Severe Preeclampsia Research Articles

Severe preeclampsia and HELLP syndrome at 18 weeks gestation

Severe preeclampsia and HELLP syndrome at 18 weeks gestation

Association of C-reactive Protein in Preeclampsia

Introduction: Preeclampsia is a multisystemic disorder that complicate about 7-10 percent of human pregnancies.Worldwide this syndrome contributes high maternal and perinatal mortality and morbidity. C-reactive protein, a marker of tissue damage and inflammation, is elevated in seurm in overt preeclampsia. It is used as an objective and sensitive index of overall inflammatory activities in the body. Aims and Objectives: To explore the association of C-reactive protein level with the preeclampsia patients. Materials and Methods: The present study was a Case–Control study, conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of clinical pathology of Sir Salimullah Medical College Hospital, Mitford, Dhaka during the period of January 2013 to December 2013.The study population was pregnant women with preeclampsia and normal term pregnant patients admitted during study period. A total of 66 patients were included in the study. Among them 33 were clinically diagnosed preeclampsia women grouped as Cases and another 33 were age, parity and BMI matched term pregnant women as Controls. Eastmation of serum C-reactive protein was done by Nyco Card Reader-II method (Appendix-11). Statisticians analysis was perform by using SPSS. Results: C-reactive protein concentration (mg/L) was found significantly higher (p<0.001) in case group (17.93±10.5) than control group (7.45±1.80). Creactive protein was _ 6mg/L in 29(87.9%) in case group and 9 (27.3%) in control group and C-reactive protein values showed significant positive correlation with systolic and diastolic blood pressure (p<0.001) in case group. C-reactive protein concentration was found significantly higher (p<0.001) in severe preeclampsia group than mild preeclampsia group. Conclusion: Therefore, it can apparently be concluded from this study that increased maternal serum C-reactive protein level might be a strong risk factor for preeclampsia, although the precise role of C-reactive protein in this regard whether causal or consequential, is yet to be determined. Finding of this study might be helpful for formulating a guideline for management of pregnant women with preeclampsia. Medicine Today 2024, Vol.36 (2): 67-71

Hierarchical lncRNA regulatory network in early-onset severe preeclampsia

BackgroundRecent studies have shown that several long non-coding RNAs (lncRNAs) in the placenta are associated with preeclampsia (PE). However, the extent to which lncRNAs may contribute to the pathological progression of PE is unclear.ResultsHere, we report a hierarchical regulatory network involved in early-onset severe PE (EOSPE). We have carried out transcriptome sequencing on the placentae from patients and normal subjects to identify the differentially expressed genes (DEGs), including some lncRNAs (DElncRNAs). We then constructed a high-quality hierarchical regulatory network of lncRNAs, transcription factors (TFs), and target DEGs, containing 1851 lncRNA-TF interactions and 6901 TF-promoter interactions. The lncRNA-to-target regulatory interactions were further validated by the triplex structures between the DElncRNAs and the promoters of the target DEGs. The DElncRNAs in the regulatory network were clustered into 3 clusters, one containing DElncRNAs correlated with the blood pressure, including FLNB-AS1 with targeting 27.89% (869/3116) DEGs in EOSPE. We further demonstrated that FLNB-AS1 could bind the transcription factor JUNB to regulate a series members of the HIF-1 signaling pathway in trophoblast cells.ConclusionsOur results suggest that the differential expression of lncRNAs may perturb the lncRNA-TF-DEG hierarchical regulatory network, leading to the dysregulation of many genes involved in EOSPE. Our study provides a new strategy and a valuable resource for studying the mechanism underlying gene dysregulation in EOSPE patients.

Tailoring lifestyle guidance for women after pregnancies complicated by severe pre-eclampsia: a mixed-methods study into women and healthcare provider perspectives.

Tailoring lifestyle guidance for women after pregnancies complicated by severe pre-eclampsia: a mixed-methods study into women and healthcare provider perspectives.

