Previous Normal Pregnancy Research Articles

Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis.

To elucidate whether pre-eclampsia (PE) and the gestational age at onset of the disease (early- vs late-onset PE) have an impact on the risk of long-term maternal cardiovascular complications. MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for 'pre-eclampsia', 'cardiovascular disease' and 'outcome'. Inclusion criteria were cohort or case-control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early- vs late-onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type-2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random-effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed. Seventy-three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9-2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8-2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6-2.0)), hypertension (OR, 3.93 (95% CI, 3.1-5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4-8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3-1.4)), Type-2 diabetes (OR, 2.14 (95% CI, 1.5-3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3-5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6-7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1-10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early-onset PE, compared to those with previous late-onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0-3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5-21.4)), hypertension (OR, 1.48 (95% CI, 1.3-1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3-1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1-2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1-2.5). Both early- and late-onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late-onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Rupture of Non-communicating Rudimentary Horn Pregnancy at 15 Weeks with Previous Normal Pregnancies: A Case Report

Rudimentary horn is a mullerian anomaly that is a variant of unicornuate uterus. Rudimentary horn pregnancies are rare and associated with increased maternal morbidity and mortality. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with previous vaginal delivery is challenging. Although ultrasonography is an important diagnostic tool, it has low sensitivity in making diagnosis of ruptured rudimentary horn pregnancy. Therefore, clinicians should have high index of suspicion in such cases. We report a case of G3P2L2 at 15 weeks period of gestation referred to our centre as a case of intrauterine pregnancy with acute abdomen. She underwent emergency laparotomy and was found to have ruptured rudimentary horn intraoperatively. Excision of the ruptured rudimentary horn and ipsilateral salpingectomy was done and the patient had an uneventful postoperative recovery.

Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven-year follow-up

Background and aimsPre-eclampsia is associated with increased risk of cardiovascular disease and premature death. However, conventional common carotid artery intima-media thickness (CCA-IMT) measurement does not reflect this. In contrast, measurement of the individual CCA intima and media thicknesses clearly indicates increased vascular risk both at diagnosis and about one year after pre-eclampsia. This study examined whether individual CCA wall layers, risk factors for cardiovascular disease, and markers of endothelial dysfunction had normalized or remained unfavorable seven years after pre-eclampsia. MethodsThe individual CCA intima and media thicknesses were measured using 22 MHz ultrasound. Conventional cardiovascular risk factors were recorded. A thick intima, thin media and high intima/media thickness ratio (I/M) are signs of sub-clinical atherosclerosis. ResultsThe median age of women with previous pre-eclampsia (cases = 23) or normal pregnancies (controls = 35) was 39/37 years. At follow-up (median about seven years), the intima remained thicker and the I/M was higher in cases than in controls [all p < 0.0001; p < 0.001 after adjustment for time to follow-up, body mass index (BMI), and mean arterial pressure (MAP)], whereas the CCA-IMT was illogically thinner. Further, BMI, MAP, hip circumference, abdominal height, serum endostatin and apolipoprotein B levels were higher in cases (all p < 0.05). Intima and I/M measurements were correlated with age, MAP, endostatin and apolipoprotein B, whereas no logical correlations were found for CCA-IMT. ConclusionsThe arteries in cases but not controls were still adversely affected after seven years. Measuring intima thickness and I/M appears preferable to measuring CCA-IMT for demonstrating vascular risk after pre-eclampsia.

Angiogenic Properties of Menstrual Stem Cells Are Impaired in Women with a History of Preeclampsia

Preeclampsia is a pregnancy-specific disorder defined by the new onset of hypertension and proteinuria after 20 weeks of gestation. Although its precise etiology is still unknown, there is evidence suggesting that it may be a consequence of impaired decidual and stromal cell function. Recently, a stem cell population derived from endometrial tissue and isolated from menstrual effluent called menstrual stem cells (MenSCs) has been identified. MenSCs exhibit important angiogenic and inflammatory properties that may contribute to both normal and pathological complications of implantation and placentation, including preeclampsia. We hypothesized that the angiogenic and inflammatory activity of MenSCs is altered in women who have a past history of preeclampsia and that this phenotype persists postpartum. The primary outcome measures were stromal progenitor cell formation, in vitro induction of endothelial tube formation, and release of proinflammatory cytokines. MenSCs obtained from women with a previous normal or preeclamptic pregnancy displayed similar phenotypic characteristics, tri-differentiation capacity, and proliferation. MenSCs derived from women who had preeclampsia on their previous pregnancy had reduced angiogenic capacity (~30% fewer junctions and nodes, p < 0.05) and stromal progenitor cell formation (<50% measured at a serial dilution of 1 : 10.000, p < 0.05) when compared to controls. In vitro, MenSCs obtained from patients with a history of preeclampsia expressed less endoglin and secreted less VEGF but more IL-6 than controls did. These data are consistent with the hypothesis that the angiogenic and inflammatory properties of MenSCs of women with a previous pregnancy complicated by preeclampsia have reduced angiogenic capacity and are more proinflammatory than those of MenSCs of women with a previous normal pregnancy. This altered phenotype of MenSCs observed following preeclampsia could either be present before the development of the pathology, predisposing the endometrial milieu to and consequently leading to limited vascular remodeling, or be a consequence of preeclampsia itself. The former may afford opportunity for targeted therapeutic intervention; the latter, a putative biomarker for future risk of pregnancy complications.

