cases of PE and triple cases, including PE, preterm birth, and fetal growth restriction. We propose a prediction model for PE consolidating readily available clinical blood test information and pregnancy-related renal physiologic adaptations.

Every ED Visit is an Opportunity to Talk about Contraception

Every ED Visit is an Opportunity to Talk about Contraception

Blood Plasma Calorimetric Profiles of Women with Preeclampsia: Effect of Oxidative Stress.

Preeclampsia is a pregnancy-related disease with poor placentation and presents itself through hypertension and proteinuria. The disease is also associated with the oxidative modification of proteins in maternal blood plasma. In this work, we combine differential scanning calorimetry (DSC), capillary electrophoresis, and atomic force microscopy (AFM) to evaluate the changes in the plasma denaturation profiles of patients with preeclampsia (PE) as compared with those of pregnant controls. Our results demonstrate that the last trimester of pregnancy substantially affects the main calorimetric characteristics of blood plasma from pregnant controls relative to nonpregnant women. These variations correlate well with the changes in protein levels determined by electrophoresis. DSC analysis revealed significant deviations in the plasma heat capacity profiles of preeclamptic patients from those of pregnant controls. These alterations are expressed mainly in a substantial reduction in albumin-assigned transitions and an upward shift in its denaturation temperature, lower calorimetric enthalpy changes, and a reduced ratio of heat capacity in the albumin/globulin-assigned thermal transitions, which are more pronounced in severe PE cases. The in vitro oxidation model shows that the alteration of PE thermograms is partly related to protein oxidation. AFM data detected numerous aggregate formations in the plasma of PE samples and fewer small ones in the pregnant controls, which are not found in healthy nonpregnant samples. These findings could serve as a basis for further investigations to reveal the possible relationship between albumin thermal stabilization, the increased inflammatory state and oxidative stress, and protein misfolding in preeclampsia.