Efficacy and safety of 12-hour versus 24-hour magnesium sulfate in management of patients with pre-eclampsia and eclampsia: a systematic review and meta-analysis

IntroductionMagnesium sulfate is the most utilized anticonvulsant for treating patients with eclampsia and pre-eclampsia. The purpose of this study is to determine whether the 12-h regimen of magnesium sulfate outweighs the 24-h regimen in both efficacy and safety in the management of patients with mild or severe pre-eclampsia and eclampsia.MethodsWe searched six electronic databases: PubMed, Scopus, Web of Science, Cochrane Library, Ovid, and Google Scholar. This search was conducted to yield any studies that were published until 15 January 2023. We did the statistical analysis plan by Review Manager Software version 5.4.ResultsWe included 13 randomized control trials with 2813 patients in this systematic review. Our meta-analysis revealed that there were no statistically significant differences between the 12-h regimen of the magnesium sulfate group and the 24-h regimen of the magnesium sulfate group in our outcome of interest: occurrence of seizure (RD: -0.00, 95% CI [-0.01, 0.00], P = 0.56), diminished deep tendon reflexes (RD: -0.00, 95% CI [-0.01, 0.01], P = 0.80), respiratory depression (RD: -0.00, 95% CI [-0.02, 0.01], P = 0.57), and pulmonary edema (RD: -0.00, 95% CI [-0.01, 0.01], P = 0.85).ConclusionOur study showed no statistically significant difference in effectiveness and toxicity risk between the 12-h and 24-h regimens.

Pulse Pressure as a Hemodynamic Parameter in Preeclampsia with Severe Features Accompanied by Fetal Growth Restriction.

Background: Modern management of preeclampsia can be optimized by tailoring the targeted treatment of hypertension to an individual's hemodynamic profile. Growing evidence suggests different phenotypes of preeclampsia, including those with a hyperdynamic profile and those complicated by uteroplacental insufficiency. Fetal growth restriction (FGR) is believed to be a result of uteroplacental insufficiency. There is a paucity of research examining the characteristics of patients with severe preeclampsia who do and who do not develop FGR. We aimed to elucidate which hemodynamic parameters differed between these two groups. Methods: All patients admitted to a single referral center with severe preeclampsia were identified. Patients were included if they had a live birth at 23 weeks of gestation or higher. Multiple gestations and pregnancies complicated by fetal congenital anomalies and/or HELLP syndrome were excluded. FGR was defined as a sonographic estimation of fetal weight (EFW) < 10th percentile or abdominal circumference (AC) < 10th percentile. Results: There were 76% significantly lower odds of overall pulse pressure upon admission for those with severe preeclampsia comorbid with FGR (aOR = 0.24, 95% CI = 0.07-0.83). Advanced gestational age on admission was associated with lower odds of severely abnormal labs and severely elevated diastolic blood pressure in preeclampsia also complicated by FGR. Conclusions: Subtypes of preeclampsia with and without FGR may be hemodynamically evaluated by assessing pulse pressure on admission.

Soluble endoglin as a diagnosis glycoprotein in preeclampsia

Background: Angiogenic factor imbalance, such as that caused by soluble endoglin (sEng), is a feature of preeclampsia. However, the connection between sEng and clinical and laboratory indicators, and the severity of preeclampsia is not entirely understood.Methods: Ninety subjects were incorporated in this study, 30 were healthy pregnant with mean age (35.6) years. (32) mild Preeclampsia case with mean age (32.65) years preeclampsia, and (30) sever PE with mean age (32.65) wherever all women were more than 24 weeks of pregnancy. Mean blood pressure and level of proteinuria were used as indicators of the severity of the disease. ELISA was used to measure the levels of sEng in the serum. Serum lipid profile was measured by enzymatic methods. The qualitative dip-stick technique (CYBOWTM DFI Co Ltd, Republic of Korea) was used to assess the amount of urine protein.Results : A substantial difference between the PE group's serum sEng concentration and that of the healthy subjects (p 0.001) could be seen. Serum sEng concentrations of patients with moderate PE and those with severe PE differed significantly. Additionally, there were strong positive relationships between the serum sEng concentration and the SBP and proteinuria. serum sEng levels, biochemical indicators, and other factors, however, did not significantly correlate. The diagnostic accuracy (86.2) in distinguishing mild PE from the healthy patient group was good thanks to the excellent area under the curve (AUC = 0.827, p &lt; 0.0001). Conclusion: Levels of sEng in sera of PE patients were elevated. sEng was significantly correlated with PE patients.Keywords: Soluble Endoglin; Preeclampsia; Proteinuria; Blood Pressure