Cerebral Biomarkers in Women With Preeclampsia Are Still Elevated 1 Year Postpartum.

There is evidence of cerebral involvement among women with preeclampsia. Levels of the cerebral biomarkers neuron-specific enolase (NSE) and S100B are elevated during pregnancy in women developing preeclampsia. It is although not known if these biomarkers return to normal range postpartum. The aim with this study was to compare levels of S100B and NSE during pregnancy and 1 year postpartum in women who have had preeclampsia to women with normal pregnancies. This study was a longitudinal study of cases (n = 53) with preeclampsia and controls (n = 58) consisted of normal pregnant women in matched gestational weeks. Plasma samples were collected at inclusion during pregnancy and 1 year postpartum. Plasma samples were analyzed for levels of S100B and NSE by enzyme-linked immunosorbent assays kits. Levels of NSE and S100B in women with preeclampsia were higher during pregnancy than in women with normal pregnancies. One year postpartum, women who have had preeclampsia still had a higher median level of both NSE (5.07 vs. 4.28 µg/l, P < 0.05) and S100B (0.07 vs. 0.06 µg/l, P < 0.05) compared to women with previous normal pregnancies. High levels of NSE and S100B postpartum remained associated with previous preeclampsia after adjustment for confounding factors. Levels of NSE correlated to S100B during pregnancy and postpartum. Levels of NSE and S100B are still elevated 1 year postpartum in women who have had preeclampsia in contrast to women with previous normal pregnancies. We hypothesize that there might be a persistent cerebral involvement among women with preeclampsia even 1 year postpartum.

Risk factors for congenital anomalies in high risk pregnant women: A large study from South India

BackgroundHigh Risk Pregnancy (HRP) is a condition where mother or developing fetus or both are at increased risk of complications during or after pregnancy and birth. There are no studies so far which have characterized congenital anomalies (CAs) in HRP women with different previous obstetric histories. AimThe present study was aimed to determine the prevalence, types and distribution of various CAs and also to find out the exact risk factors for different obstetric histories. Subjects and methodsA total of 3301 HRP women (2011–2014) were enrolled. Diagnosis was made using 3D/4D ultrasound. Serum was analyzed for IgG & IgM against TORCH (Toxoplasma, Rubella, CMV and HSV) agents by ELISA. Eleven percent were pregnant women carrying fetuses with CAs in the present pregnancy, while remaining 89% were with bad obstetric history (BOH) and other medical and obstetric complications. ResultsEleven percent pregnant women were carrying fetuses with CAs in the present pregnancy. The major CAs observed were Central Nervous System (CNS) followed by renal anomalies. Maternal age (⩽25years, OR=1.42, p=0.002), paternal age (<30years, OR=1.51, p<0.001), consanguinity (OR=1.39, p=0.012) and primi gravida (OR=3.40, p<0.001) were identified as risk factors for HRP women with fetal CAs in present pregnancy. Maternal age ⩽25years and paternal age <30years conferred around 2-fold risk toward CAs in primi gravida women (p<0.001) whereas consanguinity was associated with CAs in HRP women with BOH (OR=1.95, p<0.018). Toxoplasmosis played a significant role in pregnant women with CAs in present pregnancy with previous normal pregnancies (OR=4.45, p=0.009). ConclusionHigh prevalence of CAs was found in HRP women compared to general population. Low parental age contributed toward CAs in primi gravida women while consanguinity was found to be a predisposing factor for CAs in HRP with previous BOH. Toxoplasmosis conferred risk for CAs in HRP women with previous normal pregnancies.

Use of serum leptin and insulin hormones levels as predictors of pregnancy outcome in pregnant women with history of recurrent early pregnancy loss

Abstract Aim To evaluate levels of leptin and insulin in cases of unexplained early RPL in comparison with cases of previous normal pregnancies and suggest these levels as prognostic factors for the continuation of pregnancy beyond the 20th week. Methods A prospective comparative controlled study was conducted at Obstetrics unit of Tanta University Hospital from Jan to Aug 2014 on 50 pregnant women who were divided into two groups: the study group included 25 cases with history of early RPL, and the control group included 25 cases with previous normal pregnancies. Serum levels of leptin and insulin were measured twice in both groups; at 5–8th and 10–12th week. Results Leptin levels in ng/ml in the first sample were 9.414 ± 3.183 and 30.559 ± 10.672 in the control and study groups respectively with significant difference. As for the second sample, it was 11.672 ± 2.611 and 29.733 ± 9.133 in the control and study groups respectively with significant difference. Insulin levels in μlU/ml in the first sample were 18.075 ± 5.845 and 32.502 ± 13.057 in the control and study groups respectively with significant difference. In the second sample, on the other hand, it was 20.237 ± 4.944 and 34.128 ± 12.677 in the control and study groups respectively with significant difference. Leptin showed higher accuracy than insulin in prediction of early pregnancy loss. Conclusion Higher levels of leptin and insulin were found in cases with early RPL especially in the aborted cases. The two hormones could be used as predictors of pregnancy continuation in these cases.

Investigating the Association of IL-17A and IL-17F with Susceptibility to Pre-eclampsia in Iranian Women.

Pre-eclampsia (PE) is one of the most important and life-threatening pregnancy disorders that affect at least 3-5% of all pregnancies. Imbalance in helper T cell functions may play a role in predisposing to PE or severity of the disease. Elevated frequencies of Th17 cells in the peripheral blood of PE patients have been reported. Several single nucleotide polymorphisms (SNP) within IL-17 gene have been identified that may affect the IL-17 production. To investigate the association between IL-17A (-197A/G) and IL-17F (+7488T/C) gene polymorphisms and susceptibility to PE in a group of Iranian women. Moreover, to study any correlation of the polymorphisms data with the level of IL-17, at mRNA level in the paternal and maternal parts of the placentas and also at protein level in the peripheral and placental blood samples. A group of 261 PE patients and 278 age-matched healthy women with at least two previous normal pregnancies formed the cases and controls of this study. IL-17A (-197A/G) and IL-17F (+7488T/C) polymorphisms were genotyped using PCR-RFLP method. The protein level of IL-17A was assessed in the sera of 40 PE and 40 healthy women using ELISA method and mRNA expression was also measured in placental samples of 19 PE and 19 control women using Q-PCR technique. Statistical analysis indicated that there were no differences in genotype, allele or haplotype frequencies regarding the studied SNPs between cases and controls. The level of IL-17A was elevated in the placental blood and the fetal tissue at protein and mRNA levels (p< 0.009 and p<0.000, respectively) in PE as compared with the healthy women. The effect of IL-17 cytokine in pre-eclampsia is not due to the studied cytokine polymorphisms but local production of IL-17 might have an effect on the predisposition to the disease.