Anesthesia Type Outcome in Severe Pre-eclampsia with Caesarean Section

Background: Preeclampsia is a hypertensive disorder during pregnancy with fetomaternal mortality. The choice of anesthesia method for cesarean sections among preeclamptic women is still debated. Objective: To compare the outcomes of spinal and general anesthesia in a cesarean section among preeclamptic women. Methods: A prospective study was conducted at Al-Imam Al-Sajjad Hospital/Al-Najaf Health Directorate from February 2021 to September 2023. Women undergoing cesarean sections due to severe preeclampsia were enrolled in the spinal or general anesthesia group. Data on maternal age, gestational age at delivery, parity, Apgar scores, maternal mortality and perinatal mortality were recorded. The background characteristics and outcomes were compared between both groups. We excluded women with mild preeclampsia, multiple pregnancies, other pregnancy medical disorders, gestational age &lt; 32 weeks, cases of eclampsia, and general anesthesia following spinal anesthesia failure. Results: The general anesthesia group had a significantly lower Apgar score at 1 minute than the spinal anesthesia group (27.3% and 57.4%, p=0.006), and at 5 minutes (15.2% and 37.03%, p=0.005). The study groups showed no significant difference regarding maternal and perinatal mortality. Conclusions: Maternal and perinatal mortality were not affected by anesthesia type in severe preeclampsia, but general anesthesia caused a higher proportion of birth asphyxia.

Comparison of Maternal and Perinatal Outcomes between Severe Preeclampsia without Complications and with HELLP Syndrome

Comparison of Maternal and Perinatal Outcomes between Severe Preeclampsia without Complications and with HELLP Syndrome

Comparison of Spinal Versus General Anesthesia for Caesarean Section in Patients with Severe Preeclampsia

Comparison of Spinal Versus General Anesthesia for Caesarean Section in Patients with Severe Preeclampsia

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

Second-trimester triglyceride-glucose index to predict adverse outcomes in women with gestational diabetes mellitus: A retrospective multicenter cohort study.

Women with gestational diabetes mellitus are at high risk for adverse maternal and neonatal outcomes. The study aimed to evaluate the performance of the triglyceride-glucose index in predicting the risk of developing adverse outcomes in women with gestational diabetes mellitus. This retrospective multicenter cohort study included 8,808 pregnant women with gestational diabetes mellitus in two grade-A tertiary hospitals in China during 2018-2022. The triglyceride-glucose index was defined as ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Significant adverse gestational diabetes mellitus outcomes were chosen by generalized linear models as the main outcomes. Multivariable logistic regression models evaluated their association with the triglyceride-glucose index. Areas under the receiver operating characteristic curves predicted adverse pregnancy outcomes. The prediction efficiency was validated in the sensitivity analysis dataset and validation cohort. The triglyceride-glucose index was associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia before and after adjusting for confounding factors (P < 0.05). The predictive performance of the triglyceride-glucose index was relatively moderate. Incorporating the triglyceride-glucose index into the baseline clinical risk model improved the area under curves for the diagnosis of preeclampsia (0.749 [0.714-0.784] vs 0.766 [0.734-0.798], P = 0.033) and macrosomia (0.664 [0.644-0.685] vs 0.676 [0.656-0.697], P = 0.002). These predictive models exhibited good calibration and robustness. The triglyceride-glucose index is positively associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia and is useful for the early prediction and prevention of adverse outcomes in women with gestational diabetes mellitus.

Possibilities of Predicting the Manifestation of HELLP Syndrome

Introduction. Despite the use of modern principles of treatment of severe preeclampsia, mortality rates for mother and newborn in the development of life-threatening complication of preeclampsia, such as HELLP syndrome, remains high. The introduction of accurate models of early diagnosis and prediction of the probability of manifestation and severity of the HELLP syndrome into everyday medical practice will improve the safety of delivery of pregnant women with severe preeclampsia.The aim of the study is to determine the current state of the issue and systematize current data on methods of predicting the probability of HELLP syndrome manifestation.Materials and methods. An analytical review of the literature. A qualitative analysis of clinical trials and reviews on prediction of HELLP syndrome was conducted using the following data sources: PubMed and Google Scholar. The search was carried out in Russian and English, using the keywords “predictors”, or “prediction”, and “HELLP syndrome”. The date of the last search query is 22 March 2024.Results. Anamnestic data and initial characteristics of patients with HELLP syndrome were analyzed.Discussion. The analytical review included publications devoted to the study of the influence of predictive capabilities of potential biochemical markers, clinical and anamnestic signs and instrumental examination data on the probability of HELLP syndrome development.Conclusion. Adequate prediction of the manifestation of HELLP syndrome is possible on the basis of a comprehensive analysis of all identified factors, allowing the identification of effective prognostic models to improve maternal and fetal outcomes in pregnant women with severe preeclampsia.