Curative surgery for placental site trophoblastic tumors

Placental site trophoblastic tumors (PSTTs) are the least common form of gestational trophoblastic disease: only approximately 300 cases have been reported [1]. They can complicate any type of pregnancy, and the time between delivery and diagnosis can be long. Patients can present with vaginal bleeding, amenorrhea, or a uterine mass. The β human chorionic gonadotropin (β-hCG) concentration is usually moderate and much lower than in patients with choriocarcinoma [2]. PSTTs are particularly resistant to chemotherapy and need specificmanagement. When identified early, the prognosis can be favorable when complete excision is performed [2,3]. The aim of the present report is to present two PSTTs treated by hysterectomy with residual tumor noted on examination of the uterus. Written informed consent for publication was obtained from the two patients, and the present report was written with the approval of the institutional review board of Lille University Hospital, France. In October 2009, awoman aged 24 years presented to Lille University Hospital with vaginal bleeding. She had previously had one normal pregnancy and one spontaneous abortion. Her serum concentration of β-hCG was approximately 300 IU/L. Ultrasonography showed a uterine mass, and magnetic resonance imaging (MRI) revealed a rounded endometrial formation distorting the shape of the myometrium (Fig. 1A). A significant homogeneous enhancement was observed with gadolinium. In April 2010, a woman aged 35 years also presented with vaginal bleeding. She had had one previous normal pregnancy and one complete hydatidiformmole. Her β-hCG level was 21 IU/L. Ultrasonography showed a 13-mm endometrial thickening. Standard staging, including pelvic MRI, was negative, without uterine mass in the endometrium or myometrium. In both cases, PSTT was diagnosed after uterine curettage. Surgical hysterectomy was subsequently performed, after which the β-hCG levels returned to normal in both patients. Gross findings of hysterectomy showed a nodularmass in the uterus infiltrating themyometrium in patient 1 (Fig. 1B). Nomacroscopic lesionwas seen in patient 2 (Fig. 1C). Histological examination revealed the samemononuclear trophoblastic proliferation with admixed multinucleate cells separating myometrial fibers in both patients (Fig. 1D and E), extending to three-quarters of the myometrium in patient 1 and limited to the inner third of the myometrium in patient 2 (International Federation of Gynecology and Obstetrics stage I for both cases). The appearance of PSTTs on imaging varies. Themost frequent ultrasonographic abnormality is a focal echogenic myometrial nodule [4]. MRI typically shows a myometrial mass isointense to adjacent normal myometrium on T1-weighted images and isointense to slightly hyperintense on T2-weighted images. Inconstant prominent blood vessels have been shown to be related to the physiological vascular invasion of extra villous trophoblast. By contrast with PSTT, choriocarcinoma is always a highly vascular tumor. For endometrial carcinoma, MRI is also helpful for assessment of the depth of myometrial invasion and extrauterine disease spread. Nevertheless, imaging findings are not specific, and some PSTTs are undetectable, as in the second case presented here. Diagnosis is made on the basis of intermediate trophoblast proliferation growing in and infiltrating myometrial fibers. Therefore, intrauterine aspiration is insufficient; a uterine curettage is necessary. PSTTs grow slowly, tend to spread through the uterus and can involve the lymph nodes with late metastasis. Preoperative staging requires pelvic, abdominal, and chest computed tomography, and pelvic and brain MRI. The most effective treatment for non-metastatic disease is hysterectomy [2]. In a series of 55 PSTTs, only one hysterectomy International Journal of Gynecology and Obstetrics 130 (2015) 84–88

Fas –FasL genotype and phenotype in preeclampsia

Fas –FasL genotype and phenotype in preeclampsia

English

OBJECTIVE: To evaluate the incidence of TORCH infections in women having history of pregnancy loss and women with high delivery risk factors (HDRF) in tertiary care hospital. Duration: A prospective study was conducted over a period of one year from January 2013 to December2013. METHODS: The study included 100 women with HDRF and 50 clinically normal women with previous normal pregnancy and full term deliveries. Serological evaluation for TORCH infections was carried out by IgG and IgM ELISA method. RESULTS: The acronym TORCH (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex virus) was introduced to highlight a group of agents which cause congenital and perinatal infections. The prevalence of TORCH infections in tertiary care hospital was studied over a period of one year. Since majority of congenital infections result from maternal infections during pregnancy, it was essential to evaluate the incidence of maternal infection like TORCH in child bearing age group. The present study showed toxoplasmosis was with a high risk seropositivity rate of 41%, followed by 27% seropositivity for Cytomegalovirus (CMV) .Rubella infections still occur each year and it occurred in 18 % cases while Herpes simplex virus infection was comparatively low seen only in 14% cases among women of child- bearing age. But unfortunately the request for TORCH screening has been ignored and clinicians should be encouraged to send appropriate specimens for specific tests depending on the clinical features of the individual case so as to reduce the adverse fetal outcome.

Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre‐eclampsia

To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.

PMM.50 A case of small bowel obstruction and ischaemia in second pregnancy after a laparoscopic Roux-en-Y gastric bypass surgery

Obstetricians need to be aware of known complications related to bariatric surgeries and the diagnostic difficulties in pregnancy.We report a rare case of G2P1 28 year old with previous laparoscopic...