Clinical Study of HELLP Syndrome and It's Outcome at Pravara Rural Hospital, Loni

Background: HELLP syndrome, a severe pregnancy complication characterized by hemolysis, elevated liver enzymes, and low platelet count, occurs in 0.5 to 0.9% of all pregnancies and in 10–20% of severe preeclampsia cases. It poses significant risks to both mother and fetus, presenting diagnostic and therapeutic challenges. Patients often experience epigastric or right upper quadrant pain, hypertension, proteinuria, fatigue, nausea, vomiting, sudden weight gain, and headaches. HELLP syndrome typically occurs in the second and third trimesters (27-37 weeks) and 15–30% of cases present postpartum. The exact causes remain unclear but may involve placental origins, autoimmune factors, gene mutations, or fatty acid oxidation disorders. Aims and Objectives: To analyze the clinical profile of HELLP syndrome cases and to assess maternal and perinatal outcomes, including morbidity and mortality. Material and Methods: This prospective cross-sectional study was conducted in the Obstetrics and Gynecology department at Pravara Rural Hospital, Loni, involving 45 patients with severe preeclampsia and eclampsia above 28 weeks of gestation diagnosed with HELLP syndrome. Patients were admitted to the ICU, and detailed histories and examinations were recorded. Patients were divided into two groups: those with HELLP syndrome (Group A) and those without (Group B). Results: Group A had a higher representation in the 20-22 age bracket, while Group B had more members aged 22-24. Cesarean sections were more common in Group A, whereas vaginal deliveries were more frequent in Group B. Blood pressure readings were higher in Group A. Maternal complications, such as abruption placentae, DIC, hepatic infarction, acute renal failure, and ascites, were more frequent in Group A, as were neonatal complications like IUGR, preterm delivery, neonatal thrombocytopenia, and RDS. Conclusion: The study reveals significant differences between patients with and without HELLP syndrome. Group A included younger patients, more first-time mothers, and a higher incidence of complications and mortality. These findings highlight the need for tailored management strategies for severe preeclampsia/eclampsia, especially in those with HELLP syndrome, to improve maternal and neonatal outcomes.

Twin Pregnancy Coexisting with Partial Mole and Normal Fetus: A Case Report

This case report highlights the rare occurrence of a twin pregnancy coexisting with a partial mole, presenting a unique set of challenges in management and outcome. A 20-year-old woman with primary subfertility conceived twins following ovulation induction, experiencing hyperemesis gravidarum and subsequently developing severe preeclampsia. Despite efforts to control her condition, termination of the pregnancy was necessary due to maternal safety concerns. Both twins, without anomalies, succumbed to early neonatal death. Histopathological examination revealed a partial mole. The case emphasizes the importance of vigilant monitoring and individualized treatment in such complex pregnancies, with a focus on maternal well-being. Continued follow-up is crucial to detect and manage potential gestational trophoblastic disease. This report underscores the need for informed decision-making and patient-centered care in managing twin pregnancies coexisting with molar tissue.

P-422 Modified natural cycle does not increase live birth rates compared to hormone replacement therapy: success rates and perinatal outcomes of 1.354 single euploid blastocyst cryotransfers

Abstract Study question Frozen euploid single blastocyst transfer in modified natural cycle (mNC) increases success rates, improving obstetric outcomes compared to hormone replacement therapy (HRT) protocols? Summary answer Elective euploid single-blastocyst transfer (eeSBT) in mNC did not show higher success rates nor better obstetric and perinatal outcomes compared to HRT protocols What is known already eeSBT has become the gold standard for clinical trials in assisted reproduction, increasing sample homogeneity and reducing bias; when choosing endometrial preparation protocols for thawed embryo transfers, recent clinical studies have reported the superiority of mNC over HRT in terms of delivery and miscarriage rates, obstetrical and perinatal outcomes, treatment safety and costs; however, few data are available on eeSBT ≥3BB (Gardner score) cryotransfers comparing both protocols Study design, size, duration Retrospective single-centre comparative clinical study, including 1.354 eeSBT (≥3BB, Gardner score) between Jan-2018 and Dec-2022: 1.109 (82%) in HRT and 245 (18%) in mNC. HRT and mNC groups were homogeneous for egg donor’s age (28,9±5,8 yo Vs 30,6±5,9 yo), recipient’s age (41,7±5,0 yo Vs 39,5±4,5 yo), body mass index (22,6±4,8 Vs 23,1±3,4) severe male factor (3,5% Vs 7,3%), the need for sperm donation (30,4% Vs 27,8%), and the average throphoectoderm embryo quality (A = 32,1% Vs A = 31,8%) Participants/materials, setting, methods We studied the clinical, obstetric and perinatal outcomes of the 1.354 eeSBT performed, comparing HRT and mNC cycles for: pregnancy rate, miscarriage rate, live birth rate, twin pregnancy rate, severe preeclampsia, preterm birth rate (&amp;lt;37, &amp;lt;35, &amp;lt;32 and &amp;lt;28 weeks) and neonatal weight. We used Chi-square test to compare groups (p &amp;lt; 0,05). Main results and the role of chance There were no statistically significant differences between HRT Vs mNC protocol when comparing pregnancy rates (63,8% Vs 62,0%, p = 0,61), miscarriage rates (15,3% Vs 15,8%, p = 0,87) and live birth rates (44,6% Vs 46,1%, p = 0,67). The were no twin pregnancies in the mNC group, and only 5 (1%) in the HRT group. There we no significant differences in the severe preeclampsia rate, even if it doubled in the HRT group compared to mNC (1,8% Vs 0,9%, p = 0,48). Preterm, major and extreme preterm birth rates were higher in HRT but comprable to the mNC group: &amp;lt;37 weeks (7,7% Vs 6,2%, p = 0.59) &amp;lt; 35 weeks (2,8% Vs 1,8%, p = 0,59) &amp;lt;32 weeks (1,2% Vs 0,9%, p = 0,77) &amp;lt;28 weeks (0,4% Vs 0,9%, p = 0,51). There were no significant differences in neonatal weight (3287 + 477g HRT Vs 3271 + 512g in mNC, p = 0,88). Limitations, reasons for caution The HRT group included 84 patients in menopause (confounding factor), but when excluding them in a preliminary study results didn’t change. We decided to include eeSBT both from egg donation and own patient’s egg IVF treatments, after verifying that there were no significant differences in clinical results between both groups. Wider implications of the findings In eeSBT, the use of modified natural cycle could be encouraged because of its better cost-effectivenes and patient’s comfort. This study reports a non-significant trend for higher success rates in mNC compared to HRT; further prospective trials should be promoted to give accurate advice to patients undergoing thawed embryo transfers. Trial registration number Not Applicable

Pregnancy Outcome in Pregnancies Complicated by Fetal Growth Restriction and Severe Preeclampsia

Abstract Background common pathophysiological feature favors parallel occurrence of severe pre-eclampsia (PET) and fetal growth restriction. Objective To identify pregnancy and neonatal outcome differences between early-onset and late-onset preeclampsia, in relation to fetal growth restriction (FGR) Methods this retrospective study included 50 singleton pregnancies with FGR and severe PET who were admitted in Ain Shams University Maternity Hospital. Fetal growth restriction was defined as EFW and/or AC &amp;lt; 10th percentile. Preeclampsia with severe features included patients with systolic BP ≥ 160 mmHg, diastolic BP ≥ 110 mmHg, elevated liver transaminases twice the normal values, elevated serum creatinine twice the normal levels, or &amp;gt; 1.1mg/dl, HELLP syndrome, features of impending eclampsia, pulmonary edema, and/or thrombocytopenia with platelets level &amp;lt; 100 x 109/L. obstetric and neonatal outcomes were compared in early and late onset PET. Results The current study revealed that there was no difference between early and late onset PET in fetal and pregnancy outcomes while there was significant difference in neonatal outcomes. Conclusion the current study showed that risk of adverse neonatal outcomes as respiratory distress syndrome and neonatal death were higher in cases with early onset PET.