Individual artery wall layer dimensions indicate increased cardiovascular risk in previous severe preeclampsia -an investigation using non-invasive high-frequency ultrasound

Preeclampsia (PE) is associated with increased risk for cardiovascular disease later in life. Studies using gold standard of non-invasive estimation of atherosclerosis, the common carotid artery intima-media-thickness (CCA-IMT), have not indicated increased atherosclerosis in women with previous PE. That reason may be that with increasing age and degree of atherosclerosis the intima increases, while the media decreases. To assess whether the individual thickness of the CCA intima and media layers and calculation of intima/media (I/M) ratio indicate an increased cardiovascular risk in women with previous severe PE. Arterial intima- and media tthicknesses were obtained by non-invasive high-frequency ultrasound (22MHz) in 42 women with previous severe PE and 44 women with previous normal pregnancies. Women with previous severe PE had a thicker mean CCA intima and a higher I/M ratio, compared to women with previous normal pregnancies (both p<0.0001). In ROC curve analysis, intima thickness and I/M ratio discriminated strongly with regard to previous severe PE. The method using individual estimation of the CCA intima and media layers and calculating the I/M ratio, clearly showed an increased degree of atherosclerosis in women with previous severe PE. This method might become a clinically useful tool to stratify cardiovascular risk, enabling early intervention and hopefully reduce their long-term cardiovascular risk.

Cardiovascular function in women with recurrent miscarriage, pre-eclampsia and/or intrauterine growth restriction

Objective: To investigate prepregnancy cardiovascular function and risk factors in women with previous pregnancy complications. Methods: Thirty-four women with previous normal pregnancy (controls), 26 with unexplained recurrent miscarriage (RM) and 14 with pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR), planning to conceive were recruited. Brachial and central blood pressures (BP), cardiac output (CO), peripheral vascular resistance (PVR), aortic stiffness, blood biochemistry and platelet aggregation were assessed. Results: Women with previous PE/IUGR had higher brachial diastolic BP (78 ± 9 vs 71 ± 7 mmHg; p = 0.03), central systolic BP (107 ± 10 vs 99 ± 8 mmHg; p = 0.03), mean arterial pressure (92 ± 10 vs 84 ± 8 mmHg; p = 0.01) and PVR (1499 ± 300 vs 1250 ± 220 dynes.s−1 cm−5; p = 0.005), than the controls. No differences were observed in either cardiovascular function or blood biochemistry in women with unexplained RM compared with the controls. Women with previous PE/IUGR though not with RM had a stronger family history of cardiovascular disease (CVD) than controls. Conclusions: Women with previous PE and/or IUGR had higher BP and PVR compared with controls, which may predispose them to CVD later in life. However, in the absence of underlying vascular pathology, women with unexplained RM did not have abnormal cardiovascular function. Prepregnancy period provides an opportunity to identify cardiovascular risks in relation to previous obstetric history.

Markers of cardiovascular disease risk after hypertension in pregnancy

Women with a history of preeclampsia or gestational hypertension have an increased risk of cardiovascular disease. Underlying cardiovascular risk factors, persistent endothelial dysfunction or sympathetic overactivity may contribute to this risk. We studied markers of cardiovascular disease risk in nonpregnant women with a history of hypertension in pregnancy. Women with a history of preeclampsia (n = 39), gestational hypertension (n = 27) and normal pregnancies (n = 35) were studied 2-12 years after delivery. Laboratory measures included plasma fasting lipids, glucose, insulin, creatinine and urinary albumin-to-creatinine ratio. Blood pressure was measured by 24-h ambulatory blood pressure monitoring, endothelial function by flow-mediated dilatation and sympathetic activity by both head-up tilt test and cold pressor test, including the response of the circulating renin-angiotensin system to tilt testing. Compared with women who had previous normal pregnancies, women with a history of preeclampsia or gestational hypertension have higher ambulatory blood pressure, BMI and relative insulin resistance. Glomerular filtration rate, albumin-to-creatinine ratio, endothelial function and sympathetic activity was similar among the three groups. Women with a history of preeclampsia or gestational hypertension have features of the metabolic syndrome which are presumably present already before pregnancy, predisposing them to hypertensive disorders of pregnancy and later cardiovascular risk. In this study, we found no evidence for early renal damage, endothelial dysfunction or sympathetic overactivity in the postpartum state.

Cardiovascular risk factors in healthy women with previous small for gestational age infants

To investigate whether healthy women with a previous pregnancy complicated by a small for gestational age (SGA) infant have normal endothelial function, carbohydrate and lipid metabolism, and normal inflammation parameters. Brachial artery flow-mediated dilatation (FMD, endothelium-dependent) was measured in 16 subjects with previous SGA, and in 15 controls (CTR) with previous normal pregnancies. Lipid panel, glucose, insulin, tumor necrosis factor alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (s-ICAM), soluble vascular (s-VCAM-1) adhesion molecule-1 (s-VCAM-1), and androgens were also measured. FMD was reduced in women with previous SGA compared to controls (P < 0.0001). SGA women showed increased insulin resistance (P < 0.0001), s-ICAM-1 (P = 0.008), TNF-alpha (P = 0.02), testosterone (P = 0.03), and diastolic blood pressure (P = 0.01) than CTR. Endothelial dysfunction, reduced insulin sensitivity and subclinical inflammation are present in otherwise healthy women with previous SGA. These abnormalities show that the presence of a SGA infant in the obstetric history should be considered as a risk factor for cardiovascular disease later in life.

Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal

This pilot case-control study at a tertiary-care hospital over a four-month period was aimed at evaluating the possible usefulness of screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virus) in females with bad obstetric history. The study included 12 women with bad obstetric history and a similar number of matched controls with previous normal pregnancies. A serological evaluation of TORCH infections was carried out by detecting IgG and IgM antibodies against these infections by ELISA test-kit. Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study. Ten (83.3%) of the 12 cases with bad obstetric history and two (16.7%) of the 12 healthy controls were serologically positive at least for one of the TORCH agents. The seropositivity rate in women with bad obstetric history was quite high compared to that in the normal healthy controls. The results suggest that a previous history of pregnancy wastage and the serological evaluation of TORCH infections during current pregnancy must be considered while managing cases with bad obstetric history.

P09.07: Prenatal diagnosis of Klippel Trenaunay syndrome: a case report

Klippel Trenaunay syndrome is a rare congenital disease that is characterized by a triad of cutaneous capillary malformations, varicose veins and hypertrophy of bone and soft tissue, usually asymmetric in its presentation (a single extremity). This disease tends to be sporadic, with very few familiar occurrences and postulated to be related to a somatic mutation for a critical angiogenetic-vasculogenetic factor during embryonic development. The prenatal diagnosis of this syndrome has been scantly referred. We present the case of a 29 year old pregnant woman, with two previous normal pregnancies and babies, who came to our unit for a routine morphologic scan at 18.4 weeks. First trimester scan had not been performed. The fetus was structurally normal, with a choroid plexus cyst and single umbilical artery. The most striking findings were the presence of cystic and heterogenous images affecting both legs, from the gluteus to below the knee, with predominance of the left one. A significant asymmetry between both legs, specially in thickness, was seen. An additional cystic image was found below the left kidney. Angiopower color Doppler demonstrated increased vascularisation of the mass. Karyotype by amniocentesis shown to be normal 46XX. In view of all of these findings, with asymmetric limb hypertrophy and the presence of multiple hemangiomas, and arteriovenous fistulas, a very likely diagnosis of Klippel Trenaunay syndrome was suggested to the parents. After extensive counselling, parents opted for termination of pregnancy at 20.4 weeks. Pathological examination results confirmed the diagnosis.

Parallel Decrease in Arterial Distensibility and in Endothelium-Dependent Dilatation in Young Women with a History of Pre-Eclampsia

Pre-eclampsia not only complicates 5 to 8% of pregnancies but also increases the risk of maternal cardiovascular disease and mortality later in life. We analyzed three different aspects of arterial function (pulse wave velocity, augmentation index, and flow-mediated dilatation), in 55 nonpregnant, normotensive women (18–33 years old) according to their gestational history: 15 nulliparous, 20 with a previous normotensive, and 20 formerly pre-eclamptic pregnancy. Former pre-eclamptic women showed a significantly higher augmentation index and pulse wave velocity (P < 0.001 and P < 0.05, respectively) and lower flow-mediated dilatation (p = 0.01) compared to control groups. In contrast, sublingual nitroglycerine elicited a comparable vasodilatory response in the three groups. The augmentation index correlated significantly with pulse wave velocity and flow-mediated dilatation (R = 0.28 and R = −0.32, respectively, P < 0.05 for both). No significant correlations were observed between augmentation index or flow-mediated dilatation with age, body mass index (BMI), brachial blood pressure, heart rate, or metabolic parameters (plasma cholesterol, glucose, insulin, or insulin resistance). Birth weight maintained a significantly inverse correlation with the augmentation index (R = − 0.51, p < 0.002) but not with flow-mediated dilatation. Our findings revealed a parallel decrease in arterial distensibility and endothelium-dependent dilatation in women with a history of pre-eclampsia compared to nulliparous women and women with a previous normal pregnancy. A high augmentation index was the most consistent alteration associated with a history of pre-eclampsia. The study supports the current view that the generalized arterial dysfunction associated with pre-eclampsia persists subclinically after delivery.