P-643 Menopause should not be considered a confounding factor in endometrial preparation protocol’s comparative clinical trials: a retrospective cohort study with 1.109 euploid single embryo transfers

Abstract Study question Does menopause have an impact on obstetric and perinatal outcomes when performing elective euploid single-blastocyst transfers (eeSBT) in a hormonal replacement treatment (HRT) protocol? Summary answer eeSBT in a non-menopause elective HRT group(eHRT) did not show higher success rates nor better obstetric and perinatal outcomes compared to a menopause HRT group(mHRT). What is known already Menopause has been suggested to be a confounding factor in clinical trials when comparing the results and success rates for endometrial preparation in modified natural cycle (mNC) Vs HRT: including menopause patients could lead to selection bias seen that they can never be included in the mNC group. Few data are available on eeSBT ≥3BB (Gardner score) cryotransfers comparing obstetric and perinatal results between eHRT and mHRT, to have the opportunity to include them all in further comparative trials, with a low bias risk. Study design, size, duration Retrospective single-centre comparative study, including 1.109 eeSBT (≥3BB, Gardner score) between Jan-2018 and Dec-2022: 1.025 (92,4%) in eHRT and 84 (7,6%) in mHRT. The eHRT and mHRT groups were homogeneous for egg donor’s age (29,1±5,9 yo Vs 25,8±4,1 yo) recipient’s age (41,4±4,9 yo Vs 44,9±4,7 yo), body mass index (22,6±4,7 Vs 22,6±5,3) severe male factor (3,5% Vs 3,6%), the need for sperm donation (30,0% Vs 35,7%), and the average throphoectoderm embryo quality (A = 32,5% Vs A = 29,8%). Participants/materials, setting, methods We studied the clinical, obstetric and perinatal outcomes of the 1.109 eeSBT, comparing eHRT and mHRT groups for: pregnancy rate, miscarriage rate, live birth rate, twin pregnancy rate, severe preeclampsia, preterm birth rate (&amp;lt;37, &amp;lt;35, &amp;lt;32 and &amp;lt;28 weeks) and neonatal weight. We used Chi-square test and T-Test to compare groups (p &amp;lt; 0,05). Main results and the role of chance There were no statistically significant differences between eHRT and mHRT groups when comparing pregnancy rates (63,7% Vs 64,3%, p = 0,92), miscarriage rates (15,6% Vs 11,1%, p = 0,053) and live birth rates (44,3% Vs 48,8%, p = 0,42); no significant differences were found in the severe preeclampsia rate(2,0 Vs 1,2, p = 0,84), nor in the twin pregnancy rate (0,9 Vs 2,4, p = 0,34) even if it almost tripled in the mHRT group. Preterm, major and extreme preterm birth rates were comprable between eHRT and mHRT groups: &amp;lt;37 weeks (9,9% Vs 4,9%, p = 0,29) &amp;lt; 35 weeks (3,3% Vs 0, p = 0,23) &amp;lt;32 weeks (1,3% Vs 0, p = 0,46) &amp;lt;28 weeks (0,2% Vs 0, p = 0,76). There were no significant differences in neonatal weight (3292 + 481g Vs 3.135 + 419g, p = 0,052). Limitations, reasons for caution In a preliminary study, we compared and additional 245 eeSBT in mNC with the HRT group, and no significant differences in obstetric or perinatal outcomes were reported when including or excluding the mHRT sub-group. Wider implications of the findings In eeSBT, the eHRT group did not report better obstetric nor perinatal results compared to the mHRT group; further prospective clinical trials comparing mNC Vs HRT should not consider menopause as a major confouding factor, when using eeSBT. Trial registration number Not Applicable

O-265 Mapping decidualization resistance at multi-omic level

Abstract Study question What are the cellular and molecular features of decidualization resistance (DR) at single-cell resolution? Summary answer There is an absence of the stromal-epithelial transition with aberrant crosstalk among cell types in essential pathways (e.g., endoglin, WNT) confirmed at the protein level. What is known already DR refers to the inability of the endometrium to undergo decidualization changes preparing the endometrium for a conceptus, noted in disorders like endometriosis, recurrent pregnancy loss, miscarriage and preeclampsia. The molecular mechanisms causing this disorder remains unknown. It has been demonstrated that there is a transcriptomic signature of DR in the endometrium of former preeclampsia patients, during and years after suffering from the disease. Our objective is to dilucidated what is DR at single-cell resolution. Study design, size, duration This cross-sectional study compares late secretory phase endometrial biopsies from patients that previously have suffered severe Preeclampsia (sPE). The sample size consisted of 11 sPE patients and 12 control participants for single-cell RNA sequencing (scRNA-seq), 8 sPE patients and 8 controls for spatial transcriptomic mapping covering 95 tissue regions, and 10 sPE patients and 10 controls for proteomic analysis. The study spanned 2 years, from sample collection to omics analysis. Participants/materials, setting, methods Late secretory phase endometrial biopsies from sPE patients and controls underwent molecular analyses. Methods included 10x Genomics protocol for single-cell RNA sequencing, MiloR to calculate cell abundance, CellChat to infer cell-to-cell communication and ClusterProfiler for gene ontology. We solved spatial mapping at transcriptomic level using Nanostring. Proteomics data was collected by laser-capture microdissection coupled mass spectrometry. Protein-protein networks, involving PR and ESR1 receptors as master regulators of decidualization, were built using String. Main results and the role of chance Initial morphological analyses of endometrial biopsies collected during the late secretory phase revealed gross anatomical defects in glandular morphology that were histologically confirmed. scRNA-seq revealed sPE-associated alterations in cell composition involving stromal and epithelial subtypes, denoting a higher proportion of cells expressing proliferative markers in the stroma (MMP11, SFRP1) and epithelium (IHH, EMID), and a near absent epithelial-stromal transition that is normally linked to decidualization. Further, abnormal abundance and gene dysregulation were detected in the three decidualized stages identified. Mapping cell-cell communication networks confirmed aberrant crosstalk among cell types involved in essential pathways (e.g., endoglin, WNT, SPP1). Spatial transcriptomic in a replication cohort of samples revealed a landscape of dysregulated genes in stromal, luminal and glandular enriched regions, corroborating sPE-associated DR. Laser capture microdissection/mass spectrometry of samples revealed differential protein expression at a global level and confirmed many of the scRNA-seq results, such as sPE-exclusive proteins related to proliferation and the absence of a stromal to epithelial transition at a pathway level. These data lend insights into potential molecular mechanisms underlying the pathogenesis of DR. Limitations, reasons for caution DR analysed in this work is associated with sPE but we do not know if this decidualization defect would be the same in other DR associated conditions such as endometriosis, recurrent pregnancy loss, or miscarriage. Wider implications of the findings Here we present the most comprehensive snapshot of DR to date, providing a full range of markers potentially responsible for this decidualization disorder linked to sPE. We concluded that stromal and epithelial cell populations are altered revealing a near absence of the stromal-epithelial transition, cellular crosstalk and glandular constitution. Trial registration number not aplicable

Serum Uric Acid Levels as a Risk Stratification Tool in Hypertensive Disorders of Pregnancy: A Retrospective Study.

Worldwide, hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. Serum uric acid is a test that can evaluate the severity of HDP and the associated maternal and fetal morbidity and mortality. To examine the relationship between maternal serum uric acid levels and the severity of HDP and overall pregnancy outcomes. A retrospective study was conducted on women with a gestational age > 20 weeks and BP >140/90 mmHg over three years. A total of 134 patients were included in the study. Patients with chronic hypertension, hyperuricemia without hypertension, and other major illnesses were excluded. Data were collected from medical records, including age, gravida, parity, weight, height, gestational age, blood pressure at admission, urine albumin, and serum uric acid levels. Of the 134 enrolled women with HDP, 76 had gestational hypertension, 41 had preeclampsia, and 17 had eclampsia. Mean uric acid levels in mg/dL were 6.06±1.651, 6.20±0.824, and 7.38±1.26 in gestational hypertension, preeclampsia, and eclampsia, respectively, which was a significant association (p=0.002). Mean uric acid in mg/dL was 5.86±1.27 in intensive care unit (ICU) patients compared to 6.45±1.39 in ward patients (p=0.015). There was a significantly increased risk of ICU admission and preterm delivery (r=-0.401, p<0.001) in patients with elevated uric acid levels. There was a significantly increased risk of low-birth-weight babies with elevated uric acid levels (r=-0.278, p=0.001). However, there was no statistically significant increased risk of newborn intensive care unit admissions (p=0.264) with elevated uric acid levels. Serum uric acid levels vary significantly in HDP and were found to be elevated in severe preeclampsia and eclampsia. It can be considered for risk stratification in HDP based on disease severity; however, its role in determining outcomes is debatable. Using serum uric acid levels in predictive models along with known biomarkers may determine its possible additional value in disease prediction and severity.